Correlation of temporomandibular joint clinical signs with cone beam computed tomography radiologic features in juvenile idiopathic arthritis patients

OBJECTIVE: Patients with juvenile idiopathic arthritis (JIA) have a high risk of temporomandibular joint (TMJ) involvement. Early detection of osseous destruction of the TMJ that can be seen radiographically is vital to provide appropriate treatment before significant craniofacial deformities and problems with occlusion arise. The aim of study was to evaluate whether there is a correlation between the clinical signs and cone beam computed tomography (CBCT) radiologic features of TMJ in patients with JIA. MATERIAL AND METHODS: Study group consisted of 65 patients (46 females and 19 males) aged 10 to 17 years with a confirmed JIA diagnosis and mean disease duration 2 years 9 month, all patients underwent a clinical examination of the TMJ and masticatory muscles as well as a radiological assessment of the TMJ osseous structures by CBCT. RESULTS: Majority of the patients' study population experienced 2 or 3 clinical signs with mean number 2.1 (standard deviation (SD) =1.00) and 3-5 radiological features related to the TMJ destruction with mean number 4.9 (SD=1.96). Statistically significant weak correlation only between pain and condyle surface flattening (Spearman`s Rho test (rho) =0.396; p value (p) =0.001) was found. No correlation between number of clinical signs and radiological features was found. CONCLUSIONS: There was no conclusive evidence found regarding correlation between TMJ clinical signs and radiological features of osseous destruction in patients with JIA - only weak correlation between pain and condyle surface flattening was observed. The number of clinical TMJ signs does not correlate with number of radiological features. For the clinical decision both clinical examination and CBCT would be useful in the early detection of osseous destruction of the TMJ in JIA patients.publishersversionPeer reviewe

Radiologic features of temporomandibular joint osseous structures in children with juvenile idiopathic arthritis. Cone beam computed tomography study

INTRODUCTION: Patients with juvenile idiopathic arthritis (JIA) have a high risk of temporomandibular joint (TMJ) involvement. Lesions in the TMJ appear early in the course of this disease. Evaluating the structure of the TMJ in JIA patients using cone beam computed tomography (CBCT) provides an understanding of the typical radiologic features of morphological change in TMJs of JIA patients. This study aims to report these features as seen in CBCT and thus comparing them with the features observed in a control group within the same age group and in females and males. MATERIALS AND METHODS: Cross-sectional observational study whereby CBCTs of 65 (130 joints) patients with a confirmed JIA diagnosis and 30 (60 joints) control group - patients without JIA upto the age of 17. Structural radiologic features of the joint's hard tissues were assessed according to the research diagnostic criteria for temporomandibular disorders as developed by Ahmad et al. RESULTS: The radiologic features of the osseous structures of the TMJ occurred asymmetrically between the right and left sides when compared in the JIA and control groups. The most prevalent feature in the JIA group is condyle surface flattening for both sides. Condyle surface erosion and osteophyte were also frequent and occurred with high statistical significance in both males and females. CONCLUSIONS: TMJ destruction features observed in CBCT images were prevalent in the JIA group and occurred infrequently in the control group.publishersversionPeer reviewe

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030