Beliefs, attitude, and knowledge of the Iranian physiatrists towards neuromusculoskeletal ultrasound and common barriers in its application.

BACKGROUND: Regarding the increasing application of neuromusculoskeletal sonography among medical specialties, specifically physiatrists, this study aims to assess the knowledge and skill level of these specialists in neuromusculoskeletal sonography in Iran. METHODS: This descriptive, cross-sectional study was performed in 2018. The utilized questionnaire developed based on previous studies in collaboration with 6 university lecturers of Shaheed Beheshti, Iran, and Tabriz medical universities and a physiatrist from Hacettepe University (Turkey); it included questions entailing demographic data, knowledge, and performance levels. Its validity and reliability were evaluated through face validation, pilot study, and the Cronbach α calculated via SPSS. Data extraction and analysis were also performed by SPSS-25. RESULTS: Of 364 questionnaires distributed, 300 were properly filled and entered into the study, of which, 38% were filled by clinical residents, 10% university lecturers, and 52% other categories (e.g. private sector). The average number of musculoskeletal patient visits was 140.6 ± 119 and the mean number of musculoskeletal sonographies requested was 8.2 ± 5.2 per month (the three most common indications reported as the shoulder, carpal tunnel syndrome, and tendon injuries). 95% of the participants considered the importance of sonography for physiatrists to be "very high" or "high"; with the most valuable applications "as a guide for procedures (90%), its diagnostic utility (68%), and follow up/evaluating the response to treatment (45%). 86% of physiatrists reported they had participated in musculoskeletal sonography courses, 60% during residency, and the rest through workshops. Also, the participants mentioned safety (83%), the possibility of performing simultaneous diagnosis and intervention procedures (70%), repeatability (58%), and dynamic imagery (52%) as the major advantages of musculoskeletal ultrasound. CONCLUSION: a large number of doctors consider musculoskeletal sonography to be essential for physiatrists, though insufficient education on the subject and the low number of ultrasound devices are some of the obstacles in enhancing the use of this technology in PM&R setting. Presenting certified specific training courses during residency, provision of necessary rotations, using the capacities of the PM&R scientific committee, and the private sector for running workshops and professional training courses are suggested for enhancing the knowledge and skills of neuromusculoskeletal sonography.

Autologous conditioned serum applications in the treatment of musculoskeletal diseases: a narrative review.

AIM: Autologous conditioned serum has been studied as a treatment option in musculoskeletal disorders and resulted in varying outcomes. This study aims to pool the current data on this matter. MATERIALS & METHODS: Major databases were searched for the topics, and after screening the results, the final 21 papers (level of evidence I or II) were included. RESULTS & CONCLUSION: This study showed a major focus of the literature on the effectiveness of autologous conditioned serum in osteoarthritis, in which there is much high-quality evidence suggesting its safety and efficacy. Also, some of the available experiments are assessing its application in tendinopathies and radiculopathies which, despite positive results, recommend further evaluations on this topic.

Effectiveness of intra-articular autologous-conditioned serum injection in knee osteoarthritis: a meta-analysis study.

AIM: Knee osteoarthritis is a common disabling disorder, with no curative treatment. This study aims to assess autologous conditioned serum effectiveness in its treatment. MATERIALS & METHODS: Following a systematic search (2000-2020) on major databases and screening and filtering processes, eight articles were included in the final analyses. The pooled effect of visual analog scale (VAS) and the Western Ontario and McMaster Universities (WOMAC) variables was evaluated before and after the intervention. RESULTS: The combined standardized mean difference for the global WOMAC score was -2.44 and the combined weighted mean difference was -22.92. The combined standardized mean difference for the VAS score was -3.77 and the combined weighted mean difference was -32.37 (p < 0.000). CONCLUSION: This meta-analysis reported that the autologous conditioned serum can reduce pain and improve function (VAS and WOMAC outcome measures) in patients with knee osteoarthritis.

A patient with cystic lymphangioma in pancreas.

Cystic lymphangioma of the pancreas is extremely rare, accounting for less than 1% of pancreatic tumors. Though congenital, it can affect all age groups. Cystic lympangioma occurs more frequently in females. Patients usually present with epigastric pain and an associated palpable epigastric mass. Complete excision is curative, even though, depending on the tumor location, surgery may be simple or involve extensive pancreatic resection and anastomoses. In this case report, we discuss a 63-year old patient who presented with epigastric pain and on investigation was found to have pancreatic head cystic lymphangioma. At surgery the tumor was completely excised, with preservation of pancreatic duct. Histology and immunohistochemistry confirmed cystic lymphangioma of the pancreas. This case highlights that a diagnosis of cystic lymphangioma of the pancreas should be taken into consideration as a differential diagnosis of pancreatic cystic lesions.