Clinical study on the efficacy of LED phototherapy for pain control in an orthodontic procedure.

Pain is an unpleasant and emotional subjective sensory experience that occurs during orthodontic procedures. Currently, LED phototherapy is an alternative to the use of laser light as analgesic agent due to similarity of response and lower cost. This case-control, quantitative, qualitative, and longitudinal study aimed to investigate the effect of IR LED phototherapy (λ846 ± 20 nm) in pain during the process of tooth separation during orthodontic treatment. After approval by the Institution Ethics Committee, 40 patients (30 female/10 male, 20-30 years old, average age 24.5 ± 2.6 years old) fulfilling the inclusion criteria entered the study and received a set of four visual analog scales (VAS) for scoring pain immediately, 48 h, 72 h, and 7 days after the insertion of the separating elastics. The patients were randomly distributed into two groups (experimental and control). The patients of experimental group received LED phototherapy (180 mW, 22 s, 4 J, 8 J/cm2, 0.36 W/cm2, spot of 0.5 cm2, spot diameter 0.8 cm) at the same times in which VAS was performed, and control patients were not irradiated. It was found that, in both groups, there was an increase in pain 48 h after insertion of the elastic tooth separator, decreasing 72 h after its installation and reached the lowest level of pain after 7 days. Comparison between groups showed that pain level in the LED group was always statistically significantly lower (p < 0.05), except for the time of installation (T1). The use of LED light was effective in significantly reducing the level of pain after insertion of the elastic tooth separators when compared to the control group.

Immobility reactions under threat: A contribution to human defensive cascade and PTSD.

Violence exacts a burden on public health. Gun violence is a major trigger for motor defensive reactions in humans and post-traumatic stress disorder (PTSD) is its main psychiatric sequela. However, studies of the human defensive cascade, especially the motor reactions, are at an early stage. This review focuses on studies that employ stabilometry, a methodology that assesses whole body motor reactions, to address defensive behaviors to violence-related threats. Special attention is given to three reactions: "attentive immobility", "immobility under attack" and "tonic immobility", with emphasis on the latter - a peritraumatic reaction which has been strongly associated with the severity of PTSD. These reactions are characterized by reduced body sway and bradycardia, except tonic immobility that presents robust tachycardia. The advances made by investigations into the immobility reactions of the human defensive cascade contribute to helping to bridge the gap between human and non-human species. Furthermore, progresses in basic research to objectively monitor motor defensive reactions under threat can help to develop a dimensional, trans-diagnostic approach to PTSD.

Polyphenols journey through blood-brain barrier towards neuronal protection.

Age-related complications such as neurodegenerative disorders are increasing and remain cureless. The possibility of altering the progression or the development of these multifactorial diseases through diet is an emerging and attractive approach with increasing experimental support. We examined the potential of known bioavailable phenolic sulfates, arising from colonic metabolism of berries, to influence hallmarks of neurodegenerative processes. In silico predictions and in vitro transport studies across blood-brain barrier (BBB) endothelial cells, at circulating concentrations, provided evidence for differential transport, likely related to chemical structure. Moreover, endothelial metabolism of these phenolic sulfates produced a plethora of novel chemical entities with further potential bioactivies. Pre-conditioning with phenolic sulfates improved cellular responses to oxidative, excitotoxicity and inflammatory injuries and this attenuation of neuroinflammation was achieved via modulation of NF-κB pathway. Our results support the hypothesis that these small molecules, derived from dietary (poly)phenols may cross the BBB, reach brain cells, modulate microglia-mediated inflammation and exert neuroprotective effects, with potential for alleviation of neurodegenerative diseases.

Parenteral nutrition and cyclosporine: do lipids make a difference? A prospective randomized crossover trial.

AIMS: This prospective, controlled, randomized crossover trial was conducted to assess the effects of parenteral nutrition, with or without lipids, in cyclosporine (CyA) pharmacokinetics. METHODS: 10 adult patients were randomized on the day of allogeneic bone marrow transplantation to receive isocaloric and isonitrogenous parenteral nutrition admixtures without (regimen A) or with lipids (regimen B). Admixtures were started on average by day + 7.4; 5 patients received regimen A followed by B, 5 in reverse order. Blood samples were collected at day 4 after transplantation, under oral diet, and 4 days after the initiation of each regimen as the sole nutrition support. At each time point, 8 whole blood samples were analysed for CyA to evaluate: area under the curve (AUC), trough concentration and systemic clearance. Clinical/laboratory events were recorded until 31 months of follow-up. RESULTS: There was no evidence of a period or treatment-by period interaction, thus results were combined for further analysis. There were no statistically significant differences between regimens in any CyA pharmacokinetic parameters; there were no significant differences from baseline values, except for a higher systemic clearance of CyA with regimen A (0.40+/-0.09 vs 0.29+/-0.06 L/Kg/h, p=0.03). CONCLUSIONS: The provision of 0.8 g/Kg/d of a 50:50 mixture of medium and long chain triglycerides did not affect CyA parameters, which were closer to baseline. In the short or long term there were no attributable side effects.

Smoking and psychiatric disorders: a comorbidity survey.

Epidemiological and clinical studies have shown a positive correlation between smoking and psychiatric disorders. To investigate the prevalence of cigarette smoking, 277 psychiatric outpatients with anxiety or depressive disorders (DSM-IV) answered a self-evaluation questionnaire about smoking behavior and were compared with a group of 68 control subjects. The diagnoses (N = 262) were: 30.2% (N = 79) major depressive disorder, 23.3% (N = 61) panic disorder, 15.6% (N = 41) social anxiety disorder, 7.3% (N = 19) other anxiety disorders, and 23.7% (N = 62) comorbidity disorders. Among them, 26.3% (N = 69) were smokers, 23.7% (N = 62) were former smokers and 50.0% (N = 131) were nonsmokers. The prevalence of nicotine dependence among the smokers was 59.0% (DSM-IV). The frequency of cigarette smoking did not show any significant difference among the five classes of diagnosis. The social anxiety disorder patients were the heaviest smokers (75.0%), with more unsuccessful attempts to stop smoking (89.0%). The frequency of former smokers was significantly higher among older subjects and nonsmokers were significantly younger (chi2 = 9.13, d.f. = 2, P = 0.01). Our data present some clinical implications suggesting that in our psychiatric outpatient sample with anxiety disorder, major depression and comorbidity (anxiety disorder and major depression), the frequency of cigarette smoking did not differ from the frequency found in the control group or in general population studies. Some specific features of our population (outpatients, anxiety and depressive disorders) might be responsible for these results.

Pharmacotherapy of dysthymia: review and new findings.

Open trials with tricyclics, classical monoamine oxidase inhibitors (MAOIs) or lithium in dysthymia yielded a response rate in 45% of subjects. A long-term treatment of dysthymia with 276 patients treated during 4 years with either moclobemide, tranylcypromine or a combination of amitryptiline plus chlordiazepoxide is described. After discontinuation there was a relapse rate of 89.1%. The controlled studies with tricyclics, MAOIs, reversible inhibitors of monoamine oxidase (RIMAs), specific serotonin reuptake inhibitor (SSRIs) or benzamides showed that drugs well-tolerated work better in dysthymia, due to the fact that the treatment must be long-term. Sertraline was studied vs placebo or imipramine in primary dysthymia. Moclobemide, imipramine and placebo were also studied in 315 patients. Mean doses were 650 mg/d of moclobemide and 203.2 mg/d of imipramine. Moclobemide and sertraline were both efficacious and well tolerated. In a long term treatment the clinician should assess the risk-benefit ratio. Dysthymic patients are very sensitive to unwanted effects and compliance is a serious issue.

Negative affect as a predisposing factor for cortisol release after an acute stress--the impact of unpleasant priming.

Glucocorticoids have a key role in stress responses. There are, however, substantial differences in cortisol reactivity among individuals. We investigated if affective trait and mood induction influence the reactivity to psychological stress in a group of 63 young adults, male (n=27) and female (n=36), aged ca. 21 years. On the experimental day the participants viewed either a block of pleasant or unpleasant pictures for 5 min to induce positive or negative mood, respectively. Then, they had 5 min to prepare a speech to be delivered in front of a video-camera. Saliva samples were collected to measure cortisol, and questionnaire-based affective scales were used to estimate emotional states and traits. Compared to basal levels, a cortisol response to the acute speech stressor was only seen for those who had first viewed unpleasant pictures and scored above the average on the negative affect scale. There were no sex differences. In conclusion, high negative affect associated with exposure to an unpleasant context increased sensitivity to an acute stressor, and was critical to stimulation of cortisol release by the speech stressor.

Resilience and vagal tone predict cardiac recovery from acute social stress.

Previous studies showed that heart period decreases during and recovers after an acute stress. We investigated if individual predispositions and emotional priming influence heart period recovery after a speech stress task. Psychometric scales and resting cardiac vagal tone were used to measure individual traits. The presentation of a sequence of either pleasant or unpleasant pictures, as emotional primers, preceded the speech stress. Heart period was measured throughout the experiment. Stress induced tachycardia irrespective of emotional priming or traits. In the recovery period, participants with higher resting cardiac vagal tone or presenting higher resilience significantly reduced the heart acceleration. Furthermore, these traits interacted synergistically in the promotion of the recovery of heart period. Pleasant priming also improved recovery for participants with lower negative affect. In conclusion, the stress recovery measured through heart period seemed dependent upon individual predispositions and emotional priming. These findings further strengthen previous observations on the association between greater cardiac vagal tone and the ability to regulate emotion.

Sexual dysfunction: a neglected complication of panic disorder and social phobia.

Little is known about sexual dysfunctions comorbid with anxiety disorder. The aim of this study is to evaluate retrospectively the sexual function of social phobic patients in comparison with a panic disorder sample. Using a semistructured interview (SCID-I), 30 patients with social phobia and 28 patients with panic disorder were examined. The DSM-IV criteria were employed to diagnose sexual dysfunctions in this sample; however, the "C" criterion, which states that "the sexual dysfunction cannot be related to other Axis I disorders," was excluded. Panic disorder patients reported a significantly greater proportion of sexual disorders compared with social phobics: 75% (21/28) vs. 33.3% (10/30) (p = .0034). Sexual aversion disorder was the most common sexual dysfunction in both male (35.7%; 5/14) and female (50%; 7/14) panic disorder patients, and premature ejaculation was the most common sexual dysfunction in male social phobic patients: 47.4% (9/19). These results suggest that sexual dysfunctions are frequent and neglected complications of social phobia and panic disorder.

Tolerability of moclobemide, a new reversible inhibitor of monoamine oxidase-A, compared with other antidepressants and placebo.

Moclobemide, a new selective and reversible inhibitor of monoamine oxidase A (RIMA), has been compared with various tricyclic antidepressants (TCAs) in numerous controlled studies. Pooled data from these studies, comprising 1656 patients, as well as the consideration of individual trials, show that moclobemide is far better tolerated than the TCAs. Its side effects mainly comprise mild degrees of nausea and dizziness at the beginning of treatment in a small proportion of patients. Age and sex do not affect the tolerability of moclobemide: it is equally well tolerated by elderly patients. In 2300 patients treated with moclobemide in doses up to 600 mg/day, without dietary restrictions, there was no tyramine-related hypertensive reaction. It is concluded that moclobemide may be the second-generation antidepressant doctors were waiting for--equally effective as the classical antidepressants but far better tolerated.

Smoking and psychiatric disorders: a comorbidity survey

Epidemiological and clinical studies have shown a positive correlation between smoking and psychiatric disorders. To investigate the prevalence of cigarette smoking, 277 psychiatric outpatients with anxiety or depressive disorders (DSM-IV) answered a self-evaluation questionnaire about smoking behavior and were compared with a group of 68 control subjects. The diagnoses (N = 262) were: 30.2 percent (N = 79) major depressive disorder, 23.3 percent (N = 61) panic disorder, 15.6 percent (N = 41) social anxiety disorder, 7.3 percent (N = 19) other anxiety disorders, and 23.7 percent (N = 62) comorbidity disorders. Among them, 26.3 percent (N = 69) were smokers, 23.7 percent (N = 62) were former smokers and 50.0 percent (N = 131) were nonsmokers. The prevalence of nicotine dependence among the smokers was 59.0 percent (DSM-IV). The frequency of cigarette smoking did not show any significant difference among the five classes of diagnosis. The social anxiety disorder patients were the heaviest smokers (75.0 percent), with more unsuccessful attempts to stop smoking (89.0 percent). The frequency of former smokers was significantly higher among older subjects and nonsmokers were significantly younger (chi² = 9.13, d.f. = 2, P = 0.01). Our data present some clinical implications suggesting that in our psychiatric outpatient sample with anxiety disorder, major depression and comorbidity (anxiety disorder and major depression), the frequency of cigarette smoking did not differ from the frequency found in the control group or in general population studies. Some specific features of our population (outpatients, anxiety and depressive disorders) might be responsible for these results

Dysthymia - Review - New Findings - Treatment Guindelines

Open trials with tricyclics, classical MAOIs or Lithium in dysthymia yielded a response rate in 45 per cent of subjects. A liong-term treatment of dysthymia with 276 patients treated during four years with eithermoclobemide,tranylcypromine or a combination of amitryptiline plus chlordiazepoxide is described. After discontinuation there was a relapse rate of 89.1 per cent. The controlled studies with tricycles, classical MAOIs, RIMAs, SSRs or benzamides showed that drugs well tolerated work better in dyathymia, due to the fact that the treatment has to be long-term. Sertraline was studied versus placebo or imipramine in primary dysthymia. Moclobemide, imipramine and polacebo were also studied in 315 patients. Mean doses were 650.0 mg-day of moclobemide, 203.2 mg-day of imipramine. Moclobemide and sertraline were both efficacious and well tolerated. In a long term treatment the clinician should assess the risk-benefit ratio. Dysthymic patients are very sensitive to unwanted effects and compliance is a serious issue