Functional Imaging of the Knee-A Comprehensive Review.

Knee pain is a common presenting problem in the general population. Radiographs and magnetic resonance imaging (MRI) are the cornerstones of imaging in current clinical practice. With advancements in technology, there has been increasing utilization of other modalities to evaluate knee disorders. Dynamic assessment utilizing computed tomography and portable ultrasounds have demonstrated the capacity to accurately assess and reproducibly quantify kinematics of knee disorders. Cartilage physiology can be evaluated with MRI. Emerging research has even demonstrated novel musculoskeletal applications of positron emission tomography to evaluate anterior cruciate ligament graft metabolic activity following reconstruction. As technology continues to evolve and traditional ways are improved upon, future comparative studies will elucidate the distinct advantages of the various modalities. Although radiology is still primarily an anatomic specialty, there is immense potential for functional imaging to be the standard of care. This review focuses on the most common musculoskeletal applications of functional imaging as well as future utilization.

The application of harm reduction to methamphetamine use during pregnancy: a call to arms.

Compared with opioid use disorder, methamphetamine use is a public health crisis that has limited evidence-based pharmacologic interventions for long-term treatment. The prevalence of methamphetamine use during pregnancy is growing and contributes to adverse maternal and neonatal outcomes. Because of widespread stigma and social complexities associated with methamphetamine use during pregnancy, these patients often experience limited prenatal care, further contributing to poor outcomes. In public health circles, harm reduction describes a framework for conceptualizing substance use by championing health promotion and the safest use of substances, as opposed to the unachievable goal of abstinence. There is limited evidence supporting the application of harm reduction in this population. We call for action and research to investigate how the progressive concept of harm reduction might be applied to mitigate adverse outcomes for obstetrical patients who use methamphetamine.

Obstetrical and perinatal outcomes of patients with methamphetamine-positive drug screen on labor and delivery.

BACKGROUND: The incidence of methamphetamine use in reproductive-age women across the United States is increasing. The existing literature on methamphetamine use in pregnancy has indicated an elevated risk of adverse maternal and neonatal health outcomes. OBJECTIVE: This study aimed to investigate pregnancy outcomes in patients with recent methamphetamine use compared with patients who received negative test results for methamphetamine at the time of delivery. STUDY DESIGN: A single-site retrospective cohort study from January to December 2015 was performed. Patients with a documented urine drug screen during the delivery encounter were identified from the electronic medical records. The outcomes of patients with methamphetamine-positive urine drug screens were compared with controls with urine drug screens negative for methamphetamine. Maternal outcomes of interest included placental abruption, hypertensive disorders, premature preterm rupture of membranes, postpartum hemorrhage, and preterm birth. Utilization of prenatal care, social work consults, and child protective services referrals were also recorded. Neonatal outcomes included birthweight, neonatal intensive care unit length of stay, Apgar scores, and perinatal mortality. RESULTS: The 2 groups had similar demographic characteristics (age, multiparity, ethnicity), with the methamphetamine-positive group more likely to have no or limited prenatal care. Both groups engaged in polysubstance use. A methamphetamine-positive urine drug screen at the time of delivery carries an increased risk of abruption (odds ratio, 5.63; confidence interval, 1.21-26.21) but indicated no increased risk of maternal hypertensive disorders. Additional associated risks include preterm birth (odds ratio, 3.10; confidence interval, 1.44-6.68), lower Apgar scores at 1 and 5 minutes (P=.012 and P=.02, respectively), and increased perinatal mortality (odds ratio, 6.9; confidence interval, 1.01-47.4). CONCLUSION: Positive urine drug testing for methamphetamines during labor admission confers considerable maternal and perinatal morbidity and mortality including an increased risk of placental abruption, preterm birth, and perinatal demise. Given the limited treatments for methamphetamine addiction, further research is urgently needed.