Immunopathological Assessment of the Oral Mucosa in Dermatitis Herpetiformis.

Dermatitis herpetiformis (Duhring's disease, DH) is a chronic blistering cutaneous condition with pruritic polymorphic lesions, consisting of vesicles, papules or nodules and erythema, found predominantly on the extensor surfaces of the limbs, buttocks, and neck. Diagnosis is based on characteristic clinical and immunopathological findings. Oral manifestations of DH have rarely been described. The aim of the study was to evaluate IgA, IgG, IgM and C3 complement deposits in the oral mucosa in DH patients. Direct immunofluorescence (DIF) was performed on the oral mucosa specimens collected from 10 DH patients. Biopsy was taken in a local anesthesia from perilesional site from the buccal mucosa and then preserved in a standard procedure using polyclonal rabbit IgG, IgA, IgM and C3 antibodies. Granular IgA and C3 deposits were found in 6 patients (60%), and in 3 subjects (30%) the result was indeterminate. Significant fluorescence of the deposits along the basement membrane was observed in 2 patients, moderate fluorescence in 3 patients, and in 4 cases the result was indeterminate. C3 deposits were found in 5 subjects (50%), 3 of them being moderate and 2 indeterminate. No IgM and IgG deposits were detected in the collected buccal mucosa specimens.

Haematinic deficiencies and patient clinical profiles in Polish patients with recurrent aphthous stomatitis (RAS).

BACKGROUND: Recurrent aphthous stomatitis is a common ulcerative disorder of the oral mucosa, where the immune impairment may develop in genetically predisposed subjects exposed to certain environmental factors. The aim of the study was to investigate the frequency of anaemia, iron and vitamin B12 deficiency in recurrent aphthous stomatitis (RAS) and to explore its impact on the clinical presentation of RAS. METHODS: A total of 141 adults including the following: 71 subjects with RAS and 70 controls were enrolled in the study. A detailed dental and haematological assessment, including full blood count, serum iron and vitamin B12 evaluation, was performed in all study participants. The results were statistically analysed with Mann-Whitney, Kruskal-Wallis, χ2 and Fisher tests with P < .05 designated as a significance level. RESULTS: Recurrent aphthous stomatitis patients were found to suffer anaemia, iron and vitamin B12 deficiency more frequently than the controls. The mean serum iron levels were also significantly lower in RAS subjects than in controls, although still within the norm. The lowest mean serum iron levels were observed in patients with a mild course of RAS. No significant differences in mean serum iron and vitamin B12 levels were revealed as a function of stratification according to the number of lesions per single flare-up. CONCLUSIONS: The results of our study indicate an association between iron and vitamin B12 deficiency and RAS in a Polish population. However, as the haematinic deficiencies did not significantly modify the course and clinical phenotype of the disease, further studies to explore their role in RAS aetiology are required.

Evaluation of serum zinc levels in patients with recurrent aphthous stomatitis (RAS).

BACKGROUND: Recurrent aphthous stomatitis (RAS) is an ulcerative disease of the oral mucosa without a clearly defined etiology. The aim of the study was to evaluate the serum zinc levels in patients with RAS in comparison to healthy controls and to validate the association between zinc levels and the course of RAS. METHODS: Seventy-five patients with RAS and 72 controls underwent full dental examination. Serum zinc levels were determined by flame atomic absorption spectroscopy (F AAS). The results were statistically analyzed with Kruskal-Wallis, Mann-Whitney, chi-square tests and the test of difference between the two rates of structure with p < 0.05 as a significance level (Statistica 10, StatSoft®). RESULTS: No statistically significant differences were detected in serum zinc levels between RAS patients and healthy controls. The mean serum zinc concentration was found to be 84.2 µg/dL in RAS group and 83.9 µd/dL in controls, within the accepted norms. Zinc deficiency was observed in 10.7% patients from the RAS group and in 6.9% controls. No significant differences in serum zinc levels were found between patients when the course of the disease was considered. CONCLUSIONS: Serum zinc concentrations did not differ significantly in RAS patients and in healthy controls and it did not influence the course of the disease. Therefore, zinc does not appear to be an important modifying factor in the development of RAS.

The absence of an association between Interleukin 1ß gene polymorphisms and recurrent aphthous stomatitis (RAS).

OBJECTIVES: Recurrent aphthous stomatitis (RAS) is a chronic, ulcerative disease with a probable polygenic mode of inheritance and complex etiology with a strong immunological background. The aim of the present study was to determine the possible association between two single nucleotide polymorphisms (SNPs) of the IL-1ß gene: IL-1ß-511 T>C (rs16944) and IL-1ß+3954C>T (rs1143634) and RAS susceptibility in a moderately large group of patients. DESIGN: One hundred and four patients with minor, major and herpetiform RAS and 75 healthy volunteers were genotyped at IL-1ß-511 T>C (rs16944) and IL-1ß+3954C>T (rs1143634) using the PCR-RFLP approach. The results were statistically analysed with chi-square test and test of difference between two rates of structure, with p<0.05 assumed to be a statistically significance level (Statistica 10, StatSoft®, Kraków, Poland). RESULTS: There were no statistically significant differences in the genotype distribution for the IL-1ß C[+3954]T polymorphism between the RAS and control groups. The frequency of IL-1ß*T[-511]/*T[-511] homozygotes among the patients was significantly higher when compared to our study control (p<0.0347). The results after stratification into carriers and non-carriers of C and T alleles did not clearly indicate which SNP may be considered a risk factor for RAS. CONCLUSIONS: The genetic association between the studied SNPs of the IL-1ß gene and RAS remains controversial and requires further investigation.

Clinical phenotype of recurrent aphthous stomatitis and interleukin-1ß genotype in a Polish cohort of patients.

BACKGROUND: The aim of this study was to evaluate the relation between a clinical profile and the interleukin-1ß (IL-1ß) genotype in a Polish cohort of patients with RAS. METHODS: One hundred and four patients with RAS were enrolled in the study and all were subject to an oral examination. The severity of RAS was assessed according to the clinical type of the disease, the number of lesions per flare-up and the length of intervals between the episodes. The genotyping of two SNPs of the IL-1ß gene, IL-1ß c.-511 T>C (rs16944) and IL-1ß c.+3954 C>T (rs1143634), was carried out by genomic DNA isolated from blood samples and by using the PCR-RFLP approach. The results were statistically analysed with chi-square and Fisher's tests and Spearman's rank correlation, with P < 0.05 assumed to be a significance level (Statistica 10; StatSoft® , Kraków, Poland). RESULTS: No statistically significant associations or correlations were found between the presence of *2 allele and minor, major or herpetiform RAS nor after the stratification using the RAS severity score and the classification based on the number of lesions per one flare-up. A weak correlation was found between the number of lesions per one flare-up and heterozygosity promoting the A type of RAS, characterized by a low number of eruptions. CONCLUSIONS: The presence of IL-1 ß *2 allele within the c.+3954 and c.-511 SNPs was found to be neither a significant risk factor for a higher incidence of any type of RAS, nor did it influence the disease severity and mode of recurrences.

Vitamin D status in recurrent aphthous stomatitis.

INTRODUCTION: Recurrent aphthous stomatitis (RAS) is a common chronic inflammatory oral mucosa disease with an unknown cause. However, dysregulation of the immune response seems to play an important role in this disease. AIM: To evaluate the vitamin D status in RAS patients and its effects on RAS severity, given the likely immunomodulatory function of vitamin D in the human organism. MATERIAL AND METHODS: Sixty-six patients with RAS and 66 controls were examined. Immunomodulatory or immunosuppressive treatment and other ulcerative oral diseases were used as exclusion criteria. The severity of RAS was assessed according to the clinical classification of the disease, the number of lesions per flare-up and the length of intervals between the attacks. The serum vitamin D level was established in each participant. RESULTS: The mean serum vitamin D (25(OH)D) levels were found to be 16.81 ng/ml in the study group and 19.22 ng/ml in the control group, with no statistically significant difference between the two groups. In the study group, 5 (7.6%) participants were diagnosed with the "normal" vitamin D levels, while 16 (24.2%) had "insufficient" levels and 45 (68.2%) had "deficient" levels. The corresponding distribution in the control group was 8 (12.1%), 18 (27.3%) and 40 (60.6%), respectively. There was no statistical significance in the difference of vitamin D deficits between the study and the control groups. No correlation was detected between the severity of RAS and the serum vitamin D level. CONCLUSIONS: Vitamin D does not seem to be a trigger factor for RAS occurrence and does not appear to influence the severity of the disease in the studied group.

Hepcidin and iron status in pregnant women and full-term newborns in first days of life.

OBJECTIVES: The amount of iron is regulated by hepcidin. The aim of the study was to assess hepcidin concentrations in healthy pregnant women before delivery, in cord blood, and in 3-day-old newborns in relation to maternal and neonatal iron status. MATERIAL AND METHODS: The study group consisted of 44 mother-newborn pairs. Serum concentrations of hepcidin, ferritin, and transferrin receptor (sTfR) were assessed. RESULTS: Maternal hepcidin was significantly lower than cord blood (p < 0.001), and full-term newborn values (p < 0.001). Mothers also had the lowest ferritin and sTfR concentrations. The highest concentration of hepcidin was observed in the newborns. They had lower sTfR and higher ferritin concentrations than in cord blood (p < 0.001). Maternal ferritin correlated negatively with sTfR (R = -0.50 p = 0.005), and positively with hepcidin (R = 0.41; p = 0.005). There were no correlations between hepcidin and ferritin or sTfR concentrations in cord blood, nor between hepcidin and ferritin or sTfR concentrations in the newborns. Moreover, there were no correlations between maternal and cord blood or neonatal blood hepcidin, nor between maternal hepcidin and infant iron status. There were also no correlations between hepcidin in cord blood and hepcidin or parameters of the iron status in the children. CONCLUSIONS: It may be assumed that a relatively low concentration of hepcidin in women in late pregnancy facilitates their iron accumulation. Higher levels of hepcidin in full-term newborns than in their mothers may be the result of a relatively high level of iron from the stored supplies. Neonatal iron status was independently associated with either maternal or cord blood hepcidin.

Vitamin D and Its Relevance in the Etiopathogenesis of Oral Cavity Diseases.

Vitamin D belongs to a group of fat-soluble secosteroids which assume many roles in the human organism. In humans the most important forms are vitamin D3 and vitamin D2. Their primary function is the regulation of the calcium and phosphorus balance, which promote the growth of healthy bony tissue. Studies over the past few years have revealed a much wider role of vitamin D involving the aging processes, carcinogenesis, the carbohydrate balance as well as the effects on the course of various infections. In this paper we discuss the basic functions of vitamin D in the human body and the mechanisms of its activity and we summarize recent reports on the impact of vitamin D on the oral cavity with a special emphasis on autoimmunologic diseases, including: recurrent aphthous stomatitis, Behçet syndrome and Sjögren syndrome.

Tuberculosis of the oral cavity: an uncommon but still a live issue.

This paper aims at characterizing clinical features, occurrence, diagnostic process and treatment of oral tuberculosis (TB), basing on the available literature. Oral TB manifestations are uncommon and usually secondary to pulmonary changes. They predominantly appear as ulcers. Eruptions are usually single, painful and resistant to conventional treatment. Diagnosis always needs to be confirmed histopathologically. Anti-tubercular systemic therapy is required in every patient diagnosed with oral TB, while topical treatment is only adjuvant. A low incidence of oral TB together with a non-specific clinical picture might pose difficulties in its diagnosis. Oral changes in TB are likely to be overlooked what can result in further spread of Mycobacterium tuberculosis due to a delay in instituting proper treatment. Tuberculosis morbidity has risen recently and more multi-drug resistant strains of TB bacilli are found, what can result in a higher incidence of oral TB. Clinicians should be therefore aware of a possible occurrence of this entity and consider it while making a differential diagnosis of atypical oral changes.

Burning mouth syndrome - a common dental problem in perimenopausal women.

Burning mouth syndrome (BMS) is characterized by the presence of burning, paresthesia or pain of the oral mucosa in the absence of pathologic lesions revealed during the clinical examination. Moreover, the pain may be accompanied by oral dryness, hypersensitivity to some food compounds and taste disorders. Etiopathogenesis of this condition remains unclear. Potential local causative factors include among the others mechanical irritation, parafunctions and dysfunctions of the stomatognathic system, contact allergy to dental materials and electro-galvanic phenomena. Potential systemic causes include diabetes mellitus, B group vitamin deficiency (vitamins B1, B2, B6 and B12), folic acid and iron deficiency, hormonal imbalance, gastrointestinal diseases, psychiatric and neurological disorders and drug-induced side effects. The hypothesis concerning the role of hormonal changes in the development of BMS seems to be confirmed by a high incidence of this condition in perimenopausal women. Up to now, due to an unclear etiology of the disease, the treatment is very often ineffective and mainly symptomatic, which may exacerbate patient's anxiety and discomfort. In this paper we present the main etiologic factors of the burning mouth syndrome. We discuss the basic diagnostic and therapeutic methods and the influence of hormonal replacement therapy on the course of BMS based on the current medical reports.

Etiopathogenesis of recurrent aphthous stomatitis and the role of immunologic aspects: literature review.

Recurrent aphthous stomatitis (RAS; recurrent aphthous ulcers; canker sores) belongs to the group of chronic, inflammatory, ulcerative diseases of the oral mucosa. Up to now, the etiopathogenesis of this condition remains unclear; it is, however, considered to be multifactorial. The results of currently performed studies indicate that genetically mediated disturbances of the innate and acquired immunity play an important role in the disease development. Factors that modify the immunologic response in RAS include: food allergies, vitamin and microelement deficiencies, hormonal and gastrointestinal disorders (e.g., celiac disease, Crohn's disease, ulcerative colitis), some viral and bacterial infections, mechanical injuries and stress. In this paper, we presented the main etiopathogenetic factors of RAS with a special emphasis on the mechanisms of the immune response modification. Moreover, we discussed the crucial clinical symptoms and types of RAS together with epidemiologic data based on the current medical literature reports and our own observations.

Recurrent aphthous stomatitis: genetic aspects of etiology.

Recurrent aphthous stomatitis (RAS; recurrent aphthous ulcers - RAU; canker sores) is a chronic inflammatory, ulcerative condition of the oral mucosa. Its prevalence in the general population ranges between 5% and 20%, depending on the method and group studied. The etiopathogenesis of the disease is considered to be multifactorial, but remains still not fully understood. In patients with RAS, an enhanced immunologic response occurs to some trigger factors that may include: mechanical injury, stress or bacterial and viral antigens. Higher prevalence of aphthae in relatives may also indicate the genetic background of the condition. The inheritance of some specific gene polymorphisms, especially those encoding proinflammatory cytokines, which play a role in the formation of aphthous ulcer, may predispose family members to RAS. The purpose of this paper was to present the main clinical features of recurrent aphthous stomatitis, epidemiologic data and crucial etiopathogenetic factors with a special emphasis on genetic background of the condition.

[Exposure to carbon monoxide toxicity as a cause for hospitalization of patients in the Children's Clinical Hospital in Lublin in the years 2006-2012]. / Narazenie na toksyczne dzialanie tlenku wegla jako przyczyna hospitalizacji pacjentów w Dzieciecym Szpitalu Klinicznym w Lublinie w latach 2006-2012.

Exposure to carbon monoxide (CO) accounts for a frequent cause for patient hospitalization in the Children's Clinical Hospital (DSK). The most common source of exposure includes the use of defective heating appliances operating on gas or coal and less frequently the fire toxic fumes. The purpose of the present study was to estimate the number of hospitalized patients in DSK in Lublin between the years 2006-2012 according to age, sex, urban-rural residence, season, carboxyheamoglobin (COHb) levels and hospitalization period. The subjects were assigned to three age groups: I - neonates and infants, II - children from 1 to 6 years of age, III - children aged between 7 to 17 years. In total 99 patients (50 female, 49 male) were admitted to hospital on account of carbon monoxide intoxication. Children aged 6 years and above constituted the most numerous age group. Furthermore 1 neonate and 5 infants (6.1%) and 43 children aged 1 to 6 years (43.4%) were hospitalized. The intoxications were visibly season-related. The highest frequency of CO poisoning lasted from October until March. The largest incidence was recorded in December and January. The majority of the children were urban residents - 67%, 33% were from rural areas. Carboxyhaemoglobin levels upon admission ranged from 0 to 26.7%. The average hospitalization lasted 2.4 days. Carbon monoxide intoxication remains a pressing health concern. The awareness of CO intoxication hazards among general public, application of appropriate first aid techniques, identification of clinical symptoms and treatment methods present the opportunity to save lives and reduce the long-term effects of CO poisoning.

[Genetically modified food--unnecessary controversy?]. / Zywnosc genetycznie modyfikowana--niepotrzebne kontrowersje?

Fast development of genetic engineering and biotechnology allows use of genetically modified organisms (GMO) more and more in different branches of science and economy. Every year we can see an increase of food amount produced with the use of modification of genetic material. In our supermarkets we can find brand new types of plants, products including genetically modified ingredients or meat from animals fed with food containing GMO. This article presents general information about genetically modified organisms, it also explains the range of genetic manipulation, use of newly developed products and current field area for GMO in the world. Based on scientific data the article presents benefits from development of biotechnology in reference to modified food. It also presents the voice of skeptics who are extremely concerned about the impact of those organisms on human health and natural environment. Problems that appear or can appear as a result of an increase of GMO are very important not only from a toxicologist's or a doctor's point of view but first of all from the point of view of ordinary consumers--all of us.

[Preventive treatment of prolongation of the QT interval]. / Postepowanie profilaktyczne w przypadku wydluzonego odstepu QT.

Prolongation of QT interval is an indicator of bad prognosis in general population of people with heart disease, in patients after myocardial infarction and in people without recognized heart disease. Prolongation of QT interval occurs in many diseases and clinical states. It may be congenital or acquired ECG anomaly and it determines the basic symptom of long QT syndrome. In this paper we present clinical meaning of QT interval, measurement rules and problems with correct valuation of QT/QTc in electrocardiogram. We also discuss reasons of QT interval prolongation--congenital or acquired long QT syndrome, as well as the procedure in case of QT interval prolongation and possibilities of preventive treatment of iatrogenic long QT syndrome.

[The harmfulness of drugs and slimming substances--a toxicologist's point of view]. / Szkodliwosc leków i srodków wspomagajacych odchudzanie--punkt widzenia toksykologa.

Obesity in rapidly developing countries has recently become an epidemic. That is why the need to fight against this chronic disease is becoming more and more apparent. In order to lose weight it is necessary to achieve negative energy balance either by increasing physical activity or using a low calorie diet. When these methods are ineffective, pharmacotherapy is used. The criterion for the application of medical treatment is a BMI above 30 kg/m2 or above 27 along with the presence of other risk factors. Drugs for weight loss fall into three groups: appetite inhibitors, those increasing energy expenditure by enhancing thermogenesis and those inhibiting the absorption of food in the intestines. This paper presents an overview of these classes of drugs and dietary supplements with an emphasis on their adverse effects and the possibility of poisoning. Despite the fact that in Poland only one drug - orlistat has been registered for the treatment of obesity, the availability of other products is unlimited due to the Internet. This fact, and the tendency of patients to treat obesity by themselves using pharmacological substances, poses a major threat and a challenge to the toxicologist.