Sleep-related rhythmic movement disorder in adults - A systematic review with a case report

Sleep-related rhythmic movement disorder is characterised by stereotyped and repetitive rhythmic movements involving large muscle groups during sleep with frequencies between 0.5 and 2 Hz. Most of the published studies on sleep-related rhythmic movement disorder have focussed on children. Therefore, we performed a systematic review on this topic focussing on the adult population. The review is followed by a case report. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. A total of seven manuscripts (n = 32 individuals) were included in the review. The clinical manifestation of body or head rolling predominated in the majority of included cases (53.13% and 43.75%, respectively). In n = 11 (34.37%) cases, a combination of rhythmic movements was observed. The literature review also revealed a wide spectrum of co-morbidities: insomnia, restless leg syndrome, obstructive sleep apnea, ischaemic stroke, epilepsy, hypertension, alcohol and drug dependency, mild depression, and diabetes mellitus. The case report presented a 33-year-old female who was referred to the sleep laboratory due to a suspicion of sleep bruxism and obstructive sleep apnea. Although the patient was initially suspected of having obstructive sleep apnea and sleep bruxism, after conducting video-polysomnography she met the criteria for sleep-related rhythmic movement disorder as she presented body rolling, which were surprisingly most evident during the rapid eye movement sleep stage. In summary, the prevalence of sleep-related rhythmic movement disorder among adults has not been determined yet. The present review and case report is a good starting point for discussion regarding rhythmic movement disorder in adults and further research on this topic.

Efficiency of occlusal splint therapy on orofacial muscle pain reduction: a systematic review

BACKGROUND

This systematic review aims to examine the existing original studies to determine the effectiveness of occlusal splints (OSs) in the management of orofacial myalgia and myofascial pain (MP) in comparison with no treatment or other interventions.

MATERIALS AND METHODS

Based on the inclusion and exclusion criteria of this systematic review, randomized controlled trials were qualified, in which the effectiveness of occlusal splint therapy in the management of muscle pain was examined in comparison with no treatment or other interventions. This systematic review was conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020. The authors searched three databases (PubMed, CINAHL (The Cumulative Index to Nursing and Allied Health Literature) and Scopus) for English publications published between January 1, 2010, and June 1, 2022. The last database search was carried out on June 4, 2022. Data were extracted from the included studies and assessed for risk of bias using the revised Cochrane risk-of-bias tool for randomized trials.

RESULTS

Thirteen studies were identified for inclusion in this review. In total, 589 patients were diagnosed with orofacial muscle pain who underwent education and various forms of therapy including different types of OSs, light emitting diode therapy, acupuncture, low-level laser therapy, device-supported sensorimotor training, Kinesio Taping, myofunctional therapy, and physical therapy. All studies included demonstrated a high risk of bias.

CONCLUSIONS

There is insufficient evidence regarding whether OS therapy in the treatment of orofacial myalgia and MP offers an advantage over other forms of interventions or no treatment. Further reliable clinical studies in this area are needed to improve the quality of research, which should be performed with larger groups of blinded respondents and controls.

CLINICAL RELEVANCE

Due to the large-scale nature of orofacial muscle pain, it is assumed that each dental clinician will meet patients with orofacial muscle pain repeatedly in daily practice; hence, the review of the effectiveness of OSs in the management of orofacial myalgia and MP is necessary.

Determination of pain intensity, pain-related disability, anxiety, depression, and perceived stress in Polish adults with temporomandibular disorders: A prospective cohort study

BACKGROUND

There is a need to assess a relationship between the psychoemotional state of patients and the occurrence and the intensity of pain and temporomandibular disorders (TMD) in relation to a Polish population. There are no such precision data in the literature relating to the population of big Eastern European country. The study conducted by the authors refer to a large group of male and female adult patients of the Polish population in a different age profile. As a result, this study provides a picture of the situation that also takes into account population characteristics that may affect the clinical situation of patients.

OBJECTIVE

The aim of the study was to assess the pain intensity, pain-related disability, anxiety, depression, and perceived stress among Polish adults with TMD as well as the association between psychosocial impairment and TMD.

MATERIALS AND METHODS

This prospective cohort study included 219 adult patients from the Outpatient Clinic for Temporomandibular Disorders at the Academic Dental Polyclinic in Wroclaw. The patients completed validated questionnaires, and received a TMD diagnosis based on a standardized examination (Diagnostic Criteria for Temporomandibular Disorders) performed by a qualified dentist. A statistical analysis was carried out on the collected data.

RESULTS

Myalgia was the most commonly diagnosed condition among the TMD patients. Furthermore, the prevalence of perceived stress, anxiety, and depression was high in the studied sample. Females showed more depression symptoms than males, while the level of anxiety and stress was similar in both groups. The most statistically significant correlation was observed between the group of masticatory muscle disorders and the level of depression, stress, pain intensity, and pain-related disability.

CONCLUSION

Due to the high prevalence of increased levels of anxiety, depression, and perceived stress, it is essential to screen the psychosocial status of Polish TMD adult patients. Psychosocial status may have an impact on a studied patient's response to treatment and pain intensity, and pain-related disability. Therefore, Polish TMD adult patients should be provided with management based on an interdisciplinary approach.

CLINICAL TRIAL REGISTRATION

[https://clinicaltrials.gov/], identifier [NCT05183503].

Otomycoses of candidal origin in eastern Slovakia

Mycological analysis of swabs and scraping samples from the external ear canals of 40 patients with clinically diagnosed otomycosis (10 neonates, 30 adults) revealed the presence of fungi as etiological agents. They were investigated microscopically using 20 % potassium hydroxide, and by cultivation on Sabouraud's glucose agar. The Candida species were identified using the germ-tube test, micromorphology observations of colonies on rice agar, and particularly by the commercial kit AUXAcolor. The following Candida species were identified in the aural material examined: C. albicans (n = 21; 52.5 %), C. parapsilosis (11; 27.5), C. tropicalis (3; 7.5), C. krusei (3; 7.5), C. guilliermondii (2; 5.0). The above yeasts were present in samples together with Staphylococcus epidermidis (31), S. aureus (16), alpha-hemolytic streptococci (14), Neisseria spp. (14), Proteus mirabilis (3), Pseudomonas aeruginosa (3), Escherichia coli (1) and Haemophilus influenzae (1). The most frequent predisposing factors for otomycosis were swimming in public pools and/or bath, spa and diabetes mellitus.

Diabetes mellitus and candidiases

Patients in various clinical states of diabetes mellitus (according to the recommendation of the American Diabetes Association) as a primary diagnosis were examined for fungal infections by Candida species. Candida spp. were detected in urine, in the material taken from the mouth cavity, nails, skin lesions, ears and eyes, by cultivation on the Sabouraud agar, CHROMagar Candida, and by saccharide assimilation. In the group of diabetics with symptoms of oral candidiasis and denture stomatitis C. albicans was identified in 8 cases, C. tropicalis in 3, C. parapsilosis in 2; 1 strain of C. guilliermondii was also isolated. In patients with urinary tract infections the presence of C. albicans was shown in 12 cases; C. parapsilosis was detected in 6 cases and two strains of each C. tropicalis and C. krusei were also isolated. In patients with leg ulcers C. albicans (25 cases), C. parapsilosis (5), C. tropicalis (3) and one strain of each C. krusei and C. robusta were isolated. Otomycosis was associated with one strain of C. albicans, C. parapsilosis, C. tropicalis and C. guilliermondii. C. albicans was most frequently associated with onychomycosis, paronychia and endophthalmitis; C. parapsilosis was the second most rated yeast.

Preliminary clinical experience with the preparation and therapeutic use of autologous osteoblasts and chondrocytes

Particular results of autologous osteoblasts preparation from patient's bone marrow and autologous chondrocytes from cartilage, both for therapeutic application are given. Osteoblastic cells were cultivated from fresh bone marrow in the presence of dexamethasone in alpha MEM medium containing 10% of patient's and 10% of fetal bovine sera and other necessary additives without any cytokine stimuli. Alkaline phosphatase cell surface activity was used as a marker for quick osteoblastic phenotype confirmation. Autologous chondrocytes were enzymatically separated from fresh knee cartilage. Pieces of cartilage, 2 mm(3) in volume, were sufficient for live cellular graft preparation. Viability of chondrocytes obtained by this approach was more than 90%. In both cases, in osteoblasts as well as in chondrocytes, the amount of cells obtained during the 4 week culture, was sufficient for clinical use.

Histochemical study of innervation and NADPH-D activity of the thymus

Acetylcholinesterase (ACHE)-positive nerve fibres in the thymus of the rat form perivascular plexuses as well as free ACHE-positive nerves, which do not follow the course of the vessels. A higher number of ACHE-positive nerves was observed in corticomedullary border and the medulla, a lower number in the cortex of the thymus lobuli. A gradual reduction of ACHE-positive intrathymus nerve formation was recorded and correlated with the increasing age of the rats. Nicotinamide adenine dinucleotide phosphate-diaphorase positive cells observed in the rat thymus were irregular with numerous projections and were located on the boundary of the cortex and medulla.

Localisation of NADPH-diaphorase-positive structures in the thymus of the rat, mouse and rabbit

Localisation of the diaphorase activity of nicotinamide adenine dinucleotide phosphate (NADPH-d), acting as a marker of nitric oxide synthesis (NOS), was studied in the thymus of the rat, mouse and rabbit. The NADPH-d-active cells observed in the rat thymus were irregular in shape with numerous projections and were located on the boundary between the cortex and the medulla. The NADPH-d--active cells in the thymus of the mouse were located predominantly in the medulla. They varied in coloration and their shape was oval, round, or irregular. NADPH-d-positive nerve fibres were located perivascularly. The rabbit thymus displayed a lightly stained cortex, whereas the medulla was seen as a rounded complex of intensively stained cells, without sharp demarcation between them. In the rat thymus, the NADPH-d-positive nerve fibres were not evident, whereas NADPH-d-positive nerve fibres were seen in the perivascular topography of the mouse and the rabbit thymus. These results suggest that NO may participate in the regulation of the thymic function in the species. In summary, the present results reveal the distribution of NADPH-diaphorase-d-positive structures in the rat, mouse and rabbit thymus.

Candida-associated denture stomatitis

Candida-associated denture stomatitis was demonstrated by its cultivation in 171 out of 240 patients examined with partial or total dentures. After taking smears from lesions of the oral mucosa (tongue, cheeks, palate) and the contiguous denture surface by cotton wool swabs and inoculating them onto Sabouraud glucose agar and CHROMagar Candida, individual yeast species were identified by a germ tube, filamentous, and assimilation tests employing the commercial kit AuxaColor. Seven Candida species were identified in smears from the oral mucosa lesions and the contiguous denture surface: C. albicans (95 patients), C. tropicalis (26), C. parapsilosis (20), C. krusei (14), C. guilliermondii (12), C. lusitaniae (1) and C. freyschusii (1). Diabetes mellitus, neoplastic diseases, chemotherapy, radiotherapy, and broad-spectrum antibiotic therapy were identified as some of the large number of factors predisposing patients to stomatitis prothetica.

The histopathological characterization of oral Candida leukoplakias

Sixty four biopsy specimens of oral Candida leukoplakias were examined. Histological sections were stained with periodic acid-Schiff (PAS) reagent and by Grocott's silver method. C. albicans isolates were cultivated from all the patients but fungal hyphae were proved histologically only in 23 of them. PAS-positive and Grocott-positive elements were exclusively observed in the superficial epithelial layers, e.g., the cornified layer and the stratum granulosum. The inflammatory reaction was characterized by an early phase during which polymorphonuclear cells predominated. The skeletal muscle fascicles immediately adjacent to the infected epithelium showed striking degeneration and atrophy associated with a marked infiltrate of chronic inflammatory cells.

Collagenous spherulosis in epithelial-myoepithelial carcinoma of the parotid gland. Histological and immunohistological study of a case

Previously unreported histological and immunohistochemical features of collagenous spherulosis in an epithelial-myoepithelial carcinoma found in an 80-year-old woman are described. The multinodular tumor located in the right parotid gland was completely removed surgically. No local recurrence of the tumor appeared during the 22-month period of periodic checkups. This is believed to be the first report on collagenous spherulosis in an epithelial-myoepithelial carcinoma of the salivary gland. Different immunohistochemical characteristics of epithelial and myoepithelial neoplastic cells were found very useful for their analysis namely in parts of the tumor where one cell type greatly predominated (e.g. clear cell-type predominance). The double staining of histological sections can in this sense be recommended for the differentiation from other clear cell tumors of salivary glands allowing the correct categorization of the neoplasm.

Detection of anti-Candida antibodies by the indirect immunofluorescence assay in patients with cancer in the orofacial region

An indirect immunofluorescence assay was performed to detect antibodies to Candida albicans blastospores and germ tubes. Serum specimens were obtained from 82 patients with neoplastic diseases in the orofacial region and thrush of the oral mucosa. C. albicans was identified in the oral cavity of 63 patients investigated but serum anti-Candida antibodies were detected in only 23 of them. Serological examination showed that titers of antibodies to C. albicans blastospores ranged from 1:20 to 1:1280. High titers from 1:640 to 1:1280 were detected in patients without antibiotic, cytostatic, or radiotherapeutic treatment. The titers of antibodies to C. albicans germ tubes ranged from 1:20 to 1:640. Our results indicate that titers of antibodies to the C. albicans germ tubes were lower and were detected in a smaller number of patients.

Relative pathogenicity of Candida tropicalis in rat tongue mucosa

The potential of C. tropicalis to colonize and infect rat tongue mucosa was demonstrated. Thirty female Sprague-Dawley rats were infected orally with three different strains of C. tropicalis. The animals were killed one and three weeks following the inoculation and sections of their tongue were stained with hematoxylin-eosin and Grocott stain. Histological changes were observed in the group of animals killed one week after inoculation and infected with C. tropicalis strain isolated from the crural ulcer of a diabetic patient. The most important finding was acute purulent myositis with the formation of abscesses. The myositis was local without signs of spreading to the surrounding tissue. Epithelium-penetrating hyphae observed in the Grocott-stained sections were relatively fewer and more sparsely distributed.

[Intrahepatic biliary lithiasis: endoscopic transpapillary treatment]

Six cases of intrahepatic biliary lithiasis, condition rarely observed in western countries, are reported. Following a review of the literature and on the basis of personal experience, stress is laid on problems of classification, clinical and instrumental diagnosis and, in particular, the therapeutic approach to intrahepatic biliary lithiasis by the endoscopic transpapillary way.

[Endoscopic sphincterotomy in the treatment of biliary lithiasis. Our experience]

Endoscopic Sphincterotomy (E.S.) is a simple and efficacious method for the management of bile duct stones and papillary stenosis. In this series, the E.S. was attempted in 25 patients and performed in 23 (92%). Nine patients had common bile duct stones. Eleven patients (48%) had common bile duct and gallbladder stones. Two patients (8.7%) had intrahepatic lithiasis and one patient (4.3%) had papillary stenosis without gallstones. After E.S. all patients underwent instrument removal of bile duct stones, using "Dormia" basket and "Fogarty" balloon catheter. Transnasal bile duct drainage was performed in 20 patients (86.9%). Early complications were observed in three patients (13%); one sphincterotomy side bleeding and two acute pancreatitis, which were treated successfully conservatively. Mean follow-up was 10.7 months (range 3-27 months). Late complications did not occur for the method and/or for gallbladder stones. Four patients over 80 years of age, died for unrelated causes during follow-up.