A multi-center, double-blind, randomized, placebo-controlled trial protocol to assess Traumeel injection vs dexamethasone injection in rotator cuff syndrome : the TRAumeel in ROtator cuff syndrome (TRARO) study protocol

Background: Shoulder pain is a common musculoskeletal symptom with a wide range of potential causes; however, the majority of conditions can be managed with conservative treatment. The aim of this study is to assess the efficacy and safety of Traumeel injections versus corticosteroid injections and placebo in the treatment of rotator cuff syndrome and bursitis and expand the current evidence base for the conservative treatment of rotator cuff syndrome. Methods/Design: This is a multi-center, randomized, double-blind, 16-week, three-arm, parallel-group, active-and placebo-controlled trial to assess the efficacy and safety of Traumeel 2 ml injection versus dexamethasone 8 mg injection versus placebo (saline solution). Patients will be randomly allocated to Traumeel, dexamethasone or placebo in a 2: 2: 1 randomization. After 1 week screening, patients will receive 3 injections at weekly intervals (days 1, 8 and 15) with additional follow-up assessments on day 22, a telephone consultation in week 9 and a final visit at week 15. Male and female patients aged 40 to 65 years, inclusive, will be recruited if they have acute episodes of chronic rotator cuff syndrome and/or bursitis. Patients with calcifications in the shoulder joint or a complete rotator cuff tear will be excluded. At least 160 patients will be recruited. All subacromial injections will be performed under ultrasound guidance utilizing a common technique. The only rescue medication permitted will be paracetamol (acetaminophen), with usage recorded. The primary endpoint is change from baseline in abduction-rotation pain visual analog scale (0-100 mm scale, 0 corresponds to no pain and 100 to extreme pain) at day 22 (Traumeel injections versus dexamethasone injections) for active external rotation. Secondary efficacy parameters include range of motion, disability of arm, shoulder, hand score and patient's/investigator's global assessment. Clinical efficacy will be assessed as non-inferiority of Traumeel with respect to dexamethasone regarding the primary efficacy parameter. Discussion: It is hoped that the results of this trial will expand the treatment options and evidence base available for the management of rotator cuff disease

Associations between poor oral health and reinjuries in male elite soccer players : a cross-sectional self-report study

Background: Although it is well known that oral pathogens can enter the systemic circulation and cause disease, it is largely unknown if poor oral health increases the risk of sports injuries. The purpose of this study is to investigate the association between poor oral health and reinjuries in male elite soccer players, adjusted for psychosocial problems and player characteristics. Methods: 184 Players in premier league soccer clubs and 31 elite, junior soccer players in the Netherlands, Belgium and England, were enrolled in a retrospective cross-sectional study. The Sports Injury Risk Indicator, a self assessed questionnaire, was used to obtain information on reinjuries, age and player position, oral health and psychosocial problems. The number of different types of oral health problems was used as an indicator of poor oral health. (SumDental, range 0-2: 0 = no oral health problems, 1 = one type of oral health problem and 2 = two or more types of oral health problems). Multivariable logistic regression was used to investigate whether SumDental was associated with reinjuries, after adjustment for psychosocial problems and player characteristics. Results: 37% of the players reported no oral health problems, 43% reported one type of oral health problem and 20% reported two or more types of oral health problems. After full adjustment for age, player position and psychosocial problems (i.e. injury anxiety, psychophysical stress, unhealthy eating habits and dissatisfaction with trainer/team), poor oral health (SumDental) was positively associated with all kind of reinjuries whether analyzed as a continuous variable or as a categorical variable. The fully adjusted odds ratios for SumDental analyzed as a continuous variable were: in relation to repeated exercise-associated muscle cramps: 1.82(95% confidence interval (CI): 1.07, 3.12), in relation to muscle or tendon reinjury 1.57 (95% CI: 1.01, 2.45) and in relation to multiple types of reinjury 1.88 (95% CI: 1.19, 2.97). Conclusion: The results from this study justify a thorough examination of the effects of oral health problems on the injury risk of playing elite soccer

Quadriscupid aortic valve with concurrent aortic stenosis and insufficiency

We present the case of a 22-year-old man with a congenital mixed aortic valve dysfunction who underwent cardiac Magnetic Resonance Imaging (MRI) for the assessment of aortic valve morphology and function prior to valve replacement. Cardiac MRI showed a four-leaf-clover aortic valve morphology, the typical presentation of a quadricuspid aortic valve. The patient underwent a successful Bentall procedure to replace the aortic valve, aortic root and ascending aorta. This case report illustrates the MRI findings of a quadricuspid aortic valve with associated aortic stenosis and regurgitation

Carlyle and the search for authority

(print) x, 234 p. ; 24 cmPREFACE vii -- ONE Introduction : The Crisis of Authority and the Critique of Political Economy 1 -- TWO Becoming an Author : 1820-1830 15 -- THREE Revolution and Authority : 1830837 40 -- FOUR Authoring the Polity : 1838-1850 90 -- FIVE The Return of the Father : 1851-1865 142 -- SIX The End of Writing 163 -- LIST OF ABBREVIATIONS 175 -- NOTES 177 -- WORKS CITED 211 -- INDEX 22

Absent anterior cruciate ligament

This case report presents the MRI findings of aplasia of the anterior cruciate ligament with associated hypoplasia of the posterior cruciate ligament (Manner type 2). Radiographically the presence of a shallow femoral notch and hypoplastic tibial spines (the so-called "dromedar" sign) can aid in the diagnosis. Operative treatment is often not indicated since the congenital absence of the ACL implies long-standing altered biomechanics to which the knee has well adapted in the majority of cases

Are oral health and fixed orthodontic appliances associated with sports injuries and postural stability in elite junior male soccer players?

Background: Dental caries and periodontitis are associated with elevated levels of pro-inflammatory cytokines which may trigger muscle fatigue during exercise, a strong risk factor for sports injuries. Fixed orthodontic appliances (FOA) may cause poor oral health and may disturb proprioceptive inputs of the stomatognathic system. This study aims to explore associations of poor oral health and of use of a FOA with injury frequency and postural stability. Methods: One hundred eighty seven Belgian elite junior male soccer players, aged 12-17years, completed a self-report questionnaire asking about injuries in the past year, oral health problems, use of a FOA, demographics and sports data, and stood in unipedal stance with eyes closed on a force plate to assess postural stability. Results: Ordinal logistic regression with number of injuries in the past year as ordinal dependent variable and dental caries and/or gum problems, age and player position as covariates, showed that participants who reported dental caries and/or gum problems and never had had a FOA reported significant more injuries in the past year compared to the reference group of participants who reported no oral health problems and never had had a FOA (adjusted OR=2.45; 95% CI, 1.19-5.05; p=0.015). A 2 (temporomandibular joint problems) x2 (FOA) x2 (age) ANOVA with postural stabilities as dependent variables, showed a significant FOA x age interaction for the non-dominant (standing) leg. Post-hoc t-tests showed a significant better postural stability for the non-dominant leg (and a trend for the dominant leg) for the older compared with the younger participants in the non-FOA group (p=.002, ES=0.61), while no age differences were found in the FOA-group. Conclusions: These results indicate that poor oral health may be an injury risk factor and that a FOA may hinder the development of body postural stability

Community health workers as a strategy to tackle psychosocial suffering due to physical distancing : a randomized controlled trial

Background: During the COVID-19 pandemic, many primary care professionals were overburdened and experienced difficulties reaching vulnerable patients and meeting the increased need for psychosocial support. This randomized controlled trial (RCT) tested whether a primary healthcare (PHC) based community health worker (CHW) intervention could tackle psychosocial suffering due to physical distancing measures in patients with limited social networks. Methods: CHWs provided 8 weeks of tailored psychosocial support to the intervention group. Control group patients received ‘care as usual’. The impact on feelings of emotional support, social isolation, social participation, anxiety and fear of COVID-19 were measured longitudinally using a face-to-face survey to determine their mean change from baseline. Self-rated change in psychosocial health at 8 weeks was determined. Results: We failed to find a significant effect of the intervention on the prespecified psychosocial health measures. However, the intervention did lead to significant improvement in self-rated change in psychosocial health. Conclusions: This study confirms partially the existing evidence on the effectiveness of CHW interventions as a strategy to address mental health in PHC in a COVID context. Further research is needed to elaborate the implementation of CHWs in PHC to reach vulnerable populations during and after health crises