ENT involvement and orobuccal movements' disorders in Pandas patients: assessment and rehabilitations tools.

• Several cardiovascular/hemostatic disturbances haves been reported in patients with COVID-19, but the real frequency and their potential association with the pathogenic mechanisms of SARS-CoV-19 still remain to be defined. • We investigated the relative frequency of acute coronary syndrome, deep venous thrombosis, pulmonary embolism, stroke and upper gastrointestinal bleeding in COVID patents attending emergency departments (EDs), before hospitalization and compared them with frequencies in the general ED population attending 50 Spanish EDs. • We found that the risk of pulmonary embolism is clearly increased in COVID patients, with an OR of 4.53 with respect to non-COVID patients (95% confidence interval 4.03- 5.10). Additionally, the diagnosis of pulmonary embolism was 2 fold more frequent among ED comers in 2020 compared to 2019, suggesting a SARS-CoV-2 role in such increment of cases.. The remaining entities studied were not found to be unequivocally increased in the present study and need further investigation.

These were to 1) estimate the prevalence of subjective symptoms and clinical signs of temporomandibular disorders (TMD) in children and adolescents in the city of Jönköping, Sweden, 2) follow possible variations in TMD signs and symptoms over a 20-year period, and 3) study possible associations between TMD symptoms and signs and factors of interest. About 100 individuals in the age groups of 3, 5, 10 and 15 years participated in cross-sectional stratified epidemiological investigations in 1983, 1993 and 2003. All participants were asked to fill in a questionnaire including questions on general and oral health, dental care habits and some socio-demographic issues. More specific questions recorded the presence or absence of subjective symptoms: tiredness in the jaws on awakening or during chewing; clicking sounds or crepitations from the temporomandibular joints (TMJs); locking/ catching of the mandible; luxation of the mandible; reduced jaw movement capacity; pain during jaw movements; other pain conditions in the jaws or in the TMJ regions. Subjects were examined clinically at each time period for; jaw mobility (maximum jaw opening including vertical overbite, maximum laterotrusion to the right and to the left, maximum protrusion); TMJ function (normal function, deflection on jaw opening of >2 mm, TMJ clicking or crepitations, TMJ locking, TMJ luxation); pain on jaw movement (no pain on movements, pain on one movement, pain on more than one movement); muscle pain (no muscle pain, pain on palpation in 1-3 sites, pain on palpation in >3 sites); TMJ pain (no joint pain, pain on lateral palpation of one or both joints, pain on posterior palpation of one or both joints). No functional examination of the masticatory system was performed in children aged 3 and 5 years. TMD-related symptoms were very rare in 3- and 5-year-olds. In the age groups of 10- and 15-year olds, 5-9% of the participants reported more severe symptoms, up to 50% showed one or more TMD signs, while it was estimated that 1-2% were in need of TMD treatment. Several symptoms and signs increased with age. No gender differences, with the exception of recurrent headache, were noted. Oral parafunctions were reported by 11-47%. Apart from a few variables, no statistically significant changes in the prevalence of TMD symptoms and signs were observed over the 20-year period. Clenching/grinding of teeth and general health factors were found to be associated with TMD symptoms and signs. The prevalence of more severe TMD symptoms and signs in children and adolescents was generally low in all three examinations and did not change significantly during the 20-year period. Increasing age, general health factors and oral parafunctions were associated with TMD symptoms and signs in 10- and 15-year-olds.

Temporomandibular disorders (TMDs) and cervical spine problems are a growing public health issue, as they increase the risk of disability in people with hypermobility joint syndrome (HJS). The present study aimed to assess the prevalence of TMD symptoms, and cervical spine and TMJ disability in HJS patients. A survey was conducted among physical therapy students (mean age: 21 years). The study comprised 2 stages. The 1st one was HJS assessment (the Beighton scale and the Brighton criteria). Based on the assessment, 56 HJS subjects were enrolled for the study. The control group (CG) consisted of 60 HJS-free subjects, according to the aforementioned criteria. The 2nd stage of the study involved conducting a self-administered questionnaire on the prevalence of TMD symptoms. Both the TMD disability questionnaire (TMD-Q) and the neck disability index (NDI) scores were recorded. Pain intensity was assessed using the numeric rating scale (NRS). The HJS group showed higher NRS scores (p < 0.001). Headache, neck and shoulder girdle pain, and temporomandibular joint (TMJ) pain were found to be more severe in almost each patient from the HJS group as compared to CG. Those individuals had a greater degree of disability on the TMD-Q and the NDI scales (p < 0.001). The HJS group showed significant positive correlations between the TMD-Q and NDI scores (p = 0.0035), and between the TMD-Q and TMJ symptom questionnaire scores (p = 0.0047). A significant positive correlation between the NDI and TMJ symptom questionnaire scores was found both in the HJS group (p < 0.001) and CG (p < 0.001). The HJS bearers tended to obtain higher TMJ and cervical spine disability scores, at the same time reporting increased headache, neck and shoulder girdle pain, and TMJ pain intensity. Therefore TMJs should be carefully examined for possible signs of dysfunction in HJS subjects prior to dental or prosthetic treatment. According to our data, TMJ and cervical spine disability assessment should be included as a routine practice in the case of HJS patients, who should remain under the long-term care of a multidisciplinary team of doctors and therapists.

BackgroundThe aim of this investigation was to study change in adults over a 20 year period in the prevalence of respiratory symptoms and disorders and its association to year of birth, life style and sleep related variables.MethodAdults 20–44 years of age, 6085 women and 5184 men, were randomly selected from seven centres in Northern Europe and followed for 20 years. The number of participants in the first survey was 21,595 and 11,269 participated in all three surveys. The participants were divided into three birth cohorts: 1944–1955, 1956–1965 and 1966–1975.ResultsDuring the 20 year period the prevalence of wheeze decreased (− 2%) and the prevalence of asthma (+ 4%) and allergic rhinitis (+ 5%) increased, whereas the prevalence of nocturnal respiratory symptoms was relatively unchanged. The increase in allergic rhinitis was largest in those born 1966 to 1975 except in Estonia. There was large decrease in smoking (− 20%), increase in obesity (+ 7%) and snoring (+ 6%) during the study period. Smoking, obesity, snoring and nocturnal gastroesophageal reflux (nGER) were related to a higher risk of all symptoms. Obesity, snoring and nGER were also independently related to asthma.ConclusionWe conclude that as our participants got older there was a decrease in wheeze, no change in nocturnal symptoms and an increase in reported asthma and allergic rhinitis. These changes in prevalence are probably related to a decrease in smoking being counteracted by an increase in allergy, obesity and sleep related disorders.

BackgroundThe psychological symptoms of temporomandibular joint (TMJ) ankylosis were similar to that of depressive disorder, but there were no relevant evidences to confirm that the humans or animals with TMJ ankylosis had depressive disorder. The aim of this study was to investigate the association between TMJ ankylosis and depressive disorder in the rat model.MethodsThirty 3-week-old male Sprague–Dawley (SD) rats were used in this study. The damage of TMJ complexes and narrowed joint space were performed in the unilateral TMJ of test group to induce TMJ bony ankylosis (experimental side). The other TMJ of test group underwent a sham operation (sham side). The TMJs of control group did not undergo any operations. At 8 weeks postoperatively, behavioral tests, body weight, passive maximum mouth opening (PMMO), and TMJ morphological features were evaluated, and the hippocampuses were analyzed using western blotting and immunocytochemistry. The data was compared between the test group and control group by independent t-test, between the experimental side and sham side by paired t-test. The correlations between PMMO/area of bony fusion and duration of immobility, sucrose preference, CB1 receptor protein, mean optical density of CB1 receptor protein, and the number of BrdU-positive cell were evaluated using linear regression analysis. The level of significance was 0.05.ResultsIn the test group, the traumatic TMJ complexes with narrowed joint space developed TMJ bony ankylosis, the area of bony mass of experimental side (21.26 mm2) was larger than that of sham side (1.73 mm2) (p < 0.001). There were significant difference with the sucrose preference (test group: 0.36, control group: 0.76, p < 0.001), duration of immobility (test group: 127.36 s, control group: 59.41 s, p < 0.001), body weight (test group: 156.70 g, control group: 270.06 g, p < 0.001), PMMO (test group: 9.98 mm, control group: 28.79 mm, p < 0.001), CB1 receptor protein (test group: 41.00%, control group: 86.69%, p < 0.001), mean optical density of CB1 receptor protein (test group: 29.60 a.u., control group: 54.69 a.u., p < 0.001), and the number of BrdU-positive cell between the test group and control group (test group: 2133.71, control group: 4301.95, p < 0.001). PMMO was negatively correlated with the duration of immobility (r = 0.953, p < 0.001), while the area of bony fusion was positively correlated (r = 0.961, p < 0.001). PMMO was positively correlated with the sucrose preference, CB1 receptor protein, mean optical density of CB1 receptor protein, and the number of BrdU-positive cell (r = 0.955, 0.955, 0.976, 0.958, p < 0.001, all), while the area of bony fusion was negatively correlated (r = 0.970, 0.981, 0.971, 0.958, p < 0.001, all).ConclusionsThe present study verified that depressive disorder was found in the rat model of traumatic TMJ bony ankylosis. The severity of TMJ bony ankylosis correlated with the severity of depressive disorder.

The prevalence of temporomandibular disorders in patients with chronic whiplash-associated disorder is a controversial issue that may be influenced by the widespread pain character and psychologic distress frequently observed in patients with chronic pain. The aim of this study was to determine the prevalence of temporomandibular disorder pain, widespread pain, and psychologic distress in persons with chronic whiplash-associated disorder pain, using a controlled, single blind study design. The prevalence of temporomandibular disorder pain in the chronic whiplash-associated disorder pain group was compared with 2 control groups: a chronic neck pain group and a no neck pain group. From 65 persons, a standardized oral history was taken, a physical examination of the neck and the masticatory system was performed, widespread pain was investigated by tender point palpation, and psychologic distress was measured with a questionnaire (SCL-90). Because the recognition of temporomandibular disorder pain and neck pain remains a matter of debate, 3 well-defined classification systems were used: one based on the oral history, a second on a combination of oral history and pain on active movements and palpation, and a third one based on a combination of oral history and function tests. Irrespective of the classification system used, the chronic whiplash-associated disorder pain group more often suffered from temporomandibular disorder pain (0.001<P<0.028) and widespread pain (0.001<P<0.003) than the no neck pain group. Moreover, patients with whiplash-associated disorder showed more psychologic distress (0.000<P<0.044) than the other 2 groups. The higher prevalence of widespread pain and psychologic distress in patients with chronic whiplash-associated disorder suggests that the higher prevalence of temporomandibular disorder pain in these patients is part of a more widespread chronic pain disorder.

Objective This study compared temporomandibular joint (TMJ) magnetic resonance imaging (MRI) findings between bruxism and control groups with unilateral TMJ pain as well as the TMJ MRI findings for the painful and non-painful sides of individuals in the two groups. Methods Clinical and MRI findings of patients seen at Uşak University, Dentistry Faculty, Department of Oral and Maxillofacial Surgery for unilateral TMJ pain between 2017 and 2020 were analyzed. Bruxism was diagnosed based on clinical findings and patient history. The MRI variables were disc/condyle relationship (normal, disc displacement with reduction, or disc displacement without reduction), disc structure (normal and abnormal), condyle degeneration type (normal, moderate, or severe), and joint effusion (absent or present). Pain was recorded based on a visual analog scale (VAS) numbered between 0 and 10. Statistical analyses were performed using IBM SPSS. The data were distributed non-normally according to the results of Kolmogorov–Smirnov tests. The Mann–Whitney U test was used to compare age and VAS. Chi-square tests were used to compare categorical variables. Statistical significance was defined as p < 0.05 Results This study assessed the MRI records of 558 cases of TMJ pain. No significant differences in disc/condyle relation, disc structure, condyle structure, or effusion were observed between the control and bruxism groups (p > 0.05). However, a significant difference in TMJ MRI findings was observed between the painful and non-painful sides of each individual in the control and bruxism groups (p = 0.001, p < 0.001 and p = 0.004, p < 0.001, respectively). Conclusion The results of this study established a relationship between the painful side for each patient and TMJ MRI findings. In particular, individuals with bruxism had a higher rate of TMJ internal derangement and effusion on the painful side.

BackgroundThe prevalence of SLE in Malaysia was reported as 43/100,000 individuals and Chinese (57/100,000) have the highest prevalence followed by Malays (33/100,000) and Indians (14/100,000) [1,2].The American College of Rheumatology...

Context: Temporomandibular disorders are musculoskeletal condition presenting with pain and dysfunction in masticatory muscles, temporomandibular joint (TMJ) and related structure. Aim: To determine the role of myofascial release technique on mobility and function in TMJ Disorder patients with neck pain. Settings and Design: Experimental study design conducted in Dr. D.Y. Patil College of Physiotherapy, Pimpri, Pune. Subjects and Methods: Overall 30 subjects who fulfilled the inclusion criteria were randomly divided into two groups. Experimental group (Group A) was given nonsteroidal anti-inflammatory drugs (NSAID's) and myofascial release to Upper trapezius, Sternocleidomastoid, Masseter and Temporalis three times a week for 2 weeks. Control group (Group B) was given NSAID's. At the end of treatment prepost comparison was done for temporomandibular (TM) joint range of motion and function. Statistical Analysis Used: Data was analysed with Primer software using Wilcoxon signed rank sum test and Mann–Whitney U-test. Results: Mobility in terms of mouth opening and lateral excursion post intervention in both groups have been significantly improved, however, in the experimental group significant improvement was seen in lateral excursions only. Limitation of daily function score reduced from 22.2 to 5 in the experimental; group and 21.3–13.5 in the control group. However more statistical reduction was seen in the experimental group (P = 0.001). Conclusions: Myofascial release technique along with NSAIDSs was able to improve mobility and function among the TM joint disorder patients with neck pain.

Relevance. In recent years, many have been devoted to the problem of the temporomandibular joint (TMJ) diseases, in which the attention is paid to the widespread pathology of TMJ in young people, which develops against the background of the genetically-determined weakness of connective tissue (CTs), which is also the present occurrence of various concomitant diseases of polygenic-multifactorial nature, including the organs of the urinary system (US). The study of the state of the iris is used as a screening technique that allows you to quickly, simply, harmlessly, informatively, painlessly, non-invasively diagnose the genetically determined structural and functional state and quality of the CTs. Objective. To investigate the iris changes in patients with TMJ and US diseases, to reveal the dependence of the occurrence of degenerative-dystrophic and destructive-inflammatory changes in the joints and US on the structural and functional state of the CTs, to supplement the known traditional methods of diagnosing genetically determined CTs weakness. Materials and methods. The study involved 54 patients (men – 14, women – 40), whose average age was 37.3±7.6 years, who were treated at the Dental Medical Center of the Bogomolets NMU. Control group – 22 patients (men – 10, women – 12) without general somatic pathology, with a physiological bite, without signs of TMJ diseases, whose average age was 25.7±6.8 years. Main group – 22 patients (men – 4, women – 28) with TMJ diseases and US pathology, whose average age was 31.6±7.7 years. Iridobiomicroscopy was performed in patients of both groups. Iridogenetic constitutional signs were determined: the color of eyes, constitutional type after E.S. Velkhover, type with the connective tissue weakness after I. Deck, the density of iris stoma. The obtained laboratory data were referenced in the International System of Units and processed by variational statistics using MedStat and EZR v.1.35 (Saitama Medical Center, Jichi Medical University, Saitama, Japan, 2017), which is a graphical interface to RFSC (The R Foundation for Statistical Computing, Vienna, Austria). Results. Among the examined patients with TMJ diseases and MVS pathology, 75% showed predominantly light eye color and V degree (46.9%) of iris stroma density, in the control group: dark iris color (54.5%) and II degree (68.2%) of iris density. Iridogenetic constitutional signs of the CT weakness in the patients with TMJ diseases have been determined: the light color of eyes, radial-lacunar constitutional type after E.S. Velkhover (75%), lymphatic constitutional type with the connective tissue weakness after I. Deck (57,9%). Structural local or chromatic changes of the iris stroma in the projection region of the kidney (75%) and bladder (43.6%) in young patients with TMJ diseases showed a congenital weakness of the CTs of these organs and a tendency to develop pathology of the US. Conclusions. Patients with degenerative-dystrophic and destructive-inflammatory diseases of the TMJ and concomitant US pathology are characterized by iridogenetic constitutional signs of the CTs weakness in the patients with TMJ diseases have been determined: the light color of eyes, radial-lacunar constitutional type after E.S. Velkhover, low degree of iris stroma density, lymphatic constitutional type with the connective tissue weakness after I. Deck. Structural local or chromatic changes of the iris stroma in the projection region of the kidney and bladder in young patients with TMJ diseases showed a congenital weakness of the CTs of these organs and a tendency to develop pathology of the US. It can be assumed that the development of TMJ diseases in young patients is based on dysplastic changes in the CTs system, which is additionally manifested in the examined patients by pathological changes in the US. Iridobiomicroscopy, as a screening technique for determining the structural and functional state of CTs, makes it possible to increase the accuracy of diagnostics when examining patients with TMJ diseases who have concomitant pathology of internal organs, including US.

Tic disorders are neurodevelopment disorders that typically begin in childhood. Few studies have explored the relationship between tic disorders and other physical and mental diseases. This study aims to identify which physical and mental diseases are more likely to occur before tic disorders diagnosis and which coexist afterward. We include 52,953 tic patients with 837,801 visits and a matched control group of 14,537 with 164,619 visits. We found that the primary system affected in tic disorders are respiratory system disorders; symptoms, signs, and abnormal clinical and laboratory findings mental and behavioral disorder; diseases of the eye and adnexa, and diseases of the ear and mastoid process with significant differences compared to control group (χ 2 = 112.54, p < 0.001). Importantly, the disease systems involved before and after tic disorders diagnosis are essentially the same, but specific high-incidence diseases differ. In the male and children’s groups, vasomotor and allergic rhinitis and conjunctivitis were most common before diagnosis, while abnormal involuntary movements and hyperkinetic disorders were most common after diagnosis. In the adolescent group, vasomotor and allergic rhinitis and hyperkinetic disorders were the most common both before and after diagnosis. In the female group, conjunctivitis and other respiratory disorders were most common before diagnosis, while abnormal involuntary movements and other respiratory disorders were most common after diagnosis. Future research should focus on timely interventions for these physical and mental diseases to potentially reduce the incidence of tic disorders.

Roles of pollution in the prevalence and exacerbations of allergic diseases in Asia

Background: The non-surgical therapies prevail over surgical therapies in the management of temporomandibular disorders pain. Vestibular stimulation was known to relieve pain through its connections with analgesic brain areas. Although there is literature that supports the analgesic effect of vestibular stimulation, the research studies in this area are comparatively less in Indian settings. Hence, the present study was undertaken. Aims and Objectives: The present study was undertaken to observe the effectiveness of 4 weeks of electrical vestibular stimulation in managing temporomandibular pain. Materials and Methods: Sixty male and female participants who reported temporomandibular pain were recruited. They were then randomly assigned into two groups. The intervention group received electrical vestibular nerve stimulation for 4 weeks and regular treatment as an adjunctive therapy. Placebo stimulation was administered to the control group along with the regular treatment. The numerical pain rating scale, the Jaw functional limitation scale-8, and depression anxiety stress scales-21 were used in the study. Results: Pain score, jaw function score, and psychological parameters before intervention in the study and control groups were not significantly different. However, the pain score, jaw function score, and psychological parameters after intervention in the study group were significantly lower than in the control group. Conclusion: The study results support the analgesic effects of electrical vestibular nerve stimulation in pain management in patients with temporomandibular pain. The study recommends more studies in this area to recommend the implementation of electrical vestibular stimulation in the management of temporomandibular pain.

IntroductionNocturnal worsening of asthma symptoms is a common feature of asthma. Physical exercise training improves general asthma control; however, there is no evidence showing the effects of physical exercise on nocturnal asthma symptoms. Indeed, asthma patients with daytime and nighttime symptoms are physiologically different, and thus the effects of physical exercise on asthma may also be different in these two groups. The objective of this systematic review is to explore the effects of physical exercise on nocturnal asthma symptoms.MethodsSearches were conducted in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL and SPORTdiscus (last search on November 2017). Authors from studies that did not report nocturnal symptoms but used questionnaires and/or diaries were contacted for detailed information. Studies that provided results on nocturnal symptoms before and after physical activity intervention were included. Prevalence of nocturnal symptoms was calculated for each study from the percentage of study participants with nocturnal symptoms before and after intervention.ResultsEleven studies were included (5 with children and 6 with adults). The prevalence of nocturnal symptoms at baseline ranged from 0% to 63% among children and from 50–73% among adults. In children and adults with nocturnal asthma, aerobic physical exercise reduced the prevalence and frequency of nocturnal symptoms.ConclusionsAerobic physical exercise improves nocturnal asthma in children and adults by reducing the prevalence and frequency of nocturnal symptoms. Physical exercise training could be used with conventional treatments to improve quality of life and asthma control in patients with nocturnal worsening of asthma.

Juvenile idiopathic arthritis can affect the temporomandibular joint (TMJ) that can cause growth disturbances of the lower jaw (mandible). The collagen-induced arthritis (CIA) juvenile rat model may be an appropriate model for studying how juvenile arthritis affects this joint during growth. However, studies using this animal model to investigate TMJ arthritis are limited. To validate an animal model for studying TMJ arthritis in growing rats, our study aimed to investigate the changes in mandibular growth and expression of proteins and cytokines in the mandibular condyle of CIA juvenile rat TMJs. A total of 27 male Wistar rats (3-weeks old) were scanned with micro-computed tomography (MicroCT) and divided into three groups (n=9). CIA was induced in each TMJ in the CIA group. The Saline group received saline injections (sham injections) into their TMJs, and the Healthy group remained untreated (no TMJ injections) as negative controls. After 4 weeks, our results show that mandibular growth was significantly reduced in the CIA group compared to the saline group (p < 0.01). There was no difference in mandibular growth between the two control groups (Saline and Healthy). Inflamed synovial tissue, cartilage invaginations, and lipid accumulation were observed in the CIA TMJs. Toluidine blue staining revealed decreased proteoglycan production in the CIA cartilage. As well, using immunohistochemistry, type II collagen expression decreased, interleukin-1β expression increased and matrix metalloproteinase-13 expression increased in the CIA TMJs in comparison with the two control groups (Saline and Healthy). Immunostaining of tumor necrosis factor-α (TNF-α) was quantifited and we showed that TNF-α expression was significantly greater in the CIA cartilage compared to both control groups (p < 0.05), and there was no difference in TNF-α expression between the Saline and Healthy groups. This CIA juvenile rat model of TMJ juvenile arthritis shows that CIA reduced mandibular growth and induced degenerative changes in TMJ condylar cartilage. This new information will help to understand the pathogenesis involved in CIA juvenile rat TMJs for this animal model to be used in research investigating new therapeutics to treat TMJ juvenile arthritis.