Ultrasound-guided injections in pain medicine are a common intervention. They have been used to manage myofascial trigger points (MTrPs) in different muscles of the body. The main objectives of this article were to review ultrasound-guided injection techniques used for treating MTrPs. We also summarize the anatomy and sonoanatomy of MTrPs using the upper trapezius muscle as an example.
Objective: Myofascial pain is a chronic pain disorder characterized by the presence of painful localized regions of stiff muscle and/or myofascial trigger points. Intramuscular myofascial trigger point injections are considered first-line treatments for myofascial pain. Common injectates include local anesthetics and botulinum toxin-A (BTX-A). The objective of this systematic review was to compare the effectiveness of local anesthetics and BTX-A on pain intensity in patients with myofascial pain. Methods: A comprehensive systematic search of 3 databases, EMBASE, CENTRAL, and Medline was conducted. The search was comprised of words to describe “myofascial pain” and “injections.” We performed a meta-analysis comparing local anesthetic and BTX-A injections across these follow-up week periods: 0 (immediately following the injection), 1 to 2, 3 to 4, 5 to 6, 7 to 8, 9 to 10, 11 to 12, 16, 18, 24 weeks with local anesthetics and BTX-A as subgroups. We also performed subgroup analyses comparing the effectiveness of local anesthetic injections and BTX-A injections at various muscle locations and comparing the effectives of single versus multiple injection sessions. Results: In total, 33 studies were included. A qualitative analysis suggested that local anesthetics and BTX-A were inconsistently effective at mitigating pain across all follow-up periods. The meta-analyses revealed that local anesthetic injections were more effective than BTX-A at mitigating pain intensity. Multiple injection sessions of local anesthetics were more beneficial than a single session. Conclusions: Additional studies are needed to determine sources of heterogeneity mediating the observed differences in effectiveness of local anesthetic and BTX-A injections among the studies. Additional replicative studies are also needed to delineate the relative efficacy and effectiveness of local anesthetic and BTX-A injection. The quantitative results of this study suggest that patients overall experience more pain relief with local anesthetic injections.
BackgroundThere is an increasing trend in the consumption of poor-quality diets worldwide, contributing to the increase of non-communicable diseases. Diet directly influences physiological composition and subsequently physical health. Studies have shown that dietary macronutrient and energy content can influence the proportion of intramuscular fat (IMF), which mediates various metabolic and endocrine dysfunction. The purpose of this systematic review was to identify evidence in the literature assessing the association between different dietary interventions on the proportion of IMF in humans.MethodsThree medical databases were investigated (Medline, EMBASE, and Cochrane) to identify studies assessing changes in IMF after dietary interventions. The primary outcome measure was the change in IMF proportions after a dietary intervention. The effects of high-fat, high-carbohydrate, low-calorie, and starvation diets were assessed qualitatively. A meta-analysis assessing the effect of high-fat diets was conducted. Follow-up sensitivity and subgroup analyses were also conducted.ResultsOne thousand eight hundred and sixty-six articles were identified for review. Of these articles, 13 were eligible for inclusion after a full screening. High-fat diets increased IMF proportions, standardized mean difference = 1.24 (95% confidence interval, 0.43–2.05) and a significant overall effect size (P = 0.003). Diets with an increased proportion of carbohydrates decreased IMF proportions; however, increasing caloric intake with carbohydrates increased IMF. Starvation diets increased IMF stores, and hypocaloric diets did not result in any IMF proportion changes.ConclusionThis systematic review suggests that high-fat diets and diets with caloric intake increased above the amount required to maintain BMI with carbohydrates, and short-term starvation diets are associated with increases in IMF content. Further studies are needed to assess the effects of macronutrient combinations on IMF and the influence of diet-induced IMF alterations on health outcomes. In addition, IMF poses a possibly effective clinical marker of health.
Objective: To summarize the literature on the electrophysiology of Cavanagh Syndrome (CS), to present a clinical application and to propose an updated electrophysiologic protocol. Methods:A systematic literature search for CS was carried out and a clinical application is presented.Results: CS is characterized by congenital thenar hypoplasia and can be associated with other regional muscular and vascular anomalies. The main electrophysiologic abnormality in patients with CS is a reduced amplitude median compound muscle action potential (CMAP) to the thenar eminence, which is also seen in CTS. Radiographic, and electrodiagnostic findings of a patient with co-morbid CS and CTS is presented. Evaluating the median CMAP to the first lumbrical may assist with the diagnosis of CTS in patients with CS. Conclusions:As CTS and CS can present with thenar atrophy and low amplitude CMAPs, electromyographers should be aware of the clinical and radiographic characteristics of CS and consider electrophysiologic evaluation of the first lumbrical.
(1) Background: Intravesical instillation of therapeutic Bacillus Calmette-Guerin (BCG) is the standard of treatment for non-muscular invasive bladder cancer. Although the exact immunomodulatory effects of BCG therapy in non-muscular invasive bladder cancer (NMIBC) are still unclear, it has been considered a safe and effective treatment with the largest to-date report of complications citing minimal side effects, none of which included arterial involvement; (2) Methods: A systematic literature review was performed using PubMed, Cochrane, Medline, and Google Scholar from database inception to March 2021. Only eligible studies reporting aneurysm formation in adult patients with a history of BCG immunotherapy and no previous vascular pathology were included; (3) Results: A systematic literature review was conducted, highlighting 17 reports suggestive of BCG-induced mycotic aneurysm development. We added a case of a 78-year-old male, 30 months after last BCG-instillation, with a mycotic abdominal aneurysm yielding Mycobacterium tuberculosis with pyrazinamide resistance culture.; (4) Conclusions: Concluding results suggest a higher incidence of vascular complications from BCG intravesical therapy in the treatment of non-muscular invasive bladder cancer than previously reported. Recommendations are made to emphasize further research of this immunotherapy complication to facilitate the creation of guidelines for diagnosis and management of these patients.
BACKGROUND A healthy and well-functioning thyroid gland is important to everyone, but it is especially important to a woman in their child bearing age. Postpartum thyroiditis is a syndrome of transient or permanent thyroid dysfunction occurring in the first year after delivery and based on autoimmune inflammation of thyroid gland. (1,2) AIMS AND OBJECTIVES 1. To determine the prevalence of thyroid dysfunction in postpartum period. 2. To see the prevalence of TPOab in the postpartum thyroiditis. 3. Percentage of recovery normal thyroid function after postpartum period. MATERIAL AND METHOD This study was carried out in the Department of Medicine and Obstetrics and Gynaecology Department of L.L.R.M Medical College, Meerut, from May 2013 to May 2014; 100 women of postpartum period was selected from OPD and Wards and subjected to a protocol which include history specially palpitation, depression, fatigue, sweating, constipation and examination with a special reference to general body built, height, weight, pulse, BP, respiratory rate, pallor, cyanosis, icterus, oedema, lymphadenopathy, body temperature, eyes signs, hairs and skin changes and BMR were noted. All the system were examined thoroughly. Thyroid gland was examined thoroughly. All the women are subjected to following investigation. A complete haemogram T3, T4, TSH, TPO antibodies and blood sugar (Fasting and PP). All were followed at 6 weeks and 6 months with above protocol. RESULT The study groups consist of 100 women of post-partum period, (06 weeks to 06 months) with no previous history of thyroid disorder. All subjects were randomly selected. Most of the women were between age group of 20 to 25 years of age, approximately 45% of the study group. Most of the women were parity of (1-2) and (2-3). Out of 100 women, 11 women showed postpartum thyroid dysfunction (Approximately 11%); 06 women were hyperthyroid having thyroid value between 21.9-29.0 and TSH between 0.005-0.350. Two women show subclinical hypothyroidism (Normal T3, T4 and high TSH). Three women were hypothyroid (Decrease T3 and T4, increase TSH). All women were followed with OPD, phone and home visit at 6 months. Out of 11 women who were previously showing postpartum thyroid dysfunction, one women showed complete recovery which was previously hyperthyroid. Out of 6 hyperthyroid 2 became hypo, 1 became euthyroid and 3 remained hyper at 6 months. Out of 5 hypothyroid, 1 became euthyroid, 4 remained hypothyroid. Thus at the end of study, approximately 9% women were having thyroid dysfunction. In this study, 8 women were having positive TPOAb, in which 5 women were showing thyroid dysfunction and 3 women who were positive did not show postpartum thyroid dysfunction. Thus in TPOAb positive women prevalence was app. 62%. In this study 4 women were having gestational diabetes, out of which 1 woman also had postpartum thyroid dysfunction. There is also increase in depressive symptoms in this group (TPOAb positive). CONCLUSION Postpartum thyroiditis is significantly present in women of postpartum period,...
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