ScienceRise: Medical Science

The role of ultrasound densitometry for screening diagnostics of osteopenia in children with juvenile idiopathic arthritis

2024-11-22T18:53:14+02:00

Juvenile idiopathic arthritis (JIA) in children remains one of the most severe medical and social problems in the world. One of the complications of the disease is the development of osteopenic syndrome (OS) with the possible formation of osteoporosis. Therefore, in the process of monitoring patients with JIA, it is necessary to monitor the structural and functional state of bone tissue.

The aim of the study was to determine the role of ultrasound densitometry (UD) for the screening diagnosis of OS in children with JIA.

Materials and methods: examined 63 children with JIA aged 5 to 18 years. All patients underwent a general clinical examination and determination of the serum content of 25 hydroxyvitamin D (25 (OH) D) and UD to assess the mineral density of bone tissue.

Results. In children with JIA, 41.76 % of cases were diagnosed with OS of various degrees of severity, which corresponds to the results of many studies conducted using such a "gold standard" of diagnosis as dual-energy X-ray absorptiometry (DXA). At the same time, osteopenia I degree was diagnosed in 20.0 % of cases, II degree – in 35.0 % of cases, III degree – in 30.0 % of cases, and in 3 patients (15.0 %) the Z-index was below -2 .5, which meets the criteria for osteoporosis. It was established that children with OS were older than children without this syndrome, significantly more often complained of pain in the joints, morning stiffness and restriction of movements, and during examination, joint deformity was more often detected in them. In addition, children with OS were characterized by a significantly lower level of 25 (OH)D in blood serum (17.3 [14.3, 25.8] vs 28.8 [20.6, 46.3] ng/ml; p< 0.05).

Conclusions. UD can be used for screening diagnosis of OS in children with JIA. The ease of use of ultrasound densitometry devices, the absence of radiation exposure of the child, the possibility of conducting an examination at the bedside, and the low cost are clear advantages of this method of examining bone mineral density compared to DXA

Assessment of interalveolar height deficiency using computed tomography in patients with TMJ dysfunction in articulation-occlusion disorders

2024-11-22T19:06:56+02:00

This article reviews the assessment of interalveolar height deficit in morphometric comparison with its projection onto the superior space of the temporomandibular joint (TMJ) using cone-beam computed tomography (CT) of the TMJ. The technique for calculating the gaps between the fossa and the head, determining the coefficients for their comparison, and their correlation with clinical signs of TMJ dysfunction in occlusal and articulatory disorders is described.

The aim - to determine CT diagnostic criteria for decreased interalveolar height in patients with functional TMJ disorders with occlusal and articulatory disorders at the stage of orthopedic treatment planning.

Materials and research methods. An examination was conducted of 150 patients with functional disorders of the chewing apparatus and occlusal disorders, who were included in the experimental group and 30 practically healthy individuals - the control group. Both groups were comparable in age and sex. Cone-beam tomography was performed on the MyRay Hyperion X9 PRO model with iRYS 16.3.1 software. During the clinical dental examination, the occlusion of the dentition was assessed, the reduction of the interalveolar height was determined, the width of the mouth opening was assessed, the mobility of the lower jaw was assessed, the symmetry of the mouth opening was determined, clicking and crunching in the TMJ were determined.

Research result. When analyzing cone-beam tomography data, interalveolar height deficiency was classified as a decrease in the proposed coefficient for assessing the size of the upper TMJ space in at least one joint. A decrease in the specified ratio was found in 130 (86.67 %) patients with TMJ dysfunction and occlusal and articulation disorders according to CT data and confirmed by the anatomical and physiological method in 81 (54.00 %) patients, while its moderate decrease was confirmed by measurements by the topographic and physiological method (0.5-2.5 mm) in 62 (76.54 %) people and a significant decrease (more than 2.5 mm) in 19 (23.46 %) people, in 20 (13.33 %) patients, the coincidence of the absence of interalveolar height deficiency according to CT data and the anatomical and physiological method was noted.

Bilateral reduction of interalveolar height was found in 82 (54.67 %) patients of the study group; 36 (24.00 %) of them had clinically observed pain syndrome. When assessing the deficiency of interalveolar height by the topographic-physiological method, confirmation of its moderate reduction (0.5-2.5 mm) was found in 51 (62.20 %) individuals and a significant reduction (more than 2.5 mm) in 8 (9.75 %) individuals. Unilateral reduction of interalveolar height was found in 48 (32.00 %) patients of the study group; 20 (41.66 %) of them had clinically observed pain syndrome.

Conclusions. The assessment of the size of the superior articular space in comparison with the average value of the anterior and posterior articular gaps when determining their sizes using cone-beam CT of the TMJ may be a marker of decreased interalveolar height in patients with TMJ dysfunction and occlusal and articulatory disorders

The impact of early physical rehabilitation in the intensive care unit on the mental state and cognitive functions of patients with COVID-19

2024-12-18T16:50:37+02:00

As of 2021, according to the World Health Organization (WHO), over 700 million cases of COVID-19 have been recorded globally, of which approximately 20 % required hospitalisation and 5 % were transferred to Intensive Care Units (ICU). The primary cause for hospitalisation of patients in ICU is respiratory failure caused by acute respiratory distress syndrome (ARDS) associated with COVID-19. Breathing problems, prolonged ICU stays, and the need for mechanical ventilation significantly affect patients' overall health, reducing their ability to self-care, decreasing muscle strength, and negatively impacting cognitive functions. Early physical rehabilitation is considered a potentially effective method to improve treatment outcomes, particularly in reducing anxiety and depression and restoring cognitive functions.

The aim of our study is to investigate the impact of early physical rehabilitation in the ICU on cognitive function and mental state in patients with COVID-19.

Materials and methods: We conducted a retrospective cohort study on patients with a confirmed diagnosis of COVID-19 who required hospitalisation in the ICU between October 2020 and March 2021. We compared the effects of one and two daily sessions of physical rehabilitation on anxiety and depression levels, as well as cognitive functions in these patients.

Results: We found that two daily sessions of physical rehabilitation significantly reduced anxiety and depression levels in patients with COVID-19, especially among males. Cognitive function dynamics did not show significant differences between the groups, which may indicate the limited impact of physical rehabilitation on cognitive functions in the short term.

Conclusion: Early physical rehabilitation is an important component of the treatment for patients with COVID-19 in the ICU. Increasing the frequency of physical rehabilitation sessions per day contributes to improving patients' mental state, reducing anxiety and depression, and also holds potential for preserving cognitive functions, which is critically important for the long-term recovery of patients after severe illness

Characteristics of structural changes of the retina in early period of traumatic optic nerve damage in the experiment

2024-12-30T11:15:33+02:00

The aim of this study was to characterize the structural changes of the retina in the early period of traumatic damage to the optic nerve.

Materials and methods. The research used a model of crushing the optic nerve. The study was conducted on 30 mature rabbits with a body weight of 2.0 kg to 2.5 kg. Morphological examinations included light and electron microscopy. The retina of the right eye (control) and left eye (lesion side) was evaluated on the 14th day of the experiment.

The animals were kept and removed from the experiment (through an overdose of narcotic drugs – ketamine) in accordance with the "Bioethical Requirements of the Helsinki Declaration on the Ethical Regulation of Medical Research". Protocol No. 125/22 dated March 24, 2022.

The results. The results of the morphological study showed structural changes occurring in the retina on the 14th day after traumatic damage to the optic nerve, namely the presence of microcirculation disorders and the development of edematous and destructive processes. Neurons exhibit degenerative changes such as karyopyknosis, vacuolization, and colliquative necrosis. Lipofuscin inclusions were recorded in the layer of nerve fibers. On the other hand, presumably restorative and compensatory processes are observed, such as the appearance of young mitochondria and endoplasmic reticulum hypertrophy and hyperplasia.

The thickness of the layer of ganglion cells of the retina increased by 52 %, and the nerve fibers layer – by 35 % on the affected side compared to the control side. What is found may be the result of the damage itself, but at the same time it can be seen as a protective mechanism and contribute to future recovery.

Conclusions. It was found that changes in cytoarchitectonics of the retina in the early period of traumatic damage to the optic nerve are manifested by a combination of degenerative and restorative processes