Functional limitation of the masticatory system in patients with bulbar involvement in amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis (ALS) with bulbar dysfunction affects the motor neurons responsible for controlling the muscles in the jaw, face, soft palate, pharynx, larynx and tongue. This cross-sectional study aimed to determine the functional limitation of the jaw in patients with ALS and bulbar dysfunction who had upper motor neuron (UMN), lower motor neuron (LMN) or balanced involvement. One hundred and fifty-three patients with ALS and 23 controls were included. All participants answered using the 8-item Jaw Functional Limitation Scale (JFLS-8). Patients with ALS were grouped by neurologic examination as follows: non-bulbar ALS, bulbar UMN-predominant ALS; bulbar LMN-predominant ALS; and bulbar balanced (UMN + LMN) ALS. Jaw limitation between the different groups was compared using the Kruskal-Wallis test. Patients with non-bulbar ALS had similar mandibular limitations to healthy participants. Only patients with balanced UMN and LMN bulbar manifestations reported greater difficulties in chewing soft food or in jaw mobility compared to the non-bulbar ALS group. Patients with bulbar involvement also had greater difficulties in chewing tough food or chicken and in swallowing and talking compared to the non-bulbar group, regardless of whether UMN or LMN predominant. No significant differences were found between the groups in smiling and yawning difficulties. Bulbar involvement in patients with ALS is associated with functional limitation of the masticatory system. However, balanced bulbar UMN and LMN involvement is associated with the worst impairments in chewing soft food and in opening the jaw widely.

Peripheral, functional and postural asymmetries related to the preferred chewing side in adults with natural dentition.

The aim of this cross-sectional study was to determine the preferred chewing side and whether chewing side preference is related to peripheral, functional or postural lateral preferences. One hundred and forty-six adults with natural dentition performed three masticatory assays, each consisting of five trials of chewing three pieces of silicon placed into a latex bag for 20 cycles, either freestyle or unilaterally on the right- or left-hand side. Occlusal contact area in the intercuspal position, maximum bite force, masticatory performance and cycle duration were measured and the lateral asymmetry of these variables was calculated. Laterality tests were performed to determine handedness, footedness, earedness and eyedness as functional preferences, and hand-clasping, arm-folding and leg-crossing as postural lateral preferences. The preferred chewing side was determined using three different methods: assessment of the first chewing cycle for each trial, calculation of the asymmetry index from all cycles and application of a visual analogue scale. Bivariate relationship and multiple linear regression analyses were performed. Among unilateral chewers, 77% of them preferred the right side for chewing. The factors most closely related to the preferred chewing side were asymmetry of bite force, asymmetry of masticatory performance and earedness, which explained up to 16% of the variance. Although several functional or postural lateral preferences seem to be related to the preferred chewing side, peripheral factors such as asymmetry of bite force and of masticatory performance are the most closely related to the preferred chewing side in adults with natural dentition.

Profile changes in admissions to a psychiatric hospitalisation unit over 15 years (2006-2021), considering the impact of the pandemic caused by SARS-CoV-2.

The objective of this current work was to explore whether modification of the diagnostic criteria upon the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the impact of the COVID-19 pandemic had influenced the diagnostic and sociodemographic profiles of mental health admissions. For that purpose, we designed an observational, longitudinal, and retrospective study of the data recorded in the discharge reports of the Brief Hospitalization Unit at Castellon (Spain), between January 2006 and December 2021. The sample consisted of 7,037 participants, with a mean age of 42.1 years. The mean age of admissions, number of women, and presentation of affective disorders, addictions, and dementias all increased significantly during the DSM-5 period. Beyond diagnoses, the reduction in readmissions before the pandemic could be attributed to the use of long-acting injectable antipsychotics. In contrast, the pandemic did not change the percentage of readmissions or the volume of admissions. Also, during the pandemic period, the significant results obtained indicate that the average stay was reduced, affective disorders decreased, and addictions increased. Therefore, clinicians should consider these diagnostic and sociodemographic fluctuations when adapting clinical care, taking into account gender perspective, ageing of patients and increasing of dual and affective disorders.

[Involvement of intestinal dysbiosis in the etiopathogenesis and treatment of autism spectrum disorder: a bibliographic review]. / Implicación de la disbiosis intestinal en la etiopatogenia y el tratamiento del trastorno del espectro autista: una revisión bibliográfica.

INTRODUCTION: Autism spectrum disorder is a neurodevelopmental disorder with phenotypic heterogeneity and variable symptomatic course of partly unknown etiology. The prevalence of gastrointestinal disorders in autism leads to investigate the role that intestinal microbiota may have as a causal factor and to propose specific therapeutic interventions. The role of microbiota in brain development and function, demonstrated in animal models, justifies its investigation in this neuropsychiatric disorder. OBJECTIVE: The aim was to investigate the relationship between altered microbiota composition and autism spectrum disorder, and to assess the therapeutic role of prebiotics, probiotics and fecal transplantation in this neurodevelopmental disorder. DEVELOPMENT: A literature review was conducted in PubMed, Cochrane Library and Google Scholar to select relevant articles related to the topic that were published between January 2012 and April 2020. Thirty-five relevant articles were selected. In 23 of them, significant differences were found in the composition and diversity of the microbiota in children with ASD, as well as in the biomolecules involved in certain metabolic pathways. The other 12 investigations reported gastrointestinal and behavioral improvements after therapeutic intervention. CONCLUSIONS: It is reasonable to state that there is enough evidence to support the existence of a relationship between intestinal microbiota and autism spectrum disorders. This fact should be explored in depth to assess the etiopathogenic burden of dysbiosis and the possible therapeutic tools.

TITLE: Implicación de la disbiosis intestinal en la etiopatogenia y el tratamiento del trastorno del espectro autista: una revisión bibliográfica.Introducción. El trastorno del espectro autista es un trastorno del neurodesarrollo con heterogeneidad fenotípica y curso sintomático variable de etiología parcialmente desconocida. La prevalencia de trastornos gastrointestinales en este perfil de pacientes invita a investigar el papel que la microbiota intestinal puede tener como factor causal y a plantear intervenciones terapéuticas específicas. El papel de la microbiota en el desarrollo y la función cerebral, demostrado en modelos animales, justifica su investigación en este trastorno neuropsiquiátrico. Objetivo. Investigar la relación entre la alteración en la composición de la microbiota y el trastorno del espectro autista, y evaluar el papel terapéutico de prebióticos, probióticos y trasplante fecal en este trastorno del neurodesarrollo. Desarrollo. Se realizó una revisión bibliográfica en PubMed, Cochrane Library y Google Scholar con el fin de seleccionar los artículos relevantes relacionados con el tema que se publicaron entre enero de 2012 y abril de 2020. Se seleccionaron 35 artículos relevantes. En 23 de ellos se encontraron diferencias significativas en la composición y la diversidad de la microbiota en niños con TEA, así como en biomoléculas involucradas en determinadas rutas metabólicas. Las otras 12 investigaciones describieron mejorías gastrointestinales y comportamentales tras la intervención terapéutica. Conclusiones. Resulta razonable afirmar que existe evidencia suficiente para apoyar la existencia de una relación entre la microbiota intestinal y los trastornos del espectro autista. Esta vinculación ha de ser explorada en profundidad para perfilar el peso etiopatogénico de la disbiosis y las posibles herramientas terapéuticas.

[Impact of thrombolytic therapy on short and long-term survival of a cohort of patients with acute myocardial infarction consecutively admitted to all the hospitals of a health care area. GESIR-5 study]. / Impacto de la trombólisis sobre la supervivencia a corto y largo plazo de una cohorte de pacientes con infarto agudo de miocardio atendidos de forma consecutiva en todos los hospitales de una región sanitaria. Estudio GESIR-5.

AIM: This study aims to assess the application of thrombolysis in patients with acute myocardial infarction admitted to all the hospitals of a health care area in Catalonia (Spain), and to estimate the effect of thrombolysis on short and long-term survival. METHODS: From May 1992 to May 1993, all the patients with myocardial infarction admitted to the hospitals of the Costa de Ponent area in the first 72 hours after the initial symptoms were consecutively included in this prospective study. Information on pre-hospital phase, emergency room management and hospitalization was collected. All the patients discharged alive from hospital were followed up by telephone one and four years after hospital admission. RESULTS: 521 patients aged 74 years or less were included. Thrombolytic therapy was applied in 35.3%. There were no statistically significant differences in the proportion of thrombolysis between hospitals with or without intensive care or coronary units. Ten patients died in the emergency room; in the remaining cases, the 28-day case fatality was 10.0%. The effect of thrombolytic treatment on 28-day case fatality was estimated in a logistic regression model, after controlling for age, gender, Killip, ventricular arrhythmia and location of infarction (OR: 0.36; CI 95%: 0.15-0.88). In 28-day survivors, the 4-year cumulated probability of survival was 88.4%, being significantly higher in the group who had received thrombolytic therapy. CONCLUSIONS: In the population studied, 28-day case mortality of acute myocardial infarction is similar to that reported in other Mediterranean regions. The benefits of thrombolysis in the acute phase are found to persist after 4 years.

Dual bite demonstrated by kinesiography: a case report.

A 60-year-old man sought treatment for extensive tooth wear resulting from bruxism. He had no signs of temporomandibular joint dysfunction. The kinesiographic study revealed that he had a dual bite, with two intercuspal positions, separated by 3 mm anteroposteriorly and by 7 mm laterally. The dentition was restored with metal-ceramic crowns to restore a normal occlusion. The kinesiographic follow-up studies revealed that, initially, it was difficult for the patient to adapt to a new occlusal design, but 6 years later, the dual bite had disappeared. However, the disoccluding angle had flattened where the second intercuspal position had previously existed, corresponding, clinically, to a change from canine guidance to anterior-canine guidance.

Limitations in the use of attachments in a Mediterranean population.

It has been asserted that the average height of natural teeth in Mediterranean Latin populations is relatively short and that these teeth are of insufficient size to host standard attachments manufactured by different companies. The occlusogingival height of 159 potential abutment teeth from 50 Spanish patients was measured and compared to the sizes of intracoronal and extracoronal attachments available from one manufacturer. Twenty-one abutments (13% of the sample) were smaller than the smallest intracoronal attachment available. Eighty-seven percent of the abutments in the sample would have allowed the use of an attachment. However, only 11% of the sample would have allowed the use of a large intracoronal or medium extracoronal attachment, and none would have been able to host a large extracoronal attachment. In addition, 35% of the sample could only have accepted a small intracoronal attachment. In such cases, the capacity for retention would have to be carefully evaluated.

Study of mandibular movements during speech.

We recorded the mandibular movements produced during the reading of a text, in Spanish, using a kinesiograph in a random sample of 71 people aged 24 to 35. In each recording we measured nine variables and did a descriptive analysis of each variable. Our findings support that the mandibular movement during speech has some definite characteristics. The most important fact is that it could be a high percentage of occlusal contacts at incisal level during speech. This has to be taken into account when exploring an occlusal trauma of unknown etiology.

Study of the mandibular movements during swallowing.

The authors recorded the mandibular movement produced during the swallowing of 150 ml of water with the aid of a straw between the lips using a kinesiograph in a random sample of 66 people between the ages of 24 and 35. In each recording 13 variables were measured, and a descriptive analysis of each one was carried out. The authors' findings support that there is no dental contact during liquid swallowing with the aid of a straw between the lips.

Dental casting alloys behaviour during power toothbrushing with toothpastes of various abrasivities. Part II: corrosion and ion release.

The purpose of this study was to evaluate the long term effect of abrasivity of toothpastes normally used over the corrosion behavior and ion release of the different dental casting alloys. Three dental casting alloys (Ni-Cr, Co-Cr and commercially pure Ti) were studied. Four specimens of each material were immersed, brushed without paste or brushed with one of four toothpastes of different Relative Dentine Abrasivity (RDA 50, 52, 80, and 114). An electric toothbrush with a load of 250 g was used for 420 min. Corrosion behavior was determined by means a potenciostat with high sensitivity and the ion release determined by Inductively Coupled Plasma-Mass Spectrometry. Two-way ANOVA and non-parametric tests were used to detect significant differences. Titanium specimens exhibited the best corrosion behavior after and before the toothbrushed, being the worst of the three alloys the Cr-Ni. Titanium oxide produced spontaneously on the Ti surface is the main cause of the high corrosion resistance of the material. However, the eutectoid of the CrNi with chemical composition between different phases produces pitting on the phases boundaries with an important decrease of the corrosion resistance. Besides, the CrNi produces high values of the Ni and Cr release. Slight increment in roughness were observed after toothbrushing and depended on the material but not on the toothpaste used. The increase of the microhardness (residual stresses) provokes a decrease of the corrosion resistance and an increase of the ion release.

Dental casting alloys behaviour during power toothbrushing with toothpastes with various abrasivities. Part I: wear behavior.

The purpose of this study was to evaluate the long term effect of abrasivity of toothpastes normally used over the surface and mechanical properties of dental casting alloys. Three dental casting alloys (Ni-Cr, Co-Cr, c.p. Ti) and one ceramic were chosen. Four specimens of each material were immersed in artificial saliva, brushed without or with one of four toothpastes of different Relative Dentine Abrasivity (RDA 50, 52, 80, and 114). An electric toothbrush with a load of 250 g was used for 420 min. Mass loss was determined by difference in weight, microhardness and surface roughness were also measured. Two-way ANOVA and non-parametric tests were used to detect significant differences. Titanium specimens (478 microg/cm(2)) exhibited the most mass loss, whereas ceramic (282 microg/cm(2)) and Co-Cr (262 microg/cm(2)) exhibited the least. However, ceramic demonstrated the most volume loss (0.239 mm(3)). The abrasivity effect of the toothpaste correlated with the RDA values. Slight variations in microhardness were observed after toothbrushing and depended on the material but not on the toothpaste used. Material surfaces were slightly smoothed by toothbrushing but no significant differences were detected. Dental casting alloys and ceramic are susceptible to abrasion by brushing with an electric toothbrush depending on the RDA value of the toothpaste. Variations in microhardness and surface roughness were not clinically relevant.

Reproducibility of lateral excursive tooth contact in a semi-adjustable articulator depending on the type of lateral guidance.

The purposes of this study were (i) to compare the reproducibility of lateral tooth contacts of casts mounted in a semi-adjustable articulator when condylar guidance was set by different methods and (ii) to assess the margin of error of the variations of condylar guidance without changing lateral tooth contacts, depending on the type of lateral guidance. In subjects with different types of lateral guidance, intraoral lateral tooth contacts identified with occlusal registration strips were compared with those identified by use of a semi-adjustable articulator, setting the condylar guidance in four different ways: using protrusive wax wafers, by axiography and by adding and subtracting 5 degrees from the value of condylar guidance obtained by protrusive wax wafers. Tolerance to variations of condylar guidance without changing lateral tooth contacts was determined by increasing and decreasing the value of condylar guidance until lateral tooth contacts changed. Different ways of setting condylar guidance on a semi-adjustable articulator give rise to different values of condylar guidance in the same subject. The occlusal repercussions of these variations of condylar guidance values depend on the type of lateral guidance. Canine protection had the greatest tolerance to variations in the setting of condylar guidance without changing lateral occlusal contacts.

[Diagnosis and treatment of the patient with trigeminal neuralgia]. / Diagnóstico y tratamiento del paciente con neuralgia del trigémino.

Neuralgia of the trigeminus (NT) is the most common of cranial nerve neuralgias. Its diagnosis is entirely clinical and its most common form of presentation is well understood. Questions of differential diagnosis can emerge with certain entities such as atypical trigeminal neuralgia, short-duration unilateral neuralgiform cephalea of the trigeminus (SUNCT) arising from injection to the conjunctival, lacrimal or other glands, cluster headache, chronic paroxymal hemicrania, pain arising in the teeth and myofacial pain syndrome. The three main causative factors of NT are compression of the nerve root by an artery in the prepontine space, thereby creating an area of demyelinization, compression of the nerve by a tumor, and multiple sclerosis. The first is the most common of the three. NT can be classified as essential in 10 to 30% of patients. Recent advances in magnetic resonance (MR), and its advantages over other imaging systems, have made MR the diagnostic method of choice. The first treatment is medical and the basic drugs involved can be considered classic. Other therapies have been suggested in recent years, however, and should probably be studied further. Two substances stand out among those proposed: tocainide, an antiarrhythmic drug, and pimozide, an antipsychotic. Surgical treatment of NT can address either the cause (tumor or vascular compression) or symptoms, the latter being indicated when medical treatment fails. Surgery can be performed on peripheral nerves, on the gasserian ganglion and on the posterior fossa. The indications, outcomes and possible complications are quite different for each approach, making choice controversial.