Musculoskeletal orofacial pain and other signs and symptoms of temporomandibular disorders during pregnancy: a prospective study

AIMS: To describe the course of reported musculoskeletal pain in the temporomandibular region and other signs and symptoms of temporomandibular disorders (TMD) as well as psychological distress over the course of pregnancy and 1 year postpartum. METHODS: Women with musculoskeletal orofacial pain (n = 19) and pain-free comparison subjects (n = 16) in the first trimester of pregnancy were selected through records review from the population of a large health maintenance organization. Subjects completed a self-administered questionnaire assessing pain, depression, and somatic symptoms; provided a sample of whole unstimulated saliva; and underwent a standardized clinical examination during the third, sixth, and ninth months of pregnancy and 1 year postpartum. RESULTS: At baseline (third month of pregnancy), 16 of the 19 patients with musculoskeletal orofacial pain met criteria for an RDC/TMD diagnosis. Reported musculoskeletal orofacial pain diminished significantly during the second or third trimester of pregnancy and increased again postpartum. Measures of mandibular opening increased over pregnancy in both cases and comparison subjects and remained high postpartum. Depression and somatic symptoms changed little over the course of pregnancy but were substantially lowered at 1 year postpartum for both groups. As expected, subjects with pain had higher levels of palpation pain, diminished mandibular range of motion, and higher levels of psychological distress compared to subjects without orofacial pain. CONCLUSION: Musculoskeletal orofacial pain and related symptoms appear to improve over the course of pregnancy. This improvement occurs in the presence of increased joint laxity and is not paralleled by improvements in psychological distress. Thus, it was concluded that the improvement in pain is most likely associated with the dramatic hormonal changes occurring during pregnancy.     

Effect of foot bathing on distal-proximal skin temperature gradient in elders

Increased distal (foot)-proximal (abdominal) skin temperature gradient (DPG) has been associated with better sleep initiation. Warm foot bath can affect distal skin temperature to change DPG. However, the optimum water temperature and duration necessary to raise DPG has not been established. This study explored the effects of 1-h foot bathing at two water temperatures of 40 and 41 degrees C, respectively, on DPG in Taiwanese elders (n=6, ages 60-73 years). Each subject's feet and legs were immersed in a temperature-controlled water tub to 20 cm above the ankles for 60 min in each of two water temperatures. Oral, abdominal, and foot temperatures were taken during (at 10-min intervals), and after (at 1-min intervals) foot bathing. DPG was calculated by subtracting abdominal temperature from foot temperature. Results showed the value of DPG was significantly increased in the 10th min bathing at both water temperatures and maintained above 0 degrees C. DPG gradually declined after bathing at both water temperatures. The value of DPG with 41 degrees C water was slightly higher than 40 degrees C. All subjects tolerated both bathing temperatures well for 1h. Both 40 and 41 degrees C foot bathing for 1h can increase the DPG and may be an effective way to affect whole body skin blood flow and trigger heat dissipation.     

Factors associated with objective (actigraphic) and subjective sleep quality in young adult women

OBJECTIVE: The aim of this study was to describe factors associated with actigraphic and subjective sleep quality in young women. METHODS: Participants were 73 regularly menstruating women, 20-40 years old, who were not taking oral contraceptives, pregnant, or shift workers. Women contributed an average of 7 nights of actigraphy data during the luteal menstrual cycle phase, resulting in a total of 595 nights of data. RESULTS: One night of actigraphy data was unreliable for measuring total sleep time, sleep onset, and time in bed (intraclass correlation < or =.15) but was acceptable for measuring sleep efficiency and total wake time (intraclass correlation [ICC]=.52). Going to bed late, medication use, employment, increased daylight hours, longer menstrual cycle length, and higher body mass index (BMI) were associated with poorer actigraphic sleep measures. Employment, age, and perceived stress were associated with subjective sleep quality. CONCLUSION: Multiple factors were associated with sleep quality in these young women who were sleeping at home. However, the associations differed for subjectively versus actigraphically assessed sleep quality. Actigraphy is feasible for measuring sleep, but multiple recording nights may be needed to obtain reliable estimates.     

Quantitative neuropathologic correlates of changes in ratio of N-acetylaspartate to creatine in macaque brain

PURPOSE: To elucidate the neuropathologic basis of transient changes in the ratio of N-acetylaspartate (NAA) to creatine (Cr) in the primate brain by using a simian immunodeficiency virus (SIV)-infected macaque model of the neurologic manifestation of acquired immune deficiency syndrome. MATERIALS AND METHODS: This study was approved by the Massachusetts General Hospital Subcommittee on Research and Animal Care and the Institutional Animal Care and Use Committee of Harvard University. Rhesus macaques infected with SIV were evaluated during the 1st month of infection. A total of 11 animals were studied, including four control animals, three animals sacrificed 12 days after infection, three animals sacrificed 14 days after infection, and one animal sacrificed 28 days after infection. All animals underwent in vivo proton ((1)H) magnetic resonance (MR) spectroscopy, and postmortem frontal lobe tissue was investigated by using high-spectral-resolution (1)H MR spectroscopy of brain extracts. In addition, quantitative neuropathologic analyses were performed. Stereologic analysis was performed to determine neuronal counts, and immunohistochemical analysis was performed to analyze three neuronal markers: synaptophysin, microtubule-associated protein 2 (MAP2), and calbindin. Analysis of variance (ANOVA) was used to determine substantial changes in neuropathologic and MR spectroscopic markers. Spearman rank correlations were calculated between plasma viral load and neuropathologic and spectroscopic markers. RESULTS: During acute infection with SIV, the macaque brain exhibited significant changes in NAA/Cr (P < .02, ANOVA) and synaptophysin (P < .013, ANOVA). There was no significant change in the concentration of Cr. No significant changes were found in neuronal counts or other immunohistochemical neuronal markers. With the Spearman rank test, a significant direct correlation was detected between synaptophysin and ex vivo NAA/Cr (r(s) = 0.72, P < .013). No correlation between NAA/Cr and neuronal counts, calbindin, or MAP2 was found. CONCLUSION: NAA/Cr is a sensitive marker of neuronal injury, not necessarily neuronal loss, and best correlates with synaptophysin, a marker of synaptodendritic dysfunction.     

Benefit of pharmaceutical anti-oedematous treatment in acute adult epiglottitis

Acute adult epiglottitis is a potentially life threatening infectious and respiratory emergency as it may result in airway obstruction. Endotracheal intubation, if needed, is a highly risky option in this situation and responsible for important morbidity and mortality rate. The option of a pharmaceutical anti-oedematous treatment, in order to avoid the risks involved in the endotracheal route has rarely been described. We here report the case of a 50-year-old man with a serious acute infectious epiglottitis who was treated at home by a Mobile Intensive Care Unit where a treatment of nebulized epinephrine and intravenous steroids was undoubtedly a successful option to the endotracheal route. So that, for adult patients and in the absence of any risk of an imminent respiratory arrest, this anti-oedematous treatment should be considered in order to avoid endotracheal route, an option which should be undertaken in case of complications. Nevertheless, this isolated case study concerning an adult is not transposable to children for which airway obstruction tolerance is lower.     

Delirium Tremens

The varied clinical manifestations and management of 14 male patients with delirium tremens (DT) have been studied. Eight patients were initially hospitalised for diseases unrelated to ethanol abuse i.e. 2 each for gun shot wound, myocardial infarction and stroke, and one each for pneumonia and gastroenteritis. One patient was going through withdrawal because of prodrome of viral hepatitis before he was hospitalised for uncontrolled agitation and delirium. Two known cases of mild essential hypertension on dietary therapy reported for agitation, abnormal behaviour, a single episode of tonic clonic seizure and hypertensive encephalopathy as they could not/did not get alcohol for 3 days. Three patients presented denovo with DT without concomitant illness. The other features besides delirium and hallucinations were tremulousness in 10, tachycardia in 12, fever in 3, diaphoresis in 2 and tonic clonic seizures in 4 patients. The symptoms fluctuated markedly at short intervals and 2 patients did not have any features of sympathetic overactivity. Altered hepatic biochemical parameters and ketonuria with normal blood sugar were noted in 4 and one patients respectively. Other biochemical parameters including serum electrolytes were normal. CT scan brain done for 5 patients revealed subdural haematoma in one. Cerebro spinal fluid (CSF) and EEG findings were noncontributory. All made good recovery with heavy doses of intravenous vitamin B complex, glucose and oral benzodiazepine. Short course of haloperidol was used in 2 patients. Two patients developed pancreatitis during follow up. All patients made complete recovery, and 8 patients have been followed for 8 to 12 months without relapse. The reason for hospitalisation in such cases is often unrelated to alcohol abuse; hence a detailed history of alcoholism is mandatory to identify those at risk as well as for prompt treatment and decreasing the mortality.Key Words: Alcohol withdrawal, Concomitant illnesses, Delirium, Precipitating events