Twenty-four hour ambulatory monitoring of tremor, sweating, skin temperature and locomotor activity in the alcohol withdrawal syndrome

The use of lasers for direct pulp capping

Direct pulp capping helps extend the life of a diseased tooth by maintaining tooth vitality. Nowadays, lasers are more frequently used during direct pulp capping in the clinic, but their use has not been previously reviewed. This review presents the basic properties of currently available lasers, scientific evidence on the effects of laser application on direct pulp capping, and future directions for this technology. An extensive literature search was conducted in various databases for articles published up to January 2015. Original in vitro, in vivo, and clinical studies, reviews, and book chapters published in English were included. Various laser systems have been increasingly and successfully applied in direct pulp capping. Lasers offer excellent characteristics in terms of hemostasis and decontamination for field preparation during direct pulp capping treatment; however, the sealing of exposed pulp with one of the dental materials, such as calcium hydroxide, mineral trioxide aggregates, and bonded composite resins, is still required after laser treatment. Clinicians should consider the characteristics of each wavelength, the emission mode, irradiation exposure time, power, type of laser tip, and the distance between the laser tip and the surface being irradiated.

Diurnal and twenty-four hour patterning of human diseases: acute and chronic common and uncommon medical conditions

The symptom intensity and mortality of human diseases, conditions, and syndromes exhibit diurnal or 24 h patterning, e.g., skin: atopic dermatitis, urticaria, psoriasis, and palmar hyperhidrosis; gastrointestinal: esophageal reflux, peptic ulcer (including perforation and hemorrhage), cyclic vomiting syndrome, biliary colic, hepatic variceal hemorrhage, and proctalgia fugax; infection: susceptibility, fever, and mortality; neural: frontal, parietal, temporal, and occipital lobe seizures, Parkinson's and Alzheimer's disease, hereditary progressive dystonia, and pain (cancer, post-surgical, diabetic neuropathic and foot ulcer, tooth caries, burning mouth and temporomandibular syndromes, fibromyalgia, sciatica, intervertebral vacuum phenomenon, multiple sclerosis muscle spasm, and migraine, tension, cluster, hypnic, and paroxysmal hemicranial headache); renal: colic and nocturnal enuresis and polyuria; ocular: bulbar conjunctival redness, keratoconjunctivitis sicca, intraocular pressure and anterior ischemic optic neuropathy, and recurrent corneal erosion syndrome; psychiatric/behavioral: major and seasonal affective depressive disorders, bipolar disorder, parasuicide and suicide, dementia-associated agitation, and addictive alcohol, tobacco, and heroin cravings and withdrawal phenomena; plus autoimmune and musculoskeletal: rheumatoid arthritis, osteoarthritis, axial spondylarthritis, gout, Sjögren's syndrome, and systemic lupus erythematosus. Knowledge of these and other 24 h patterns of human pathophysiology informs research of their underlying circadian and other endogenous mechanisms, external temporal triggers, and more effective patient care entailing clinical chronopreventive and chronotherapeutic strategies.

Circadian phase determines effects of repeated ethanol vapor exposure and withdrawal on body temperature and activity rhythms of male mice

BACKGROUND

Physiological responses to acute ethanol (EtOH) injection depend critically on the timing of their administration. Whether daily timing modulates effects of longer intoxication intervals characteristic of alcohol-dependent humans remains unknown. The present work examines time-of-day effects during EtOH exposure and withdrawal measured by locomotor activity (ActLoc ) and body temperature (Tb ) across multiple rounds of EtOH exposure/withdrawal.

METHODS

Two groups of C57BL/6J mice (n = 8 per group), implanted with radio-telemeters, were entrained to opposite light-dark periods (14:10 LD cycle) so that their rest/activity cycles were 12 hours apart. Under a 2-hour skeleton photoperiod animals were simultaneously exposed to 3 daily cycles of EtOH vapor inhalation (14 hours EtOH on) and withdrawal (10 hours EtOH off). During this time, air-only control groups (n = 4 per group) matched for entrainment were handled in a comparable manner. After the third cycle of EtOH vapor, the animals were left undisturbed for 11 days to recover. The 14-day protocol was repeated 3 additional times.

RESULTS

During intoxication, mice exposed to EtOH in the subjective night exhibited greater hypothermia and more overall disruptions in the Tb and ActLoc rhythms. Acute withdrawal induced hypothermia during the subjective night and hyperthermia during the subjective day. Animals in both phases demonstrated significant disruptions in ActLoc during withdrawal. ActLoc had little effect on Tb during EtOH exposure, but it significantly influenced Tb during acute withdrawal.

CONCLUSIONS

The physiological responses of both EtOH exposure and withdrawal differ as a function of time of day. These findings suggest that controlling for the circadian phase of exposure and/or withdrawal may mitigate the severity of symptomatic withdrawal.

The nature, time course and severity of methamphetamine withdrawal

AIMS

To characterize the natural history of methamphetamine withdrawal during the first 3 weeks of abstinence.

DESIGN

Cross-sectional study with comparison group. Setting A substance use treatment facility in Chiang Mai Province, Thailand.

PARTICIPANTS

The sample comprised 21 in-patients undergoing treatment for methamphetamine dependence. Nine age- and sex-matched non-dependent individuals provided comparison data.

MEASUREMENTS

Instruments including: the Amphetamine Withdrawal Questionnaire, a modified version of the Cocaine Selective Severity Assessment, Clinical Global Impression scale and the St Mary's Hospital Sleep Questionnaire were completed daily for the first 3 weeks of abstinence.

FINDINGS

Methamphetamine withdrawal severity declined from a high initial peak within 24 hours of the last use of amphetamines reducing to near control levels by the end of the first week of abstinence (the acute phase). The acute phase of amphetamine withdrawal was characterized by increased sleeping and eating, a cluster of depression-related symptoms and less severely, anxiety and craving-related symptoms. Following the acute withdrawal phase most withdrawal symptoms remained stable and at low levels for the remaining 2 weeks of abstinence.

CONCLUSIONS

This study has provided evidence of a methamphetamine withdrawal syndrome that can be categorized into two phases, the acute phase lasting 7-10 days during which overall symptom severity declined in a linear pattern from a high initial peak, and a subacute phase lasting at least a further 2 weeks.

Ambulatory monitoring devices and the forensic autopsy

Ambulatory monitoring devices (AMDs) such as Holter (ECG) and apnea (respiratory) monitors with built-in date- and time-correlated memories are occasionally encountered in the forensic autopsy. Diagnostic data are usually readily obtained by returning the device to the hospital department or rental company. This data can be easily correlated with autopsy findings to arrive at surprisingly precise conclusions in some cases. We present two illustrative cases: an elderly man wearing a Holter monitor who shot himself in the mouth with a shotgun, and a 15-month-old oxygen-dependent prematurely born boy with bronchopulmonary dysplasia whose apnea monitor had been turned off 5 days before he died of bronchopneumonia. We discuss other kinds of AMDs that may be encountered in the forensic autopsy and suggest that information from these monitors perhaps should become part of the forensic autopsy report.