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To systematically review the literature on the effects of ankle supports on lower extremity biomechanics during functional tasks. Systematic review with meta-analysis. Eight electronic databases were searched from inception to July 2019. Studies of biomechanical outcomes during functional tasks that used a within-participant (repeated measures) design were included. Two independent reviewers screened studies, extracted data, assessed the methodological quality of the included studies and rated the quality of evidence. Meta-analysis was performed and reported as standardised mean differences and 95% confidence intervals. A total of 8350 studies were identified in the electronic search and 42 studies involving a total of 761 participants were included in the review (21 studies included for qualitative reporting and 21 studies in the meta-analysis). Most individual studies and the meta-analyses demonstrated no effect of ankle supports on ground reaction force or ankle inversion angle. However, there was high quality evidence that ankle taping decreased plantarflexion angle at initial contact during landing from a height (P = 0.0009, standerdised mean differences = 0.72, 95% confidence intervals = 1.15, 0.03, I 2 = 3%). The effect of ankle supports on transverse plane ankle biomechanics has not been adequately investigated. Ankle taping only decreased plantarflexion angle at initial contact during landing from a jump. Ankle supports did not affect inversion angle or forces in linear and multiplanar tasks. There was insufficient evidence on the effect of ankle supports on ankle transverse plane biomechanics.

Background: Dental caries is a multifactorial disease in which microorganisms play an important role. Recently, herbs have been tried as mouthrinses to combat the side effects of chemical mouthrinses. The anticaries efficacy of Sodium fluoride, Tulsi leaf, and Black myrobalans fruit extracts on Streptococcus mutans (S. mutans) have been reported in the literature, but no comparative study has been done yet. Aim: This study aims to observe the change in the pH of saliva and to assess the efficacy of the herbal rinses-Tulsi and Black myrobalans on S. mutans count while comparing it with Sodium fluoride mouthrinse. Methods: Herbal ethanolic extracts of Tulsi (4%) and Black myrobalans (2.5%) were prepared as mouthrinses and compared with sodium fluoride mouthrinse (0.05%). Sixty high caries risk patients were selected and allocated randomly into three groups [n = 20], categorized as Group A-Sodium fluoride mouthrinse, Group B-Tulsi mouthrinse, and Group C-Black myrobalans mouthrinse. They were instructed to rinse their mouth with their assigned mouthrinses for 7 days. Salivary samples were collected and sent to the laboratory at baseline, 1 h postrinsing and after 7th day of rinsing for determining the salivary pH and S. mutans count. The increase in pH and reduction of S. mutans were determined. The values obtained were tabulated and statistically analyzed. Results: There was a significant increase in the salivary pH and reduction in S. mutans count after rinsing in all the three groups. Increase in salivary pH was more in the Sodium fluoride mouthrinse when compared to the experimental herbal groups (Group B and Group C). While S. mutans counts reduced more with Tulsi mouthrinse at 1 h postrinsing and after the 7th day of rinsing more reduction was seen in Black myrobalans mouthrinse group. Conclusion: The results of the study suggest that herbal mouthrinses could be tried as an adjunctive anticaries agent against dental caries causing microorganisms.

The most prevalent cause of peripheral nerve entrapment is carpal tunnel syndrome, which is characterized by compression of the median nerve at the wrist as a result of nearby or localized microvascular interference as well as structural alterations to the median nerve or adjacent tissues. However, no special information regarding the median nerve or its surroundings is provided by clinical examination or electrophysiological testing. The purpose of this study is to evaluate the effectiveness of magnetic resonance neurography (MRN) and ultrasound in identifying changes and abnormalities of the median nerve in carpal tunnel syndrome. The twenty-five patients in this study ranged in age from 27 to 63 years old, with a mean age of 47. There were 18 female patients and seven male patients. All patients were sent to the radiology department from the orthopedics, neurology, outpatient clinic, and neurology department, at Ain Shams Hospital, Faculty of Medicine, Ain Shams University. All of the patients had clinically manifested pain along the median nerve distribution, each of the sixteen patients had hand paresthesia, and four had thenar muscle atrophy. In the current study, Ultrasound exhibits low negative predictive value of 67% and specificity of 67%, but high positive predictive value of 95%, sensitivity of 95%, and overall accuracy of 92%. On the other hand, (MRN) exhibits a low negative predictive value of 60% and a high specificity of 75% in the diagnosis of nerve entrapment, but it also displays a high positive predictive value of 95%, sensitivity of 90%, and overall accuracy of 88%. Regarding the assessment of the recurrence cause and post-surgical evaluation is more reliable by Magnetic Resonance Neurography examination. Magnetic resonance neurography and high-resolution ultrasonography can be utilized to diagnose patients with median nerve entrapment and patients who cannot be diagnosed electrophysiologically.

Explore attitudes and practices of Australian professionals using ankle taping or bracing for the management and prevention of lateral ankle sprains. Cross-sectional study. Anonymous online survey. Australian healthcare or athletic workers, registered with an official governing body, involved in the management and/or prevention of lateral ankle sprains. Quantitative data was collected from 20 close-ended questions. Qualitative data from 14 open-ended questions were categorized into topics using inductive thematic analysis. Data was analysed using descriptive statistics and presented in figures and tabular format. A total 160 respondents answered the survey; the majority were podiatrists (42.5%), physiotherapists (23%), or sports/athletic trainers (13.8%). Ankle supports were overwhelmingly recommended and considered to be effective in the management (95% and 89% bracing and taping, respectively) and prevention (96% and 92% bracing and taping, respectively) of lateral ankle sprains. For management, semi-rigid brace with straps (26%) and figure eight taping technique (42%) were the most frequently used. For prevention, the most commonly used were soft brace with straps (30%) and the figure eight taping technique (37%). Australian professionals expressed a positive attitude towards using ankle supports in the management and prevention of lateral ankle sprains. •Ankle supports are recommended to manage and prevent lateral ankle sprains.•Contrast in current practice and guidelines for support type and duration of use.•Patient personal preference is an important factor for ankle support selection.

Corresponding author's email: nkotwal@childrensnational.org Introduction: Chromosome 13 duplications have been associated with various pathologic features but no pulmonary manifestations have been reported thus far.We present an unusual case of lung cysts in a newborn and discuss the clinical course and management options. Computed tomography of the chest (while the bronchial block was in place) showed large cysts in the right upper and middle lobes communicating with each other and with adjacent airways. Because the cysts appeared to be intra-parenchymal and not pleural, and the patient was stable, decision was made to continue with conservative management and not to attempt pleurodesis.

Abstract Introduction Compliance with Positive Airway Pressure (PAP) therapy is currently evaluated based on the number of hours used per night. Usually an average of <4hrs is considered non-adherence in adults. However, obstructive sleep apnea (OSA) in children is highly heterogeneous and this approach may not fit all age groups. This study aimed to define PAP usage patterns in children using clustering analysis of PAP compliance data. Methods Cross-sectional study of children (0-20yrs) on PAP therapy in the Sleep Center of Children’s National in Washington D.C. We used hierarchical clustering (Ward’s method) integrating mean usage time in “all days” and “usage days only” followed by post-clustering comparisons of clinical variables. Results A total of 89 children were included in this study. Hierarchical clustering resulted in a three-cluster best-fit model with distinct PAP usage patterns. Cluster 1 (n=33) was characterized by low usage (<2hrs all days and <4hrs days used), high rates of residual severe OSA and universal report of mask removed at home. Cluster 2 (n=39) was characterized by intermediate (<6hrs all days) but inconsistent PAP use, particularly in obese children and in individuals on high pressures despite no residual severe OSA. Cluster 3 (n=17) was characterized by high and consistent usage (≥6hrs in all days) and the lowest rates of residual severe OSA. Conclusion PAP compliance in children is heterogeneous and should not be evaluated based on the average hours used per night only (e.g. 4hrs). Our data suggest that a more appropriate initial milestone of 2hrs (all days) or 4hrs (days used) identifies clusters of low vs. intermediate usage that may need different interventions (e.g. mask desensitization vs. titration). An advanced milestone in pediatric PAP therapy that correlates with consistent use and adequate OSA control is ≥6hrs in all days and thus identifies candidates for interventions that may decrease healthcare utilization (e.g. telemedicine). Longitudinal studies are needed to define the dynamics of these pediatric PAP clusters of usage overtime across different developmental stages and thus optimize and personalize current clinical practice in pediatric PAP therapy. Support (If Any):

Abstract Introduction Timely diagnosis and treatment of severe obstructive sleep apnea (OSA) in children is crucial to prevent long-term adverse outcomes. Key obstacles to timely diagnosis could be lack of access to and thoroughness of assessment by pediatric providers with likely disparities among racial/ethnic groups and inner-city children. To address the knowledge gap on disparities in diagnosis, we examined duration of symptoms prior to the diagnosis of severe pediatric OSA in relation to racial/ethnic background and geographic distribution. Methods This is a cross-sectional study enrolling children diagnosed with severe OSA in the Sleep Center of Children’s National,Washington DC. Severe OSA was defined as obstructive apnea hypopnea index of >10 events/hr based on initial overnight polysomnogram. We used electronic medical record review to characterize individuals with severe OSA and stratified results based on racial/ethnic background and socioeconomic based geographic distribution in Washington, DC metropolitan area. Results We enrolled 179 eligible children with severe OSA (mean age 7.4 yrs ± 5.3SD) during the study period (Sep 2015- June2017). The majority of individuals were African American/Black (56.4%) followed by Hispanics (17.3%). Geographically,50.8% children were living in inner-city areas (DC wards 5–8 and PG County,MD) whereas 49.2% were located in suburban or urban wealthier areas of DC, MD or VA. The median time to diagnosis was 12 months in young children (0–7 yrs.) and 24 months in school age children/adolescents (>7yrs). Notably, African American/Black children >7 yrs of age had highest median time to diagnosis, which was >5 times greater than in age-matched Caucasian children (33 months vs. 6 months; p=0.02). Also, children >7 yrs of age with severe OSA living in inner-city areas had 3 times longer time to diagnosis than those located in suburban/urban wealthier areas (36 months vs. 12 months; p=0.01). Conclusion Our study suggests the presence of racial/ethnic and socioeconomic status based geographic disparities in the time to diagnosis of pediatric severe OSA. These findings indicate the critical need to focus care, resources and education to identify and treat pediatric OSA in minority communities of inner city areas. Support (If Any):