Chronic Orofacial Pain: Burning Mouth Syndrome and Other Neuropathic Disorders

Chronic orofacial pain is a symptom associated with a wide range of neuropathic, neurovascular, idiopathic, and myofascial conditions that affect a significant proportion of the population. While the collectiveimpact of the subset of the orofacial pain disorders involving neurogenic and idiopathic mechanisms is substantial, some of these are relatively uncommon. Hence, patients with these disorders can be vulnerable to misdiagnosis, sometimes for years, increasing the symptom burden and delaying effective treatment. This manuscript first reviews the decision tree to be followed in diagnosing any neuropathic pain condition, as well as the levels of evidence needed to make a diagnosis with each of several levels of confidence: definite, probable, or possible. 

It then examines the clinical literature related to the idiopathic and neurogenic conditions that can occasion chronic orofacial pain, including burning mouth syndrome, trigeminal neuralgia, glossopharyngeal neuralgia, post-herpetic neuralgia, and atypical odontalgia. Temporomandibular disorders also are examined, even though they are not neurologic conditions, because they are common and can mimic symptoms of the latter disorders. For each of these conditions, the paper reviews literature regarding incidence and prevalence, physiologic and other contributing factors, diagnostic signs and symptoms, and empirical evidence regarding treatments. Finally, in order to improve the quality and accuracy of clinical diagnosis, as well as the efficiency with which effective treatment is initiated and delivered, criteria are offered that can be instrumental in making a differential diagnosis.(Read more)

Accidental Ethanol Ingestion in a 32 Day Old Infant.

We report a case of a 32 day old previously healthy male who presented to an outside hospital in the early morning with chief complaint of "not acting normal". The mother reported that she woke up at 4am and prepared a 4 ounce bottle of formula with Enfamil and water for the baby, andthe baby drank 3 ounces of the formula. Approximately an hour later, she observed that the baby was not acting right. The baby was having excessive oral secretions, shaking his arms up and down, and was agitated. 

The father later recalled that he had left clear undiluted gin that he had shared with his friend earlier that evening in a disposable water bottle on the nightstand next to the formula powder. Waking up in the middle of the night and mistaking it for water, the mother then used the alcohol while mixing the patient’s formula. The patient was immediately taken to an outside hospital.(Read more)

Mechanisms of Toxicity which Impact on Risk Assessment and Safety Evaluation.

Toxicology study aimed to understand the mechanisms of toxicity which impact on risk assessment and safety evaluation. Xenobiotic due to industrialization have hugeadverse effects on human and animal health. Toxicological studies are having great importance in marking the relationship between dose and its effects on the exposed organism. In the previous volume 2 issue 2 of the journal comprised of 4 research article and a short communication received across the globe.

Municipal effluents are complex mixtures of contaminants such as polycyclic aromatic and aliphatic hydrocarbons, heavy metals, pesticides and pharmaceutical along with microorganisms which are a major source of contamination to aquatic biota. The purpose of Gagnes study was to assess the effects of dietary zinc oxide nanoparticles in adult fathead minnows. For assessing the immunocompetence leucocyte viability, phagocytosis activity, oxidative stress and DNA strand breaks in gills methods were employed. The results reveals that ingested nanoparticles could affect the immune system of fish exposed to municipal wastewaters in comparison with non-exposed fish, and exposed fishes were more vulnerable to pathogenic microorganisms.(Read More)

Welcome Editorial Advances in Gynaecological Ultrasound

It gives me great pleasure to welcome our readers to an exciting issue of JBR Journal of Clinical Diagnosis and Research to start the New Year.The related articles on Advances in GynecologicalUltrasound will include screening and diagnosis of mullerian congenital anomalies, screening and diagnosis of uterine cancer, menopause and ultrasound in infertility.

Many debates surrounded the most appropriate approach of mullerian anomalies diagnosis. In congenital uterine anomalies 3D ultrasound is critical in reaching the correct diagnosis, by means of assessing the coronal plane of the uterus. Canalization defects reduce fertility and increase rates of miscarriage and preterm delivery. Unification defects seem to preserve fertility, but some are associated with miscarriage and preterm delivery. Arcuate uteri seem associated with second-trimester miscarriage. All uterine anomalies increase the chance of fetal malpresentation at delivery.(Read More)

Preparation with Mechanical Bowel Cleansing or/and Oral Antibiotics or Nothing for Elective Colorectal Surgery: Two-Two-Arm Multicentre Randomised Controlled Studies (MECCLANT –C and –R Trials)

During almost all the 20^th century and practically based on observational studies and experts opinion, mechanical bowel preparation (MBP) has been considered as necessary prior to colorectal surgery, in order to remove gross faecal and bacteria colonic load and thus to prevent anastomotic leakage and reduce septic postoperative complications. 

However, several more recent randomised clinical trials, meta-analyses, systematic reviews and surveys have consistently shown that MBP does not prevent either anastomotic leakage or surgical site infection (SSI), and does not reduce immediate postoperative morbidity or. Furthermore, MBP is costly, time consuming, harmful and unpleasant for the patient, and also impedes implementation of enhanced recovery programmes. As a result of the aforementioned evidence,it is recommended that MBP for colorectal surgery must be abandoned.(Read more)

Very Late-Onset Neutropenia in a Japanese Schizophrenia Patient Treated with Clozapine

The patient was a 46-year-old Japanese man who had met the DSMIV diagnosis of schizophrenia, disorganized-type, for the prior 30 years. He had been on antipsychotic regimens since being diagnosed when he was 16 years old. He had been treated with therapeutic doses of sulpiride, haloperidol, levomepromazine, risperidone, olanzapine, aripiprazole, or lithium on several occasions, after which the treatments were stopped due to inadequate treatment response. 

After that, clozapine was started during his eighth hospitalization in 33-year-old in which he was brought to the hospital for persistent auditory hallucinations, monologia, persecutory delusion aggressiveness, and psychomotor excitement. (Read more)

Cardiac Troponin I Levels in Children with Acute Severe Asthma Treated with IV Salbutamol

Acute severe asthma attacks in children are life-threatening emergencies. With appropriate and prompt treatment most children recover uneventfully. When complications occur, they are usually a consequence of disease progression and/or its treatment. Established cardiac complications associated with acute asthma treatment in children include supraventricular tachycardia (SVT) and acute coronary ischaemia. 

More recently, two groups have reported elevated cardiac troponin I (CTnI) levels in children treated foracute asthma. In this case series, the raised levels of CTnI were not generally accompanied by overt symptoms or signs of coronary ischaemia. Following an index case of a child with acute severe asthma who developed acute coronary ischaemia in association with elevated CTnI levels and IV salbutamol therapy, our local policy has been to screen/monitor patients on continuous IV salbutamol for cardiac ischaemia using blood CTnI levels. Here, we report our observations of CTnI levels in children treated with intravenous (IV) salbutamol for acute severe asthma.

This is a retrospective audit of routine clinical practice. The case mix comprises of children treated for acute severe asthma with IV salbutamol at the Leicester Royal Infirmary between September 2012 and April 2013. All children with severe asthma are managed in adjoining high dependency care or intensive care units. Patients with severe asthma were identified using ward admission databases.

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