Marijuana is not associated with progression of hepatic fibrosis in liver disease: a systematic review and meta-analysis.

BACKGROUND: An estimated 22 million adults use marijuana in the USA. The role of marijuana in the progression of hepatic fibrosis remains unclear. AIMS: We carried out a systematic review and meta-analysis to evaluate the impact of marijuana on prevalence and progression of hepatic fibrosis in chronic liver disease. PATIENTS AND METHODS: We searched several databases from inception through 10 November 2017 to identify studies evaluating the role of marijuana in chronic liver disease. Our main outcome of interest was prevalence/progression of hepatic fibrosis. Adjusted odds ratios (ORs) and hazards ratios (HRs) were pooled and analyzed using random-effects model. RESULTS: Nine studies with 5 976 026 patients were included in this meta-analysis. Prevalence of hepatic fibrosis was evaluated in nonalcoholic fatty liver disease (NAFLD), hepatitis C virus (HCV), and hepatitis C and HIV coinfection by two, four, and one studies. Progression of hepatic fibrosis was evaluated by two studies. Pooled OR for prevalence of fibrosis was 0.91 (0.72-1.15), I=75%. On subgroup analysis, pooled OR among NAFLD patients was 0.80 (0.75-0.86), I=0% and pooled OR among HCV patients was 1.96 (0.78-4.92), I=77%. Among studies evaluating HR, pooled HR for progression of fibrosis in HCV-HIV co-infected patients was 1.03 (0.96-1.11), I=0%. CONCLUSION: Marijuana use did not increase the prevalence or progression of hepatic fibrosis in HCV and HCV-HIV-coinfected patients. On the contrary, we noted a reduction in the prevalence of NAFLD in marijuana users. Future studies are needed to further understand the therapeutic impact of cannabidiol-based formulations in the management of NAFLD.

A study on Evaluation of efficacy of bethanechol in the management of chemoradiation-induced xerostomia in oral cancer patients.

OBJECTIVES: Squamous cell carcinoma is the most common oral cancer. Radiotherapy with concomitant chemotherapy is an ideal treatment modality largely used for oral cancers, which precipitates many side effects, of which the most challenging and debilitating side effect is xerostomia. This study aimed to evaluate the efficacy of bethanechol in patients with xerostomia following chemoradiation therapy for oral cancer. MATERIALS AND METHODS: Fifty patients with xerostomia postchemoradiation therapy, aged between 30 and 65 years, were selected based on selection criteria. Thirty patients in the study group were administered 25 mg bethanechol three times daily (TDS) and 20 patients in the control group with placebo capsules. The subjective symptoms of oral dryness were periodically evaluated at baseline, at the end of 1st, 2nd and 3rd weeks using a self-reported questionnaire. Salivary analysis such as whole resting saliva and whole stimulated saliva (WSS) volumes, amylase, pH and sodium potassium ratio were evaluated before and 3 weeks after bethanechol and placebo therapy. RESULTS: Twenty-four (80%) patients in bethanechol group and only 2 (10%) patients in control group showed subjective improvement in oral dryness at the end of 3rd week. A significant difference was found between two groups in whole resting and stimulated saliva volume, pH and amylase. However, there was no statistically significant difference in sodium potassium ratio with insignificant adverse effects after 3 weeks of bethanechol therapy. CONCLUSIONS: 25 mg bethanechol (TDS) has shown subjective improvement in oral dryness in 24 (80%) patients with significant improvement in whole resting and WSS volumes, pH and salivary amylase with insignificant adverse effects.

Burning mouth syndrome: an enigma / Síndrome de boca urente: un enigma

El síndrome de boca urente (SBU) es una condición enigmática porque la intensidad de los síntomas rara vez se corresponde con los signos clínicos de la enfermedad. Los síntomas incluyen ardor bucal, boca seca, dolor, cambios en los hábitos alimenticios, graves síntomas de la menopausia, y problemas no específicos de salud, entre otros. SBU es más frecuente en las mujeres posmenopáusicas con relación mujer/hombre de 7:1. La etiología del SBU es multifactorial, como los cambios hormonales (menopausia), las carencias nutricionales y alteraciones del gusto por nombrar algunos. SBU es un reto con respecto al diagnóstico y al manejo. El presente artículo analiza algunos de los acuerdos recientes de la etiopatogenia de SBU, así como el papel de la gestión farmacoterapeutica en este trastorno.

Burning mouth syndrome (BMS) is an enigmatic condition because the intensity of symptoms rarely corresponds to the clinical signs of the disease. Symptoms include oral burning, dry mouth, pain, changes in eating habits, severe menopausal symptoms, and non specific health problems etc. BMS is most prevalent in postmenopausal women with female: male ratio of 7:1. The etiology of BMS is multifactorial such as hormonal changes (menopause), nutritional deficiencies and taste disturbances to name a few. BMS is a challenge to diagnose and manage. The present article discusses some of the recent understanding of etiopathogenesis of BMS as well as the role of pharmacotherapeutic management in this disorder.

Psychiatric morbidity among patients with oral sub-mucous fibrosis: a preliminary study.

BACKGROUND: Oral submucous fibrosis (OSF) is a chronic oral mucosal condition with pre-malignant potential. The association between psychiatric morbidity and OSF has been sparsely studied. METHODS: This cross-sectional study included 33 consecutive subjects clinically diagnosed with OSF who attended an academic tertiary care dental centre. General Health Questionnaire-28 was administered to assess the psychological morbidity. Dependence to areca products was assessed using the ICD-10 criteria. Patient group was compared with an age and gender matched control group (n=33) from the same hospital that comprised patients who had dental diseases other than OSF and had no areca/tobacco habit. RESULTS: Total mean scores (SD) of GHQ-28 for study group and control group respectively were 48.2 (18.1) vs. 24.2 (6.5) (P<0.001). Among the patient group, the mean total GHQ scores were significantly higher in those with functional stage C (those with worst functional staging) of OSF 63.4 (15.2) when compared with those with stage B 54 (14.2) and stage A 38.7 (17) (d.f.=2; P=0.005). 22 (66.7%) of patients met ICD-10 criteria for dependence to areca products. CONCLUSIONS: OSF may be associated with considerable psychological morbidity. This morbidity may be significantly more in patients with worst functional staging. It is difficult to determine whether this is the cause or effect of the disease. Further systematic studies are urgently needed to address this issue.

Evaluation of occlusal splint therapy in temporomandibular joint disorder patients using real-time ultrasonography.

AIM: The aim of the present study was to evaluate the effect of occlusal splint therapy by determining the cross-sectional dimension of masseter muscle using ultrasound in patients with temporomandibular joint disc displacement with reduction. METHODS: Twenty-seven patients aged between 20 and 40 years were included in the study. A detailed history was obtained, and a comprehensive clinical examination was carried out. Subjective assessment with structured pro forma was performed pre-occlusal and post-occlusal splint therapy. The objective measurement of the bilateral masseter muscle thickness was recorded using real-time ultrasonography before and after splint therapy. RESULTS: The mean ultrasound thickness of the masseter muscle in the pre-clenching state before splint therapy was 9.45 mm (SD 1.39), and the post-clenching state was 13.15 mm (SD 2.23). After splint therapy, the mean thickness in the pre-clenching state was 9.14 mm (SD 1.31), and the post-clenching state was 12.78 mm (SD 2.23; P<0.001). CONCLUSION: Ultrasonographic measurements of the masseter muscle in patients with temporomandibular joint disc displacement with reduction can be a useful tool to assess the effectiveness of occlusal splint therapy. Such conservative measures can significantly reduce masticatory muscle tenderness, especially of the temporalis and masseter.

Gorlin-Goltz syndrome with situs inversus: a rare case report / Síndrome de Gorlin-Goltz com situs inversus: relato de um caso raro

OBJECTIVE: To review the literature and present a case of Gorlin´s syndrome with situs inversus. RESULTS AND DISCUSSION: Together with the major features, a great number of processes considered as minor features have also been described in the Gorlin´s syndrome. The latter includes numerous skeletal, dermatology related and neurological anomalies among others. In the present clinical case many criteria allowed a diagnosis of Gorlin´s syndrome, but for the first time this unique finding of situs inversus is seen with this syndrome. CONCLUSION: However, further research is needed to confirm the association between situs inversus and Gorlin´s syndrome.

OBJETIVO: Revisar a literatura e apresentar um caso de síndrome de Gorlin com situs inversus. RESULTADOS E DISCUSSÃO: Conjuntamente com os aspectos principais, um grande número de processos considerados menores têm sido descritos na síndrome de Gorlin. Entre outras, numerosas anomalias esqueletais, dermatológicas e neurológicas têm sido relatadas. No presente caso clínico, muitos critérios permitiram o diagnóstico da síndrome de Gorlin, porém, pela primeira vez relata-se a ocorrência deste achado único, o situs inversus. CONCLUSÃO: Entretanto, pesquisas adicionais são necessárias para confirmar a associação entre situs inversus e síndrome de Gorlin.

Thalidomide: an emerging drug in oral mucosal lesions.

Thalidomide has reemerged as a potential drug with new found uses despite its history of having caused devastating congenital birth defects. The drug has become the subject of major interest because of its clinical value in certain clearly defined disorders. Interest in thalidomide was initially rekindled in the mid-1960s by its remarkable effect in lessening the complication of leprosy called erythema nodosum leprosum. Several studies thereafter have demonstrated the use of thalidomide as a wonder drug. However, it was only in July 1998 that the US Food and Drug Administration granted approval for the use of thalidomide under strict patient guidelines. Its apparent immunomodulatory and anti-inflammatory properties led to widespread application in clinical practice. Thalidomide has gained respectability as a promising new drug in oral mucosal lesions. Studies have suggested that thalidomide is effective in severe aphthous stomatitis, Behçet's syndrome, certain oral manifestations of human immunodeficiency virus (HIV) infection, erosive lichen planus, and possibly malignancies.