Maternal mental health and children oral health: a literature review.

AIM: Recently, serious considerations regarding mental health conditions and their impact on the whole organism have been made. This area is still quite unknown within the dental community, despite the potential impact these conditions can have on both oral care and health. Previous studies have concluded that both pregnant women and mothers have been found to be particularly sensitive to the risk of developing mental disorders such as anxiety and major depression. There is a very high possibility for the children of these mothers to experience neglect and disregard due to of the development of these conditions, which will negatively affect their behavioural and physical growth as a result. This impact stretches into oral health as well, as these children have been reported to be more inclined to develop early childhood caries, bruxism, and after-birth enamel defects, in addition to illnesses like diabetes and disabilities. MATERIALS: A literature search was conducted in Pubmed, Medline, and Scopus for the keywords 'maternal depression', 'oral health' and 'children', combined with 'AND' or 'OR' Boolean Operators. CONCLUSION: The results of the present literature suggest a strong connection between maternal mental disorders and poor children's oral care, and as a result, dental professionals should be extremely careful when treating and communicating with these patients.

Pain perception in paediatric patients: evaluation of computerised anaesthesia delivery system vs conventional infiltration anaesthesia in paediatric patients.

Aim: The aim of the present study is to compare the effectiveness of a computerised system (QuickSleeper) compared to traditional syringe in injection of local anaesthetic focusing on the perception of anxiety and pain in paediatric patients. Methods: Study design: 100 children aged between 3 and 15 years in need of two dental treatments that required local anaesthesia were selected and treated randomly but alternately with computerised and traditional local anaesthesia. After each anaesthetic injection, patient's anxiety was measured using the Venham test. Results: Electronic anaesthesia showed statistically significant better results than traditional anaesthesia according to the Venham pain scale, in both mandibular and maxillary sites. Statistics: Data were analysed using the paired Wilcoxon test. Conclusion: The computer-assisted anaesthesia system resulted in a significantly lower pain perception score and yielded to helpful, cooperative behaviour. For this reason, it is an advantageous alternative to traditional injection anaesthesia and can avoid invasive treatments and trauma for young patients.

Autoimmune hypoglycaemia caused by alpha-lipoic acid: a rare condition in Caucasian patients.

Insulin autoimmune syndrome (IAS), a rare cause of autoimmune hyperinsulinaemic hypoglycaemia, is relatively well known in Japan. The incidence in Caucasians is less than one-fifth of that reported in Japanese people, but it is becoming increasingly recognised worldwide in non-Asians as well. Drugs containing sulphydryl groups are known to be associated with the disease in genetically predisposed individuals. Moreover, several recent reports showed a direct association between the onset of IAS and the consumption of dietary supplements containing alpha-lipoic acid (LA). Insulinoma remains the most prevalent cause of hypersulinaemic hypoglycaemia in Caucasians. Consequently, primary investigation in these patients is generally focused on localisation of the pancreatic tumour, often with invasive procedures followed by surgery. We described a case of an Italian woman presenting to us with severe recurrent hypoglycaemia associated with high insulin and C-peptide levels and no evidence of pancreatic lesions at imaging diagnostic procedures. She had taken LA until 2 weeks before hospitalisation. After an evaluation of her drug history, an autoimmune form of hypoglycaemia was suspected and the titre of insulin autoantibodies was found to be markedly elevated. This allowed us to diagnose LA-related IAS, thus preventing any unnecessary surgery and avoiding invasive diagnostic interventions. Learning points: IAS is a rare cause of hyperinsulinaemic hypoglycaemia that typically affects Asian population, but it has been increasingly recognised in Caucasian patients. It should be considered among the differential diagnosis of hyperinsulinaemic hypoglycaemia to avoid unnecessary diagnostic investigations and surgery. It should be suspected in the presence of very high serum insulin levels (100-10 000 µU/mL) associated with high C-peptide levels. There is a strong association with administration of drugs containing sulphydryl groups included LA, a dietary supplement commonly used in Western countries to treat peripheral neuropathy.

Cluster categorization of urban roads to optimize their noise monitoring.

Road traffic in urban areas is recognized to be associated with urban mobility and public health, and it is often the main source of noise pollution. Lately, noise maps have been considered a powerful tool to estimate the population exposure to environmental noise, but they need to be validated by measured noise data. The project Dynamic Acoustic Mapping (DYNAMAP), co-funded in the framework of the LIFE 2013 program, is aimed to develop a statistically based method to optimize the choice and the number of monitoring sites and to automate the noise mapping update using the data retrieved from a low-cost monitoring network. Indeed, the first objective should improve the spatial sampling based on the legislative road classification, as this classification is mainly based on the geometrical characteristics of the road, rather than its noise emission. The present paper describes the statistical approach of the methodology under development and the results of its preliminary application to a limited sample of roads in the city of Milan. The resulting categorization of roads, based on clustering the 24-h hourly L Aeqh, looks promising to optimize the spatial sampling of noise monitoring toward a description of the noise pollution due to complex urban road networks more efficient than that based on the legislative road classification.

Comparison of the incidence of intracranial hemorrhage in two different planning techniques for stereotactic electrode placement in the deep brain stimulation.

AIM: Intracranial hemorrhage is an infrequent but potentially devastating complication associated with the placement of electrodes for deep brain stimulation (DBS). The objective of this retrospective review is to compare the risk of hemorrhage before and after the introduction of image-guided neuronavigation for the implant of electrodes for DBS. METHODS: We reviewed all DBS implant performed at our Institute between 1998 and 2010. In 63 of the 106 patients, the targeting was based on ventriculography and merge of CT/MRI. After 2006, in the latter 43 procedures, we introduced targeting based on the merging of angio CT and MRI.. In both implant techniques, microelectrode recording (MER) was used to better define the target. All DBS procedures were performed by a single surgeon (M.P.). Patients had postoperative imaging (MRI or CT) 4-24 h following surgery. RESULTS: In the group of patients implanted with the first targeting technique, 3 hematomas occurred and all of them solved with sequelae (one residual weakness and two hemiplegias.) After the introduction of neuronavigator, 2 hemorrhages occurred, one solved without sequelae while the second resulted in epileptic seizures. CONCLUSION: Although the incidence of hemorrhage occurred before and after the use of neuronavigation is the same, the severity is lower in the neuronavigated procedures. Targeting based on the merging of CT angiography and MRI T1/T2 seemed to increase the safety of the lead placement reducing the risk of sequelae related to bleeding. The use of MER was not found to be correlated with an increased hemorrhage rate.

Acute endovascular treatment (< 48 hours) of uncoilable ruptured aneurysms at non-branching sites using silk flow-diverting devices.

A blood blister-like (BBL) or dissecting aneurysm should be carefully considered if located at a non-branching site of the supra-clinoid internal carotid artery (ICA). Several surgical and endovascular treatment methods have been proposed but they all carry a relatively high risk of morbidity and mortality. This study evaluated the effectiveness of a novel Silk flow-diverting device (SFD) placed in the early acute stage. Three patients presenting with acute subarachnoid haemorrhage caused by small blister-like aneurysms of the carotid siphon were treated within 48 hours after admission by placement of SFDs. More than one device was placed to cover the lesion. None of the patients were premedicated and started anti-platelet therapy during the procedure. All aneurysms were successfully occluded. A good outcome was observed in two out of three treated patients. No thromboembolic or haemorrhagic event occurred during or after the procedures, or during follow-up (6-14 months). SFD prevented rebleeding and the use of these devices could be proposed as an option to treat fragile uncoilable BBL aneurysms, even in the early acute phase without anti-platelet premedication. Larger studies and long-terms results are necessary.

[Unreliability of the clinical diagnosis in deep venous thrombosis of the lower limbs]. / Inaffidabilità della diagnosi clinica di trombosi venosa profonda degli arti inferiori.

277 patients subjected to phlebography for clinically suspect acute deep venous thrombosis of the lower extremities have been examined. Instrumental examination evidenced the presence of thrombosis in 140 of them (50.5%) while in the remaining 137 (49.5%) in whom venography proved negative, it was possible to define the pathologies responsible for the clinical picture in 89% of cases. In out-patients, the incidence of thrombosis proved lower (46%, 65/141 patients) than that presented by patients already hospitalised for other pathologies (55%, 75/136 patients). No significant differences were observed in the incidence of clinical symptoms and signs between patients with thrombosis and patients without at phlebography, while as regards the distribution of risk factors, there was a greater incidence of the following: age over-65, cancers, recent surgery and fractures of the lower extremities in the group of patients suffering from thrombosis. Personal experience would therefore appear to point to the total fallibility of the clinical diagnosis of deep venous thrombosis of the lower extremities and the consequent need for a constant objective instrumental diagnostic approach to this type of pathology.

[Hepatic injury in mitral valvular cardiopathy. Clinical and diagnostic aspects]. / Il danno epatico nella cardiopatia valvolare mitralica. Aspetti clinici e diagnostici.

Liver function was studied in 38 patients with various types of mitral valve disease hospitalised with suspected "cardiac liver". Liver biopsy confirmed the suspicion in 22 cases including 4 with cardiac cirrhosis. The remaining 16 patients had other liver pathologies. No significant differences were noted in the distribution of symptoms, clinical signs and laboratory indices of liver function between the two groups of patients. Among instrumental examinations laparoscopy resulted in a diagnostic accuracy of 89.4% and liver echography of 73% when their results were compared with those of needle biopsy. In other words clinical and laboratory diagnosis of "cardiac liver" was found to be totally unreliable whereas, among instrumental examinations, liver echography proved to be a reasonably efficient alternative to laparoscopy. The diagnostic accuracy of this non-invasive test suggests that it should be used systematically for the screening and follow-up of this type of patients, whereas invasive investigations would be reserved for selected cases.

[Diagnostic aspects and results of drug therapy in pulmonary thromboembolism]. / Aspetti diagnostici e risultati della terapia medica nella tromboembolia polmonare.

Out of a group of 28 patients examined for suspected pulmonary thromboembolism (PTE), the diagnosis was confirmed by angiopneumography in 18 cases. In these patients the symptoms and clinical, electrocardiographical, radiological and scintiphotographical findings corresponded with those reported in the literature. 9 patients were treated with Urokinase (UK) at the dosages recommended by the Food and Drug Administration (FDA), followed by full-dose heparin, and 9 were treated with heparin alone. All patients survived and were discharged undergoing warfarin treatment. Follow-up checks were made after 1 and 6 months. Most of the patients treated with UK showed signs of swift improvement (within 24 hours) in clinical and instrumental terms with no significant haemorrhagic complications. An improvement was also observed in patient treated with heparin alone after the first week of treatment. To conclude: a) clinical diagnosis of PTE is neither sensitive nor specific; b) standard blood tests, electrocardiogram, chest x-ray and lung perfusion scintiphotography display different degrees of sensitivity compared with angiopneumography but all have a poor specificity; c) thrombolytic treatment is safe and effective in selected cases; d) long-term clinical results do not depend on treatment given during the acute stage of the disease.

Do malfunctioning bioprosthetic heart valves represent a potential thrombogenic focus?

In vivo platelet reactivity, expressed by plasma concentration of beta-thromboglobulin (beta TG) and platelet factor 4 (PF4), was determined in 57 patients with bioprosthetic heart valves: 35 had well-functioning bioprostheses (WFBP), while 22 had documented malfunctioning bioprostheses (MFBP). beta TG and PF4 values in patients with WFBP were not significantly different from controls, even when these determinations were repeated at monthly intervals, whereas beta TG and PF4 concentration was significantly higher in patients with MFBP compared to both groups. There was a strong positive correlation between beta TG and PF4 in all subjects studied. Serum lactic dehydrogenase, indirect bilirubin level and reticulocyte count were significantly higher in patients with MFBP than in those with WFBP, but no correlation was found between platelet reactivity and rate of intravascular hemolysis. Our results suggest that there is an increased platelet release in vivo of the platelet-specific proteins in patients with MFBP not related to mechanical damage, and that bioprostheses, at least in a degenerative state, may represent a potential thrombogenic focus.