No abstract

World Health Organization announced the novel coronavirus disease outbreak to be a global pandemic. The distribution of community outbreaks shows seasonal patterns along certain latitude, temperature, and humidity i.e. similar to the behavior of seasonal viral respiratory tract infections. COVID-19 displays significant spread in northern midlatitude countries with an average temperature of 5-11 °C and low humidity. Vitamin D deficiency has also been described as pandemic, especially in the Europe. Regardless of age, ethnicity, and latitude; recent data showed that 40% of the Europeans are vitamin D deficient (25(OH)D levels <50 nmol/L), and 13% are severely deficient (25(OH)D <30 nmol/L).A quadratic relationship was found between the prevalences of vitamin D deficiency in most commonly affected countries by COVID-19 and the latitudes. Vitamin D deficiency is more common in the subtropical and midlatitude countries than the tropical and high latitude countries. The most commonly affected countries with severe vitamin D deficiency are from the subtropical (Saudi Arabia; 46%, Qatar; 46%, Iran; 33.4%, Chile; 26.4%) and midlatitude (France; 27.3%, Portugal; 21.2% and Austria; 19.3%) regions. Severe vitamin D deficiency was found to be nearly 0% in some high latitude countries (e.g. Norway, Finland, Sweden, Denmark and Netherlands).Accordingly, we would like to call attention to the possible association between severe vitamin D deficiency and mortality pertaining to COVID-19. Given its rare side effects and relatively wide safety, prophylactic vitamin D supplementation and/or food fortification might reasonably serve as a very convenient adjuvant therapy for these two worldwide public health problems alike. Accepted manuscript supplementation for potential risk of hypercalcemia while taking high doses of vitamin D3. Needless to say; as vitamin D is synthesized mainly in the skin, sun (UV-B) exposure (15-20 min daily) inducing the light pink color of minimal erythema would be the natural way of production and activation of vitamin D by keratinocytes. 55 Accordingly, presenting this paper, we would like to call attention to the possible association between severe vitamin D deficiency and mortality pertaining to COVID-19. Given its rare side effects and relatively wide safety, prophylactic vitamin D supplementation and/or food fortification might reasonably serve as a very convenient and incomparable/invaluable adjuvant therapy for these two worldwide public health problems alike. al. Low serum vitamin D is not associated with an increase in mortality in oldest old subjects: the Octabaix three-year follow-up study. Gerontology. 2014; 60: 10-5. 13. Veronese N, Sergi G, De Rui M, et al. Serum 25-hydroxyvitamin D and incidence of diabetes in elderly people: the PRO.V.A. study. J Clin Endocrinol Metab. 2014; 99: 2351-8. 14. Aspell N, Laird E, Healy M, et al. The prevalence and determinants of vitamin D status in community-dwelling older adults: Results from the English Longitudinal Study of Ageing (ELSA). Nutrients. 2019; 11...

Masticatory muscle thickness provides objective measurements of the oral motor function, which may change in patients with oral myofascial pain. In this study, we aimed to establish a reliable ultrasound (US) protocol for imaging the superficial and deep masticatory muscles and to identify the potential influencers of the measurements. Forty-eight healthy participants without orofacial pain were enrolled. The intra-and inter-rater reliabilities of US measurements for masseter, temporalis, and lateral pterygoid muscles were assessed. Intraclass correlation coefficients for all muscles were greater than 0.6. The generalised estimating equation was used to analyse the impact of age, gender, laterality, and body mass index on the measurements, whereby age and body mass index were likely to be associated with an increase in masticatory muscle thickness. The thickness tended to be lesser in females. Laterality seemed to exert minimal influence on masticatory muscle thickness. Our study shows acceptable reliability of US in the evaluation of superficial and deep masticatory muscle thickness. Future studies are warranted to validate the usefulness of US imaging in patients with oral myofascial pain syndrome. Temporomandibular disorder (TMD) is frequently observed in patients seeking dental treatment. It comprises various findings concerning the stomatognathic system, involving the temporomandibular joints, masticatory muscles, teeth, and ears 1,2. The prevalence of TMDs in the general population ranges from 34.9 to 42.4% across different studies 3,4 , and the incidence is more prevalent in females 5. Of note, oral myofascial pain is commonplace in about 10-15% of patients with TMD 6. The aetiology of oral myofascial pain is still controversial. The proposed mechanisms include overuse of the masticatory muscles and a decrease in its pain threshold following central sensitization 7. While overuse might lead to hypertrophy of the masticatory muscles in the early stages, persistent pain could result in disuse atrophy in chronic cases 8. In this sense, masticatory muscle thickness provides objective measurements of the oral motor function 9 , which is supposed to change in patients suffering from oral myofascial pain. Several imaging modalities, such as computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US) have been used to image the masticatory muscles. CT allows precise delineation of the skull bone where the masticatory muscles attach. However, radiation and poor resolution of the soft tissues make it unsuitable for muscle thickness measurements. Nowadays, MRI serves as the gold standard for depicting soft tissue pathologies 10 , but it is limited by its high cost and contraindications in patients with metal implants. US has various advantages over CT and MRI, i.e. real-time evaluation, zero radiation, cost-effectiveness, portability, and ease of dynamic examination 11. Further, it is capable of delineating muscle fibres-making it highly effective for imaging muscle trauma and neuromuscular diseas...

Cutaneous nerve entrapment plays an important role in neuropathic pain syndrome. Due to the advancement of ultrasound technology, the cutaneous nerves can be visualized by high-resolution ultrasound. As the cutaneous nerves course superficially in the subcutaneous layer, they are vulnerable to entrapment or collateral damage in traumatic insults. Scanning of the cutaneous nerves is challenging due to fewer anatomic landmarks for referencing. Therefore, the aim of the present article is to summarize the anatomy of the limb cutaneous nerves, to elaborate the scanning techniques, and also to discuss the clinical implications of pertinent entrapment syndromes of the medial brachial cutaneous nerve, intercostobrachial cutaneous nerve, medial antebrachial cutaneous nerve, lateral antebrachial cutaneous nerve, posterior antebrachial cutaneous nerve, superficial branch of the radial nerve, dorsal cutaneous branch of the ulnar nerve, palmar cutaneous branch of the median nerve, anterior femoral cutaneous nerve, posterior femoral cutaneous nerve, lateral femoral cutaneous nerve, sural nerve, and saphenous nerve.

Sarcopenia is an important public health problem, characterized by age-related loss of muscle mass and muscle function. It is a precursor of physical frailty, mobility limitation, and premature death. Muscle loss is mainly due to the loss of type II muscle fibres, and progressive loss of motor neurones is thought to be the primary underlying factor. Anterior thigh muscles undergo atrophy earlier, and the loss of anterior thigh muscle function may therefore be an antecedent finding. The aim of this review is to provide an in-depth (and holistic) neuromusculoskeletal approach to sarcopenia. In addition, under the umbrella of the International Society of Physical and Rehabilitation Medicine (ISPRM), a novel diagnostic algorithm is proposed, developed with the consensus of experts in the special interest group on sarcopenia (ISarcoPRM). The advantages of this algorithm over the others are: special caution concerning disorders related to the renin-angiotensin system at the case finding stage; emphasis on anterior thigh muscle mass and function loss; incorporation of ultrasound for the first time to measure the anterior thigh muscle; and addition of a chair stand test as a power/performance test to assess anterior thigh muscle function. Refining and testing the algorithm remains a priority for future research. LAY ABSTRACT Sarcopenia is an important public health problem, characterized by age-related loss of muscle mass and muscle function. The diagnostic recommendations published to date have addressed total or appendicular muscle mass. However, under the umbrella of the International Society of Physical and Rehabilitation Medicine (ISPRM), experts in the special interest group on sarcopenia (ISarcoPRM) developed a new algorithm, based on regional measurements and functional evaluations of the anterior thigh muscle, which is the most commonly and initially affected condition in sarcopenia. Unlike other suggestions, diseases associated with the renin-angiotensin system are emphasized in this algorithm, and ultrasound has been used for measurement of anterior thigh muscle mass.