Periodontitis, Blood Pressure, and the Risk and Control of Arterial Hypertension: Epidemiological, Clinical, and Pathophysiological Aspects-Review of the Literature and Clinical Trials.

PURPOSE OF REVIEW: Arterial hypertension is an important risk factor for cardiovascular disease. In the world, about 45% of people suffer from arterial hypertension, while good blood pressure control is achieved by only approximately 50% of all hypertensive patients treated. The reason for the high prevalence of arterial hypertension and its poor control is low knowledge of hypertensinogenic factors. One such factor is periodontitis, which is a disease of social importance. RECENT FINDINGS: It has been shown that the occurrence of periodontitis leads to an increase in blood pressure, increasing the risk of arterial hypertension. Periodontitis can also lead to ineffectiveness of antihypertensive treatment. Some interventional studies have shown that treatment of periodontitis reduced blood pressure in patients with arterial hypertension. The pathogenesis of arterial hypertension in periodontitis is complex and concerns mainly the impairment of the vasodilatation properties of the endothelium. Hygiene and periodontitis treatment should be a method of preventing arterial hypertension and a method of increasing the effectiveness of antihypertensive treatment.

Natriuretic peptides in diagnostics and therapy.

Natriuretic peptides are peptide hormones which are involved in the regulation of blood pressure, water-mineral balance and multiple metabolic processes. The beginning of research on this group of hormones starts in 1981, when the deBold and collaborators discovered ANP. Eight natriuretic peptides have been described so far: ANP, BNP, CNP, DNP, urodilatin, uroguanylin, osteocrin, musculin and three receptors: NPR-A, NPR-B and NPR-C thanks to which these hormones accomplish their physiological functions. Determination of natriuretic peptide concentration in plasma is used in the diagnosis and treatment of heart failure and pulmonary embolism. Research results indicate that the determination of natriuretic peptides concentration in plasma may also be important in the acute coronary syndromes, subclinical complications of hypertension and atrial fibrillation. The concentration of natriuretic peptides is changing in many diseases. The beneficial effects of natriuretic peptides have led to the production of drugs that are their synthetic derivatives. These drugs are mainly used among patients with heart failure. Research is currently underway on the efficacy and safety of other synthetic natriuretic peptides.

Coronavirus SARS-Cov-2 and arterial hypertension - facts and myths.

Arterial hypertension is the most common comorbid disease in patients who died as a result of SARS-Cov-2 infection. Numerous observational studies indicate a relationship between arterial hypertension and its treatment and SARS-Cov-2 coronavirus infection. It is known from experimental studies that SARS-Cov-2 enters the cells by interacting with the ACE2 enzyme, while it is not known whether ACE2 is the only factor that allows the virus to enter the cell. There is no clear evidence of a link between the use of medications such as ACE and ARB and an increased risk of SARS-Cov-2 infection. It has been shown that the use of recombinant ACE2 can be potentially beneficial in COVID-19 therapy by limiting the entry of the virus into the cell. Blood glucose as well as lipid profile should be monitored during SARS-Cov-2 coronavirus infection. This article attempts to gather key information on arterial hypertension and COVID-19.

Angiopoietin-like proteins inhibitors: New horizons in the treatment of atherogenic dyslipidemia and familial hypercholesterolemia.

Angiopoietin-like proteins (ANGPTL) are involved in the regulation of numerous physiological and biochemical processes. ANGPTL3, 4 and 8, which are involved in the regulation of lipoprotein metabolism, are particularly important. ANGPTL3, 4 and 8 have been shown to regulate triglyceride availability depending on the nutritional status of the body. In addition, a deficiency of these proteins has been found to cause hypolipidemia (reduction of all lipid fractions). Increases in ANGPTL3, 4 and 8 appear to be associated with cardiovascular risk. Animal studies indicate that the use of ANGPTL3 (evinacumab) inhibitors significantly reduces plasma total cholesterol, triglycerides and low-density lipoprotein concentrations. The use of evinacumab in clinical trials also led to the normalization of plasma lipid concentrations in patients with atherogenic dyslipidemia and homozygous familial hypercholesterolemia. The results of these studies indicate that evinacumab may in the future be used in the treatment of lipid disorders, especially those with hypertriglyceridemia.

The Global Pandemic as a Life-Changer? Medical, Psychological, or Self Help during COVID-19 Pandemic: A Cross-Sectional Representative Study.

The survey was conducted on a representative adult sample of Poles one year after the announcement of the global COVID-19 pandemic. The survey aimed to determine how the public in different social groups and age categories assessed the impact of the pandemic on their personal and professional lives, and where and to what extent respondents sought psychological and medical help to cope with the effects caused by the pandemic. The survey was conducted using the CAWI technique based on a questionnaire designed by an interdisciplinary team of experts. The study indicated that 61.9% of respondents declared that the COVID-19 pandemic did not bring any good, and had rather adverse effects on their lives, and 57.7% of respondents declared that the pandemic had not affected their professional lives. Nearly half of the respondents (45.0%) declared that although the pandemic forced them to change their personal lives, it did not work out for them. Due to the impact of the COVID-19 pandemic, every eighth respondent (12.3%) contacted a mental health specialist-a psychologist, or psychiatrist. Young people most often use psychological and medical help. Due to its representative nature, the survey can be used for in-depth qualitative analyses of the impact of the pandemic on people's mental health.

Colchicine - From rheumatology to the new kid on the block: Coronary syndromes and COVID-19.

Colchicine is an effective anti-inflammatory agent used to treat gout, coronary artery disease, viral pericarditis, and familial Mediterranean fever. It has been found to act by preventing the polymerization of the protein called tubulin, thus inhibiting inflammasome activation, proinflammatory chemokines, and cellular adhesion molecules. Accumulating evidence suggests that some patients with coronavirus disease 2019 (COVID-19) suffer from "cytokine storm" syndrome. The ideal anti-inflammatory in this setting would be one that is readily available, cheap, orally administered, with a good safety profile, well- tolerated, and that prevents or modulates inflammasome activation. The researchers selected colchicine for their study. This paper is a review of the literature describing the effects of colchicine, which is a drug that is being increasingly used, especially when standard therapy fails. Colchicine was shown to reduce inflammatory lung injury and respiratory failure by interfering with leukocyte activation and recruitment. In this publication, we try to systematically review the current data on new therapeutic options for colchicine. The article focuses on new data from clinical trials in COVID-19, rheumatic, cardiovascular, and other treatment such as familial Mediterranean fever, chronic urticaria, and PFAPA syndrome (periodic fever, aphthous, stomatitis, pharyngitis, and cervical adenitis). We also summarize new reports on the side effects, drug interactions, and safety of colchicine.

Coffee and cardiac arrhythmias: Up-date review of the literature and clinical studies.

Coffee, next to water, is the most consumed drink in the world. Coffee contains over 1000 chemical compounds, the most popular of which are caffeine, chlorogenic acid, kahweol, cafestol and trigonelline. Numerous studies have shown the beneficial effects of coffee on the cardiovascular system, nervous system, digestive system and kidneys. Due to the high incidence of cardiac arrhythmias, especially atrial fibrillation, the influence of coffee consumption on arrhythmogenesis remains a controversial and clinically important issue. Many mechanisms by which coffee can increase and decrease the risk of arrhythmias have been described. Habitual consumption of moderate amounts of coffee seems to lead to less arrhythmias, which is reflected in the results of many clinical trials and meta-analyzes. This review summarizes the mechanisms of coffee action on the heart muscle and the results of the most recent important clinical trials assessing the impact of coffee consumption on the risk of various cardiac arrhythmias.

Knowledge of Primary Care Patients Living in the Urban Areas about Risk Factors of Arterial Hypertension.

Arterial hypertension (AH), one of the most common diseases of civilization, is an independent risk factor for cardiovascular morbidity and mortality. This disease is the second, after lipid disorders, the most common cardiovascular risk factor and a significant cause of premature death. In Poland, one in three adults (approximately 11 million people) suffers from it. The aim of our survey was to determine patients' knowledge of the factors (e.g., age, smoking cigarettes, drinking coffee, shift work) that may influence the development of hypertension. The survey was conducted among 205 adult primary care patients living in urban areas. There was a high correlation between patients' education and risk factors of AH, such: as excess salt in the diet (p = 0.038), smoking electronic cigarettes (p = 0.005), moderate alcohol consumption (p = 0.028), moderate daily physical activity (p = 0.011), female and male sex (p = 0.032 and p = 0.012), air pollution (p < 0.001) and others. In addition, a statistically significant factor shaping patients' attitudes toward hypertension prevention was the correlation between the respondents' education and their parents' prevalence of hypertension (p = 0.40). This study increases the knowledge of patients' awareness of hypertension. It may serve as guidance for primary care providers to pay special attention to environmental interviews with patients and the patient's family history for the prevention of hypertension incidence.

Heart Failure-Do We Need New Drugs or Have Them Already? A Case of Coenzyme Q10.

Heart failure (HF) is a global epidemic that contributes to the deterioration of quality of life and its shortening in 1-3% of adult people in the world. Pharmacotherapy of HF should rely on highly effective drugs that improve prognosis and prolong life. Currently, the ESC guidelines from 2021 indicate that ACEI, ARNI, BB, and SGLT2 inhibitors are the first-line drugs in HF. It is also worth remembering that the use of coenzyme Q10 brought many benefits in patients with HF. Coenzyme Q10 is a very important compound that performs many functions in the human body. The most important function of coenzyme Q10 is participation in the production of energy in the mitochondria, which determines the proper functioning of all cells, tissues, and organs. The highest concentration of coenzyme Q10 is found in the tissue of the heart muscle. As the body ages, the concentration of coenzyme Q10 in the tissue of the heart muscle decreases, which makes it more susceptible to damage by free radicals. It has been shown that in patients with HF, the aggravation of disease symptoms is inversely related to the concentration of coenzyme Q10. Importantly, the concentration of coenzyme Q10 in patients with HF was an important predictor of the risk of death. Long-term coenzyme Q10 supplementation at a dose of 300 mg/day (Q-SYMBIO study) has been shown to significantly improve heart function and prognosis in patients with HF. This article summarizes the latest and most important data on CoQ10 in pathogenesis.

What Is or What Is Not a Risk Factor for Arterial Hypertension? Not Hamlet, but Medical Students Answer That Question.

Hypertension is a leading cause of cardiovascular disease and premature death worldwide. The most important method of preventing hypertension is social awareness of its causes. An important role in educating society about hypertension is played by medical personnel. The study involved 327 students of medicine representing all years of study. The study used a proprietary questionnaire containing test questions about knowledge of the causes of hypertension (classical and non-classical factors), as well as questionable and false risk factors for the disease. The students' knowledge of the complications of hypertension was also assessed. Most of the students rated their knowledge about hypertension as good. Classical risk factors for hypertension were identified by students in all years of study: I-III and IV-VI. Non-classical risk factors for hypertension were less often identified by the students. The students almost unanimously indicated that the complications of hypertension include heart failure, heart attack, stroke, aortic aneurysm, kidney failure, atherosclerosis, eye diseases and worse prognosis in COVID-19. Students' knowledge of the causes of hypertension increased during medical studies. The knowledge of the respondents about classical risk factors for hypertension was extensive, whereas knowledge of non-classical risk factors it was insufficient. Most of the respondents were well aware of the complications of hypertension. Some students identified some factors incorrectly as increasing the risk of hypertension. Emphasis should be placed on the dissemination of knowledge about non-classical hypertension risk factors to medical students.

Unexpected Relationships: Periodontal Diseases: Atherosclerosis-Plaque Destabilization? From the Teeth to a Coronary Event.

Atherosclerotic cardiovascular disease (ASCVD) and periodontal disease (PD) are global health problems. High frequency of ASCVD is associated with the spread of many risk factors, including poor diet, sedentary lifestyle, diabetes, hyperlipidemia, obesity, smoking, hypertension, chronic kidney disease, hypertension, hyperhomocysteinemia, hyperuricemia, excessive stress, virus infection, genetic predisposition, etc. The pathogenesis of ASCVD is complex, while inflammation plays an important role. PD is a chronic, multifactorial inflammatory disease caused by dysbiosis of the oral microbiota, causing the progressive destruction of the bone and periodontal tissues surrounding the teeth. The main etiological factor of PD is the bacteria, which are capable of activating the immune response of the host inducing an inflammatory response. PD is associated with a mixed microbiota, with the evident predominance of anaerobic bacteria and microaerophilic. The "red complex" is an aggregate of three oral bacteria: Tannerella forsythia Treponema denticola and Porphyromonas gingivalis responsible for severe clinical manifestation of PD. ASCVD and PD share a number of risk factors, and it is difficult to establish a causal relationship between these diseases. The influence of PD on ASCVD should be treated as a factor increasing the risk of atherosclerotic plaque destabilization and cardiovascular events. The results of observational studies indicate that PD significantly increases the risk of ASCVD. In interventional studies, PD treatment was found to have a beneficial effect in the prevention and control of ASCVD. This comprehensive review summarizes the current knowledge of the relationship between PD and ASCVD.

Telemedicine Treatment and Care for Patients with Intellectual Disability.

In recent years, telemedicine has been developing very dynamically. The development of new technologies allows their use in the treatment of dermatological, cardiological, endocrine and other diseases. However, there are few reports on the use of digital technologies in the mental health care of people with intellectual disabilities. Intellectual disability is a disease that affects a large number of people. Patients suffering from intellectual disability encounter barriers that make it difficult for them to fully use telemedicine, however, these barriers can be overcome with appropriate support and adaptation. A review of the literature on telemedicine solutions in the care of people with intellectual disabilities indicates that the applications support the communication of these people with the doctor, enable simple behavioral interventions, stimulate cooperation in treatment, provide simple medical education as well as record medical data for the doctor. The authors present the potential risks related to the use of telemedicine solutions for people with intellectual disabilities as well as the project of creating a new, multi-module telemedicine system.

Possible Antidepressant Effects of Memantine-Systematic Review with a Case Study.

The treatment of bipolar depression is hampered by the inadequate efficacy of antidepressants, moderate effect of mood stabilizers, and the side effects of some second-generation antipsychotics. There is limited evidence to date regarding the antidepressant effects of memantine in bipolar depression. The aim of the article was to provide a short review of preclinical and clinical studies on the antidepressant effect of memantine, and to present the case of a bipolar depression patient successfully treated with memantine. The described patient with bipolar disorder was unsuccessfully treated with two mood stabilizers. The addition of memantine at a dose of 20 mg/d to the treatment with lamotrigine and valproic acid resulted in a reduction in the severity of depression measured on the HDRS-17 scale by 35%, and by 47.1% after 7 weeks. The discussion presents experimental evidence for the antidepressant effect of memantine, as well as data from clinical trials in recurrent and bipolar depression. The presented case is the second report in the medical literature showing the antidepressant effect of memantine as an add-on treatment for bipolar depression. The described case and literature analysis indicate that memantine may be an effective and safe method of augmentation of mood stabilizing therapy in bipolar depression.

Whole Body Cryotherapy and Hyperbaric Oxygen Treatment: New Biological Treatment of Depression? A Systematic Review.

Treatment with antidepressants is often insufficiently effective, especially in treatment-resistant depression. In such a situation, it is possible to change the drug, add a second antidepressant, or use pharmacological and non-pharmacological methods of augmenting the effect of pharmacotherapy. New methods that may fall into the scope of multi-module depression treatment as an augmentation of depression treatment are whole body cryotherapy (WBC) and hyperbaric oxygen treatment (HBOT). 545 records were selected and analyzed for these two treatments and finally three clinical trials were selected for analysis. The review also includes data on the possibility of using WBC and HBOT in somatic indications and in organic mental syndromes. Despite the small number of studies on the effectiveness of WBC or HBOT in depression, the current data show that both methods may be effective in the treatment of depression. WBC may be effective in the augmentation of antidepressants, and additionally, it is a method in which a quick antidepressant effect is obtained. HBOT may be effective in endogenous depression, just as it is effective in the treatment of somatic depression symptoms. The results are very preliminary, but if confirmed in subsequent studies, both WBC and HBOT may become new treatment options in treating depression. The authors point to the need and directions for further research into these treatment methods as an augmentation strategy for pharmacological treatment of depression.

Assessment of the Effect of A-PRF Application during the Surgical Extraction of Third Molars on Healing and the Concentration of C-Reactive Protein.

Extraction procedures for mandibular third molars are performed all over the world every day. Local inflammation resulting from surgery, and the pain that patients experience, often make it impossible to take up daily life activities, such as work or sports. Growth and anti-inflammatory factors, located in the fibrin network, have a positive effect on tissue-healing processes and should also reduce local inflammation. Advanced platelet-rich fibrin (A-PRF) applied locally influences such processes as: angiogenesis, osteogenesis and collagenogenesis. It also affects mesenchymal cell lines and anti- and pro-inflammatory mediators. Due to the autologous origin of the material, their use in guide bone regeneration (GBR) is more and more widespread in dentistry. The results of previous studies indicate that the use of A-PRF in the treatment area significantly reduces postoperative pain, while the formation of edema is not affected. C-reactive protein (CRP), which is an acute phase protein, appears in the blood as a consequence of inflammation. Due to the dynamics of changes in concentration of CRP, it is a protein that is sufficiently sensitive and is used in studies to monitor the tissue healing process. The effect of A-PRF application on CRP concentrations, before and after surgery, has not been investigated yet. The study was conducted on 60 generally healthy patients. A faster decrease of CRP levels was shown in patients who used A-PRF after the procedure. Additionally, it accelerated healing and reduced the occurrence of a dry socket close to 0.

Tips for Effective Implementation of Virtual Reality Exposure Therapy in Phobias-A Systematic Review.

Background: The high incidence of phobias and the limited accessibility of psychotherapy are the reasons for the search for alternative treatments that increase the availability of effective treatment. The use of virtual reality (VR) technology is an option with the potential to overcome the barriers in obtaining an effective treatment. VR exposure therapy (VRET) is based on a very similar rationale for in vivo exposure therapy. The study aimed to answer the question of how to perform exposure therapy in a virtual reality environment so that it is effective. Methods: A systematic review of the literature, using PRISMA guidelines, was performed. After analysis of 362 records, 11 research papers on agoraphobia, 28 papers on social phobia and 10 about specific phobias were selected for this review. Results: VRET in agoraphobia and social phobia is effective when performed from 8 to 12 sessions, on average once a week for at least 15 min. In turn, the treatment of specific phobias is effective even in the form of one longer session, lasting 45-180 min. Head mounted displays are an effective technology for VRET. Increasing the frequency of sessions and adding drug therapy may shorten the overall treatment duration. The effectiveness of VRET in phobias is greater without concomitant psychiatric comorbidity and on the condition of inducing and maintaining in the patient an experience of immersion in the VR environment. Long-term studies show a sustained effect of VRET in the treatment of phobias. Conclusion: A large number of studies on in VR exposure therapy in phobias allows for the formulation of some recommendations on how to perform VRET, enabling the effective treatment. The review also indicates the directions of further VRET research in the treatment of phobias.