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Sleep Bruxism versus Diurnal Bruxism
Abstract and Figures
This study aimed to establish correlations between the type of bruxism, dental wear form and some behavioral aspects. There are presented two cases of bruxism, one case which is a pure form of nocturnal bruxism and the other one characteristic for diurnal bruxism, both selected from a group of patients diagnosed with bruxism. 418 patients with bruxism were examined and the two cases were selected. For nocturnal bruxism diagnostic were used the minimum criteria set by American Sleep Disorder Association. Diurnal bruxism diagnostic was based on clinical signs. Dental wear form was described for two pure cases of nocturnal or diurnal bruxism. Behavioral aspects specific to each group of patients were based on personal history of patients. From the total of 418 subjects included in the study, 17.94% had clinical signs of bruxism, 5.01% nocturnal bruxism, 10.52% diurnal bruxism, and 2.39% had both forms of bruxism. Patients diagnosed with nocturnal bruxism had eccentric form of bruxism, while patients diagnosed with diurnal bruxism had centric form of bruxism. While nocturnal bruxism is considered a form of sleep disease, diurnal bruxism is a parafunctional activity, their treatment being different as management and outcome.
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Background. Pamidronate (P) and Zoledronate (Z) are new generation bisphoshonates (BS) used for treatment of bone lesions in patients (pts) with multiple myeloma (MM), solid tumors and no oncologic diseases. They are monthly administered for prolonged periods of time and they are generally well tolerated. Recently, severe osteonecrosis (ON) of the jaw has been reported as an adverse effect of treatment. Avascular bone necrosis has been often observed after major dental procedure. In site of lesion, occasionally, Actinomyces spp were recovered from culture. The aetiology is not understood, although it has been postulated to be secondary to the antiangiogenic effect of BS.
Patients. We performed a review of pts of the two hematologic departments treated in the last two years with monthly intravenous BS therapy (Pamidronate 90 mg and /or Zoledronate 4 mg). Overall, 118 patients were studied: 48 males, 70 females; 104 presented MM, 8 severe osteoporosis, 4 iperparathyroidism, 1 Paget disease and 1 breast carcinoma. All patients with a neoplastic disease had received at least one line of chemotherapy.
Results. Fourteen pts presented ON (13 with MM and one with severe osteoporosis). The median doses of BS therapy were: 560 mg (range 0–6480 mg) for P, 80 mg (range 0–308 mg) for Z. Five pts had an important exposed jawbone and 11 pts developed ON after a previous tooth extraction. Mandible was involved in 9 pts and maxilla in 5. Diagnosis was made with oral inspection, X-ray, TC and histology. Actinomyces spp were recovered in only one patient.
Statistical Analysis. All variables were analyzed for descriptive statistics and to check their distribution by Shapiro-Wilk test. The median values of cumulative dosage were used as cut-off points, and a score 0 was attributed to all dosages lower or equal to median dose, whereas a score 1 was attributed to all dosages grater than median doses. The presence and absence of the event were respectively coded as 1 and 0, and then logistic regression analysis was carried out. The significance for the whole univariate and multivariate models was set at p< 0.05 for the regressors: the odds ratio (OR) was also calculated together with its CI 95%.. At univariate analysis, the significant contributor to oral lesions was only the dosage of pamidronate above or below median value (p=0.021). At multivariate analysis, significant regressors proved to be the female sex (p=0.032; OR 0.142)) and the score of cumulative dosage of drugs (p=0.005; OR 3.977; CI 95%.(OR) 1.517–10.424)
Conclusions. Oncologists should pay attention to ON occurrence in long survivors in chronic therapy with BS. Major debridement surgeries are to be avoided if at all possible. Our preliminary data in these pts showed that the lesions are more probable in females than in males and that the administration of more than 560 mg of Pamidronate and of more than 80 mg of Zoledronate is significantly associated with ON lesions.
During 2002 the International Association of Pancreatology developed evidenced-based guidelines on the surgical management of acute pancreatitis. There were 11 guidelines, 10 of which were recommendations grade B and one (the second) grade A. (1) Mild acute pancreatitis is not an indication for pancreatic surgery. (2) The use of prophylactic broad-spectrum antibiotics reduces infection rates in computed tomography-proven necrotizing pancreatitis but may not improve survival. (3) Fine-needle aspiration for bacteriology should be performed to differentiate between sterile and infected pancreatic necrosis in patients with sepsis syndrome. (4) Infected pancreatic necrosis in patients with clinical signs and symptoms of sepsis is an indication for intervention including surgery and radiological drainage. (5) Patients with sterile pancreatic necrosis (with negative fine-needle aspiration for bacteriology) should be managed conservatively and only undergo intervention in selected cases. (6) Early surgery within 14 days after onset of the disease is not recommended in patients with necrotizing pancreatitis unless there are specific indications. (7) Surgical and other forms of interventional management should favor an organ-preserving approach, which involves debridement or necrosectomy combined with a postoperative management concept that maximizes postoperative evacuation of retroperitoneal debris and exudate. (8) Cholecystectomy should be performed to avoid recurrence of gallstone-associated acute pancreatitis. (9) In mild gallstone-associated acute pancreatitis, cholecystectomy should be performed as soon as the patient has recovered and ideally during the same hospital admission. (10) In severe gallstone-associated acute pancreatitis, cholecystectomy should be delayed until there is sufficient resolution of the inflammatory response and clinical recovery. (11) Endoscopic sphincterotomy is an alternative to cholecystectomy in those who are not fit to undergo surgery in order to lower the risk of recurrence of gallstone-associated acute pancreatitis. There is however a theoretical risk of introducing infection into sterile pancreatic necrosis. These guidelines should now form the basis for audit studies in order to determine the quality of patient care delivery. Copyright (C) 2002 S. Karger AG, Basel and IAP.
Background: The Canadian Psychiatric Association and the Canadian Network for Mood and Anxiety Treatments partnered to produce clinical guidelines for psychiatrists for the treatment of depressive disorders. Methods: A standard guidelines development process was followed. Relevant literature was identified using a computerized Medline search supplemented by review of bibliographies. Operational criteria were used to rate the quality of scientific evidence, and the line of treatment recommendations included consensus clinical opinion. This section, on Axis I, Axis II, and Axis III comorbidity, is 1 of 7 articles that were drafted and reviewed by clinicians. Revised drafts underwent national and international expert peer review. Results: Comorbid depression on Axis I is particularly prevalent in patients with anxiety disorders, substance use disorders, and eating disorders, but it also occurs in patients with schizophrenia, attention-deficit hyperactivity disorder (ADHD), and dementia. Depressive comorbidity has implications for assessment, management, and outcome. The relation between depression and personality disorders is complex. Patients with this comorbidity often require longer, more intense, and multimodal therapies. Depression is also prevalent in medical illnesses, requires careful diagnosis, and responds to standard antidepressant treatments. Conclusions: Comorbidity can influence the course and outcome of both associated conditions. Depression-specific psychotherapy and/or pharmacotherapy should be considered when comorbid depression is diagnosed.
Histatins are a structurally related family of salivary proteins known as histidine-rich proteins that are produced and secreted by the human major salivary glands. In vitro, histatins are potent cytotoxic proteins with selectivity for pathogenic yeasts including Candida albicans. Studies that investigate the mechanism of action of histatin proteins upon this important human pathogen have used a candidacidal assay in which the histatin is applied extracellularly. In order to develop a model system to study the mechanism of histatin action independently from binding and translocation events, the authors constructed C. albicans strains that contain chromosomally encoded human salivary histatin genes under the control of a regulated promoter. Intracellular expression of either histatin 5 or histatin 3 induced cell killing and ATP release in parallel. Since histatin killing can be initiated solely from intracellular sites, extracellular binding and internalization are preceding transport events. Thus the mechanism of histatin-induced ATP release does not require extracellular binding, and intracellular targets alone can activate ATP release. By employing a codon-optimization strategy it was shown that expression of heterologous sequences in C. albicans can be a useful tool for functional studies.
Concerns have been raised over possible adverse effects of prophylactic antiretroviral therapy (ART) on the fetus and newborn. We analyzed data relating to uninfected children enrolled in the European Collaborative Study and investigated the association between ART exposure, perinatal problems, and major adverse health events later in life. Median length of follow-up was 2.2 (0-15.9) years. Of the 2414 uninfected children, 687 (28%) were exposed to ART in all three periods (antenatal, intrapartum, and neonatal). Of the 1008 infants exposed to ART at any time, 906 (90%) were exposed antenatally, 840 (83%) neonatally, and 750 (74%) both antenatally and neonatally. ART exposure was not significantly associated with pattern or prevalence of congenital abnormalities or low birth weight. In multivariate analysis, prematurity was associated with exposure to combination therapy without a protease inhibitor (PI) (OR = 2.66; 95% CI: 1.52-4.67) and with a PI (OR = 4.14; 95% CI: 2.36-7.23). ART exposure was associated with anemia in early life (P < .001). There was no evidence of an association with clinical manifestations suggestive of mitochondrial abnormalities. The absence of serious adverse events in this large cohort of uninfected children exposed to prophylactic ART in the short to medium term is reassuring.
Objective: To assess the effectiveness of metformin in improving clinical and biochemical features of polycystic ovary syndrome. Design: Systematic review and meta-analysis. Data sources: Randomised controlled trials that investigated the effect of metformin compared with either placebo or no treatment, or compared with an ovulation induction agent. Selection of studies: 13 trials were included for analysis, including 543 women with polycystic ovary syndrome that was defined by using biochemical or ultrasound evidence. Main outcome measure: Pregnancy and ovulation rates. Secondary outcomes of clinical and biochemical features of polycystic ovary syndrome. Results: Meta-analysis showed that metformin is effective in achieving ovulation in women with polycystic ovary syndrome, with odds ratios of 3.88 (95% confidence interval 2.25 to 6.69) for metformin compared with placebo and 4.41 (2.37 to 8.22) for metformin and clomifene compared with clomifene alone. An analysis of pregnancy rates shows a significant treatment effect for metformin and clomifene (odds ratio 4.40, 1.96 to 9.85). Metformin has an effect in reducing fasting insulin concentrations, blood pressure, and low density lipoprotein cholesterol. We found no evidence of any effect on body mass index or waist:hip ratio. Metformin was associated with a higher incidence of nausea, vomiting, and other gastrointestinal disturbance. Conclusions: Metformin is an effective treatment for anovulation in women with polycystic ovary syndrome. Its choice as a first line agent seems justified, and there is some evidence of benefit on variables of the metabolic syndrome. No data are available regarding the safety of metformin in long term use in young women and only limited data on its safety in early pregnancy. It should be used as an adjuvant to general lifestyle improvements and not as a replacement for increased exercise and improved diet.
