The Effectiveness of Treating Osgood-Schlatter Disease (OSD) with Leukocyte-Rich Platelet-Rich Plasma (LR-PRP) Depending on the Duration of the Disease.

Background: Osgood-Schlatter disease (OSD) occurs mainly in physically active adolescents, causing significant physical activity restrictions. The aim of this study is to compare the effectiveness of treating OSD with leukocyte-rich platelet-rich plasma (LR-PRP) depending on the duration of the disease and to attempt to develop an alternative treatment method to the currently used conservative therapy. Methods: Treatment efficacy was evaluated using the VAS, Tegner, Lysholm, and KOOS scales. Subject satisfaction, return to sports activity, potential adverse effects, and X-ray evaluation were likewise used to assess the success of the procedure. Results: Analysis across all scales showed statistically significant treatment effectiveness with LR-PRP in both groups of patients. When comparing the two groups, significantly better treatment outcomes were achieved in the acute phase of OSD. Treatment satisfaction in the acute OSD group was 95%, compared to 64% in the chronic group. The MCID value after LR-PRP injection in acute OSD compared to chronic OSD reached 100% vs. 81% on the VAS scale, 95.5% vs. 55% on the Tegner scale, 95% vs. 47% on the Lysholm scale and 91% vs. 27% on the KOOS scale. No adverse effects were recorded in either group. Conclusions: The high efficacy of LR-PRP treatment in patients with acute OSD, in correlation with high safety, as well as rapid and lasting results, can be an effective and beneficial alternative to conservative treatment. This single procedure seems particularly justified in a group of young professional athletes, where absence from training can lead to serious consequences.

Methodological Principles of Nasal Food Challenge.

Thanks to their valuable assessment possibilities (subjective complaints and changes in nasal patency during the examination), nasal provocation tests may serve as an alternative tool for oral food challenges in the future. However, this test requires successive attempts to regulate its methodology in order to develop a standardized lyophilisate form and determine the threshold dose for a positive result. The study objective was to present the methodological foundation for nasal food allergen provocation tests induced by freeze-dried powdered chicken egg whites. A control group of 25 individuals with no history of allergy to chicken eggs or any other allergy was included in the study. Optical rhinometry and visual analog scales were used to assess the response of nasal mucosa to local allergen challenges. Minor variations in nasal flows, as measured by optical rhinometry, were observed in the provocation tests. The mean optical density measurements (as measured regardless of the allergen dose used) varied from positive to negative values and vice versa, e.g., amounting to 0.018 OD (standard deviation 0.095) at 15 min and -0.011 OD (standard deviation 0.090) at 30 min. No significant differences were observed concerning the perceived nasal discomfort using the visual analog scale. Due to the absence of nasal mucosal reactivity, nasal challenge is an excellent methodological tool for implementing food allergen tests.

Isolated Gastrocnemius Contraction and Gastroc Recession Surgery in Case of Planter Fasciitis: A Systemic Review and Meta-Analysis.

Objective: The current systematic and meta-static review aimed to analyze the correlation between isolated gastrocnemius contracture and plantar fasciitis and the effectiveness of gastroc recession surgery in the treatment of plantar fasciitis. Methodology: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to conduct this meta-analysis. A literature search was carried out on the following databases, including Google Scholar, PubMed, EMBASE, and the Cochrane databases with the appropriate medical subject headings (MeSH) to identify the eligible articles. Results: A total of 13 studies were included in this meta-analysis. In this study, there is a significant difference in chronic plantar fasciitis outcome when comparing experimental and control (RR: 0.02; 95% CI: 0.01 to 0.05; P < 0.001; I2 = 29%). There is a significant difference in pain scale outcome when comparing pre-treatment and post-treatment (RR: 3.25; 95% CI 1.44 to 7.32; P = 0.004 < 0.01; I2 = 0%). A significant difference in VAS scale outcome when comparing pre-treatment and post-treatment (RR: 2.58; 95% CI 1.52 to 4.38; P = 0.0004 < 0.01; I2 = 0%). Conclusion: In conclusion, the current systematic review and meta-analysis of gastrocnemius recession and proximal medial gastrocnemius release and other treatment measures for plantar fasciitis suggests that the improvement of ankle dorsiflexion, reduction in pain, and patient satisfaction are almost similar in all the treatment measures. Among the five treatment measures, gastrocnemius recession remains the best, followed by proximal medial gastrocnemius release.

Effect of botulinum toxin A on pain, bite force, and satisfaction of patients with bruxism: A randomized single-blind clinical trial comparing two protocols.

Purpose: The current study aims to evaluate bite force, perception of orofacial pain, and treatment satisfaction of patients with bruxism using two protocols of botulinum toxin A (BTX-A) injections. Material and Methods: Two groups of patients seeking bruxism treatment and presenting bilateral orofacial pain of muscle origin were randomly created according to BTX-A injection sites: masseter muscle only, bilaterally (3 points in each muscle, 10 U per point), and masseter and temporal muscles (3 points in each masseter muscle and 2 points in each temporal muscle, 10 U per point). The patients were evaluated preoperatively and longitudinally at 15, 90, 120, and 180 days by the use of visual analog scales for pain and treatment satisfaction and a gnathodynamometer for bite force recording. Results: The final sample included 10 participants in each group. Both groups presented mitigation of pain at 15, 90, 120, and 180 days in comparison with baseline; however, reduction in the posterior bite force was noted only at 15, 90, and 120 days. Quite high treatment satisfaction was reported from both groups at 15, 90, 120, and 180 days. No differences were observed between the groups in all evaluations and study periods. Conclusion: In general, considering pain relief, reduction in bite force, and treatment satisfaction, both protocols of BTX-A seem to be somewhat equally effective in the short-term management (up to 120 days) of bruxism.

Comparative Study of the Surgical Excision of Impacted Mandibular Third Molars Using Surgical Burs and an Erbium-Doped Yttrium Aluminum Garnet (Er:YAG) Laser.

Background The use of lasers has increased in the field of dentistry in recent years. However, in the field of oral and maxillofacial surgery, the use of lasers has been largely restricted to soft tissue, and less focus is placed on the use of lasers for hard tissues. Aim The present study aimed to comparatively evaluate the efficacy of a erbium-doped yttrium aluminum garnet (Er:YAG) laser for cutting the bone while removing the impacted mandibular third molar with the use of a surgical bur. Methods The study assessed 80 subjects undergoing removal of impacted mandibular third molars. The subjects were recruited from the Department of Oral and Maxillofacial Surgery, Luxmi Bai Institute of Dental Sciences and Hospital, Patiala, Punjab, India. They were randomly divided into two groups, each consisting of 40 subjects. Group I used an Er:YAG laser to remove the bone, while Group II used a surgical bur. Assessments and comparisons were made for complications, wound healing, trismus, edema, bleeding, and pain. Results The study examined the efficacy of the Er:YAG laser for cutting the bone and extracting the impacted mandibular third molars using a surgical bur in two groups of 80 patients each. When the laser was used in place of a surgical bur, Group I patients experienced less edema, bleeding, and discomfort; nevertheless, the difference was not statistically significant. Time taken by laser for bone cutting was significantly higher compared to the surgical bur. In Group I (laser), trismus existed for a longer time. For mouth opening, the preoperative mouth opening was comparable in the two groups with p = 0.87. Conclusion Pain, hemorrhage, and edema were lesser, and the time required for bone cutting was substantially longer in the laser group. Apart from these, laser-assisted intra-oral bone cutting should be preferred because of its less invasive nature, simpler procedure, and simpler osteotomy when compared to traditional surgical burs and also in anxiety-prone patients.

The application of gargle containing honeysuckle and semen oroxyli to reduce the pain and complications after uvulopalatopharyngoplasty.

Purpose: The main purpose of this pilot study was to detect the positive effects of our self-made gargle containing honeysuckle and semen oroxyli on post-operative pain and complications after Uvulopalatopharyngoplasty (UPPP). Methods: Patients with obstructive sleep apnea (OSA) who had underwent elective UPPP during the period of April 2019 to January 2022 were randomly divided into treatment group and control group. The patients in the treatment group were instructed to gargle the solution containing honeysuckle and semen oroxyli (25 ml) four times a day for 2 weeks. The patients in the control group were instructed to gargle normal saline (25 ml) at the same schedule. The post-operative resting throat pain, swallowing throat pain and patient comfort level were evaluated at 12 h, 1 week and 2 weeks after UPPP. The post-operative complications were collected and analyzed. Results: During the study period, 218 patients completed all the post-operative assessments. For resting throat pain, the treatment group had much lower VAS scores at 1 week and 2 weeks after UPPP. For swallowing throat pain, treatment group had much lower VAS scores than control group at 2 weeks after surgery. And patients in the treatment group felt more comfortable comparing to those in control group at 1 week and 2 weeks after UPPP. Although the treatment group had less numbers of patients with post-operative wound infection or bleeding, the difference between the 2 groups was not statistically significant. Conclusion: The gargle containing honeysuckle and semen oroxyli could relieve both resting and swallowing throat pain and increase patient comfort after UPPP.

[Itching in dialysis, from the patient's point of view].

Itching is an annoying symptom, which afflicts patients with chronic renal failure. To assess the diffusion of itching in the dialysis population in Italy, we carried out a questionnaire, which was distributed to patients of various Italian dialysis centers. The purpose of this investigation was to bring out all those aspects, which make itching a state of chronic suffering, which daily undermines the quality of life of patients. The questionnaire had 16 questions on the intensity of itching, the timing of appearance, the report to doctors and nurses, and any suggested remedies, in addition to some other concerning age, sex, and dialysis age. The questionnaires were distributed to 153 Dialysis Centers and received 1905 responses. In 46.7% of the answered questionnaires, the patients declared the absence of itching. Instead, 53.3% of the patients interviewed reported having itching with varying degrees of intensity. We used for quantifying the intensity of itching the numerical rating scale (NRS). Among the interviewees, those (20.4%) who reported a greater intensity and severity of the symptom described it as often present always, even at night, so as to heavily condition sleep. Only 32.5% of patients solved the problem by contacting their nephrologist or dialysis nurse, and a lower percentage by contacting the dermatologist or general practitioner.

Self-perception of periodontal health and pain experience during periodontal examination in 14- to 15-year-old Danish adolescents.

OBJECTIVE: To evaluate different aspects of periodontal examination among Danish adolescents. MATERIALS AND METHODS: In all, 521 Danish adolescents underwent a periodontal examination and answered a questionnaire concerning their self-perception of periodontal health (PH). Furthermore, 107 participants reported their pain experience during periodontal examination using a visual analog scale. The self-perception of PH and the pain experience were correlated with plaque score (PS), bleeding on probing (BOP), probing pocket depth (PPD), and interdental clinical attachment loss (CAL). RESULTS: Good PH was reported by 424 (81%) of the participants. However, the association between PH and PS, BOP, PPD, and CAL was small (sensitivity: 7.7, 7.8, 12.0, and 0.0%, respectively). Only 57 (11%) of the participants reported bleeding gums (BG) during tooth brushing, but the correlation with BOP showed a sensitivity of 11.7%. The specificity of both self-perception of PH and BG was high. Sixty-seven (66.6%) of the participants experienced 'mild pain' during periodontal examination. There were no differences in periodontal outcomes between the pain groups (p > .05). CONCLUSIONS: The adolescents showed a poor ability to identify themselves as having poor PH and BG, and 67 (66.6%) of the adolescents experienced mild pain during periodontal examination. The findings emphasize the need for dental staff to monitor the PH of Danish adolescents and advise them as necessary.

Chronic Unreduced Anterior Shoulder Dislocation Managed by Latarjet Procedure: A Prospective Study.

The shoulder joint is the most common joint to undergo dislocation, with the anterior subtype being the most common. The most accepted definition of chronic dislocation is a shoulder joint that has remained dislocated for a minimum of three weeks. Due to rare presentation, there is a lack of consensus among surgeons regarding the optimal management option of chronic shoulder dislocation. The goal of this prospective study was to assess the efficacy of open reduction with Latarjet procedure in the management of chronic unreduced shoulder dislocation. A total of seven patients were included in this study. Five patients were males and two were females. The study was conducted in a single tertiary care centre between July 2015 and May 2018. All patients were managed by open reduction with the Latarjet procedure. The capsulolabral structures were repaired in all the cases. The post-operative functional outcome was assessed by shoulder range, Rowe score, and the University of California, Los Angeles (UCLA) score at regular intervals for a period of one year. There was a significant improvement in terms of pain relief and functional status of the patients. The patients were satisfied as they could do their daily routine activities without pain at a one-year follow-up. Early post-operative rehabilitation and physiotherapy are key to improving the functional range.

A Comparative Study of CT Scan and Nasal Endoscopic Findings of Lateral Wall of Nose, in Headache of Rhinogenic Origin.

Headache disorders are rated among the ten most disabling conditions worldwide. Contact points like septal spur, septal deviation, concha bullosa and bulla ethmoidalis can cause rhinogenic headache (RH). Diagnostic nasal endoscopy (DNE) is an essential part of evaluation of sinonasal disease and is the key to understanding anatomical variations. As compared to CT paranasal sinus (CT PNS), DNE is cheaper and has wider availability, being part of the basic training of present ENT curriculum. We conducted a prospective observational study from September 2018 to June 2020 on 202 patients who were diagnosed to have RH. The aim of this study was to the define the role of DNE as the primary examination for early and accurate diagnosis of rhinogenic headache as compared to CT PNS. RH patients were evaluated with DNE followed by CT PNS. Evaluation of the findings of anatomical variations of lateral wall of nose on DNE and CT PNS was done. In our study the most common anatomic variations in order of frequency in both DNE and CT PNS was deviated nasal septum, impacting spur and unilateral concha bullosa. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of DNE for the various anatomical variations was statistically better than CT PNS findings. We conclude that DNE is a better than CT PNS as a diagnostic technique to detect various anatomical variations, thus initiating early management of RH.

Minimal clinically important difference for pain on the VAS scale and the relation to quality of life in women with endometriosis.

OBJECTIVES: The minimal important difference can be helpful in interpreting data from clinical trials. The objective of the study was to calculate the minimal important difference for improvement on the VAS scale for women with endometriosis. STUDY DESIGN: A prospective study was conducted to evaluate the effect of pertubation with lignocaine on dysmenorrhea and quality of life in women with endometriosis. Data collected in the trial were used for additional analyses in the present descriptive study. Eligible women (n=37) had endometriosis with pain>VAS 50mm (visual analogue scale). MAIN OUTCOME MEASURES: In a questionnaire, women evaluated their maximum pain on the VAS- scale during every menstrual period before and after treatment. They also estimated the changes in overall pain level by answering the response categories "much better", "somewhat better", "about the same", "somewhat worse" or "much worse". The women were grouped according to their own estimation of change in pain intensity after four months. The minimal important differences for change on the VAS scale correlate to the mean change for women who felt "somewhat better" (n=18) excluding those who were pain free (n=2). RESULTS: The minimal important difference for improvement on the VAS scale was found to be -39mm and/or -49%. CONCLUSION: If the patients have a pain level of at least 50mm on VAS scale at inclusion, the cut off for success in clinical trials is suggested to be defined as an either >40mm or a >50% decrease on VAS scale. Trial registry ClinicalTrials.gov Identifier: NCT01329796.

Interaction of tinnitus suppression and hearing ability after cochlear implantation.

OBJECTIVES: To study the postoperative impact of cochlear implants (CIs) on tinnitus, as well as the impact of tinnitus on speech recognition with CI switched on. METHODS: Fifty-two postlingual deafened CI recipients (21 males and 31 females) were assessed using an established Tinnitus Characteristics Questionnaire and Tinnitus Handicap Inventory (THI) before and after cochlear implantation. The tinnitus loudness was investigated when CI was switched on and off in CI recipients with persistent tinnitus. The relation between tinnitus loudness and recipients' satisfaction of cochlear implantation was analyzed by the visual analogue scale (VAS) score. RESULTS: With CI 'OFF', 42 CI recipients experienced tinnitus postimplant ipsilaterally and 44 contralaterally. Tinnitus was totally suppressed ipsilateral to the CI with CI 'ON' in 42.9%, partially suppressed in 42.9%, unchanged in 11.9% and aggravated in 2.4%. Tinnitus was totally suppressed contralaterally with CI 'ON' in 31.8% of CI recipients, partially suppressed in 47.7%, unchanged in 20.5%. Pearson correlation analysis showed that tinnitus loudness and the results of cochlear implant patients satisfaction was negatively correlated (r = .674, p < .001). CONCLUSION: The study suggests six-month CI activation can be effective for suppressing tinnitus. The tinnitus loudness may affect patients' satisfaction with the use of CI.

Manual reduction in acute haemorrhoids.

AIM: In prolapsed internal hemorrhoids exposed outside the anus, manually reducing the prolapse with 48 hours of commencement of anal pain, decreased the progression of thrombosis. The aim of our study was to evaluate the effects of manual reduction of the inflamed piles hemorrhoids. MATERIALS OF STUDY: Eleven patients, 7 males and 4 pregnant females (in early post partum) with an average age of 34 years ± 8 (range 23- 52) were enrolled with anal pain cause by haemorrhoidal congestion, but prior to full blown thrombosis. Patients underwent a manual reduction of the external prolapsed haemorrhoidal plexus. In the 48 hours following the procedure, patients were instructed on how to insert any prolapsed hemorrhoid (piles) themselves. Pain intensity was measured using the visual analog scale (VAS) at time of consultation and then 10 days after the reduction. RESULTS: At day 10 following treatment we observed a statistically significant reduction in anal swelling (11 vs 1, n° pzt; p = 0.001), anal pain (11 vs 2, n° pzt; p = 0.001) and VAS score (8.6 ± 0.7 vs 0.4 ± 1.2; p = 0.001). Two patients (18%) underwent surgical haemorrhoidectomy sec. Milligan Morgan and 1 patient (9%) underwent excision of thrombosed external hemorrhoids. 73% of patients did not require surgery. CONCLUSIONS: Manual reduction of the prolapsed piles outside the anus decreased pain immediately and it also allows postponement of surgery or any other treatment.

High volume image-guided injections and structured rehabilitation improve greater trochanter pain syndrome in the short and medium term: a combined retrospective and prospective case series.

BACKGROUND: the aim of this study was to measure the effects of high volume image-guided injections and structured rehabilitation (HVIGI&SR) for greater trochanter pain syndrome (GTPS). METHODS: 31 consecutive subjects were recruited (23 retrospectively; 8 prospectively) over 5 months. GTPS was diagnosed based on history and examination findings, alongside radiological examination. The HVI-GI used a 22-gauge spinal needle to administer 10ml of 0.5% Marcaine and 50 mg hydrocortisone just deep to the periosteum underlying the gluteal tendon insertion under ultrasound guidance, followed by structured rehabilitation. A visual analogue scale (VAS) for pain was used as the main outcome measure. RESULTS: the mean VAS improved from 81.7 mm (±17.6) to 42.3 mm (±28.3), (p<0.05) in the prospective subjects at a mean of 6 weeks, considered clinically significant. In the retrospective subjects the mean VAS had improved from 74.6 (±10.9) mm to 38.2(±31.2) mm at two weeks (p<0.01) and 31.3 (±27.6) mm at the final time point, a mean of 60 weeks (p<0.01). The Hip and Groin Outcome Score in the prospective group showed a non-significant increase from 173.2 to 296.1 (p=0.12). CONCLUSION: HVIGI&SR should be considered when short- and medium-term pain-relieving treatment for GTPS is required. Controlled studies are warranted to fully establish effectiveness, and assess long term effects. LEVEL OF EVIDENCE: case series.