Ultrasound in medicine has a history arbitrarily going back to the days when a modified custom-built metal flaw detector was used in post-War Glasgow to diagnose abdominal masses. Spanning a period of 30 years, the article describes the coming of age of ultrasound within the field of rheumatology. This historical paper highlights collaborative research focusing on validation and standardization of the imaging modality. In addition, the work of several persons who have played a key role in the development of ultrasound in the field of rheumatology is emphasized. In real time and at the point of care, ultrasound can demonstrate where inflammation is present, thereby giving doctors and patients a better idea of why and where pain and stiffness originate. In retrospect, we may conclude that ultrasound has profoundly changed the practice of clinical rheumatology.
Purpose: To evaluate the anatomical distribution, of fractures and dislocations of the proximal and middle phalanges, the current treatment modalities, and potential variations in treatment approaches. Methods: This multi-centre cross-sectional study included patients presenting with single fractures of the proximal or middle phalanges and dislocations (excluding the thumb) over a three-month period in 2020. Data collection included demographic details, injury location and fracture pattern, and treatment modalities. Treatment categories included non-operative management (e.g., functional treatment allowing digit mobilisation, immobilisation, and immobilisation duration), surgical interventions, and post-operative care (functional treatment or immobilisation). Results: A total of 461 patients were included, with 395 (86%) managed non-operatively and 66 (14%) undergoing surgical intervention. The most frequently encountered injuries were proximal interphalangeal joint (PIPJ) avulsion fractures (139/461, 30%), followed by proximal phalanx shaft fractures (132/461, 29%), and PIPJ dislocations (57/461, 12%). Among patients with PIPJ palmar plate avulsion fractures managed non-operatively, 72% (88/123) were treated with functional treatment in the emergency department (ED), increasing to 94% after the initial follow-up. For proximal phalanx shaft fractures this was 28% (26/93), increasing to 53% after follow-up, and for PIPJ dislocations this was 71%, increasing to 80%. The rates of functional treatment for PIPJ avulsion fractures and dislocations showed significant variation across hospitals (p<0.001). Operative treatment of proximal and middle shaft fractures primarily involved closed reduction and K-wire fixation, performed in 69% (25/36) and 82% (9/11) of the cases, respectively. Conclusion: This study provides valuable insights into the anatomical distribution of various types of injuries of the proximal and middle phalanges, including intra-articular and avulsion fractures, and dislocations. Additionally, it highlights practice variations in non-operative treatment approaches and immobilisation duration, influenced by hospital setting. These findings could inform future research aimed at optimizing treatment strategies for these prevalent injuries.
The results of this study suggest that CTEPH is not a more common long-term complication after COVID-19-associated PE than after PE in non-COVID-19 patients, and thrombus resolution did not seem to be different from non-COVID-19-associated PE https://bit.ly/3IjvWL3
Objectives The aim of this multicentre COVID-PREDICT study (a nationwide observational cohort study that aims to better understand clinical course of COVID-19 and to predict which COVID-19 patients should receive which treatment and which type of care) was to determine the association between atrial fibrillation (AF) and mortality, intensive care unit (ICU) admission, complications and discharge destination in hospitalised COVID-19 patients.Setting Data from a historical cohort study in eight hospitals (both academic and non-academic) in the Netherlands between January 2020 and July 2021 were used in this study.Participants 3064 hospitalised COVID-19 patients >18 years old.Primary and secondary outcome measures The primary outcome was the incidence of new-onset AF during hospitalisation. Secondary outcomes were the association between new-onset AF (vs prevalent or non-AF) and mortality, ICU admissions, complications and discharge destination, performed by univariable and multivariable logistic regression analyses.Results Of the 3064 included patients (60.6% men, median age: 65 years, IQR 55–75 years), 72 (2.3%) patients had prevalent AF and 164 (5.4%) patients developed new-onset AF during hospitalisation. Compared with patients without AF, patients with new-onset AF had a higher incidence of death (adjusted OR (aOR) 1.71, 95% CI 1.17 to 2.59) an ICU admission (aOR 5.45, 95% CI 3.90 to 7.61). Mortality was non-significantly different between patients with prevalent AF and those with new-onset AF (aOR 0.97, 95% CI 0.53 to 1.76). However, new-onset AF was associated with a higher incidence of ICU admission and complications compared with prevalent AF (OR 6.34, 95% CI 2.95 to 13.63, OR 3.04, 95% CI 1.67 to 5.55, respectively).Conclusion New-onset AF was associated with an increased incidence of death, ICU admission, complications and a lower chance to be discharged home. These effects were far less pronounced in patients with prevalent AF. Therefore, new-onset AF seems to represent a marker of disease severity, rather than a cause of adverse outcomes.
