The evaluation of psychiatric drug therapy on oral lichen planus patients with psychiatric disorders

Objectives: Current treatments of oral lichen planus are palliative, not curative. Because psychiatric disorders significantly influence the development and severity of oral lichen planus, the use of psychiatric drug therapy may be an adjunct in treatment. The purpose of this study was to determine the efficacy of drug therapy of psychiatric disorders in oral lichen planus. Study design: Our controlled clinical study consisted of forty-six patients with oral lichen planus and psychiatric disorders who were randomly divided into two groups. Both groups were given topical corticosteroids and the study group received additional psychiatric drug therapy. Patients were monitored for a period of 6 months. Response to treatment was evaluated in each group and was compared with the other group using Mann-Whitney tests. We evaluated the correlation between psychiatric disorders and the recovery of oral lesions using Spearman?s correlation coefficient analysis. Results: Decrease in the size of the lesions was significantly greater in the study group after six months, but this difference was not significant in relationship to the pain experienced and the kind of lesion. Spearman?s correlation coefficient analysis demonstrated that, in the sixth month, there was a significant and direct relationship between recovery from the psychiatric disorders and response to treatment of OLP lesions, particularly as it pertained to the kind of lesion. Conclusion: The present study indicates that the combination of psychiatric drug therapy and routine treatment methods were effective in reducing the size of the lesions, but did not have any significant effect on the symptoms

Ataxia in Childhood: Epidemiological, Clinical and Neuroradiologic Features, and the Risk of Recurrence

How to Cite This Article: Javadzadeh M, Hassanvand Amouzadeh M, Sadat Esmail Nejad Sh, Abasi E, Alipour A, Mollamohammadi M. Ataxia in Childhood:Epidemiological, Clinical and Neuroradiologic Features, and the Risk of Recurrence. Iran J Child Neurol.Summer 2017; 11(3):1-6.AbstractObjectiveThis study was conducted on the demographic data, clinical characteristics, electroencephalography, neuroradiological findings, and their impact on the recurrence of ataxia. Materials & MethodsA 3-yr retrospective review of 49 children with ataxia in Mofid Children Hospital, Tehran, Iran was conducted from Apr 2013 to Apr 2016.The demographic, clinical and paraclinical data were recorded in pre-preparedquestionnaires. The patients were also classified in two groups of with or without recurrence and the results were compared. The diagnostic etiologies in our patients were classified as brain tumor, drug ingestion, encephalitis, postinfectious immune-mediated disorders, pseudoataxia, trauma, congenital malformations of the central nervous system and hereditary ataxias. ResultsForty-nine children with ataxia were enrolled. The mean age of the patients with a recurrence of ataxia was more than those without a recurrence.Neurodevelopmental delay in patients with recurrence was more frequent than those without a recurrence. Abnormal findings in the neuroimaging were seen more in the patients with recurrence than those without recurrence. The most common cause of ataxia in patients with recurrence was hereditary ataxia and in patients without recurrence was a viral post infectious disorder. ConclusionAfter a mean follow-up period of 16.36 months (range: 2-37 months), 9 cases (18.4%) showed recurrence. Older age, abnormal neuroimaging, and neurodevelopmental delay should be considered as the risk factors of recurrence of ataxia in children. References1.Piña-Garza JE. Ataxia. In: Piña-Garza JE, editor. Fenichel’s clinical pediatric neurology. 7th ed. Philadelphia: Elsevier Saunders;2013.p.215-35.2.Konczak J, Timmann D. The effect of damage to the cerebellum on sensorimotor and cognitive function in children and adolescents. Neurosci Biohav Rev 2007; 31: 1101-1113.3.Jafar-Nejad P, Maricich SM, Zoghbi HU. The Cerebellum and the Hereditary Ataxias. In: Swaiman KF, Ashwal S, Ferriero DM, Schor NF, editors. Swaiman’s Pediatric Neurology. 5th ed. Philadelphia: Elsevier Saunders;2012.p.939-64.4.Mink JW. Movement Disorders. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, editors. Nelson Textbook of Pediatrics. 20th ed. Philadelphia: Elsevier;2016.p.2882-96.5.Musselman KE, Stoyanov CT, Marasigan R, Jenkins ME, Konczak J, Morton SM, et al. Prevalence of ataxia in children: a systematic review. Neurology 2014; 82(1):80-9.6.Martínez-González MJ, Martínez-González S, García-Ribes A, Mintegi-Raso S, Benito-Fernández J, Prats-Viñas JM. Acute onset ataxia in infancy: its aetiology, treatment and follow-up. Rev Neurol 2006; 42(6):321-4.7.Benini R, Ben Amor IM, Shevell MI.Clinical clues to differentiating inherited and noninherited etiologies of childhood ataxias. J Pediatr 2012; 160(1):152-7.8.Karimzadeh P, Ghofrani M. A Survey on 100 Children with Acute Ataxia in Mofid Children Hospital Tehran, Iran. Iran RJ 2003; 4(1):7-13.(Full Text in Persian)9.Farghaly WM, El-Tallawy HN, Shehata GA, Rageh TA, Hakeem NA, Abo-Elfetoh NM. Population-based study of acquired cerebellar ataxia in Al-Kharga district, New Valley, Egypt. Neuropsychiatr Dis Treat 2011; 7:183.10.Ryan MM, Engle EC. Acute ataxia in childhood. J Child Neurol 2003; 18(5):309-16.11.Nafissi S, Maghdouri A, Sikaroodi H, Hosseini SS. Epidemiology of Cerebellar Ataxia on the Etiological Basis: A Cross Sectional Study. Acta Medica Iranica 2009; 47(6):465-8.12.Esscher E, Flodmark O, Hagberg G, Hagberg B. Non-progressive ataxia: origins, brain pathology and impairments in 78 swedish children. Dev Med Child Neurol 1996; 38(4):285-96.13.Salman MS, Lee EJ, Tjahjadi A, Chodirker BN. The epidemiology of intermittent and chronic ataxia in children in Manitoba, Canada. Dev Med Child Neurol 2013; 55(4):341-7.14.Weiss S, Carter S. Course and prognosis of acute cerebellar ataxia in children. Neurology 1959; 9:711– 721.15.Teoh HL, Mohammad SS, Britton PN, Kandula T, Lorentzos MS, Booy R, et al. Clinical Characteristics and Functional Motor Outcomes of Enterovirus 71 Neurological Disease in Children. JAMA Neurol 2016; 73(3):300-7.16.Connolly AM, Dodson WE, Prensky AL, Rust RS. Course and outcome of acute cerebellar ataxia. Ann Neurol 1994; 35(6):673-9.   

Rhizomes of Eremostachys laciniata: Isolation and Structure Elucidation of Chemical Constituents and a Clinical Trial on Inflammatory Diseases

Purpose: The purpose of this study was the isolation and structure elucidation of chemical compounds from the rhizomes of Eremostachys laciniata (L) Bunge (EL), an Iranian traditional medicinal herb with a thick root and pale purple or white flowers as well as the clinical studies on the therapeutic efficacy and safety of topical application of the EL extract in the management of some inflammatory conditions, e.g., arthritis, rheumatoid arthritis and septic arthritis (Riter’s syndrome). Methods: The structures of the isolated compounds were elucidated unequivocally on the basis of one and two dimensional NMR, UV and HR-FABMS spectroscopic data analyses. A single-blinded randomized clinical trial was carried out with the extract of the rhizomes of E. laciniata (EL) to determine the efficacy and safety of the traditional uses of EL compared to that of piroxicam in treatment of inflammatory diseases, e.g., osteoarthritis, rheumatoid arthritis and Reiter’s syndrome. Results: Eleven iridoid glycosides, two phenylethanoids and two phytosterols were isolated and identified for the first time from the rhizomes of EL. After 14 days of treatment with the EL and piroxicam ointments, all groups showed significant improvements compared to the control groups. EL (5%) ointment induced better initial therapeutic response than piroxicam (5%) onitment. Conclusion: This clinical trial established that EL was suitable for topical applications as a safe and effective complementary therapy for inflammatory diseases

Elongated styloid process: Is it a pathologic condition?

Objectives: The aims of this study were to evaluate the length, morphology, and calcification patterns of the elongated stylohyoid process (ESP) on panoramic radiographs and to investigate the symptoms related to it. We then addressed the question: Is ESP a pathologic condition or a physiologic phenomenon? Materials and Methods: In this study, 207 stylohyoid complexes were evaluated based on length, radiographic appearance, and calcification pattern on panoramic radiographs. Similar to previous studies, we considered 30 mm as a threshold for elongation of the process. Complexes were classified into two groups based on length: ESP (greater than or equal to 30 mm) and normal (less than 30 mm). Clinical symptoms were evaluated by using a questionnaire and clinical examination. Data were analyzed by the Kolmogorov-Smilonov test, Mann-Whitney U test, and Spearman correlation. Results: The average length of the stylohyoid complex was 31.7 mm. The median was 30.0 mm and corresponded to the threshold for the ESP. The Spearman correlation between the length of the complex and age was 0.323 (P=0.0001). "Continuous" and "calcified outline" were the most frequent morphology and calcification pattern, respectively, for both groups. Clinical symptoms related to ESP were not detected. Conclusion: Classification of the stylohyoid complexes based on apparent length on panoramic radiographs in elongated and normal types appears to be incorrect. Considering that the radiographic appearance of the ESP and normal groups was similar and pathologic symptoms were not detected and that there was a relationship between age and length of the complex, elongation of this complex can be considered as a physiologic phenomenon

Assessment of prevalence study of 40 variables related to painful dysfunction syndrome of masticatory muscles in patients referred to faculty of dentistry in Mashhad, Northeast of Iran

Introduction: Painful dysfunction syndrome of masticatory muscles is one of the most important causes of pain in orofacial region. Therefore, the aim of this study was to evaluate the prevalency of 40 variables related to this disorder. Materials and Methods: A total 39 patients (32 females, 7 males) with painful dysfunction syndrome of masticatory muscles were studied. Patients were evaluated for prevalence of age, sex, job, marriage status, masticatory muscles tenderness, maximum mouth opening, deviation, deflection, temporomandibular joint involvement, habits, parafunctions, mall occlusions, neck pain, headache, ear pain and previous history of jaw involvement. Results:  Mean age of patients was 35±13.32 years old and most common range of age was  20-40, 51% were house wife and 74.4% were married. Other variables included: Clicking (74.4%), temporomandibular joint pain (54%), headache (46.2%), ear pain (41%), neck pain (35.9%), limitation of maximum opening (71.8%), class I mall occlusion (74.4%), cross bite and deep bite (25.6%), deviation (7.7%), deflection (41%), bruxism (56.4%), clenching (64.1%) Masseter and external petrygoid (85%) muscles of masticatoty muscles had higher involvement. Conclusion: Because of painful dysfunction syndrome of masticatory muscles has variable signs and symptoms, diagnosis and treatment planning may be very difficult, Therefore having more information about this disorder can help physicians to make best decisions

Myofascial Pain Dysfunction Syndrome (MPDS)

Introduction: Myofascial Pain Dysfunction Syndrome (MPDS) is one of the most important causes of the orofacial pain. The main purpose of this study was to evaluate 40 related variables in this regard. Materials and Methods: Thirty nine patients with MPDS were evaluated in this study. Different factors including age, gender, occupation, marital status, sensitivity of masticatory muscles, maximum opening of the mouth, deviation, deflection, involvement of temporomandibular joint, habit, parafunction, malocclusion, neck pain, headache, earache and history of jaw involvement, etc were analyzed in this  evaluation. Results: In our study, 39 patients (32 females and 7 males), 20-40 years old, with the average age of 35 ± 13.32 years were studied. 51% were housewives and 74.4% were married. The most common involvements were Clicking (74.4%), pain in temporomandibular joint (54%), headache (46.2%), earache (41%), neck-pain (35.9%), trouble in the mouth opening (71.8%), malocclusion Class I (74.4%), cross bite and deep bite (25%), clenching (64.1%) and involvement of masseter and lateral pterygoid muscle (84%). Conclusion: Since MPDS consists of variable symptoms, it might be very difficult to provide any definite diagnosis and treatment. Therefore the more the specialists extend their knowledge and information about this disorder, the more they will make the best decision in this regard

Oral lichen planus: retrospective study of 420 Iranian patients

Objective: In terms of the demographic and clinical characteristics, this is the one of the largest studies on Iranian patients with Oral Lichen Planus (OLP).Study design: Data was taken from the medical records of 420 consecutive patients referred to the Oral Medicine Department, and who were subsequently found to have clinical and usual histopathology consistent with features of OLP.Results: Seventy percent of the patients had been referred to the Oral Medicine Department by general dental practitioners. 52.6% were referred due to oral mucosal and/or gingival pain or burning sensation. Reticular OLP was the most common presentation (76.9%); about 18% of patients reported symptoms or signs, or had a known history of OLP, or possible Lichen Planus affecting non-oral epithelia. A malignant transformation rate of 0.07% was observed

Evaluating the Accuracy Rates of Clinical and Radiographic Diagnoses Compared with Histopathologic Diagnosis of Oral Exophytic Lesions

Introduction: The aim of this study was to identify the reasons for failure in clinical, radiographic, and histopathologic diagnoses as well as their interactions with each other. Methods: Personal information and lesion characteristics of 51 patients with central or peripheral exophytic lesions were collected in Mashhad dental school. Specialists determined clinical and radiographic diagnoses and after taking biopsy, the clinical and radiographic diagnoses were compared with histopathologic diagnosis. Results: Fifty three patients with oral exophytic lesions were evaluated among which 66.6% were peripheral and 33.4% were central exophytic lesions. Males constituted 52.9% of the patients while 47.1% were female. The first clinical and radiographic diagnoses were not confirmed with the histopathologic diagnosis in some patients. 80.4% of the first clinical diagnoses were consistent with the pathologic reports and in other cases, the clinical diagnosis were not confirmed histopathologically. In addition, radiographic diagnoses in six patients were not consistent with pathologic diagnosis. Conclusion: Great concordance was observed between clinical and radiographic diagnosis with pathologic report

Wegener Granulomatosis with Oral Involvement as Primary Manifestation: A Case Study

Introduction: Wegener Granulomatosis is a rare multisystemic disease with an unknown cause, characterized by necrotic granulomatous lesions in respiratory tract, systemic vasculitis in small arteries and veins and necrotizing glomerulonephritis. Wegener can affect any organ including kidneys, eyes or other organs but classically affects upper and lower respiratory tract. One of the rare but important signs of this disease is oral involvement, generally occurring in 6-13% of patients, however, oral involvement as the primary manifestation of disease, occurs in only 5-6% of cases. The most common oral manifestation is strawberry gingivitis. Patients: Our patient was a 35 year-old man with gingival bleeding during brushing which began approximately 45 days before referring to the department of oral and maxillofacial diseases, Mashhad Dental School. In intraoral examination, his gingiva had a papillomatous appearance and was purple in color (strawberry appearance). Due to the presence of strawberry appearance in absence of plaque, primary diagnosis of Wegener granulomatosis was established and the patient was referred for histopathological evaluation. In laboratory tests, C-ANCA was positive and P-ANCA was negative. Finally, diagnosis of Wegener granulomatosis was confirmed and his treatment was started. Rheumatologic condition of patient's lungs was evaluated by chest X-ray and CT-scan and blood tests, biochemistry tests and urine analysis were performed for the patient. He did not have pulmonary or renal involvement. In our study, the patient was followed up after 1, 2 and 11 months from the first visit. Discussion: Up to now, few reports have been published on Wegener disease with oral involvement and in most of these articles, Wegener was diagnosed after respiratory symptoms and kidney or other organs involvement. Only in few studies was Wegener diagnosis confirmed on the basis of oral symptoms and gingival involvement. Immediate and aggressive administration of immunotherapy treatments are required due to the fatal nature of the disease as the survival rate of patients with untreated WG is low and 90% of these patients die within 1 year after respiratory or kidney involvement