Effects of 12-week aquatic exercises on gross motor function, swimming skills and walking ability in children with cerebral palsy.

BACKGROUND: Cerebral palsy (CP) is the most common cause of physical disability in childhood defined as a group of permanent disorders of movement. The aim of this study was to determine the effects of 12-week aquatic exercise program on gross motor function, swimming skills, and walking ability in children with cerebral palsy. METHODS: Eighteen children (Mean ± SD age: 12.3 ± 3 years) with cerebral palsy classified at Levels I, II and III on the Gross Motor Function Classification System were allocated to one group, where the first 12 weeks were a control period while another 12 weeks were an experimental period. The participants underwent the same battery of tests focusing gross motor function, swimming skills, and walking ability on three occasions. RESULTS: Control period was stable with no significant changes in any of measurements. After the 12-week experimental program, a statistically significant improvement was determined in gross motor function (p=0.005), swimming skills (p=0.000), walking endurance and walking (p=0.000). No significant differences (p>0.05) were observed for walking efficiency. CONCLUSIONS: The 12-week aquatic exercise program (3/week, 60 minutes), combining Halliwick method, swimming and walking activities may improve the gross motor function, swimming skills, walking endurance and velocity in ambulatory children with cerebral palsy.

The Association Between Level of Physical Activity and Body Mass Index, and Quality of Life Among Elderly Women.

The process of aging leads to changes in functional abilities, fitness levels, level of physical activity, and body mass index (BMI), all of which causes changes in the quality of life. The current study aims to determine the association between the level of physical activity (PA) and BMI, and quality of life (QoL) among elderly women. The total sample numbered 156 women, with an average age of 67.7 ± 5.6 years. To determine the level of physical activity, the self-reported International Physical Activity Questionnaire Long Form (IPAQ-LF), was used. To calculate the values of the BMI, the standard procedure recommended by the World Health Organization was used. Quality of life was evaluated using the short form of the WHOQOL-BREF questionnaire designed by the World Health Organization. All the data were processed using the statistical package for data analysis SPSS 20.0. Pearson's correlation analysis shows statistically significant relations at the level of p < 0.01 between PA and Physical health in Housework = 0.36, Leisure time PA = 0.27, Walking = 0.24, Moderate PA 0.43, Total PA = 0.43, while the correlations between the variables at the significance level of p < 0.05 were determined in PA in transportation = 0.19 and High-intensity PA = 0.16. Multiple linear regression analysis of different levels of PA as independent variables on individual domains of QoL shows that there is an association of PA and Physical health (Sig = 0.000), more precisely, Total PA is statistically the most closely related to Physical health (Sig = 0.000), and then follows PA at work and Social relations (Sig = 0.036). Similar results were obtained when BMI is added to model A. In contrast to model A, model B shows a statistically significant association between PA and BMI with the environmental domain of QoL (Sig = 0.001). The results of the current study indicate that high- and moderate-intensity physical activity both have benefits for physical health, whereas moderate PA showed higher significance levels. Results also show that elderly women with higher BMI values achieve better results in the environmental domain of QoL.

Oral mucosa and salivary findings in non-diabetic patients with chronic kidney disease.

INTRODUCTION: Chronic kidney disease (CKD) and dialysis treatment could affect oral mucosa and cause qualitative or quantitative changes of saliva. OBJECTIVE: The aim of the study was to investigate oral manifestations, unstimulated salivary flow rate (USFR), salivary pH value and biochemical composition of saliva in non-diabetic patients with CKD. DESIGN: The study group (PD) consisted of 50 pre-dialysis patients diagnosed with CKD, positive control group (HD) of 25 haemodialysis patients and negative control (H) of 25 age and gender-matched healthy persons. Creatinine clearance rate (CrCl) was calculated from the blood creatinine using the Cockcroft-Gault formula. After a detailed intraoral examination, whole unstimulated saliva samples were collected to determine salivary pH value, and biochemical composition using a spectrophotometric method. RESULTS: Statistical analysis revealed that PD subjects had more oral lesions (p < 0.05) and symptoms (p < 0.001) than controls. The mean CrCl was significantly lower (p < 0.05) in CKD subjects with pale mucosa, xerostomia, dysgeusia, and uremic odour, comparing to those without listed symptoms. PD subjects had significantly decreased USFR and increased pH, urea and creatinine than H controls (p < 0.05). A moderately strong positive correlation between serum and salivary creatinine in both PD (p < 0.05) and HD (p < 0.05) groups was found. CONCLUSION: This study confirmed that xerostomia and dysgeusia are major symptoms among pre-dialysis patients. Their presence along with uremic odour and pale mucosa is directly related to decreased kidney function. On the diagnostic point, decreased USFR, especially hyposalivation and increased salivary creatinine, should be considered a significant indicator of CKD in stages before dialysis therapy.

The Effect of Zinc Gluconate Supplementation on Symptoms and Tongue Epithelium Regeneration in Non-psoriatic Patients with Migratory Glossitis.

The aim of this study was to evaluate zinc gluconate as a treatment option in patients with symptomatic migratory glossitis (MG). Using simple random sampling, 28 non-psoriatic patients with symptomatic MG were divided into a test and control group. The test group took 20 mg/day of chelated zinc gluconate for one month, and was put on a diet rich in zinc. The control group was only put on a diet rich in zinc. Changes in the size of red atrophied areas (width and length) and the intensity of symptoms were evaluated as primary and secondary outcomes, respectively, at baseline, after therapy, and one month later. In the test group, the mean value of the red atrophy area width and length displayed some significant reduction as a primary outcome. There were no significant changes in the size of red patches in the control group. Secondary outcome showed that the intensity of subjective symptoms in the test group significantly decreased (P=0.042) compared with controls. The filiform papillae had partially or completely regenerated in 85.7% of cases in the test group and in 23.1% of the controls (P=0.001). Red patches with raised keratotic rims may have healed spontaneously and reappeared in constantly changing patterns that are typical for MG. This phenomenon was not observed in patients supplemented with zinc, and new atrophy areas occurred in only one case. Low-dose zinc gluconate.

Stressful Life Events and Personality Traits in Patients with Oral Lichen Planus.

The onset and aggravation of symptoms in patients with oral lichen planus (OLP) are related to psychosomatic constitution and stress involvement. The aim of this study was to evaluate the influence of stressful life events and neuroticism as a personality trait in patients with OLP. A total of 32 patients with clinically and histopathological proven cases of OLP (16 with the nonerosive and 16 with erosive form), along with 31 healthy controls without oral lesions matched for age and sex were included in the study. Neurotic tendency and intensity of anxiety, depression, and negative affects and the number and type of stressful life events were investigated by the instruments Big Five Plus Two and Holmes and Rahe`s Social Readjustment Rating Scale, respectively. Data about life experience in war and its consequences were also collected. Univariate and multivariate analysis showed significantly greater anxiety, depression and negative affects tendency, as well as greater intensity and number of experienced stressful life events compared with controls (P<0.01). The distribution of subjects with at least one stressful event (P<0.01), family matters (P<0.01) and war experiences (P<0.05) was significant in the OLP group. The logistic regression results (OR=1.97) indicate that with each new stressful event a person is about two times more likely to get OLP. The degree, number, and type of stressful life changes and neuroticisms tendency independently play an important role in the onset or reactivation of OLP, depending on the individual's psychological constitution and the large differences in each person's ability to cope and their particular reactions to stress.

Is denture stomatitis always related with candida infection? A case control study.

AIM: To examine the oral mucosa under the denture base and to determine the influence of local factors that contribute to denture stomatitis. METHODS: In this prospective, case control study 30 patients with palatal inflammatory lesions were evaluated. A degree of palatal inflammation was scored. Swab samples were taken from tongue and palatal mucosa for microbiological examination. Denture plaque index, data of night wearing dentures, pH values of tongue and palatal mucosa were determined for all subjects. RESULTS: Significantly higher incidence of poor denture cleanliness index (p=0.01) and night wearing of dentures (p=0.009) were found in patients with denture stomatitis. There were significant differences between the groups in relation to the pH value of the tongue and palatal mucosa (p=0.016 and p=0.035, respectively). No significant association was found between denture stomatitis and microbiological findings, dentures age, type of dentures, presence of previous prosthesis, frequency or manner of dentures hygiene and smoking habits. CONCLUSION: Poor denture hygiene, overnight wearing of dentures and oral mucosa pH less than 6.5 are predominant local etiologycal factors that contribute to denture stomatitis development.

Unstimulated whole salivary flow rate and anxiolytics intake are independently associated with oral Candida infection in patients with oral lichen planus.

Many factors have been proposed to influence oral infection with yeast. The aim of this study was to determine the prevalence of oral yeasts in oral lichen planus (OLP) patients and control subjects, and to perform a multiple logistic regression analysis to identify factors that influence oral Candida infection in OLP patients. In this cross-sectional study, 90 new patients with OLP and 90 sex- and age-matched control subjects with no mucosal lesions were interviewed about their health status, use of medication, and smoking and alcohol habits. Swab and unstimulated whole saliva samples were collected and salivary pH was measured. A positive Candida culture was more prevalent among OLP patients (48.9%) than among control subjects (26.7%). Candida albicans was the most frequently isolated species in both groups. By logistic regression analysis, unstimulated whole salivary flow rates of 0.11-0.24 ml min(-1) (OR = 5.90) and 0.25-0.32 ml min(-1) (OR = 3.51) and benzodiazepine anxiolytics intake (OR = 8.30) were independently associated with the presence of Candida among OLP patients. Age, denture wearing, levels of dentition, decreased salivary pH, antihypertensive drugs, and alcohol consumption were not associated with oral Candida infection in OLP patients. The results indicate that data on benzodiazepine anxiolytics intake and evaluation of unstimulated whole salivary flow rate should be considered as part of the clinical evaluation to identify OLP patients at risk for Candida infection.

The histological characteristics of clinically normal mucosa adjacent to oral cancer.

BACKGROUND: The 'field cancerization' theory tries to explain the risk of local recurrences and development of second primary tumors in oral sqamous cell carcinoma (OSCC) patients. According to this theory it is assumed that clinically normal mucosa adjacent to oral cancer, except molecular, has already developed certain premalignant histopathological changes. AIMS: The aim of this study was to determine histological characteristics of clinically normal-looking mucosa at different distances from the apparent tumor lesion margins in OSCC patients. MATERIALS AND METHODS: Normal-appearing oral mucosa biopsy specimens were obtained from 30 new (untreated) oral cancer patients from sites at a distance of 10 mm and 20 mm from the tumor lesion margins and were compared with normal oral mucosa from 30 control patients with benign oral lesions. RESULTS: A total of 21 patients (70%) in the OSCC group demonstrated histological abnormalities under microscopic examination versus 7 (23.3%) control patients (P<0.01). Seventeen oral cancer patients (57%) showed significant difference in incidence and type of histological changes of normal-looking mucosa at a distance of 10 mm from the tumor lesion; 8 (27%) demonstrated reactive changes, 6 (20%) mild dysplasia and 3 (10%) squamous cell carcinoma, compared to histological abnormalities registered in 11 (OSCC) patients (36%) at a distance of 20 mm from the tumor; 10 (33%) displayed reactive changes and 1 (3%) mild dysplasia. CONCLUSIONS: Histological abnormalities of clinically normal-looking oral mucosa taken at different distances from the tumor lesion indicated the existence of subclinical field change and represent an important parameter during the assessment of the adequacy of surgical resection margins in oral cancer management.

[Candida albicans infection in patients with oral squamous cell carcinoma].

BACKGROUND/AIM: Systemic candidiasis in intensive care units remains an improtant problem due to antifungal resistance. Patients undergoing radiotherapy for head and neck cancer are at increased risk of developing oral candidiasis and they more frequent have prior fungi colonization. Due to identification of specific risk factors predisposing to fungal infection in order to threat such patients the aim of this study was to determine the presence of Candida species in patients with oral squamous cell carcinoma and compare it to the control subjects (patients with benign oral mucosal lesions). METHODS: A total number of 30 consecutive oral cancer examined patients were included in this prospective study (24 men and 6 women with a mean age of 61.47 years, range 41-81 years). The control group consisted of 30 consecutive patients with histologically proven benign oral mucosal lesions (16 men and 14 women with a mean age of 54.53 years, range 16-83 years). The samples for mycological examination were obtained by using sterile cotton swabs from the cancer lesion surface and in the patients of the control group from the benign mucosal lesion surface. Samples were inoculated in Sabouraud dextrose agar. For identification purposes, Mackenzie germ tube test was performend on all isolates. RESULTS: The prevalence of Candida was significantly higher in oral cancer patients than in control subjects (chi2 = 5.455, p = 0.020). Candida was found on nine of the 30 cancer surfaces; 5 (16.7%) were identified as non-albicans Candida and 4 (13.3%) as Candida albicans. In the control group, only Candida albicans was isolated from 2 (6.7%) patients. In this study, no statistically significant differences in the presence of Candida species was found with respect to gender, age, smoking, alcohol consumption, wearing of dental protheses and the site of cancer lesion. CONCLUSION: The increased prevalence of yeasts on the surfaces of oral carcinoma indicates a need for their suppression before any cancer treatment. There was no evidence for an association between gender, age, smoking, alcohol consumption, wearing of dental protheses, the site of cancer lesion and the yeast presence.

[Histological characteristics of oral leukoplakia]. / Histoloske karakteristike oralne leukoplakije.

INTRODUCTION: Leukoplakia (LKP) is defined as a white patch or plaque on the mucosa of oral cavity, vulva, vagina etc., which cannot be removed and cannot be clinically or microscopically explained by presence of a disease. LKP is included in the group of lesions with malignant potential. MICROSCOPIC CHARACTERISTICS: Basic microscopic characteristics of oral LKP include hyperkeratosis of ortho- or parakeratotic type and acanthosis of the epithelium, with various degrees of chronic inflammatory infiltrates in lamina propria. Also, various degrees of epithelial dysplasia may occur. Some of the most important microscopic characteristics of dysplasia are: loss of polarity of basal cells, increased nuclear cytoplasmic ratio, irregular epithelial stratification, increased number of abnormal mitotic figures and their presence in the superficial epithelium, cellular and nuclear pleomorphism, keratinization of single cell groups. MALIGNANT POTENTIAL: LKP is the most common oral mucosal lesion (evident in 3% of adults). At the same time, up to 85% of all precancerous lesions are manifested as LKP. Overall malignant potential of LKP does not exceed 4%, but some authors found that even 16% LKP with some degree of dysplasia, have a potential to transform to carcinoma. MICROSCOPIC DIFFERENTIAL DIAGNOSIS: The most important differential diagnostic criteria are listed for lesions with similar microscopic appearance. CONCLUSION: Nowdays LKP is diagnosed more frequently than before, probable due to a better patients' education and dentists' caution, but not due to real increase in incidence.

[New knowledge on the diagnosis of oral leukoplakia]. / Novija saznanja o dijagnostici oralne keukoplakije.

INTRODUCTION: There have been many discussions and debates in the literature over appropriate criteria for diagnosing oral leukoplakia and for predicting its prognosis. CLINICAL ASPECTS: In general, two clinical variants of leukoplakia are being recognised: the homogeneous and non-homogeneous type. Clinical subdivisions of leukoplakia in these two types can be used for cases in which no biopsy is available. DIAGNOSTIC PROCEDURES: A 2-4 week interval to observe a possible regression or disappearance of a white lesion, after elimination of possible causative factors, seems to be a fully acceptable period of time before taking a biopsy. Taking a biopsy in homogeneous leukoplakia and especially non-homogeneous leukoplakia should be a standard rule. It is recommended that the histologic report should include a statement on absence or presence of epithelial dysplasia and an assessment of its severity. This recommendation was made in order to provide a classification and staging system reflecting the size and histopathologic findings.

[Prevalence of oral leukoplakia]. / Prevalencija oralne leukoplakije.

INTRODUCTION: This paper reviews epidemiologic studies on prevalence of oral leukoplakia. Special emphasis is placed on population selection, diagnostic criteria, type and training of examiners and risk factor assessment. Prevalence of leukoplakia in these studies has ranged from 0.6% to 4.6%. Variations in prevalence among the studies could depend on methodology, especially studied populations and diagnostic criteria. Most investigations have investigated the entire available adult population in a geographic region or a random sample. Others have comprised selected populations, such as hospital or clinic patients. Our study has shown that prevalence of oral leukoplakia was 2.2% in a relatively small and highly selected population. AGE AND GENDER: The onset of leukoplakia usually takes place after the age of 30 years. Our study showed that oral leukoplakia occurred in men over 40 years of age and in women over 50 years of age. These results are supported most previous findings. Gender distribution varies in most studies, ranging from a strong male predominance (4:1), to almost 1:1 in the Netherlands. SMOKING AND PREVALENCE OF ORAL LEUKOPLAKIA: Tobacco smoking is the most important known etiological factor in development of oral leukoplakia. Smokers have a six-fold increase in the risk of developing leukoplakia of the oral mucosa in regard to non-smokers. Six European studies, including our study, found a prevalence of smoking between 56 and 97 percent in leukoplakia patients. Our study also showed that the majority of smokers with leukoplakia (74.0%) smoked more than 20 cigarettes per day compared to 34.5% of those without leukoplakia. ALCOHOL AND PREVALENCE OF ORAL LEUKOPLAKIA: Smoking and alcohol consumption are often coexistent factors making it difficult to assess the effects of these factors individually. In our study the highest prevalence of leukoplakia (33.3%) was established in subjects who smoked cigarettes and consumed alcohol, compared to those who smoke tobacco only (18.2%).

[Effects of smoking on the periodontium]. / Uticaj pusenja na stanje parodoncijuma.

INTRODUCTION: The exact mechanisms by which smoking effects the periodontal tissues are not known. Studies in which plaque or calculus are taken into consideration come to conflicting conclusions regarding effects of smoking. AIM: The aim of this study was to examine the oral hygiene and periodontal status in smokers and compare them with nonsmokers. MATERIAL AND METHODS: The study group comprised 83 smokers and 83 nonsmokers. The mean age (SD) of smokers and nonsmokers was 42.4 +/- 7.0 years and 43.7 +/- 6.4 years, respectively. The age difference was not statistically significant. The average tobacco consumption of the smokers at the time of investigation was 14 cigarettes a day and they had been regular smokers for 21 years on average. RESULTS: The amount of dental plaque was evaluated in accordance with the criteria of Green-Vermillion by using disclosing solution. The periodontal condition was evaluated by Ramfjord Periodontal Disease Index. For gingival recession the distance from the cemento-enamel junction to the gingival margin was determined on mid-buccal and mid-lingual surfaces of all teeth. Each subject was radiographically examined with a full mouth intraoral survey. Alveolar bone loss was determined as the distance from the cemento-enamel junction to the point where lamina dura became continuous with the compact bone of the interdental septum. Mean alveolar bone loss based on all mesial and distal measurements was calculated for each subject. The amount of dental plaque was high in both smokers (2,60,60) and nonsmokers (1,50,70), whereas the differences were statistically significant (p < 0.001). CONCLUSION: Periodontal destruction, alveolar bone loss and gingival recession were significantly increased in smokers compared to nonsmokers (p < 0.001). It is concluded that differences observed between smokers and nonsmokers with regard to periodontal condition are attributable to differences in oral hygiene. Smoking is a risk factor for periodontal health.