Effect of ten different biomarkers in the gingival crevicular fluid of obese and non-obese undergoing fixed orthodontic treatment.

OBJECTIVE: The aim of this study is to evaluate the effect of ten proinflammatory cytokines in GCF of participants with raised body mass index (BMI) compared to non-obese subjects undergoing fixed orthodontic treatment. PATIENTS AND METHODS: In the cross-sectional cohort, subjects were shortlisted through the purposive sampling method with the same age and gender and similar characteristics (cohort). For inclusion and exclusion, predefined criteria were followed. In all included participants obese and non-obese collection of GCF was made from mandibular canine to canine. Identification of inflammatory mediators (MPO and CRP) leptin, adiponectin, and resistin (pg/mL). Bone remodeling biomarkers RANKL (pg/mL) and tissue remodeling biomarkers MMP8, MMP9, TIMP1, and MMP8/TIMP1, MMP9/TIMP1 ratio were collected and blinded by the investigator. Normal distribution of data i.e., age, BMI, the flow rate of GCF, indices plaque and gingival, and uWMS were compared using a t-test. Non-normality biomarker data were evaluated using Mann-Whitney U-test. To assess the relationship between the concentration of GCF biomarkers and plaque and gingival indices Pearson and Spearman correlation coefficients were used. RESULTS: The total number of participants included was 44. In the obese and non-obese groups, the male/female ratio was the same i.e., (n=11 each). The mean age of participants in the obese group was (25.7±1.55 years), whereas the non-obese group was (26.1±1.29 years). In obese the mean BMI was (33.6±2.1 kg/m2) whereas in non-obese (22.9±1.9 kg/m2) (p<0.02). Among the levels of biomarkers adiponectin (p<0.006) and leptin (p<0.028) demonstrated a significant difference between obese and non-obese participants. Also, a significant difference was noted between obese and non-obese in tissue remodeling biomarker MMP9 (p<0.03). CONCLUSIONS: A surge in the level of the biomarkers, i.e., MMP9, leptin, and adiponectin in the gingival crevicular fluid is found in obese undergoing fixed orthodontic treatment.

Generalized and localized osteoarthritis and risk of fall among older adults: the role of chronic diseases and medications using real world data from a single center.

OBJECTIVE: This study examined the prevalence of falls among older adults with generalized and localized osteoarthritis (OA) and identified the association between falls and both chronic diseases and medications. PATIENTS AND METHODS: A retrospective design using the Healthcare Enterprise Repository for Ontological Narration (HERON) database was used. A cohort of 760 patients aged ≥65 years with at least two diagnosis codes for either localized or generalized OA were included. The extracted data included demographics (age, sex, and race), body mass index (BMI), fall history, comorbid health conditions (i.e., type 2 diabetes, hypertension, dyslipidemia, neuropathy, cardiovascular diseases, depression, anxiety, and sleep disorders), and medications [i.e., pain medication (opioids, non-opioids), antidiabetics (insulin or hypoglycemic), antihypertensives, antilipemic, and antidepressants]. RESULTS: The prevalence rates of falls and recurrent falls were 27.77% and 9.88%, respectively. Individuals with generalized OA had a higher prevalence of falls (33.8%) than those with localized OA (24.2%). Multivariable logistic regression analysis showed that individuals with OA who had hypertension [odds ratio (OR):1.86, 95% CI, (1.20, 2.89), p=0.006] and used antidepressants [OR: 1.72, 95% CI, (1.04, 2.84), p=0.035] were more likely to have a fall. Individuals with OA who had hypertension [OR: 2.69, 95% CI, (1.30, 5.60), p=0.008], neuropathy [OR: 4.95, 95% CI, (2.95, 11.68), p<0.001], and insulin [OR: 2.85, 95% CI, (1.12, 7.22), p=0.035] were more likely to have a recurrent fall (two or more falls). CONCLUSIONS: Falls are common in individuals with generalized OA. Comorbid health conditions, including hypertension and neuropathy, need to be considered in the screening of the risk of fall. Fall risk needs to be considered when discussing medication prescriptions, especially antidepressants and insulin.

Labial alveolar bone thickness and its correlation with buccolingual maxillary incisors angulation: a CBCT based study.

OBJECTIVE: Understanding the labial alveolar bone thickness (ABT) and buccolingual teeth angulation may reduce the complication that might arise during or post-operative treatment. The operator could determine the precise method to ensure long-term treatment success. This study aimed to evaluate the ABT with buccolingual upper incisor teeth angulation based on the maxillary plane by using the cone-beam computed tomography (CBCT). MATERIALS AND METHODS: A total of 371 CBCT radiographs were initially assessed and 100 CBCT radiographs were included. On the maxillary incisors, the labial alveolar bone thickness is evaluated at three points (Point A: Four mm below from CEJ, Point B: Midpoint from the labial alveolar-palatal alveolar crest plane and root apex. Point C: Root Apex of the tooth). The distance from these points to labial alveolar bone was measured for the ABT. Moreover, buccolingual angulation of the tooth was measured by the angle formed by the maxillary plane and the long axis of the tooth. RESULTS: There is no significant difference observed between genders in the labial alveolar bone thickness. The labial alveolar bone thickness grew gradually from the cementoenamel junction (CEJ) level to the apical level. Moreover, there was a statistically significant positive correlation observed between labial alveolar bone thickness at the apical level (Point C) and angulation (p<0.05). CONCLUSIONS: The labial bone thickness was less than 2 mm in the majority of cases at the three points among maxillary incisors. In addition, there is a correlation between buccolingual angulation of the maxillary incisors and labial alveolar bone thickness.

Clinical characteristics and liver profiles of Dubin-Johnson syndrome in neonates: Multicenter retrospective study.

OBJECTIVES: Dubin-Johnson syndrome (DJS) is a rare benign autosomal recessive disorder characterized by cholestasis in neonates. The aim of the present study was to describe the clinical characteristics, hepatic profiles, histopathology, gene mutations, and treatment outcomes of neonatal DJS. MATERIAL AND METHODS: A multicenter retrospective study was undertaken with patients who had DJS. The authors identified DJS in neonates and reviewed medical records for details. The diagnosis of DJS was based on the presence of unexplained prolonged conjugated hyperbilirubinemia and presence of a mutation in the ATP Binding Cassette Subfamily C Member 2 (ABCC2) gene detected in genomic DNA extracted from circulating blood cells. RESULTS: Eleven children with DJS were identified in the study. The study population comprised eight males and three females. The median age at presentation was 21 days. Dysmorphic features were not recorded in any of the patients. Cholestasis, high serum bile acids, and normal transaminase levels were found in all patients (100%). Serum alkaline phosphatase and gamma glutamyl transferase were elevated in four patients (36%). Hypoalbuminemia and coagulopathy were not noted in these patients. Consanguinity was present in nine patients (82%). All patients had normal abdominal ultrasound findings. Genetic molecular testing showed that 82% of the patients reported a pathogenic variant of the ABCC2 gene defect with the same variant c.2273G>T (Gly 758 val) chromosome 10. All patients were alive without liver transplantation. CONCLUSIONS: This is the largest study worldwide describing that neonatal DJS is a benign cholestatic disease with favorable outcomes. Low-grade direct hyperbilirubinemia, normal transaminases, and elevated serum bile acids are the main characteristic findings of DJS.

Association between rheumatoid factors and proinflammatory biomarkers with implant health in rheumatoid arthritis patients with dental implants.

OBJECTIVE: To evaluate the levels of crevicular fluid rheumatoid factors (RFs), and other proinflammatory cytokines including interleukin (IL)-6, and tumor necrosis factor-alpha (TNF-ɑ) and correlate these biomarkers with the clinical peri-implant parameters among rheumatoid arthritis (RA) patients with or without concomitant connective tissue disorder (CTD). PATIENTS AND METHODS: Three groups of 14 participants each [Group-I: healthy, Group-II: RA without CTD, and Group-III: RA with CTD] were selected. The clinical parameters observed were bleeding on probing (BOP), plaque scores (PS), pocket depth (PD) and alveolar bone loss (ABL). RFs, IL-6 and TNF-α were Enzyme-linked immunosorbent assay (ELISA) was incorporated to quantify RFs, IL-6 and TNF-α. RESULTS: BOP was significantly higher in Groups II and III as compared with Group I. Alveolar bone loss was significantly higher in Group III followed by Group II and least in Group I. Patients with RA with CTD presented with statistically higher levels of RF, IL-6 and TNF-α followed by Group II compared with Group I (p<0.05). A positive correlation existed between BOP and all the three biomarkers RF (r=0.0562; p=0.0039), IL-6 and TNF-α for Group-II patients. Similarly, a significant positive correlation existed between BOP and all the three biomarkers RF, IL-6 and TNF-α for Group-III patients. In addition, a positive correlation was also seen between ABL and RF, PD, and IL-6 in Group-III patients. CONCLUSIONS: RF might influence peri-implant inflammation in RA patients with CTD. Moreover, the increased RF levels are indicative of diagnostic marker for peri-implant complications in RA.

The relationship between vitamin D levels and cognitive impairment in patients with multiple sclerosis.

OBJECTIVE: Neurocognitive impairment is one of the most common manifestations of multiple sclerosis (MS). However, the pathophysiology of this issue is still poorly understood. The objective of this study is to investigate the relationship between vitamin D levels and cognitive function in patients with MS as assessed by the Cambridge Neuropsychological Test Automated Battery (CANTAB). PATIENTS AND METHODS: This was a cross-sectional, case-control study; the subjects were 39 Saudi patients diagnosed with MS. For all participants, demographic information, including age, sex, and educational level, was collected. Participants were also evaluated using the disease steps scale and the PHQ-9 scale. Their vitamin D levels were assessed, and the participants completed a computerized cognitive assessment using the CANTAB. RESULTS: From the total sample of 39 patients with MS, 31 (79.5%) were female. Physical disability due to MS was insignificant in 25 (64.1%) of the subjects and significant in 14 (35.9%). Seventeen (43.6%) of the participants had normal vitamin D levels; 22 (56.4%) had low vitamin D levels. The MS patients had lower MOT mean errors than the control group, and this difference was statistically significant (t = -4.313, p < 0.01). Moreover, the scores of the two groups for all subcategories of the memory domain were different at statistically significant levels. Furthermore, the control group had higher PAL total errors (adjusted), PAL total errors (6 shapes, adjusted), and PRM percent correct than the MS patients (p < 0.01). The control group also achieved lower scores on SWM between errors and SWM strategy than the MS patients (p < 0.01). The MOT mean error was found to correlate with the disease steps score (r = 0.394, p < 0.05) and with significant physical disability (r = 0.457, p< 0.01). In the memory domain, PAL total errors (adjusted) correlated with age (r = 0.381, p < 0.05), SWM between errors correlated with age at onset of disease (r = 0.345, p < 0.05), and vitamin D level (r = 0.335, p < 0.05) and SWM strategy correlated with the number of relapses in the past 12 months (r = -0.355, p < 0.05). CONCLUSIONS: Cognitive performance was impaired in patients with MS. Vitamin D deficiency, a potentially modifiable risk factor, independently predicted cognitive impairment in MS patients.

Donor organ shortage crisis: a case study review of a financial incentive-based system.

INTRODUCTION: Current organ supply system depends on altruistic noncoercive donation, which has failed to meet the demand of organ transplantation. Providing financial incentives to donors is one of several approaches to address organ shortage. However, its feasibility is debatable as it relates to medical, ethical, and economic dimensions. An incentive-based procurement system (IBPS) applied by the Mobile Donor Action Team (MDAT) was instituted in Riyadh, Saudi Arabia, resulting in a 3-fold increase in donation rate. The goal of this study was to provide a qualitative review of a 7-year experience with IBPS. MATERIALS AND METHODS: A qualitative approach was used. Documents were reviewed to create a chronological audit and shape interview questions. Sampling was purposeful and inclusive of MDAT members. Semi-structured interviews were conducted, and findings were subjected to thematic analysis. RESULTS: Documents reflected the evolution of MDAT. The essence of MDAT is field work and liberal use of financial incentives, which resulted in a 3-fold increase in the donation rate. MDAT members believed that IBPS is the main reason behind this increase. Moreover, IBPS is viewed as acceptable from a moral, ethical, and religious standpoint, with a high degree of professional satisfaction. CONCLUSIONS: Theoretical assumptions doubted the feasibility of IBPS. This real-life experience with IBPS proved the contrary. The findings may be applicable only to the setting in Riyadh, Saudi Arabia, however; further research is thus needed to explore its transferability to other settings. IBPS may be an alternative to altruistic noncoercive donation and should be piloted in different settings.