Periodontitis is associated with insulin resistance in adults living with diabetes mellitus in Uganda: a cross- sectional study.

INTRODUCTION: Evidence suggests that majority of patients with diabetes mellitus in Uganda have poor glycaemic control as well as periodontal disease. This study set out to determine the association between periodontitis and insulin resistance in adult patients with diabetes mellitus in Uganda using the triglyceride glucose index. METHODS: Two hundred and twenty-three adult study participants with confirmed diabetes mellitus were enrolled in a cross-sectional study. Oral examination was carried with the aid of a periodontal probe to determine the periodontal status and findings recorded using the WHO Oral Health Assessment Tool for Adults, 2013. We recorded clinical details for body mass index (BMI in kg/m2) and laboratory parameters including fasting blood sugar (mmol/L), glycated hemoglobin levels (HbA1c, %) and serum triglycerides (mmol/L) using a study questionnaire. Data were analyzed using R version 4.10. The glucose triglyceride index was used as a measure of insulin resistance. Logistic regression analysis carried out to determine the factors associated insulin resistance. RESULTS: The majority of the study participants was female (70%) with an average age of 48.5 years (SD+/- 11.1). The mean body mass index was 29.6 kg/m2 (SD+/- 5.82). The mean serum triglyceride index was 9.48 (SD+/- 0.675). Eighty-six-point 1% of the participants had periodontal disease. Bivariate analysis revealed high odds for male sex (OR = 1.31, 95% C.I = 0.44-4.84, p = 0.65) and periodontitis (OR = 3.65, 95% C.I = 0.79-26.15, p = 0.13) but low odds for a high BMI (OR = 0.45. 95% C.I = 0.07-1.67, p = 0.30). Multivariate regression revealed a significant association between insulin resistance and periodontitis. (AOR = 3.52, 95% C.I = 1.19-1.83, p = 0.03). CONCLUSION: Insulin resistance is highly prevalent in patients with diabetes mellitus in Uganda and is associated with periodontitis and low body weight.

Prevalence and factors associated with periodontal disease in patients with diabetes mellitus attending Kiruddu National Referral Hospital, Uganda.

Introduction: patients with diabetes mellitus present with high rates of periodontal disease. Severity and extent of periodontal disease may be directly associated with poor glycemic control. The burden of periodontal disease in patients with diabetes mellitus in Uganda is not documented. This study set out to determine the prevalence and factors associated with periodontal disease in patients with diabetes mellitus attending a national referral hospital in Uganda. Methods: this was a cross-sectional study involving 264 patients with diabetes mellitus. Data were collected using a pretested questionnaire to assess factors associated with periodontal disease. This was followed by an oral examination to determine the community periodontal index (CPI) and clinical attachment loss (CAL). Laboratory tests included glycated hemoglobin and fasting blood sugar. Factors associated with periodontal diseases were evaluated using logistic regression analysis. Results: of the 264 participants, 68.9% were females. The average age was 48.9 (SD = 11.0) years. Majority of the participants (32.6%) had diabetes mellitus for 2 to 5 years with oral hypoglycemic drugs being the most commonly (55.7%) used medication. The overall prevalence of periodontal disease was 85%. Univariate analysis revealed that prevalence of periodontal disease was associated with male sex, lower level of education, smoking, oral hygiene practices, poor glycemic control and combined diabetic medication. However, based on multivariate model, this prevalence was only significantly associated with lower level of education: aOR: 10.77 95% CI 1.04-226.38, p=0.05. Conclusion: periodontal disease is highly prevalent in patients with diabetes mellitus in Uganda, especially those with a lower level of education. All diabetic patients should be screened and managed for periodontal disease. Oral health interventions should also be packaged and presented in a simple language to allow easy comprehension by even the less educated population.

Non-surgical oral hygiene interventions on disease activity of Rheumatoid arthritis patients with periodontitis: A randomized controlled trial.

Background. Periodontitis and rheumatoid arthritis have similar epidemiology and pathophysiology. Understanding the interaction between these two diseases is vital in our settings. We set out to assess the effect of oral hygiene interventions on disease activity of rheumatoid arthritis patients with periodontitis in Kampala, Uganda. Methods. Fifty-eight patients attending an arthritis clinic with rheumatoid arthritis and periodontitis were randomly assigned to either an intervention group or a control group. Patients diagnosed with rheumatoid arthritis at least two years before, who were on the same medication, dose, or formulation for RA treatment during the preceding three months, were included. The patients were >18 years of age, would be available for all the study visits in the next six months, had at least six natural teeth, had periodontal disease classified as Dutch Periodontal Index (DPSI) >3 and provided written informed consent. Those who had a chronic disorder requiring chronic or intermittent use of antibiotics, were pregnant, were lactating, or had intent to become pregnant were excluded. The primary outcome measure was a change in Disease Activity Score of 28 Joints (DAS28 score) in two 3-month follow-up periods after the intervention. The secondary outcome measure was a change in periodontal status. Results. There was a statistically significant improvement in the DAS-28 score in both the intervention and control arms during the follow-up period (P<0.01). The participants carrying more than one bacterial species had worse DAS-28 scores. Conclusion. Oral hygiene interventions given to RA patients could drastically improve their RA treatment outcomes, especially in resource-limited settings.

Periodontitis and Rheumatoid Arthritis in sub-Saharan Africa, gaps and way forward: a systematic review and meta-analysis.

BACKGROUND: This review identified papers that described periodontitis and rheumatoid arthritis in sub-Saharan Africa. Only English language publications from January 2010 to December 2017 describing original research in sub-Saharan Africa on the association between periodontitis and rheumatoid arthritis were considered for this study. METHODS: Published databases: PubMed, Science direct and Google scholar, were searched using terms "periodontitis", "rheumatoid arthritis" and "Sub-Saharan Africa" to generate a set of putative studies. Articles with data on both rheumatoid arthritis and periodontitis compared to controls were selected. Studies on the association of periodontitis with cardiovascular disease, arthritis or rheumatoid arthritis alone were excluded. Data were extracted, critically appraised, and analyzed using a random-effect Mantel-Haenszel meta-analysis on plaque index, gingival index, pocket depth and clinical attachment loss. RESULTS: Three publications were selected for the systematic review and 2 for the meta-analysis. Two studies were from Sudan, and one was from Burina Faso. There was a significant increase in pocket depth (mean difference: 0.31; 95% CI: 0.21, 0.41; N= 274; (p ≤ 0.001) and clinical attachment loss (mean difference: 0.47; 95% CI: 0.22, 0.75; N= 274; (p ≤ 0.001) in participants with rheumatoid arthritis compared to normal controls. CONCLUSION: Findings from these combined studies show a significant relationship between periodontal disease and rheumatoid arthritis with increased periodontal pocket depth and clinical attachment loss. They also highlight the need for additional work especially in the area of associating rheumatoid arthritis with P. gingivalis, the oral microbiome and treating periodontal diseases to help in the management of rheumatoid arthritis.

Informed consent in clinical practice: patients' experiences and perspectives following surgery.

BACKGROUND: Informed consent during medical practice is an essential component of comprehensive medical care and is a requirement that should be sought all the time the doctor interacts with the patients, though very challenging when it comes to implementation. Since the magnitude and frequency of surgery related risk are higher in a resource limited setting, informed consent for surgery in such settings should be more comprehensive. This study set out to evaluate patients' experiences and perspectives of informed consent for surgery. METHODS: This was a survey of post-operative patients at three university teaching hospitals in Uganda. The participants were interviewed using guided, semi-structured questionnaires. Patients from different surgical disciplines participated in the study. RESULTS: A total of 371 patients participated in the study. Eighty percent of the participants reported having been given explanations on the indication for their surgery, 56.1 % had all their questions answered before the operation, 17 % did not know the type of operation they had undergone and another 17 % did not give their consent for the operation. Additionally, more than 81 % of the participants reported giving their own permission for surgery, although only 23.7 % were able to identify the person who obtained consent from them and 22.4 % knew the names of the surgeons who conducted the surgical procedure on them. About 20 % of the participants were not satisfied with the information provided by both the doctor before and after the operation. However, there were varying responses on when doctors should explain to patients with the majority saying it should be done before treatment or surgery, while others thought it should be done on admission, others proposed that it be made immediately after the examination among other responses. On what should be done to improve communication between doctors and patients, a number of suggestions, including the need for a detailed explanation for the patient by the doctor about their disease conditions and treatment options were suggested. CONCLUSIONS: Patients' perceptions of what constitutes informed consent are diverse and many patients undergo surgery without knowledge of the identity of the surgeon or the reason for the surgery. There is a need to improve on patients' participation in informed decision making, and this can be achieved through continuing medical education for doctors.

Informed consent practices for surgical care at university teaching hospitals: a case in a low resource setting.

BACKGROUND: Informed consent in medical practice is essential and a global standard that should be sought at all the times doctors interact with patients. Its intensity would vary depending on the invasiveness and risks associated with the anticipated treatment. To our knowledge there has not been any systematic review of consent practices to document best practices and identify areas that need improvement in our setting. The objective of the study was to evaluate the informed consent practices of surgeons at University teaching Hospitals in a low resource setting. METHODS: A cross-sectional study conducted at three university teaching hospitals in Uganda. Self-guided questionnaires were left at a central location in each of the surgical departments after verbally communicating to the surgeons of the intention of the study. Filled questionnaires were returned at the same location by the respondents for collection by the research team. In addition, 20 in-depth interviews were held with surgeons and a review of 384 patients' record files for informed consent documentation was done. RESULTS: A total of 132 (62.1%) out of 214 questionnaires were completed and returned. Respondents were intern doctors, residents and specialists from General surgery, Orthopedic surgery, Ear, Nose and Throat, Ophthalmology, Dentistry, Obstetrics and Gynaecology departments. The average working experience of respondents was 4.8 years (SD 4.454, range 0-39 years). 48.8% of the respondents said they obtained consent all the time surgery is done while 51.2% did not obtain consent all the time. Many of the respondents indicated that informed consent was not obtained by the surgeon who operated the patient but was obtained either at admission or by nurses in the surgical units. The consent forms used in the hospitals were found to be inadequate and many times signed at admission before diagnosing the patient's disease. CONCLUSIONS: Informed consent administration and documentation for surgical health care is still inadequate at University teaching hospitals in Uganda.