Tension-type headache in children: A clinical evaluation

BACKGROUND: Headache Society (IHS) criteria for episodic tension-type headache were included in the present study. Pain characteristics, associated symptoms, and stress-triggering factors were evaluated. Psychiatric and psychosocial evaluations were performed according to DSM-IV criteria. RESULTS: Pain was bilateral in 93.7% of patients and bitemporal in 50% of children. The intensity of pain increased with motion and stress in more than half of the patients, while pain decreased with rest and massage in 43.7% of patients. Ten of the 16 (62.5%) patients were diagnosed as having a psychiatric disorder. The most common stress-triggering factors were difficulty in adaptation at school and relationship problems with family members. All of the children reported 26 stress factors. Of these stress factors, 20 (76.9%) were reported by children diagnosed with psychiatric disorder. CONCLUSION: These results suggest that in children with tension-type headache a thorough psychiatric evaluation should be performed to rule out underlying psychiatric disorders.     

The Factors Contributing to Death Anxiety in Cancer Patients

Suffering comes in many ways for patients confronting cancer. One of these is an unspecifiable fear about death, which is an existential issue. The aim of this study was to investigate the relationship between death anxiety and its correlates in cancer patients. Seventy cancer patients were assessed using SCID-I, Templer's Death Anxiety Scale, the Hospital Anxiety (A) and Depression (D) Scale, the Distress Thermometer, the Visual Analogue Scale for pain (VAS), the Global Assessment of Functioning, and Glock and Stark's Dimensions of Religious Commitment scales, and these assessments were compared between cancer patients with and without death anxiety. Multiple regression analysis was conducted after correlation analysis between death anxiety and sociodemographic and clinical variables. Axis I psychiatric diagnosis, pain scores, and negative believes about what will happen after death were found to be higher in patients having death anxiety than patients not having death anxiety. Also life expectancy was perceived as shortened in patients with death anxiety. Death anxiety was associated with anxiety, depressive symptoms, and beliefs about what will happen after death. In conclusion, death anxiety could not be regarded as a natural consequence of having cancer; it is associated with the unresolved psychological and physical distress.     

On the atrial response to focal discharges in man

INTRODUCTION: Triggers and vulnerability are key factors for the occurrence of atrial fibrillation (AF). The aim of this study was to assess spatial dispersion of atrial refractoriness and vulnerability in response to both focal discharges as well as programmed electrical stimulation in patients undergoing ablation of atrial arrhythmogenic foci. METHODS AND RESULTS: Twenty-nine patients were studied, and 12 right atrial unipolar electrograms were recorded. Inducibility of AF was assessed by a pacing protocol that started with one extrastimulus, followed by more aggressive pacing until AF was obtained. Mean fibrillatory intervals were used to assess the local refractoriness of each recording site. Spatial dispersion of refractoriness was calculated as the coefficient of dispersion (CD value: standard deviation of the mean of all local mean fibrillatory intervals as a percentage of the overall mean fibrillatory interval). Based on our previous study, a CD value 3.0 was considered enhanced spatial dispersion of refractoriness. Fifteen of 29 patients had normal dispersion of refractoriness (mean CD value 1.65 +/- 0.43), and AF was inducible with burst pacing only. These patients had focal discharges causing rapid atrial tachycardia with a focal activation pattern. Activation mapping of focal activity was possible in 14 of 15 patients. Focal triggering of AF occurred in only 1 of 15 patients. Fourteen of 29 patients had enhanced dispersion (mean CD value 4.2 +/- 0.72). AF was inducible with a single extrastimulus in 11 of 14 patients (P < 0.001). Focal triggering of AF occurred in all 14 patients. CONCLUSION: Spatial dispersion of atrial refractoriness determines whether focal atrial discharges trigger AF with disorganized activity or, alternatively, only rapid atrial tachycardia.     

Does cigarette smoke exposure lead to histopathological alterations in the olfactory epithelium? An electron microscopic study on a rat model

Objective: This study was conducted to examine the influence of smoke exposure of variable duration on the ultrastructure of and histopathologic and morphologic alterations in the olfactory epithelium.

Methods: A total of 24 Wistar albino rats were randomly assigned to three groups and fed a standard rat chow and tap water. Experimental rats in groups I and II were exposed to cigarette smoke in a glass cabin over a period of 2 months for 5 or 15 min, respectively, four times daily; control rats (group III) were not exposed to cigarette smoke. After dissection, all tissue specimens were processed using routine procedures for TEM.

Results: Groups I and II exhibited the presence of intraepithelial inflammatory cells and especially deep invaginations in the nuclear membrane of supporting cells. Extended intercellular spaces, cytoplasmic protrusions on the apical surface of supporting cells, atrophy of microvilli and olfactory neuron cilia as well as numerous electron-dense granular structures and lysosome-like structures were observed to an increasing degree from group I to group II. Particularly in group II, both supporting cells and olfactory neurons exhibited a cytoplasmic edema, mitochondrial degeneration, and numerous vacuolar structures, as well as apoptotic and minimal necrotic changes. In this group, hyperplasia of basal cells was also observed.

Conclusion: Our electron microscopic findings show that cigarette smoke leads to toxic degenerative changes in the rat olfactory mucosa.     

The Influence of Different Nonsteroidal Anti-Inflammatory Drugs on Alveolar Bone in Rats: An Experimental Study

The aim

The aim of this study was to investigate the effect of dexketoprofen trometamol, meloxicam, diclofenac sodium on any untreated alveolar bone when they are used as drugs for another indication.

Materials and Methods

Twenty eight male Spraque-Dawley rats were randomized into four groups as dexketoprofen trometamol (Group I), meloxicam (Group II), diclofenac sodium (Group III) and control group. Nonsteroidal anti-inflammatory drugs (NSAID) were administered after a fibula fracture for 10 days. Untreated alveolar bone was histopathologically examined for spongious bone density, osteoclastic density and osteoblastic density.

Results

Spongious bone density was lower in study groups (Group I, group II and group III) than the control group (p<0.05). In contrast, the increase in osteoclastic density was observed in other groups apart from the control group (p<0.05). Osteoblastic density was evaluated and it was determined that group II and group III had lower results than the control group (p<0.05) but group I was equal to the control group.

Conclusion

This study showed that systemically administrated NSAIDs have the potential to affect untreated alveolar bone. This should also be considered in long term use of NSAIDs.Key Words: Non-steroidal anti-inflammatory agents, bone remodeling, osteoblast, osteoclast, maxillary bone     

The distinction between unipolar and bipolar depression: A cognitive theory perspective

Background

There is very limited data about the cognitive structure of bipolar depression when compared to unipolar depression. The aim of the study was to look into the differences between unipolar and bipolar depressed patients regarding their cognitive structure in view of Beck's cognitive theory.

Methods

In this study, 70 bipolar patients during a depressive episode, 189 unipolar depressed patients and 120 healthy subjects were recruited. The participants were interviewed by using a structured clinical diagnostic scale. To evaluate the cognitive structure differences, the Automatic Thoughts Questionnaire (ATQ) and the Dysfunctional Attitude Scale (DAS) were used.

Results

We found that on the mean ATQ total score, the unipolar depressed patients scored significantly higher (92.9 ± 22.7) than both the bipolar depressed patients (73.2 ± 24.7) and the healthy subjects (47.1 ± 19.6), even after controlling for all confounding factors, e.g. gender, marital status, depressive symptom severity (F = 157.872, p < 0.001). The bipolar depressed patients also scored significantly higher on the mean ATQ total score than the healthy controls. On the mean DAS total score, and on the mean score of its subscale of need for approval, the bipolar depressed patients scored (152.8 ± 21.2 and 48.2 ± 7.4, respectively) significantly higher than both the unipolar depressed patients (160.9 ± 29.0 and 51.9 ± 9.7, respectively) and the healthy subjects (127.9 ± 32.8 and 40.2 ± 12.2, respectively), even after controlling for any confounding factor (F = 45.803 [p < 0.001] and F = 43.206 [p < 0.001], respectively). On the mean score of the perfectionistic attitude subscale of the DAS, the depressed groups scored significantly higher than the healthy subjects, but they did not seem to separate from each other (F = 41.599, p < 0.001).

Conclusions

These results may help enhance the understanding of the potentially unique psychotherapeutic targets and the underlying cognitive theory of bipolar depression.     

Are changes in the extent of left ventricular dyssynchrony as assessed by speckle tracking associated with response to cardiac resynchronization therapy?

Echocardiographic assessment of left ventricular (LV) dyssynchrony is used to predict response to cardiac resynchronization therapy (CRT). However, the association between reduction in the extent of speckle tracking based LV-dyssynchrony and echocardiographic response to CRT has not been explored yet. The aim of this study was to assess the changes in the extent of LV dyssynchrony as a result of CRT and its association with echocardiographic response to CRT in a large consecutive series of patients. We studied 138 patients with standard CRT indication. Time-based speckle tracking longitudinal strain (maximal delay between 6-segments in 4-chamber view) was performed to assess LV-dyssynchrony at baseline and after a mean follow-up of 22 ± 8 months. Echocardiographic CRT response was defined as a reduction in LV end-systolic volume ≥15 %. Mean age was 68 ± 8 years (30 % female). Mean LV ejection fraction (LVEF) was 26 ± 7 %. Ninety six patients (70 %) were classified as echocardiographic responders. In the total study group, LV-dyssynchrony decreased from 196 ± 89 ms at baseline to 180 ± 105 ms during follow-up, P = 0.01. Of note, in responders there was a pronounced reduction in LV dyssynchrony (198 ± 88 ms at baseline vs 154 ± 50 ms after CRT, P < 0.001), whereas in non-responders there was a significant increase (191 ± 92 ms at baseline vs 243 ± 160 ms after CRT, P = 0.04). After multivariate analysis, decreased in LV-dyssynchrony, wider QRS duration and non-ischemic etiology were independently and significantly associated with CRT response. Changes in the extent of LV dyssynchrony as measured by speckle tracking after CRT are independently associated with response to CRT.