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BACKGROUND: Sleep bruxism (SB) occurring during No-REM (nREM) sleep and increase in microarousals per hour have been described in adults, but not in children. OBJECTIVE: To assess the correlation between sleep architecture and masseter muscle activity related to sleep bruxism (SB/MMA) in children. MATERIALS AND METHODS: Forty-three children aged 7-12 years (mean age: 9.4 ± 1.3) with confirmed SB underwent a two-night polysomnographic (PSG) study in a sleep laboratory, for accommodation (first night) and data collection (second night). Data on sleep architecture (total sleep duration (TSD), sleep efficiency (SE), sleep onset latency (SOL), REM and nREM sleep duration and proportion and microarousals/hour during REM and nREM sleep) and episodes/hour of SB/MMA were recorded. Single and multiple-variable linear regression analyses were performed to assess the correlation between data on sleep architecture (predictors) and SB/MMA (dependent variable). RESULTS: Shorter TSD, REM and nREM stage 1 sleep duration, longer SOL and more microarousals/hour during REM and nREM sleep were found to be positive predictors of SB/MMA in children in the multiple-variable regression analysis (R2  = 0.511). CONCLUSION: Within the limitations of this study, it can be concluded that SB/MMA is correlated with altered sleep architecture in children (shorter total sleep duration (TSD), shorter nREM and REM sleep and higher microarousals during REM and nREM sleep). Nevertheless, the clinical significance of these findings need to be demonstrated in future studies.

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Introducción: El estrés académico resulta de la confrontación de un individuo con las demandas del medio universitario, lo cual puede producir cambios a nivel neuro-endocrino-inmunológico y generar un estado de inflamación crónica en donde los niveles de proteína C-reactiva aumentan. Objetivo: Determinar los niveles de estrés académico y proteína C-reactiva en estudiantes de medicina y su posible asociación con síndrome metabólico. Métodos: Se realizó un estudio observacional descriptivo de corte longitudinal que determinó el estrés académico en 68 estudiantes de medicina (41 mujeres y 27 hombres). Se obtuvo información sociodemográfica y clínica de cada estudiante. Se aplicó un cuestionario para la evaluación del estrés académico y se obtuvieron dos muestras de sangre para realizar dos pruebas de proteína C-reactiva de alta sensibilidad en dos tiempos diferentes. Resultados: Pese a que se observaron niveles altos de estrés académico y proteína C-reactiva, no hubo una asociación directa; sin embargo, se encontraron relaciones significativas entre proteína C-reactiva y las variables clínicas, además de un riesgo alto de desarrollar síndrome metabólico. Conclusiones: Se observaron altos niveles de estrés académico asociado a las demandas y exigencias de un programa de medicina con acreditación de alta calidad. Los altos niveles de proteína C-reactiva fueron asociados a los altos niveles de obesidad abdominal, lo que hace que un número significativo de estudiantes se encuentre en riesgo de desarrollar enfermedades cardiovasculares y diabetes mellitus tipo 2, sobre todo aquellos en los que se detectó prehipertensión. No se encontró una relación significativa entre el estrés académico y los niveles de proteína C-reactiva(AU)

Introduction: Academic stress results from the confrontation of an individual with the demands of the university environment, which can produce changes at the neuro-endocrine-immunological level and generate a state of chronic inflammation where the levels of C-reactive protein increase. Objective: To determine the levels of academic stress and C-reactive protein in medical students and their possible association with metabolic syndrome. Methods: A longitudinal descriptive observational study was conducted to determine academic stress in 68 medical students (41 women and 27 men). Sociodemographic and clinical information was obtained from each student. A questionnaire was applied to assess academic stress and two blood samples were obtained to perform two high-sensitivity C-reactive protein tests at two different times. Results: Although high levels of academic stress and C-reactive protein were observed, there was no direct association; however, significant relationships were found between C-reactive protein and clinical variables, in addition to a high risk of developing metabolic syndrome. Conclusions: High levels of academic stress associated with the demands and requirements of a medicine program with high quality accreditation were observed. High levels of C-reactive protein were associated with high levels of abdominal obesity, which means that a significant number of students are at risk of developing cardiovascular diseases and type 2 diabetes mellitus, especially those in whom prehypertension was detected. No significant relationship was found between academic stress and C-reactive protein levels(AU)

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RESUMEN De acuerdo a la literatura, los pacientes hospitalizados con trastornos mentales (TM), tienen mayor riesgo a desarrollar caries y enfermedad periodontal que la población general, asociado a la dificultad motora para hacerse una adecuada higiene oral, a los efectos adversos que ocasionan los medicamentos para el control de los síntomas psiquiátricos y a la falta de cuidado oral y atención clínica. El objetivo era realizar una revisión sistemática de la literatura sobre el estado de salud oral de pacientes hospitalizados con TM. Se hizo una búsqueda sistemática de la literatura en PubMed, de acuerdo con la metodología de la declaración PRISMA, a través de los descriptores en salud MeSh "Dental Caries" y "Mental Disorders" a febrero de 2017. De acuerdo a los diferentes filtros que fueron aplicados, se obtuvieron 14 artículos que describieron el estado de salud oral -mediante el índice COP-D (dientes con caries, dientes con restauraciones, dientes perdidos y dientes con extracción mandatoria)- de pacientes hospitalizados con TM. Se debe promover el reconocimiento de la importancia de la salud oral por parte de los profesionales de la salud, cuidadores y familiares; se debe explorar la cavidad oral para determinar el estado de salud además de instruir a los pacientes y personal de apoyo en higiene oral; las instituciones de salud mental deben establecer un programa de intervención para eliminar focos infecciosos orales y luego implementar un programa preventivo multidisciplinario para mantener la salud oral de acuerdo al diagnóstico del TM.

ABSTRACT According to the literature, hospitalized patients with mental disorders have a higher risk of developing cavities and periodontal disease than the general population, associated with the motor difficulty to perform adequate oral hygiene, to the adverse effects caused by drugs for the control of psychiatric symptoms, as well as the lack of oral care and clinical care. The aim was to carry out a systematic review of the literature on the oral health status of hospitalized patients with mental disorders (MD). A systematic search of the literature was carried out in PubMed, according to the PRISMA statement methodology, through the MeSh health descriptors "Dental Caries" and "Mental Disorders" in February 2017. According to the different filters that were applied, 14 articles describing the oral health status were obtained - through the DMF-T index (teeth with cavities, teeth with restorations, missing teeth and teeth with necessary extraction)- of hospitalized patients with MD. The recognition of the importance of oral health by health professionals, carers and family members should be promoted; the oral cavity should be explored to determine the state of health in addition to instructing patients and support personnel in oral hygiene; mental health institutions should establish an intervention programme to eliminate oral infectious sites and then implement a multidisciplinary preventive programme to maintain oral health according to the MD diagnosis.

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According to the literature, hospitalised patients with mental disorders have a higher risk of developing cavities and periodontal disease than the general population, associated with the motor difficulty to perform adequate oral hygiene, to the adverse effects caused by drugs for the control of psychiatric symptoms, as well as the lack of oral care and clinical care. The aim was to carry out a systematic review of the literature on the oral health status of hospitalised patients with mental disorders (MD). A systematic search of the literature was carried out in PubMed, according to the PRISMA statement methodology, through the MeSh health descriptors "Dental Caries" and "Mental Disorders" in February 2017. According to the different filters that were applied, 14 articles describing the oral health status were obtained-through the DMF-T index (teeth with cavities, teeth with restorations, missing teeth and teeth with necessary extraction)-of hospitalised patients with MD. The recognition of the importance of oral health by health professionals, carers and family members should be promoted; the oral cavity should be explored to determine the state of health in addition to instructing patients and support personnel in oral hygiene; mental health institutions should establish an intervention programme to eliminate oral infectious sites and then implement a multidisciplinary preventive programme to maintain oral health according to the MD diagnosis.

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The aim of this investigation was to evaluate the effects of local anaesthesia on nerve growth factor (NGF) induced masseter hyperalgesia. Healthy participants randomly received an injection into the right masseter muscle of either isotonic saline (IS) given as a single injection (n = 15) or an injection of NGF (n = 30) followed by a second injection of lidocaine (NGF + lidocaine; n = 15) or IS (NGF + IS; n = 15) in the same muscle 48 h later. Mechanical sensitivity scores of the right and left masseter, referred sensations and jaw pain intensity and jaw function were assessed at baseline, 48 h after the first injection, 5 min after the second injection and 72 h after the first injection. NGF caused significant jaw pain evoked by chewing at 48 and 72 h after the first injection when compared to the IS group, but without significant differences between the NGF + lidocaine and NGF + IS groups. However, the mechanical sensitivity of the right masseter 5 min after the second injection in the NGF + lidocaine group was significantly lower than the second injection in the NGF + IS and was similar to the IS group. There were no significant differences for the referred sensations. Local anaesthetics may provide relevant information regarding the contribution of peripheral mechanisms in the maintenance of persistent musculoskeletal pain.

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BACKGROUND: According to the literature, hospitalised patients with mental disorders have a higher risk of developing cavities and periodontal disease than the general population, associated with the motor difficulty to perform adequate oral hygiene, to the adverse effects caused by drugs for the control of psychiatric symptoms, as well as the lack of oral care and clinical care. AIM: To carry out a systematic review of the literature on the oral health status of hospitalised patients with mental disorders (MD). MATERIALS AND METHODS: A systematic search of the literature was carried out in PubMed, according to the PRISMA statement methodology, through the MeSh health descriptors "Dental Caries" and "Mental Disorders" in February 2017 RESULTS: According to the different filters that were applied, 14 articles describing the oral health status were obtained - through the DMF-T index (teeth with cavities, teeth with restorations, missing teeth and teeth with necessary extraction)- of hospitalised patients with MD. CONCLUSIONS: The recognition of the importance of oral health by health professionals, carers and family members should be promoted; the oral cavity should be explored to determine the state of health in addition to instructing patients and support personnel in oral hygiene; mental health institutions should establish an intervention programme to eliminate oral infectious sites and then implement a multidisciplinary preventive programme to maintain oral health according to the MD diagnosis.

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BACKGROUND: Quantification of motor-evoked potentials (MEPs) can contribute to better elucidate the central modulation of motor pathways in response to nociceptive inputs. The primary aim of this study was to assess the modulatory effects of nerve growth factor (NGF) injection on masseter corticomotor excitability. METHODS: The healthy participants of this randomized, double blind placebo-controlled experiment were assigned to have injected into the right masseter muscle either NGF (n = 25) or isotonic saline (IS, n = 17). The following variables were assessed at baseline and 48 hr after the injection: right masseter MEP amplitude and corticomotor mapping and clinical assessment of jaw pain intensity and function. Repeated Measures ANOVA was applied to the data. RESULTS: NGF caused jaw pain and increased jaw functional disability after the injection (p < 0.050). Also, the participants in the NGF group decreased the MEP amplitude (p < 0.001) but the IS group did not present any significant modulation after the injection (p > 0.050). Likewise, the participants in the NGF group reduced corticomotor map area and volume (p < 0.001), but the IS group did not show any significant corticomotor mapping changes after the injection (p > 0.050). Finally, there was a significant correlation between the magnitude of decreased corticomotor excitability and jaw pain intensity on chewing 48 hr after the NGF injection (r = -0.51, p = 0.009). CONCLUSION: NGF-induced masseter muscle soreness can significantly reduce jaw muscle corticomotor excitability, which in turn is associated with lower jaw pain intensity and substantiates the occurrence of central changes that most likely aim to protect the musculoskeletal orofacial structures. SIGNIFICANCE: Intramuscular administration of nerve growth factor into masseter muscle causes inhibitory corticomotor plasticity, which likely occurs to prevent further damage and seems associated with lower pain intensity on function.

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BACKGROUND: Polysomnography (PSG) is the gold standard for sleep bruxism (SB) assessment. High economical costs, complex technical equipment, and unfamiliar laboratory setting limit its use in children. AIM: To determine the night-to-night variability of electromyography (EMG) episodes during a five-night recording with the GrindCare Measure (GCM), and the agreement in the assessment of masticatory muscle activity (MMA) between GCM and PSG in children. DESIGN: Forty-seven children from clinics of Universidad CES participated. Each participant was assessed with GCM for five consecutive nights. The last night, children underwent a single-night PSG study, together with the GCM. Spearman correlation coefficients were used to analyze data. RESULTS: The frequency of SB occurrence was 'sometimes' in 12 (25.5%) and 'usually' in 19 (40.4%) children. Simultaneous measurements with GCM and PSG obtained during the fifth night of measurement were not significantly correlated. Correlation between GCM total EMG episodes and EMG episodes/h and PSG total SB episodes, SB episodes/h, total bursts and burst/h measured with PSG was also not significant. CONCLUSION: EMG measurement with GCM was not accurate to detect PSG/SB in children. There was not advantage of multiple assessment for five nights with GCM, reducing the impact of night-to-night EMG episodes' variability on the GCM/PSG correlation.

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BACKGROUND: Polysomnography (PSG) is the gold standard for sleep bruxism (SB) diagnosis. PSG/SB children's criteria are not available; thus, parental-report SB is widely used. AIM: Assessing the diagnostic accuracy of parental report of sleep tooth grinding (STG) with a PSG/SB diagnosis in children, adopting adult criteria. DESIGN: Thirty-seven children from clinics of Universidad CES were included. Parents filled the Children's Sleep Habits Questionnaire (CSHQ) assessing the single-observation report - CSHQ - of STG with a No/Yes answer and five ordinal answers. A 5-day diary reporting the presence/absence of STG (multiple-observation report) was also completed. Each child underwent a single-night PSG study. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy, likelihood ratios, Spearman correlation coefficient, and Cohen's kappa coefficient were used to analyze data. RESULTS: Single observation, using No/Yes answer, showed acceptable specificity and NPV, while low PPV and sensitivity. Accuracy and likelihood ratios were low. When using the five ordinal answers, weak correlation and fair agreement (r = 0.34 and κ = 0.40) with PSG/SB adult criteria were found. Multiple-observation evaluation of STG presented moderate correlation and agreement (r = 0.50 and κ = 0.48). CONCLUSIONS: Although multiple-observation report achieved better agreement than single-observation report, our results failed supporting the validity of report strategies for the diagnosis of SB in children, as an equivalent of PSG/SB adult criteria.

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El estrés se reconoce como un proceso fisiopatológico que ocurre cuando un individuo se enfrenta a demandas ambientales que sobrepasan sus recursos, haciendo que el cuerpo emita una respuesta, la cual implica la activación fisiológica y cognitiva del cuerpo, (sistema nervioso central, sistema endocrino y sistema inmunológico), para actuar de manera más rápida y enérgica a las exigencias de la situación, por lo tanto esta respuesta es de naturaleza sistémica y trae una serie de consecuencias metabólicas tales como aumento de la síntesis de esteroides y un estado de inflamación crónica, por lo que el estrés psicológico se considera un factor de riesgo para el desarrollo de enfermedades crónicas. El estrés psicológico en un campo académico, se denomina estrés académico.

Stress is recognized as a pathophysiological process that occurs when an individual is faced with environmental demands that exceed their resources, making the body emits a stress response. This response involves the activation of physiological and cognitive body (central nervous system, endocrine system and immune system), to act faster and more energetic the situation so demands, thus this response is systemic in nature and brings a series of metabolic consequences such as increased steroid synthesis and a state of chronic inflammation, so that psychological stress is considered a risk factor for the development of chronic diseases. Psychological stress in an academic field, is called academic stress. Medical students are exposed to a greater number of stressors, which are inherent in his career, and predisposes them to have different levels of stress.

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El presente trabajo se propone evaluar la eficacia terapéutica de la amisulprida, comparándola con la viloxacina en un grupo de pacientes diagnosticados como distímicos de acuerdo con los criterios de clasificación del DSM-III-R. Se trata de un estudio controlado doble ciego con asignación aleatoria, de una serie de 80 pacientes evaluados en un examen incial y a lo largo de 4 semanas de tratamiento. Entre los instumentos empleados para la evaluación figuran la escala de depresión de Hamilton, la del retardo psicomotor de Widlocher y la de síntomas negativos de Andreasen. Se evalúa tanto la eficacia como la seguridad de los medicamentos. Se presentan un análisis de los resultados que sugiere una mejor respuesta terapéutica en el grupo de la amisulprida (AU)

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El presente trabajo se propone evaluar la eficacia terapéutica de la amisulprida, comparándola con la viloxacina en un grupo de pacientes diagnosticados como distímicos de acuerdo con los criterios de clasificación del DSM-III-R. Se trata de un estudio controlado doble ciego con asignación aleatoria, de una serie de 80 pacientes evaluados en un examen incial y a lo largo de 4 semanas de tratamiento. Entre los instumentos empleados para la evaluación figuran la escala de depresión de Hamilton, la del retardo psicomotor de Widlocher y la de síntomas negativos de Andreasen. Se evalúa tanto la eficacia como la seguridad de los medicamentos. Se presentan un análisis de los resultados que sugiere una mejor respuesta terapéutica en el grupo de la amisulprida

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