Symptom dimensions, clinical course and comorbidity in men and women with obsessive-compulsive disorder

The study aimed to compare male and female patients with obsessive-compulsive disorder (OCD) across symptom dimensions, clinical course and comorbidity. A cross-sectional study was undertaken with 858 adult OCD patients (DSM-IV) from the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders. Patients were evaluated using structured interviews, including the Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) and the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). The sample was composed of 504 women (58.7%) and 354 men (41.3%) with a mean age of 35.4 years-old (range: 18-77). Men were younger, more frequently single and presented more tics, social phobia and alcohol use disorders. Among men, symptom interference occurred earlier and symptoms of the sexual/religious dimension were more common and more severe. Conversely, women were more likely to present symptoms of the aggressive, contamination/cleaning and hoarding dimension and comorbidity with specific phobias, anorexia nervosa, bulimia, trichotillomania, skin picking and compulsive buying. In the logistic regression, female gender remained independently associated with the aggressive and contamination/cleaning dimensions. In both genders the aggressive dimension remained associated with comorbid post-traumatic stress disorder, the sexual/religious dimension with major depression and the hoarding dimension with tic disorders. Gender seems to be relevant in the determination of OCD clinical presentation and course and should be considered an important aspect when defining more homogeneous OCD subgroups. © 2012 Elsevier B.V.

Clinical features of pure obsessive-compulsive disorder

Objective Psychiatric comorbidity is the rule in obsessive-compulsive disorder (OCD); however, very few studies have evaluated the clinical characteristics of patients with no co-occurring disorders (non-comorbid or pure OCD). The aim of this study was to estimate the prevalence of pure cases in a large multicenter sample of OCD patients and compare the sociodemographic and clinical characteristics of individuals with and without any lifetime axis I comorbidity. Method A cross-sectional study with 955 adult patients of the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (C-TOC). Assessment instruments included the Yale-Brown Obsessive-Compulsive Scale, the Dimensional Yale-Brown Obsessive-Compulsive Scale, The USP-Sensory Phenomena Scale and the Brown Assessment of Beliefs Scale. Comorbidities were evaluated using the Structured Clinical Interview for DSM-IV Axis I Disorders. Bivariate analyses were followed by logistic regression. Results Only 74 patients (7.7%) presented pure OCD. Compared with those presenting at least one lifetime comorbidity (881, 92.3%), non-comorbid patients were more likely to be female and to be working, reported less traumatic experiences and presented lower scores in the Y-BOCS obsession subscale and in total DY-BOCS scores. All symptom dimensions except contamination-cleaning and hoarding were less severe in non-comorbid patients. They also presented less severe depression and anxiety, lower suicidality and less previous treatments. In the logistic regression, the following variables predicted pure OCD: sex, severity of depressive and anxious symptoms, previous suicidal thoughts and psychotherapy. Conclusions Pure OCD patients were the minority in this large sample and were characterized by female sex, less severe depressive and anxious symptoms, less suicidal thoughts and less use of psychotherapy as a treatment modality. The implications of these findings for clinical practice are discussed. © 2013 Elsevier Inc. All rights reserved.

Evaluation of different treatment methods against denture stomatitis: a randomized clinical study

Objective. The aim of this clinical study was to determine the efficacy of Uncaria tomentosa (cat's claw) against denture stomatitis (DS).Study Design. Fifty patients with DS were randomly assigned into 3 groups to receive 2% miconazole, placebo, or 2% U tomentosa gel. DS level was recorded immediately, after 1 week of treatment, and 1 week after treatment. The clinical effectiveness of each treatment was measured using Newton's criteria. Mycologic samples from palatal mucosa and prosthesis were obtained to determinate colony forming units per milliliter (CFU/mL) and fungal identification at each evaluation period.Results. Candida species were identified with HiCrome Candida and API 20C AUX biochemical test. DS severity decreased in all groups (P < .05). A significant reduction in number of CFU/mL after 1 week (P < .05) was observed for all groups and remained after 14 days (P > .05). C albicans was the most prevalent microorganism before treatment, followed by C tropicalis, C glabrata, and C krusei, regardless of the group and time evaluated. U tomentosa gel had the same effect as 2% miconazole gel.Conclusions. U tomentosa gel is an effective topical adjuvant treatment for denture stomatitis.

Phase II clinical study of an association for the treatment of interstitial cystitis (CYSTEX)

Painful bladder syndrome associated with interstitial cystitis (PBS/IC) is a clinical condition characterized pelvic pain, urinary urgency, and urinary frequency. In this study, 22 patients were assigned to make two visits over a three weeks period. The patients were randomly, double-blinded assigned in two groups. The first group received Cystex® capsules. The second group received placebo capsules. Two capsules were taken three times a day away from meals. The change from baseline in the O’Leary-Sant IC symptom and problem index was the primary outcome parameter. Changes in functional bladder capacity and intensity of pain and urgency have been chosen as secondary outcome parameters. Mood as well as physical and sexual activity were rated by 10 questions on a scale 0 to 6. The ratings were analyzed and the average for each patient in both groups Cystex® and placebo was determined as the quality of life index. For the primary outcome there was a statistically significant difference between the groups. Mean symptom score-sum decreased from 28.4 to 20.5 in the Cystex® group compared with 29.5 to 26.8 in the placebo group (p<0.05). For the secondary end points, pain and urgency intensity improved statistically significantly in the Cystex® group compared with the placebo group (p<0.05). The frequency and functional bladder capacity improved to greater degree in the Cystex® group. The differences were statistically significant for comparison of frequency (p<0.05) and not for functional bladder capacity (p>0.05). In our study, Cystex® enhanced quality of life over the placebo showing a statistically significant. This trial have shown that the efficacy and safety of therapy with Cystex® in the treatment of interstitial cystitis and is an alternative for patients suffering from this pathology. Therefore, it can be concluded that the composition of Cystex®, increased the quality of life in treated patients.

Double-Blind clinical study of a multivitamin and polymineral complex associated with Panax ginseng (Gerovital)

The present study aimed to evaluate the efficacy of a multivitamin and poly minerals supplemented with Panax ginseng extract (Gerovital®) on patients suffering from common physical or mental stress. The study design was controlled, parallel and double blind. Patients were randomly divided in two groups and underwent a thorough clinical and laboratory examination. Group A received placebo capsules and group B received Gerovital® capsules. In both cases, two capsules were taken daily during meals for eight weeks. Mood as well as physical activity were evaluated through a questionnaire assessing quality of life. From the 126 patients enrolled, 12 patients (8 in group A and 4 in group B) were excluded due to voluntary withdrawal, 55 patients completed the study in group A and 59 in group B. The treatment with Gerovital® significantly increased the quality of life when compared to placebo. After 15 days of study no difference between groups was observed. However, at 30th, 45th and 60th day, group B showed a statistically significant increase in average score from 30.05 to 41.96, 47.01 and finally 50.81 points. No increase in body weight was detected in either group. No difference in blood pressure or heart rate was also observed between treatments. The present study has shown that the daily use of Gerovital® over a 2-month period can be effective in improving quality of life in patients suffering from physical and mental stress among individuals of different ages, ranging from adults to elderly. Moreover, its use has been associated to a lower incidence of flu-like seasonal respiratory illnesses. Finally, the incidence of undesired effects was similar to placebo.

Is there difference of Streptococcus mutans count and adherence on amalgam and resin occlusal restorations? A blind clinical study

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Recovering Streptococcus mutans over restorations by the tray technique: a randomized clinical study

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Comparison between noninvasive mechanical ventilation and standard oxygen therapy in children up to 3 years old with respiratory failure after extubation: a pilot prospective randomized clinical study

Objectives: The effectiveness of noninvasive positive-pressure ventilation in preventing reintubation due to respiratory failure in children remains uncertain. A pilot study was designed to evaluate the frequency of extubation failure, develop a randomization approach, and analyze the feasibility of a powered randomized trial to compare noninvasive positive-pressure ventilation and standard oxygen therapy post extubation for preventing reintubation within 48 hours in children with respiratory failure.Design: Prospective pilot study.Setting: PICU at a university-affiliated hospital.Patients: Children aged between 28 days and 3 years undergoing invasive mechanical ventilation for greater than or equal to 48 hours with respiratory failure after programmed extubation.Interventions: Patients were prospectively enrolled and randomly assigned into noninvasive positive-pressure ventilation group and inhaled oxygen group after programmed extubation from May 2012 to May 2013.Measurements and Main Results: Length of stay in PICU and hospital, oxygenation index, blood gas before and after tracheal extubation, failure and reason for tracheal extubation, complications, mechanical ventilation variables before tracheal extubation, arterial blood gas, and respiratory and heart rates before and 1 hour after tracheal extubation were analyzed. One hundred eight patients were included (noninvasive positive-pressure ventilation group, n = 55 and inhaled oxygen group, n = 53), with 66 exclusions. Groups did not significantly differ for gender, age, disease severity, Pediatric Risk of Mortality at admission, tracheal intubation, and mechanical ventilation indications. There was no statistically significant difference in reintubation rate (noninvasive positive-pressure ventilation group, 9.1%; inhaled oxygen group, 11.3%; p > 0.05) and length of stay (days) in PICU (noninvasive positive-pressure ventilation group, 3 [116]; inhaled oxygen group, 2 [1-25]; p > 0.05) or hospital (noninvasive positive-pressure ventilation group, 19 [7-141]; inhaled oxygen group, 17 [8-80]).Conclusions: The study indicates that a larger randomized trial comparing noninvasive positive-pressure ventilation and standard oxygen therapy in children with respiratory failure is feasible, providing a basis for a future trial in this setting. No differences were seen between groups. The number of excluded patients was high.

Maxillary sinus lift without grafting, and simultaneous implant placement: a prospective clinical study with a 51-month follow-up

A prospective clinical study of maxillary sinus lift procedures in the posterior region of the maxilla, using only blood clot as filling material, was conducted. Seventeen patients underwent a maxillary sinus lift procedure; 20 maxillary sinus regions were operated on and a total of 25 implants were placed. The sinus mucosa was lifted together with the anterior wall of the osteotomized maxilla and supported by the implants placed. Computed tomography (CT) scans were obtained immediately postoperative (T-initial) and at 3 (T-1) and 51(T-2) months postoperative for the measurement of linear bone height and bone density (by grey tones). Only one implant was lost in the first stage (96% success). After dental prosthesis placement and during up to 51 months of follow-up, no implant was lost (100% success, second stage). The difference in mean bone height between T-initial (5.94 mm) and T-1 (13.14 mm), and between T-initial and T-2 (11.57 mm), was statistically significant (both P < 0.001); comparison between T-1 and T-2 also presented a statistical difference (P < 0.001). Bone density had increased at the end of the period analyzed, but this was not statistically significant (P > 0.05). Thus, the maxillary sinus lift technique with immediate implant placement, filling with blood clot only, may be performed with a high success rate.

Cutaneous sensibility impairmentafter mandibular sagittal split osteotomy: a prospective clinical study of the spontaneous recovery

Purpose The aim of this prospective study was to objectively evaluate the inferior alveolar nerve (IAN) sensory disturbances in patients who underwent sagittal split ramus osteotomy (SSRO) and its spontaneous recovery and to define the incidence of sensibility loss, time, and area at which the recovery occurs. Patients and Methods Clinical evaluation of the IAN sensory disturbance was undertaken preoperatively and at the first week, fourth week, 2 months, and 6 months postoperatively in 30 patients who underwent SSRO at the Oral and Maxillofacial Surgery Division of the Araraquara Dental School--Unesp and at the Plastic Surgery Division of the Medical Sciences School--Unicamp. The 30 patients were examined at all periods regarding the IAN functionality by Semmes-Weinstein testing. Results The mean age of the patients included in this study was 29.36 years old. All patients showed sensibility loss at the 7-day evaluation time. The comparison between sides, gender, and age did not show any significant difference. In most of the examined zone, the data collected at 6 months were statistically similar to the data collected at the preoperative period. All zones presented significant recovery, starting from 30 days after surgery. Twenty patients had total spontaneous recovery at the final period, in all examined zones. Conclusions The SSRO presents the disadvantage of temporary paresthesia; however, spontaneous nerve function recovery does occur. The Semmes-Weinstein test is a reliable, inexpensive, and easy-to-apply tool, which can be used for clinical evaluation on a daily basis at offices and hospitals.

Isoflurane and propofol contribute to increasing the antioxidant status of patients during minor elective surgery: a randomized clinical study

Isoflurane is a volatile halogenated anesthetic used especially for anesthesia maintenance whereas propofol is a venous anesthetic utilized for anesthesia induction and maintenance, and reportedly an antioxidant. However, there are still controversies related to isoflurane-induced oxidative stress and it remains unanswered whether the antioxidant effects occur in patients under propofol anesthesia.Taking into account the importance of better understanding the role of anesthetics on oxidative stress in anesthetized patients, the present study was designed to evaluate general anesthesia maintained with isoflurane or propofol on antioxidant status in patients who underwent minimally invasive surgeries.We conducted a prospective randomized trial in 30 adult patients without comorbidities who underwent elective minor surgery (septoplasty) lasting at least 2 h admitted to a Brazilian tertiary hospital.The patients were randomly allocated into 2 groups, according to anesthesia maintenance (isoflurane, n = 15 or propofol, n = 15). Peripheral blood samples were drawn before anesthesia (baseline) and 2-h after anesthesia induction.The primary outcomes were to investigate the effect of either isoflurane or propofol anesthesia on aqueous plasma oxidizability and total antioxidant performance (TAP) by fluorometry as well as several individual antioxidants by high-performance liquid chromatography. As secondary outcome, oxidized genetic damage (7,8-dihydro-8-oxoguanine, known as 8-oxo-Gua) was investigated by the comet assay.Both anesthesia techniques (isoflurane or propofol) for a 2-h period resulted in a significant decrease of plasma α-tocopherol, but not other antioxidants including uric acid, carotenoids, and retinol (P > 0.05). Propofol, in contrast to isoflurane anesthesia, significantly increased (P < 0.001) anti-inflammatory/antioxidant plasma γ-tocopherol concentration in patients. Both anesthesia types significantly enhanced hydrophilic antioxidant capacity and TAP, with no significant difference between them, and 8-oxo-Gua remained unchanged during anesthesia in both groups. In addition, both anesthetics showed antioxidant capacity in vitro.This study shows that anesthesia maintained with either propofol or isoflurane increase both hydrophilic and total antioxidant capacity in plasma, but only propofol anesthesia increases plasma γ-tocopherol concentration. Additionally, both types of anesthetics do not lead to oxidative DNA damage in patients without comorbidities undergoing minimally invasive surgery.

Clinical study on survival rate of short implants placed in the posterior mandibular region: resonance frequency analysis

Short implants are increasingly used, but there is doubt about their performance being similar to that of regular implants. The aim of this study was to compare the mechanical stability of short implants vs. regular implants placed in the edentulous posterior mandible. Twenty-three patients received a total of 48 short implants (5 × 5.5 mm and 5 × 7 mm) and 42 regular implants (4 × 10 mm and 4 × 11.5 mm) in the posterior mandible. Patients who received short implants had <10 mm of bone height measured from the bone crest to the outer wall of the mandibular canal. Resonance frequency analysis (RFA) was performed at time intervals T0 (immediately after implant placement), T1 (after 15 days), T2 (after 30 days), T3 (after 60 days), and T4 (after 90 days). The survival rate after 90 days was 87.5% for the short implants and 100% for regular implants (P < 0.05). There was no significant difference between the implants in time intervals T1, T2, T3, and T4. In T0, the RFA values of 5 × 5.5 implants were higher than values of 5 × 7 and 4 × 11.5 implants (P < 0.05). A total of six short implants that were placed in four patients were lost (three of 5 × 5.5 mm and three of 5 × 7 mm). Three lost implants started with high ISQ values, which progressively decreased. The other three lost implants started with a slightly lower ISQ value, which rose and then began to fall. Survival rate of short implants after 90 days was lower than that of regular implants. However, short implants may be considered a reasonable alternative for rehabilitation of severely resorbed mandibles with reduced height, to avoid performing bone reconstruction before implant placement. Patients need to be aware of the reduced survival rate compared with regular implants before implant placement to avoid disappointments.

Comparative clinical study of the effectiveness of different dental bleaching methods - two year follow-up

This study evaluated color change, stability, and tooth sensitivity in patients submitted to different bleaching techniques. Material and methods: In this study, 48 patients were divided into five groups. A half-mouth design was conducted to compare two in-office bleaching bleaching techniques (with and without light activation): G1: 35% hydrogen peroxide (HP) (Lase Peroxide - DMC Equipments, Sao Carlos, SP, Brazil) + hybrid light (HL) (LED/Diode Laser, Whitening Lase II DMC Equipments, Sao Carlos, SP, Brazil); G2: 35% HP; G3: 38% HP (X-traBoost - Ultradent, South Jordan UT, USA) + HL; G4: 38% HP; and G5: 15% carbamide peroxide (CP) (Opalescence PF - Ultradent, South Jordan UT, USA). For G1 and G3, HP was applied on the enamel surface for 3 consecutive applications activated by HL. Each application included 3x3' HL activations with 1' between each interval; for G2 and G4, HP was applied 3x15' with 15' between intervals; and for G5, 15% CP was applied for 120'/10 days at home. A spectrophotometer was used to measure color change before the treatment and after 24 h, 1 week, 1, 6, 12, 18 and 24 months. A VAS questionnaire was used to evaluate tooth sensitivity before the treatment, immediately following treatment, 24 h after and finally 1 week after. Results: Statistical analysis did not reveal any significant differences between in-office bleaching with or without HL activation related to effectiveness; nevertheless the time required was less with HL. Statistical differences were observed between the result after 24 h, 1 week and 1, 6, 12, 18 and 24 months (integroup). Immediately, in-office bleaching increased tooth sensitivity. The groups activated with HL required less application time with gel. Conclusion: All techniques and bleaching agents used were effective and demonstrated similar behaviors.

Acellular dermal matrix graft with or without enamel matrix derivative for root coverage in smokers: a randomized clinical study

Aim: The aim of this randomized controlled clinical study was to compare the use of an acellular dermal matrix graft (ADMG) with or without the enamel matrix derivative (EMD) in smokers to evaluate which procedure would provide better root coverage. Material and Methods: Nineteen smokers with bilateral Miller Class I or II gingival recessions >= 3 mm were selected. The test group was treated with an association of ADMG and EMD, and the control group with ADMG alone. Probing depth, relative clinical attachment level, gingival recession height, gingival recession width, keratinized tissue width and keratinized tissue thickness were evaluated before the surgeries and after 6 months. Wilcoxon test was used for the statistical analysis at significance level of 5%. Results: No significant differences were found between groups in all parameters at baseline. The mean gain recession height between baseline and 6 months and the complete root coverage favored the test group (p = 0.042, p = 0.019 respectively). Conclusion: Smoking may negatively affect the results achieved through periodontal plastic procedures; however, the association of ADMG and EMD is beneficial in the root coverage of gingival recessions in smokers, 6 months after the surgery.

A Randomized comparative clinical study of two surgical procedures to improve root coverage with the acellular dermal matrix graft

Aim This randomized, controlled, clinical study compared two surgical techniques for root coverage with the acellular dermal matrix graft (ADMG) to evaluate which procedure could provide better root coverage and greater amounts of keratinized tissue. Materials and Methods Fifteen pairs of bilateral Miller Class I or II gingival recessions were treated and assigned randomly to the test group, and the contra-lateral recessions were assigned to the control group. The ADMG was used in both groups. In the control group, the graft and flap were positioned at the level of the cemento-enamel junction (CEJ), and in the test group, the graft was positioned 1 mm apical to the CEJ and the flap 1 mm coronal to the CEJ. The clinical parameters were taken before the surgeries and after 6 months. The gingival recession area, a new parameter, was measured in standardized photographs through a special device and software. Results There were statistically significant differences favouring the proposed technique for all parameters except for the amount of keratinized tissue at 6 months. Conclusions The proposed test technique is more suitable for root coverage procedures with ADMG, and the new parameter evaluated appears valuable for root coverage analysis. (Clinicaltrials.gov Identifier: NCT01175720).