Tag: pubmed

J Cosmet Dermatol. 2021 Jun 15. doi: 10.1111/jocd.14296. Online ahead of print.

ABSTRACT

BACKGROUND: Lidocaine/tetracaine 7%/7% peel cream (L/T-pC) is very effective in reducing pain in several dermatological procedures, such as hair or tattoo laser removal or conventional photodynamic therapy associated pain. Fractional laser resurfacing (FLR) is an effective treatment strategy for facial skin ageing. The main drawback of FLR is the procedure-associated pain. So far, no controlled data are available regarding the efficacy of L/T-pC in reducing pain during a full facial microablative FLR session in subjects with facial skin ageing.

AIM: To assess the clinical efficacy of L/T-pC in reducing pain during microablative FLR treatment in subjects with facial skin ageing. We conducted a prospective, randomised, parallel-group, controlled, single-blind trial, performed in out-patients attending to a Laser Clinic for facial skin ageing treatment.

SUBJECTS AND METHODS: A total of 30 subjects (4 men, 26 women; mean age 42±10 years; range 28-57) with mild to moderate facial skin ageing (Glogau score ≥2), suitable for FLR treatment, were enrolled after their written informed consent. Participants were randomised to L/T-pC application (45 min before the laser treatment with the removal of the cream just before the starting of laser session) (n=20) or to control (emollient cream; n=10). FLR was performing using a fractional microablative CO₂ laser (Smartxide DOT 2 Deka, Calenzano, Italy) using a pulse power of 18 W (range 15-20) and pulse duration of 1.5 msec. The primary endpoint was the comparison of the mean visual-analogue score (VAS) values between the two groups using a 10-cm scale (0= no pain; 10: the most severe pain). The VAS score was measured just after the FLR session. Effective anaesthesia (percentage of subjects with a VAS score ≤3) and the assessment of local tolerability and safety of the peel cream were the secondary trial endpoints.

RESULTS: All the enrolled subjects concluded the trial. In the L/T-pC group the VAS mean score was 3.0±1.2. In the control group the VAS mean score was 8.6±0.5, representing a 65% reduction of the VAS score in the active treated group vs. controls. The difference between the two groups was statistically significant (p=0.0001; Mann-Whitney test) with an absolute difference of -5±0.4 cm; 95%CI of the difference: from -4.6 to -6.4 cm). Adequate anaesthesia (VAS score≤3) was reported in 80% of subjects in the active group vs. 0% in the control arm. The cream was very tolerated. One subject in the active group manifested moderate/severe oedema in the cream application area, subsiding in 6 hours. No other side effects were reported.

CONCLUSION: The application of L/T pC 7%/7% peel cream before a fractional laser resurfacing session significantly reduced the procedure-associated pain with good tolerability and safety profile.

PMID:34129728 | DOI:10.1111/jocd.14296

J Cosmet Dermatol. 2021 Jun 15. doi: 10.1111/jocd.14289. Online ahead of print.

ABSTRACT

BACKGROUND: All scoring systems used in Alopecia Areata (AA) focus mainly on scalp and cannot assess the severity or treatment response when AA involves the beard hair, eyebrows or eyelashes.

AIM: This study describes and assesses the reliability of a new scoring system ‘Alopecia Areata Severity Index’ (AASI) for measuring the severity of AA of scalp, beard and upper face.

METHODS: Scalp hair, beard hair, upper face (eyebrows and eyelashes) were individually assessed and the severity of AA was scored from 0 to 100 (0-50 in case of upper face). AASI score was then calculated as a sum of all these individual scores as AASI= AASI (scalp)+AASI (upper face)+AASI (beard)+. To test the inter-observer reliability of AASI score, 25 patients with varying severity of AA were scored by 4 trained dermatologists. Repeat scoring was performed after one week to test for intra-observer reliability.

RESULTS: Excellent inter-rater as well as intra-observer reliability was observed with Chronbach’s alpha value of 0.999 (CI = 0.989-1.000). The intra-observer correlation coefficient with average measure was 0.999 (CI = 0.990- 1.000) with statistically significant F test <0.005.

CONCLUSION: AASI score is a reliable scoring system to assess the severity of AA in patients with involvement of one or more areas of the body.

PMID:34129730 | DOI:10.1111/jocd.14289

J Athl Train. 2021 Jun 15. doi: 10.4085/1062-6050-0262.21. Online ahead of print.

ABSTRACT

CONTEXT: It is currently unclear how different pitching roles affect arm injury risk in professional pitchers.

OBJECTIVE: 1) Investigate the differences in arm injury hazard between professional baseball starting and relief pitchers; 2) Separately investigate elbow and shoulder injury hazard between professional baseball starting and relief pitchers.

STUDY DESIGN: Prospective cohort Setting: Minor League Baseball (MiLB) from 2013-2019 Patients or Other Participants: Pitchers Main Outcome Measures: Pitchers were followed for the entire MiLB season and athletic exposures (AE’s) and injuries were recorded. Risk ratios and risk difference were calculated between starting and relieving MiLB pitchers. A cox survival analysis was then performed in relation to time to arm injury between starting and relieving MiLB pitchers. Subgroup analyses were performed for elbow and shoulder.

RESULTS: 297 pitchers were included with a total of 85,270 player days recorded. Arm injury incidence was 11.4 arm injuries per 10,000 AE’s. Starting pitchers demonstrated greater risk ratio (1.2 (95% CI: 1.1-1.3)) and risk difference (13.6 (95% CI: 5.6-21.6)) and hazard of arm injury (2.4 (95% CI: 1.5-4.0)) compared to relief pitchers. No differences were observed for hazard of elbow injury between starting and relief pitchers (1.9 (95% CI: 0.8-4.2)). Starting pitchers demonstrated greater hazard of shoulder injury compared to relief pitchers (3.8 (95% CI: 2.0-7.1)).

CONCLUSIONS: Starting pitchers demonstrated almost two and a half times greater hazard of arm injury compared to relief pitchers. Subgroup analyses demonstrated that starters exhibited greater hazard of shoulder injury compared to relievers; but, no differences were observed for hazard of elbow injury. However, due to the wide confidence intervals, these subgroup analyses should be interpreted with caution. Clinicians may need to consider cumulative exposure and fatigue and how these factors relate to different pitching roles when assessing pitching arm injury risk.

PMID:34129678 | DOI:10.4085/1062-6050-0262.21

Hepatology. 2021 Jun 15. doi: 10.1002/hep.32014. Online ahead of print.

ABSTRACT

We greatly appreciate Shi and colleague for their interest in our work ⁽¹⁾ . An important question they raise is whether our sample size is large enough with sufficient statistical power to predict the 6-week death or further bleeding in patients with Child-Pugh B cirrhosis and acute variceal bleeding.

PMID:34129697 | DOI:10.1002/hep.32014

Angle Orthod. 2021 Jun 15. doi: 10.2319/013021-86.1. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess changes in spheno-occipital synchondrosis after rapid maxillary expansion (RME) performed with conventional tooth-borne (TB) and bone-borne (BB) appliances.

MATERIALS AND METHODS: This study included 40 subjects with transverse maxillary deficiency who received TB RME or BB RME. Cone-beam computed tomography images (CBCT) were taken before treatment (T0), and after a 6-month retention period (T1). Three-dimensional surface models of the spheno-occipital synchondrosis and basilar part of the occipital bone were generated. The CBCTs taken at T0 and T1 were registered at the anterior cranial fossa via voxel-based superimposition. Quantitative evaluation of Basion displacement was performed with linear measurements and Euclidean distances. The volume of the synchndrosis was also calculated for each time point as well as the Nasion-Sella-Basion angle (N-S-Ba°). All data were statistically analyzed to perform inter-timing and intergroup comparisons.

RESULTS: In both groups, there was a small increment of the volume of the synchondrosis and of N-S-Ba° (P < .05). Basion showed a posterosuperior pattern of displacement. However, no significant differences (P > .05) were found between the two groups.

CONCLUSIONS: Although TB and BB RME seemed to have some effects on the spheno-occipital synchondrosis, differences were very small and clinically negligible.

PMID:34129666 | DOI:10.2319/013021-86.1

J Athl Train. 2021 Jun 15. doi: 10.4085/1062-6050-0185.21. Online ahead of print.

ABSTRACT

(STATE-XXX = Wisconsin).

ABSTRACT: Objective: To describe the incidence of COVID-19 in STATE-XXX high school athletes, and to investigate the relationship of COVID-19 incidence with sport and face mask use.Design: Retrospective survey.Setting: High schools across STATE-XXX during September, 2020.Participants: Athletic directors representing 30,074 high school athletes with and without SARS-CoV-2.Independent Variables: COVID-19 rates among athletes, counties, and STATE-XXX, school instruction type (virtual vs in-person), sport type, face mask use.Main Outcome Measurements: Reported athlete case rates compared to their county’s general population. Associations between COVID-19 incidence and sport type and face mask use, adjusting for each school’s county incidence using multivariable negative binomial regression models.Results: COVID-19 incidence rates for 207 of 244 responding schools were 32.6 cases per 100,000 player-days. Reported case rates for athletes in each county were positively correlated with the county’s general population case rates (β=1.14±0.20, r=0.60, p<0.001). One case (0.5%) was attributed to sport contact by the reporting schools. No difference was identified between team and individual sports (incidence rate ratio (IRR)=1.03 [95% CI=0.49-2.2], p=0.93) or between non-contact and contact sports (IRR=0.53 [0.23-1.3], p=0.14). Outdoor sports had a lower incidence rate than indoor sports, although this did not reach statistical significance (IRR=0.52 [0.26-1.1], p=0.07). There were no significant associations between COVID-19 incidence and face mask use during play for those sports with greater than 50 schools reporting on face mask use (p>0.05 for all).Conclusions: Incidence of reported COVID-19 among high school athletes was related to county incidence and most cases were attributed to non-sport contact. A lower COVID-19 incidence in outdoor sports approached statistical significance. The lack of a significant benefit of face mask use may be due to relatively low rates of COVID-19 in STATE-XXX during September 2020. Further research is needed to better define COVID-19 transmission risk factors during adolescent sport participation.

PMID:34129671 | DOI:10.4085/1062-6050-0185.21

J Oral Facial Pain Headache. 2021 Spring;35(2):139-149. doi: 10.11607/ofph.2645.

ABSTRACT

AIMS: To compare the prevalence of facial pain and headache across various regions in Sweden.

METHODS: This study involved a comparison of cross-sectional questionnaire studies over a period of 10 years including 128,193 individuals and assessed facial pain, pain on function, and headache. Participants included (1) all Public Dental Service patients aged 16 to 90 years in Västerbotten (n = 57,283) and Gävleborg (n = 60,900); and (2) random samples of residents in Kalmar (n = 3,560) and Skåne (n = 6,450). Facial pain and pain on function were assessed for all participants, and headache was also assessed for participants in Kalmar and Skåne. Descriptive statistics were used to estimate unadjusted prevalence estimates and demographic characteristics. Prevalence estimates were adjusted for age and sex using weighted distributions from the 2015 data in the Swedish population registry before comparisons across the regions.

RESULTS: Overall, the prevalence of facial pain and headache were significantly higher in female than in male participants (P < .01). The standardized prevalence of facial pain was 4.9% in Västerbotten, 1.4% in Gävleborg, 4.6% in Kalmar, and 7.6% in Skåne. For headache, the standardized prevalence was 18.9% in Kalmar and 21.3% in Skåne. In Skåne, individuals with facial pain had a 15-fold higher odds of headache than those without.

CONCLUSION: In the present Swedish epidemiologic study, the prevalence of facial pain ranged from 1.4% in Gävleborg to 7.6% in Skåne. Besides different sampling frames and other population characteristics, the presence of a high number of immigrants in Skåne may account for some differences in pain prevalence across the Swedish regions.

PMID:34129659 | DOI:10.11607/ofph.2645

J Oral Facial Pain Headache. 2021 Spring;35(2):119-128. doi: 10.11607/ofph.2863.

ABSTRACT

AIMS: To analyze Axis I and II findings of patients diagnosed as having painful temporomandibular disorder (TMD) with headache attributed to TMD (HAattrTMD) in order to assess whether HAattrTMD is associated with a specific Axis I and II profile suggestive of the central sensitization process.

METHODS: This retrospective study included 220 patients with painful TMD divided into those with (n = 60) and those without (n = 160) HAattrTMD, and the patients were compared for Axis I and II results according to the Diagnostic Criteria for TMD (DC/TMD). A P value < .05 was considered statistically significant.

RESULTS: A total of 27.3% of the patients received a diagnosis of HAattrTMD. Myofascial pain with referral was significantly more common in the HAattrTMD group (P < .001), while local myalgia was significantly more common in the non-HAattrTMD group (P < .001). Characteristic pain intensity was significantly higher in the HAattrTMD group (P = .003), which also showed significantly higher levels of depression (P = .002), nonspecific physical symptoms (P = .004), graded chronic pain (P = .008), and pain catastrophizing (P = .013). Nonspecific physical symptoms were positively associated with HAattrTMD (odds ratio [OR] = 1.098, 95% CI = 1.006 to 1.200, P = .037). Local myalgia was negatively associated with HAattrTMD (OR = .295, 95% CI = 0.098 to 0.887, P = .030).

CONCLUSIONS: Painful TMD patients who report headache in the temple area and are diagnosed as having local myalgia rather than myofascial pain with referral probably do not have HAattrTMD. The diagnosis of HAattrTMD may point to a central sensitization process and possible current/future chronic TMD conditions.

PMID:34129657 | DOI:10.11607/ofph.2863

J Oral Facial Pain Headache. 2021 Spring;35(2):129-138. doi: 10.11607/ofph.2745.

ABSTRACT

AIMS: To answer the question: among observational studies, is there any association between primary headaches and bruxism in adults?

MATERIALS AND METHODS: A systematic review of observational studies was performed. The search was performed in seven main databases and three gray literature databases. Studies in which samples were composed of adult patients were included. Primary headaches were required to be diagnosed by the International Classification of Headache Disorders. Any diagnostic method for bruxism was accepted. Risk of bias was evaluated using the Joanna Briggs Institute Critical Appraisal Tool and the Meta-Analysis of Statistics Assessment and Review Instrument (MAStARI) tool. Associations were analyzed by calculating odds ratios (OR) in Review Manager 5.3 software. The evidence certainty was screened by Grading of Recommendations Assessment, Development, and Evaluation criteria.

RESULTS: Of the 544 articles reviewed, 5 met the inclusion criteria for qualitative analysis. The included studies evaluated both awake and sleep bruxism, as well as tension-type headaches and migraines as primary headaches. Among two migraine studies, one showed an OR of 1.79 (95% CI: 0.96 to 3.33) and another 1.97 (95% CI: 1.5 to 2.55). On the other hand, among three tension-type headache studies, there was a positive association only with awake bruxism, with an OR of 5.23 (95% CI: 2.57 to 10.65). All included articles had a positive answer for more than 60% of the risk of bias questions. The evidence certainty varied between low and very low. Due to high heterogeneity among the studies, it was impossible to perform a meta-analysis.

CONCLUSION: Patients with awake bruxism have from 5 to 17 times more chance of having tension-type headaches. Sleep bruxism did not have any association with tension-type headache, and the association with migraines is controversial.

PMID:34129658 | DOI:10.11607/ofph.2745

PLoS One. 2021 Jun 15;16(6):e0252750. doi: 10.1371/journal.pone.0252750. eCollection 2021.

ABSTRACT

INTRODUCTION: Religion and spirituality play important roles in the lives of many, including healthcare providers and their patients. The purpose of this study was to examine the relationships between religion, spirituality, and cultural competence of healthcare providers.

METHODS: Physicians, residents, and medical students were recruited through social platforms to complete an electronically delivered survey, gathering data regarding demographics, cultural competency, religiosity, and spirituality. Four composite variables were created to categorize cultural competency: Patient Care Knowledge, Patient Care Skills/Abilities, Professional Interactions, and Systems Level Interactions. Study participants (n = 144) were grouped as Christian (n = 95)/non-Christian (n = 49) and highly religious (n = 62)/not highly religious (n = 82); each group received a score in the four categories. Wilcoxon rank sum and Chi-square tests were used for analysis of continuous and discrete variables.

RESULTS: A total of 144 individuals completed the survey with the majority having completed medical school (n = 87), identifying as women (n = 108), white (n = 85), Christian (n = 95), and not highly religious (n = 82). There were no significant differences amongst Christian versus non-Christian groups or highly religious versus not highly religious groups when comparing their patient care knowledge (p = .563, p = .457), skills/abilities (p = .423, p = .51), professional interactions (p = .191, p = .439), or systems level interaction scores (p = .809, p = .078). Nevertheless, participants reported decreased knowledge of different healing traditions (90%) and decreased skills inquiring about religious/spiritual and cultural beliefs that may affect patient care (91% and 88%). Providers also reported rarely referring patients to religious services (86%).

CONCLUSIONS: Although this study demonstrated no significant impact of healthcare providers’ religious/spiritual beliefs on the ability to deliver culturally competent care, it did reveal gaps around how religion and spirituality interact with health and healthcare. This suggests a need for improved cultural competence education.

PMID:34129642 | DOI:10.1371/journal.pone.0252750