Isolated pisiform dislocation after a seizure episode.

A 31-year-old woman had a seizure episode three weeks before, leading to a fall on her left hand. Following the accident, she had discomfort on the ulnar side of her left wrist. She decided to seek treatment from a local bone setter; however, her hand discomfort continued and she then came to us for treatment. The radiography and computed tomography scan demonstrated a pisiform dislocation. The pisiform bone was surgically removed. The pisiform dislocation should be considered in the differential diagnosis of the ulnar side wrist discomfort following wrist trauma.

Harmonizing Beauty and Function: A Comprehensive Exploration of Patient Satisfaction in Rhinoplasty.

Background: Rhinoplasty has become a globally prevalent esthetic procedure, necessitating precise facial analysis and comprehensive preoperative planning for favorable postoperative outcomes. We aimed to assess patient satisfaction levels concerning nasal appearance following rhinoplasty. Methods: A case series interventional study was conducted involving 52 subjects referred to Rhinoplasty Clinics of Taleghani Hospital, Tehran, Iran from Mar 2021 to Mar 2022. Patients' satisfaction levels were evaluated using a concise checklist before and three months after surgery. Results: The mean age of the patients was 29.23 ± 7.26 years, with 19 (36.5%) being male. Statistically significant improvements were observed in all assessed factors, including nasal obstruction, nasal size, hump presence, nasal bridge width, nasal tip bulbosity, nasal deviation, radix, nostril asymmetry, and tip ptosis (P < 0.001). These findings reveal a consistent pattern of patients' satisfaction levels predominantly shifting from moderate to low across various aspects of nasal appearance post-rhinoplasty. Conclusion: The study demonstrated a significant enhancement in patients' satisfaction with their nasal appearance following rhinoplasty, indicated by statistically significant changes across all assessed factors. However, certain aspects exhibit more limited enhancement.

Post-stapedotomy dizziness after applying topical steroid on footplate: A randomized controlled trial.

Background: Otosclerosis is characterized by abnormal bone growth in the otie capsule. Nowadays, stapedotomy is commonly used for otosclerosis treatment. Currently, postoperative dizziness has been associated with stapedotomy. In 1981, intratympanic dexamethasone was utilized to manage inner ear disorders like tinnitus and acute sensorineural hearing loss. However, there is much uncertainty regarding the effect and safety of topical steroid therapy in the middle ear during stapedotomy. In the present study, we assessed the effect of topical steroid therapy during stapedotomy on postoperative dizziness. Methods: Otosclerosis patients eligible for stapedotomy were randomly divided into two groups based on dexamethasone administration or placebo. Audiometric and tympanometry results were observed and recorded for the involved frequencies. The Dizziness Handicap Inventory was used to quantify patient perceptions of dizziness and balance issues. Audiometry and dizziness assessments were repeated at discharge and 4 months after the operation. Results: The study comprised 72 otosclerosis patients undergoing stapedotomy. At discharge, the intervention group showed a significant reduction in the incidence of dizziness compared to the placebo group. However, in the 4-month follow-up after the operation, both groups experienced a decrease in dizziness incidence, with no significant difference between them. There was also no significant difference in audiometric levels between the two groups. Interestingly, the intervention group had a significantly lower need for systemic anti-dizziness drugs after surgery compared to the control group. Conclusion: Topical dexamethasone during stapedotomy effectively minimizes dizziness at discharge and reduces the need for postoperative anti-dizziness medication. Level of evidence: 2.

The Effect of Three Forms of Local Corticosteroids on Sinonasal Polyposis.

Introduction: Since sinonasal polyposis (SNP) has a high recurrence rate after surgery, various studies have investigated the effect of corticosteroid medications to prevent disease recurrence. The present study was designed to compare the effect of three forms of local corticosteroids on preventing SNP recurrence post-operatively. Materials and Methods: This double-blind, randomized clinical trial study was conducted on 108 patients with SNP who underwent functional endoscopic sinus surgery (FESS). Permuted Block Randomization randomly assigned patients into three groups of 36 people: budesonide spray, betamethasone drop, and budesonide nebulizing suspension groups. One and six months after surgery, the patients were evaluated for recurrence of SNP by nasal endoscopy. SNOT 22 questionnaire was used to assess patients' subjective improvement rate pre- and post-operatively. Results: According to the scores obtained in the Modified Lund-Kennedy Scoring, budesonide nebulizing suspension showed better effects on preventing the recurrence of sino-nasal polyps after FESS compared with betamethasone nasal drops. The score was significantly lower in the budesonide nebulizing suspension group compared to the betamethasone drop group (P=0.043). There was no statistically significant difference in the scores between the budesonide nebulizing suspension group and the betamethasone spray group (P=0.178). Also, we observed significant improvement in facial fullness in patients who received Budesonide nebulizing suspension. Conclusions: Budesonide nebulizing suspension, compared to betamethasone nasal drops, showed better effects on preventing the recurrence of SNP after FESS.

Trapezium Tunnel Syndrome.

The trapezium tunnel is situated on the lateral side of the carpal tunnel, lined with synovial tissue, and accommodates the flexor carpi radialis tendon. Trapezium tunnel syndrome is characterized by flexor carpi radialis tendinitis/peritendinitis and may lead to complicated clinical scenarios, such as flexor carpi radialis tendon rupture and the formation of primary or recurrent ganglion cysts on the volar radial side of the wrist and thenar area. Notably, the simultaneous presence of trapezium tunnel syndrome might contribute to unsuccessful outcomes in carpal tunnel surgeries. Trapezium tunnel syndrome may arise from either intrinsic or extrinsic factors. The entity of trapezium tunnel syndrome has attracted a low index of clinical suspicion because the other causes of radial side wrist pain that are more prevalent and frequent. We present a narrative review of this condition in an endeavor to heighten awareness and clinical suspicion of trapezium tunnel syndrome.

SARS-Cov-2 Cycle Threshold Value and Olfactory Dysfunction in COVID-19 Patients.

Introduction: Considering the inconsistent results regarding the association between the severity and duration of olfactory dysfunction (OD), and the viral load in coronavirus disease 2019 (COVID-19) patients, we aimed to conduct this study. Materials and Methods: This is a prospective cohort study in which COVID-19 patients were evaluated for the initial cycle threshold value (Ct values) measured by the nasopharyngeal samples along with olfactory function measured by the University of Pennsylvania Smell Identification Test (UPSIT) within 2 months of COVID-19 onset. Results: Among 309 COVID-19 patients who were included in this study, 108 (34.9%), 112 (36.2%) and 89 (28.8%) were normosmic, hyposmic, and anosmic, respectively based on the UPSIT. The severity of COVID-19 and the rate of hospitalization were higher in anosmic patients (p<0.0001, and p<0.0001, respectively). Moreover, significant associations between the initial Ct value and the severity of OD at admission and follow-ups were detected (p<0.0001 and p<0.0001, respectively). Anosmic patients had higher Ct values in comparison with hyposmic (approx. 3-fold) and normosmic (approx. 12-fold) patients. The recovery rate after one- and two-month follow-ups was 47% and 84%, respectively. At the follow-ups, OD-recovered patients significantly had lower Ct values (mean Ct value: 27.79 ± 2 and 28.21 ± 2.08) in comparison with those who have not recovered yet (mean Ct value: 30.19 ± 3.36, and 33.6 ± 3.37) (p<0.0001, and p<0.0001, respectively). Conclusions: Ct value seems to be a significant factor not only in predicting OD severity in COVID-19 patients but also in the OD recovery duration. This finding may be helpful to investigate the underlying mechanisms of OD in COVID-19 patients.

COVID-19 infodemic and health-related quality of life in patients with chronic respiratory diseases: A multicentre, observational study.

Background: The explosion of information, misinformation and disinformation (the "infodemic") related to the coronavirus disease 2019 (COVID-19) pandemic on digital and social media is reported to affect mental health and quality of life. However, reports assessing the COVID-19 infodemic on health-related quality of life (HRQL) in patients with chronic diseases are scarce. In this study, we investigated the associations between the infodemic and HRQL in uninfected individuals with pre-existing chronic respiratory diseases (CRDs) such as asthma, chronic obstructive pulmonary disease (COPD) and other CRDs. Methods: We conducted a multi-national, cross-sectional, observational study in Canada, India, New Zealand and the United Kingdom where we distributed a set of digitised questionnaires among 1018 participants with chronic respiratory diseases who were not infected with the SARS-CoV-2 virus at least three months prior to the study. We collected information about the infodemic such as news watching or social media use more than usual during the pandemic. HRQL was assessed using the short form of the chronic respiratory questionnaire (SF-CRQ). Demographic information, comorbidities, compliance, mental health, behavioural function, and social support were also recorded. We analysed the direct and indirect relationships between infodemic and HRQL using structural equation models (SEM). Results: Of all participants, 54% were females and had a mean (standard deviation (SD)) age of 53 (17) years. We found that higher infodemic was associated with worse emotional function (regression coefficient ß = -0.08; 95% confidence interval (CI) = -0.14 to -0.01), which means a one SD change of the higher infodemic latent variable was associated with a 0.08 SD change of emotional function level. The association between higher infodemic and worse emotional function was mediated by worse mental health and behavioural functions but is marginally ameliorated by improved social support. In stratification analysis, we found significant disease and country-wise variations in the associations between infodemic and SF-CRQ domain scores. Conclusions: These results provide new evidence that the COVID-19 infodemic significantly influences the HRQL in patients with CRDs through a complex interplay between mental health, behavioural function, and social support. This new dimension of research also opens avenues for further research on infodemic-related health effects in other chronic diseases.

Exposure to insulating materials and risk of coronary artery diseases: a cross-sectional study.

Background: Although previous reports link exposure to insulating materials with an increased risk of mesothelioma and chronic respiratory diseases, studies evaluating their associations with the risk of coronary artery diseases (CAD) are lacking. Aims: We aimed at evaluating the associations between exposure to insulating materials and the 10-year risk of CAD among insulators. Methods: In this cross-sectional study, we recruited 643 adults (≥18 years), full-time insulators from the Local 110 Heat and Frost Insulators and Allied Workers Union in Edmonton, Alberta. We obtained demographic information, personal and family history, and job-exposure history, including experience (years) and types of exposure to insulating materials. Clinical profiling including Framingham risk scores (FRS) was assessed. Results: Of all insulators, 89% were men (mean ± SD age: 47 ± 12 years), 27% had a parental history of cardiac diseases, and 22% had a comorbid chronic respiratory disease. In total, 53% reported exposure to asbestos, while 61, 82, and 94% reported exposure to ceramic fibers, fiberglass, and mineral fibers, respectively. In single-exposure multivariable regression models adjusted for experience, marital status, and body mass index (BMI), asbestos was found to be associated with higher FRS (ß: 1.004; 95%CI: 0.003-2.00). The association remained consistent in multi-exposure models and a higher association was found between asbestos exposure and FRS among insulators with comorbid chronic respiratory disease. Conclusion: Our study demonstrates that apart from cancer and chronic respiratory diseases, asbestos exposure may also have a cardiac effect, thus warranting the need for systematic surveillance to protect workers from the adverse effects of these materials.

Appearance Outcomes of Repositioned Native Nail Plate as a Free Graft and Artificial Nail Plate in the Reconstruction of the Fingertip Injuries.

Purpose: The aim of this study was to evaluate the cosmetic outcomes of native nail plate (NP) replacement as a free graft and using an artificial NP in reconstruction of the fingertip injuries. Methods: Two prospective cohorts of patients with fingertip injuries and avulsed NPs were evaluated. In group 1 (54 patients with 61 fingertip injuries), the native NP was available and suitable for placement under the proximal nail fold. In group 2 (31 patients with 32 fingertip injuries), the native NP was either lost or highly damaged and it was not suitable for use. In this group, an artificial NP was used. The final cosmetic outcomes of regrown NPs were evaluated at a minimum of 4 months after surgery using the Oxford Finger Nail Appearance Score. Results: "Trapped in a door" was the most common cause of injury in pediatric patients, whereas work-related injuries were the most common cause of injury in adults. The difference between the mean appearance scores of the two groups favored group 1 (native NP). There was a negative correlation between the patient age and appearance scores, irrespective of the treatment group. The presence of a distal phalanx fracture adversely affected the appearance scores. Conclusions: Replacing the native NP for splinting in fingertip injuries is advantageous. Fingertip injuries in pediatric patients and fingertip injuries without distal phalanx fractures achieved better cosmesis scores. Type of study/level of evidence: Therapeutic III.

Clinical Study Between Percutaneous Ultrasound-Guided Release and Open Classic Surgery in Treating Multiple Trigger Fingers.

Background: A trigger finger is recognized as the most common hand tendinopathies that reduce functional ability. The present study compares the clinical outcomes of open classic release surgery with ultrasound-guided percutaneous surgery in cases of multiple finger involvement. Materials and Methods: A cohort study has been performed from March 2019 to December 2020 by participating 34 trigger finger patients with multiple involvements. These patients were treated using classical open release and ultrasound-guided percutaneous release methods and both methods were compared in patients. The pain severity and functional ability obtained from the quick disabilities of the arm, shoulder, and hand (Quick-DASH) test scores were compared. Results: The pain intensity in the classical open surgery patients was not significantly different from the ultrasound-guided group, and a one-month follow-up showed that the pain intensity in the ultrasound-guided patients was significantly less than in the other group (P = 0.02). Besides, no significant difference was observed between the functional abilities before and after the one-month follow-up. Indeed, the two groups had the same situations. Also, the recovery time in the ultrasound-guided percutaneous release group was significantly faster than in the other group. These cases had statistical differences as P = 0.001 and P < 0.001, respectively. The surgical release was 100% successful in both groups. The patients' satisfaction rates in the ultrasound-guided and open classic surgery treatment methods were 94.1 and 76.4%, respectively. Conclusions: Classical open release and ultrasound-guided percutaneous surgery could successfully treat multiple trigger fingers. However, ultrasound-guided percutaneous surgery provided faster recovery and less pain intensity than the other method.

Less Social Deprivation Is Associated With Better Health-Related Quality of Life in Asthma and Is Mediated by Less Anxiety and Better Sleep Quality.

BACKGROUND: Previous studies on health-related quality of life (HRQoL) in asthma have mainly focused on clinical and environmental determinants. Little is known about the role of social determinants on HRQoL in asthma. OBJECTIVES: We aimed to investigate the association between social deprivation and HRQoL in asthma. METHODS: A total of 691 adult asthmatics from Canada, India, New Zealand, and the United Kingdom were administered a digital questionnaire containing demographic information and questions about social and psychological attributes, sleep disturbances, and alcohol abuse. HRQoL was measured using the Short Form of the Chronic Respiratory Questionnaire (SF-CRQ). We analyzed the direct and indirect relationships between social deprivation and HRQoL using structural equation models with social deprivation as a latent variable. We tested for mediation via anxiety, depression, sleep disturbances, and alcohol abuse. RESULTS: We found that less social deprivation (latent variable) was directly associated with better SF-CRQ domain scores such as dyspnea (regression coefficient ß: 0.33; 95% confidence interval [CI]: 0.07 to 0.58), fatigue (ß: 0.39; 95% CI: 0.14 to 0.64), and emotional function (ß: 0.37; 95% CI: 0.11 to 0.62), but with the worse mastery score (ß: -0.29; 95% CI: -0.55 to -0.03); however, those associations varied across participating countries. We also observed that among all individual social deprivation indicators, education, companionship, emotional support, instrumental support, and social isolation were directly associated with HRQoL, and the relationship between social deprivation and HRQoL was mediated through anxiety and sleep disturbances. CONCLUSIONS: Our results demonstrated that less social deprivation was directly, and indirectly through less anxiety and better sleep quality, associated with better HRQoL in asthma.

A Degloved Hand Was Resurfaced with Sandwich Flaps.

The right hand of a 35-year-old man trapped in a roller machine and sustained an entire degloving injury of the right hand involving fingers, thumb and a part of palmar and dorsal surfaces of the hand. The denuded hand and fingers were covered with two anteriorly based random paired flaps, forming a hand sandwich, from the opposing surfaces of medial left arm and adjacent left lateral chest wall. The denuded thumb was covered with a separate pocket of paired random vis-à-vis flaps. Finally, the right hand was turned to a functional mitten hand with a 15x13 cm flap on the dorsal surface, 10x10 cm flap on the palm surface. The thumb's covered surface with flaps was 7x 6 cm.

Concomitant Avascular Necrosis of the Lunate and Proximal Pole of the Scaphoid in a Thalassemia Minor Patient.

Avascular necrosis (AVN) of multiple carpal bones is a very rare condition. This case report presents a patient with concomitant AVN of the lunate and proximal pole of the scaphoid that had led to severe joint space narrowing and degenerative arthritis in the radiocarpal and distal radioulnar joints (DRUJs). She was known to have thalassemia minor hemoglobinopathy. Wrist arthrodesis and distal ulna hemiresection-interposition arthroplasty (Bowers technique) for a DRUJ were offered and performed. The patient was satisfied with the clinical outcomes.

The 100 Top-Cited Articles about Kienböck's Disease: A Bibliometric Analysis.

Introduction The aim of this study was to analyze the 100 top-cited articles about Kienböck's disease and their features. Materials and Methods A search through the Elsevier, Scopus database journal articles about Kienböck's disease yielded 1,025 results. The 100 top-cited articles were identified and filtered again to exclude self-citations. The 100 top-cited articles without self-citations were analyzed for the number of citation, citation density, publishing journal, language, authorship, and geographic origin. The abstracts of the articles were obtained to review and determine the types of articles and levels of evidence. Results The mean of the 100 top-cited articles' absolute number of citations was 63.3 ± 34 (range: 23-199). Citation densities ranged from 1 to 8. A total of 97 (97%) articles were written in English. The leading countries were the United States with 50 (50%) articles followed by Japan with 16 (16%) articles. Forty (40%) articles have been published in the Journal of Hand Surgery American volume. Among the 100 top-cited articles, nine articles were devoted to basic science and 91 articles have dealt with clinical science. There were three articles with level II, 24 articles with level III, 46 articles with level IV, and 18 articles with level V of evidences. Conclusion The current study presents an insight to the classic articles about Kienböck's disease. The 100 top-cited articles have established a foundation that the science on Kienböck's disease has been elaborated. The current study is likely helpful for educational purposes and further research about Kienböck's disease. Level of Evidence Economic and decision analysis/Level IV.

Effect of Amniotic Membrane Nerve Wrapping in Final Results of Traumatic Peripheral Nerve Repair.

BACKGROUND: Preventing perineural adhesions and scars formation in the traumatic peripheral injuries is very important on the recovery process. We aimed to evaluate the effect of using the amniotic membrane wrapping on the results of surgical treatment of damaged peripheral nerves. METHODS: This cohort study included 30 patients with symptoms of acute peripheral nerve injuries due to penetrating trauma in the forearm or wrist in January 2019 to November 2020 referred to the Hand and Microsurgery Department, 15 Khordad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. In 15 patients, after nerve repair, amniotic membrane coverage was used around the nerve, all patients were followed for 12 months. Ultrasound study for neuroma formation and nerve regeneration was determined based on EMG and NCV findings. The modified Medical Research Councile classification (MRCC) was used to evaluate of motor and sensory recovery. RESULTS: In the amniotic membrane wrapping group, all patients had nerve regeneration and functional nerve recovery occurred after 12 months. In the control group, 5 patients (33.4%) did not have nerve recovery and had functional and sensory impairment. In terms of functional capabilities; there was a significant difference in pinch strength, grip power and MRCC scoring between the two groups. Moreover, the mean volume of neuroma in these patients who used amniotic membrane covering was 2.7 mm3 and in the control group, it was 3.9 mm3 (P=0.001). Five patients who did not have a damaged nerve, the neuroma volume was 4.8 ± 0.9 mm3. CONCLUSION: The use of amniotic membrane covering is effective methods in the improve results of peripheral nerve repair and nerve function recovery.

Management of Symptomatic Lipoma of the Hand: A Case Series and Review of Literature.

Soft tissue lipoma is one of the most common benign tumors rarely forming in hand. In this study, 11 cases of symptomatic hand lipoma were investigated. The chief complaint was a palpable mass in all 11 patients, out of whom 6 (55%) cases presented with neurological symptoms, including paresthesia and numbness in the median, ulnar, and superficial radial nerve pathways. One patient had an intramuscularly painful forearm with a large mass presentation. In the finger, the clinical manifestations were radial anesthesia of the finger. The mass sizes were above 5 cm3 and less than 5 cm3 in seven and four patients, respectively. The mean follow-up period was 25 months. No patient demonstrated a recurrence during the follow-up period. Although lipoma is a benign tumor and often presents itself as a palpable mass in the hand, it can cause neurological symptoms and decreased function. Regardless of the size of the tumor, mass removal can prevent symptoms.