Major Systemic Diseases Research Articles

Associations between Systemic and Dental Diseases in Elderly Korean Population

Background and Objectives: Modernization and population aging have increased the prevalence of systemic diseases, such as diabetes and hypertension, which are often accompanied by various dental diseases. Our aim was to investigate associations between common dental conditions and major systemic diseases in an elderly Korean population. Materials and Methods: Utilizing electronic medical record data from 43,525 elderly patients, we examined the prevalence of systemic diseases (diabetes, hypertension, rheumatoid arthritis, osteoporosis, dementia) and dental conditions (caries, periodontal disease, pulp necrosis, tooth loss). The analysis focused on the correlations between these diseases. Results: Significant associations were found between systemic diseases and an increased prevalence of dental conditions. Patients with systemic diseases, especially those with multiple conditions, had higher incidences of periodontal disease and tooth loss. The correlation was particularly strong in patients with diabetes and rheumatoid arthritis. Interestingly, temporomandibular joint disorder was less frequent in this cohort. Conclusions: The findings highlight the importance of integrated dental care in managing systemic diseases in elderly populations. Enhanced dental monitoring and proactive treatment are essential due to the strong association between systemic diseases and dental conditions. Collaboration between dental and medical professionals is crucial for comprehensive care that improves health outcomes and quality of life for elderly patients.

The Eye as the Window to the Heart: Optical Coherence Tomography Angiography Biomarkers as Indicators of Cardiovascular Disease

Alterations in microvasculature represent some of the earliest pathological processes across a wide variety of human diseases. In many organs, however, inaccessibility and difficulty in directly imaging tissues prevent the assessment of microvascular changes, thereby significantly limiting their translation into improved patient care. The eye provides a unique solution by allowing for the non-invasive and direct visualization and quantification of many aspects of the human microvasculature, including biomarkers for structure, function, hemodynamics, and metabolism. Optical coherence tomography angiography (OCTA) studies have specifically identified reduced capillary densities at the level of the retina in several eye diseases including glaucoma. This narrative review examines the published data related to OCTA-assessed microvasculature biomarkers and major systemic cardiovascular disease. While loss of capillaries is being established in various ocular disease, pilot data suggest that changes in the retinal microvasculature, especially within the macula, may also reflect small vessel damage occurring in other organs resulting from cardiovascular disease. Current evidence suggests retinal microvascular biomarkers as potential indicators of major systemic cardiovascular diseases, including systemic arterial hypertension, atherosclerotic disease, and congestive heart failure.

Association between oral health conditions and the risk of major noncommunicable diseases: A protocol for systematic review and meta-analysis.

Although epidemiological studies suggest that oral health conditions may be associated with an increased risk of noncommunicable diseases, the findings have yet to be comprehensively synthesized, particularly for a major noncommunicable diseases-related health and economic burden. Therefore, we will perform a systematic review and meta-analysis of all available observational studies investigating the association between oral health conditions and subsequent risk of major noncommunicable diseases. With limited English publications, we will search electronic databases, including MEDLINE, Embase, PubMed, Cochrane Library, Scopus, and CINAHL. Based on the temporal properties and natural course of disease progression, we will seek cohort or case-control studies that investigate the association between oral disease conditions and the risk of noncommunicable diseases. Regarding the World Health Organization agenda, oral health conditions will include dental caries, periodontal disease, oral cancer, edentulism, other oral conditions (i.e., oro-dental trauma, cleft lip and palate, and noma), and endodontic lesions. Based on the global disease burden, primary outcomes of interest will include the four major systemic noncommunicable diseases: cardiovascular diseases, cancers, chronic respiratory diseases, and type 2 diabetes mellitus. Random-effects meta-analysis will be used to estimate pooled effects estimate and 95% confidence intervals. Statistical heterogeneity will be investigated using the I 2 index and τ 2 statistics. Preplanned subgroup and sensitivity analyses and random-effects meta-regression analyses will be performed to address possible heterogeneity and establish the robustness of the meta-analytic estimates. The prediction intervals, expected (E)-value, and evidence certainty will be appraised to synthesize the findings and draw evidence-based conclusions. This systematic review will summarize all available evidence regarding the association between oral health conditions and the risk of major noncommunicable diseases. The findings will encourage collaboration between oral health and primary care professionals for early detection and management of noncommunicable diseases and promote oral health well-being. PROSPERO: CRD42021274184.

Evaluating the chewing efficiency of complete dentures using bilateral balanced occlusion and lingualized occlusion: A comparative study

Background -Dentistry plays one of the major role in the battlefield of medical sciences. It covers the major part of the human body which deals with the complex orofacial structures and associated complex stomatognathic system. The complex stomatognathic system has to be maintained in every pathological or abnormal condition like partial to complete edentulism. The maintainance of the stomatognathic system is significantly dependent on the branch of dentistry that deals with the part or complete replacement of lost or missing functional and complex structures known as prosthodontics. The occlusion serves the basic function of the complete denture prosthesis as one of the central goal of complete denture therapy is restoring occlusion. The occlusal scheme is still the topic of debate (that which occlusal scheme is best suited for the complete denture prosthesis), as no occlusal scheme has proved best in all cases. It is revealed that the choice of occlusal scheme used in complete denture prosthesis is primarily to the practitioners personal preference and experiences that varies from patient to patient. Aim -The purpose of this study was to evaluate the chewing efficiency of two different occlusal schemes i.e. conventional bilateral balanced occlusion and bilateral balanced lingualized occlusion in complete denture patients. Method- 20 edentulous patients aged between 40 - 70 years with a mean age value of 55 years attending among the out-patient department of Patna Dental College and Hospital Patna, were selected for the present study. A thorough screening of general and systemic health is carried out and found free of all major systemic diseases. After the selection of the patients it was decided that all the 20 patients were provided complete denture with conventional bilateral balanced occlusion and after 45 days of post insertion of the newly fabricated complete dentures, the patients were recalled and asked for the subjective qualities of the complete denture. Result -Confirming better chewing ability by BBLO than CBBO. Conclusion- The result of the present study concludes that the complete dentures with BBLO performed significantly better chewing ability than CBBO Since in the present study, all the test were carried out with same set of complete dentures by modifying CBBO to BBLO upon the same patient, which had not been taken into account by any of the previous studies. All the previous studies had used two different set of complete dentures with two different patients. Thus, this is a remarkable milestone in the present study providing a definite authenticity of the study.

You Are What You Eat: Preventive Roles of Antioxidant Phytochemicals on Age-related Eye Diseases

Aim: What we eat plays a vital role in human health with no exception to the eye which results to either good or poor vision. This review aimed at determining how what we eat affect age-related eye diseases and the role of antioxidants in phytochemical compound in preventing age-related eye diseases.
 Study Design: A non-systematic review and evaluation of published literatures was done through web search engines such as PubMed and Google Scholar using Mendeley reference library for citation.
 Methodology: A total of 48 articles were reviewed using the key words such as ‘’you are what you eat,’’ Age-related eye diseases, Antioxidants, Phytochemical compounds, Oxidative Stress and Free Radicals
 Results: Increased consumption of energy-dense foods such as refined grains, processed meats, added sugar and saturated fatty foods might increase the risk of obesity, insulin resistance, chronically elevated blood glucose, chronic systemic inflammation, oxidative stress, and increased protein damage leading to initiation and progression of systemic diseases such as diabetes, hypertension, heart related diseases, as well as age-related eye diseases such as cataract, glaucoma, diabetic retinopathy, and macular degeneration. Findings also showed that many botanical compounds such as curcumin, lutein and zeaxanthin, ginseng, and many more, present in food exhibit strong antioxidative, anti-inflammatory, and antiapoptotic properties that helps in ameliorating the destructive roles of oxidative stress.
 Conclusion: Phytochemicals with proven antioxidant and anti-inflammatory activities, such as carotenoids and polyphenols, could be of benefit in preventing age-related eye diseases. Consumption of products containing these phytochemicals is recommended to provide noninvasive alternatives for protection, prevention and treatments of the major systemic and age-related eye diseases.

Underuse of reperfusion therapy with systemic thrombolysis in high-risk acute pulmonary embolism in a Portuguese center

IntroductionReperfusion therapy is generally recommended in acute high-risk pulmonary embolism (HR-PE), but several population-based studies report that it is underused. Data on epidemiology, management and outcomes of HR-PE in Portugal are scarce. ObjectiveTo determine the reperfusion rate in HR-PE patients, the reasons for non-reperfusion, and how it influences outcomes. MethodsIn this retrospective cohort study of consecutive HR-PE patients admitted to a thromboembolic disease referral center between 2008 and 2018, independent predictors for non-reperfusion were assessed by multivariate logistic regression. PE-related mortality and long-term MACE (cardiovascular mortality, PE recurrence and chronic thromboembolic disease) were calculated according to the Kaplan–Meier method. Differences stratified by reperfusion were assessed using the log-rank test. ResultsOf 1955 acute PE patients, 3.8% presented with hemodynamic instability. The overall reperfusion rate was 50%: 35 patients underwent systemic thrombolysis, one received first-line percutaneous embolectomy and one rescue endovascular treatment. Independent predictors of non-reperfusion were: age, with >75 years representing 12 times the risk of non-treatment (OR 11.9, 95% CI 2.7–52.3, p=0.001); absolute contraindication for thrombolysis (31.1%), with recent major surgery and central nervous system disease as the most common reasons (OR 16.7, 95% CI 3.2–87.0, p<0.001); and being hospitalized (OR 7.7, 95% CI 1.4–42.9, p=0.020). At a mean follow-up of 2.5±3.3 years, the survival rate was 33.8%. Although not reaching statistical significance for hospital mortality, mortality in the reperfusion group was significantly lower at 30 days, 12 months and during follow-up (relative risk reduction of death of 64% at 12 months, p=0.013). Similar results were found for MACE. ConclusionsIn this population, the recommended reperfusion therapy was performed in only 50% of patients, with advanced age and absolute contraindications to fibrinolysis being the main predictors of non-reperfusion. In this study, thrombolysis underuse was associated with a significant increase in short- and long-term mortality and events.

Study on Autoimmune Thyroid Disorders in Chronic Spontaneous Urticaria at a Tertiary Care Central Rural Hospital in India.

Background Chronic spontaneous urticaria (CSU) is a medical condition characterized by the persistence of urticaria for more than six weeks, primarily caused by mast cell activation. Autoimmune thyroid diseases (AITDs) are the most common cause of dysfunction of the thyroid gland, and they are influenced by both genetic and environmental factors. Mast cell mediators have a significant role in the pathogenesis of CSU through two main pathways: the derangement of intracellular signaling pathways in mast cells and basophils and the production of autoantibodies against these cells. This study aimed to explore the association between AITDs and CSU by examining clinical features and measuring thyroid hormones and anti-thyroid peroxidase (anti-TPO) antibodies in patients. Aim and objectives The primary aims of this study are to investigate the prevalence and clinical characteristics of autoimmune thyroid disorders in patients with chronic spontaneous urticaria. The specific objectives are to evaluate the triiodothyronine (T3), tetraiodothyronine (T4), thyroid-stimulating hormone (TSH), and anti-thyroid peroxidase (anti-TPO) antibody levels in patients and controls and to explore the correlations between these parameters and the development and severity of chronic spontaneous urticaria. Material and method The present study was an observational investigation that enrolled 40 patients, consisting of 20 cases and 20 controls. The inclusion criteria involved patients of both sexes, aged above 18 years, who had chronic spontaneous urticaria and agreed to participate in the study with informed consent. Patients with other skin conditions lacking abnormal thyroid etiopathogenesis were also included. Exclusion criteria included patients with major systemic disease, uncontrolled medical or surgical illness, renal or hepatic disorders, and pregnant or lactating females. Patients with chronic spontaneous urticaria underwent a comprehensive clinical evaluation, and their urticaria severity was scored using an established scoring system. Blood samples were collected from both cases and controls for measuring T3, T4, TSH, and anti-TPO antibody levels. The anti-TPO antibody was processed using the enzyme-linked immunosorbent assay (ELISA) method. The autoimmune thyroid disease was screened by monitoring T3, T4, TSH, and anti-TPO antibody levels. Results There were significant variations observed in thyroid-stimulating hormone and anti-thyroperoxidase antibody levels. Among the cases analyzed, 40% demonstrated an urticaria severity score of one, while 25% reported a duration exceeding eight weeks. Additionally, 25% of patients experienced severe pruritus and intense wheals. Conclusions This research has discovered a robust association between serum anti-TPOantibodies and the occurrence of chronic spontaneous urticaria. To mitigate the potential for chronic spontaneous urticaria to lead to long-term morbidity, it is imperative to consider testing for serum anti-TPO antibodies in conjunction with primary thyroid markers, including T3, T4, and TSH.

The gene expression patterns as surrogate indices of pH in the brain.

Hydrogen ion (H+) is one of the most potent intrinsic neuromodulators in the brain in terms of concentration. Changes in H+ concentration, expressed as pH, are thought to be associated with various biological processes, such as gene expression, in the brain. Accumulating evidence suggests that decreased brain pH is a common feature of several neuropsychiatric disorders, including schizophrenia, bipolar disorder, autism spectrum disorder, and Alzheimer's disease. However, it remains unclear whether gene expression patterns can be used as surrogates for pH changes in the brain. In this study, we performed meta-analyses using publicly available gene expression datasets to profile the expression patterns of pH-associated genes, whose expression levels were correlated with brain pH, in human patients and mouse models of major central nervous system (CNS) diseases, as well as in mouse cell-type datasets. Comprehensive analysis of 281 human datasets from 11 CNS disorders revealed that gene expression associated with decreased pH was over-represented in disorders including schizophrenia, bipolar disorder, autism spectrum disorders, Alzheimer's disease, Huntington's disease, Parkinson's disease, and brain tumors. Expression patterns of pH-associated genes in mouse models of neurodegenerative disease showed a common time course trend toward lower pH over time. Furthermore, cell type analysis identified astrocytes as the cell type with the most acidity-related gene expression, consistent with previous experimental measurements showing a lower intracellular pH in astrocytes than in neurons. These results suggest that the expression pattern of pH-associated genes may be a surrogate for the state- and trait-related changes in pH in brain cells. Altered expression of pH-associated genes may serve as a novel molecular mechanism for a more complete understanding of the transdiagnostic pathophysiology of neuropsychiatric and neurodegenerative disorders.

Morphometry of the lower lumbar spinal canal among a sample of the Saudi population: Are we at risk?

Objectives: Lumbar disk bulge is a common cause of lower back pain. A high percentage of patients improve with conservative management, but unfortunately, some do not. We postulate that an anatomically narrowed lumbar spinal canal might contribute to this variation in response to conservative management. One of the major causes of spinal stenosis is idiopathic congenital-developmental stenosis, and here, we aimed to observe if this non-modifiable risk factor is present among the Saudi population, by analyzing the lower lumbar canal dimensions in computed tomography (CT) scan axial cuts, which might be later a reference and guide in clinical practice. Methods: This retrospective descriptive study included 279 patients aged 20–40years old. We included those who underwent diagnostic CT abdomen and CT lumbar spine with no evidence of lumbar spinal disease or fracture at the level where measures were taken from the axial cuts. Furthermore, exclusion criteria included gross spinal pathologies such as fractures, tumors, deformities, major chronic systemic diseases, congenital anomalies (dwarfism), and metallic artifacts. Results: Of the 279 patients, 137 (49%) were male and 142 (51%) were female. Different measurements were taken from the CT scan of axial cuts of the lower lumbar canal (L3, L4, and L5). The pattern of segmental variation of the lower lumbar vertebral canal was found to be like other populations. In contrast, the mean lower lumbar vertebral canal diameters were characteristically different from the other population (non-compensating). Conclusion: In the Saudi population, anterior-posterior and interpedicular diameters were narrowed (non-compensating). We found a high prevalence (32%) of trefoil configuration in the Saudi population.

Pathogenesis and Treatment of Pruritus Associated with Chronic Kidney Disease and Cholestasis.

Itching is an unpleasant sensation that provokes the desire to scratch. In general, itching is caused by dermatologic diseases, but it can also be caused by systemic diseases. Since itching hampers patients' quality of life, it is important to understand the appropriate treatment and pathophysiology of pruritus caused by systemic diseases to improve the quality of life. Mechanisms are being studied through animal or human studies, and various treatments are being tested through clinical trials. We report current trends of two major systemic diseases: chronic kidney disease and cholestatic liver disease. This review summarizes the causes and pathophysiology of systemic diseases with pruritus and appropriate treatments. This article will contribute to patients' quality of life. Further research will help understand the mechanisms and develop new strategies in the future.

Understanding urticaria, and their management: An appraisal

Urticaria, or hives, is a common skin and mucous membrane illness characterized by erythematous, edematous, irritating, and transitory plaques. It affects roughly 20% of people at some point in their lives. It can produce substantial discomfort, last for months to years, and seldom reflect a major systemic disease or life-threatening allergic reaction, despite being self-limited and benign. In the Unani system of medicine urticaria is labeled as Shara, Avicenna, defined that Shara is a Damwi (sanguineous) disease usually but it may also be due to Safravi Khoon (bilious blood) or Balgham Boraqi (acidic phlegm). Urticaria is induced by the release of histamine and other inflammatory mediators from mast cells and basophils mediated by immunoglobulin E and non-immunoglobulin E. Anaphylaxis must be ruled out before a diagnosis can be made. In 80 percent to 90 percent of instances, chronic urticaria is idiopathic. Treatment with H1 antihistamines and, in certain circumstances, short-term systemic corticosteroids is favored; H2 antagonists may be added in refractory cases, however additional treatment options, including omalizumab, cyclosporine, and leukotriene receptor antagonists, may be examined during missed occurrences. Unani Medicine has its own framework for treating patients based on treatment principles which include; Ilja Bil Ghiza, Ilaj Bit Tadbeer, and Ilaj Bil Dawa.

Does motivational interviewing promote oral health in adolescents?

Design In total, 15 secondary schools were designated to one of three groups: (I) prevailing health education (PHE); (II) motivational interviewing (MI); and (III) MI with interactive dental caries risk assessment (MI + RA). Adolescents (n = 512) with negative oral health patterns (irregular tooth brushing and/or regular snacking) were recruited from groups I-III; 161, 163 and 188, respectively. Selected candidates received interventions corresponding to their assigned group. Participants completed a questionnaire on their oral health self-efficacy and routines at 0, 6 and 12 months. Dental caries (number of decayed surfaces/teeth status) and oral hygiene (dental plaque score) of the participants was also recorded at these intervals.Case selection The 15 secondary schools were recruited from the three main districts in Hong Kong. Those included in the study were required to be full-time students in a participating school, 12 or 13 years old, not have any major systemic disease, able to communicate in Cantonese or Mandarin and have unfavourable oral health behaviour - this was defined as brushing teeth less than twice a day and/or snacking more than twice a day.Data analysis The Statistical Package for Social Sciences was used for data processing. For the lost to follow-up cases, the intention-to-treat analyses were performed using the carry forward imputation (for example, the latest known outcome). The Kruskal-Wallis test was used to compare the medians through nonparametric methods. The distribution was compared using the chi-square test. Where the outcome was continuous, a linear mixed model was constructed (for example, plaque score and dental caries). Where the outcome was dichotomous, mixed-effects logistic regression was constructed (for example, 1) changes in oral health self-efficacy - remain negative versus change to positive; and 2) changes of oral health behaviours - remain unfavourable versus changed to favourable). Sociodemographic variables (for example, parental education and sex) were controlled for.Results Participants in groups II and III were more likely to increase tooth brushing frequency and reduce their snacking after 12 months, compared to group I. In addition to this, groups II and III had a lower number of new carious teeth compared to group I.Conclusions PHE was less effective than MI in evoking favourable changes in the oral health patterns of adolescents and preventing dental caries.

Effect of COVID 19 pandemic on oral maxillofacial trauma casualties: A cross-sectional analytical study at a regional trauma centre, Chidambaram

COVID -19 pandemic has unprecedented effect globally. The world health organization has declared it to be a Public Health Emergency of International Concern (PHEIC). The pandemic has a widespread effect on all sectors particularly on health care and management. This has an indirect effect on the lifestyle of people. Various studies have shown that there is a drastic reduction in cases with heart ailments and other major systemic diseases during this era of pandemic. This is a study conducted on trauma cases that has been reported during this pandemic before and after lockdown to analyze the effect of lifestyle on road traffic accidents, to differentiate the mode of maxillofacial injuries, to assess the severity of injury. AimTo study and compare prevalence, mode, severity and the effect of lifestyle on maxillofacial injury reported at casualty during lockdown. Objective1) To estimate the total prevalence of OMF trauma casualties for the past 7 months (Jan 2020–July 2020) at a Regional Trauma Centre, Chidambaram.2) Assess the prevalence of OMF trauma casualties during the pre & post lockdown period at a Regional Trauma Centre, Chidambaram.3) Assess the mode of injury in relation to OMF trauma casualties during the pre & post lockdown period at a Regional Trauma Centre, Chidambaram.4) Assess the severity of injury (soft tissue and bony) in relation to OMF trauma casualties during the pre & post lockdown period at a Regional Trauma Centre, Chidambaram.5) To compare the effect of alcohol in relation to OMF trauma casualties during the pre & post lockdown period at a Regional Trauma Centre, Chidambaram.

A Randomized Controlled Trial of High Rate rTMS Versus rTMS and Amitriptyline in Chronic Migraine

The patients with chronic migraine (CM) respond poorly to pharmacological agents including tricyclic antidepressants, beta-blockers, anticonvulsants, calcium channel blockers, flunarizine, and melatonin. The combination of 2 or more pharmacological agents has not shown better efficacy but increased side effects. High rate repetitive transcranial magnetic stimulation (rTMS) has been reported effective in episodic migraine and converts CM to episodic migraine. A combination of high rate rTMS with a pharmacological agent may be more effective compared to rTMS alone. We evaluate the efficacy and safety of 10 Hz rTMS compared to rTMS and amitriptyline in CM. Randomized controlled trial. Tertiary care teaching institute in India. Patients with CM as per International Classification of Headache Disorder third edition (ICHD-3) beta criteria were included whose age was between 18 years and 55 years. CM was defined if there were 15 headache days per month and at least 8 of these attacks having migraine characteristics for a period of more than 3 months. Patients with major psychiatric, other neurological or systemic disease, and those on migraine prophylaxis were excluded. The demographic details, frequency of headache attacks and headache days per month, migraine triggers, and associated symptoms were noted. The severity of headache was noted using a 0-10 Visual Analog Scale and the number of abortive drugs per month was noted. CM patients were randomly assigned to rTMS (group I) or rTMS and amitriptyline (group II). 10 Hz rTMS was applied using a figure of eight magnetic stimulation coil. The coil was placed over the left frontal cortex corresponding to the hot spot of the right abductor digiti minimi, which is approximately 7 cm lateral from the midline and 2 cm anterior to interaural line. The motor threshold was measured, and 70% of it was used for rTMS. Ten trains of 10 Hz rTMS, each train comprising of 60 pulses with an inter-train interval of 45 seconds were delivered in one session. Three such sessions were delivered on an alternate day and were repeated every month for 3 months. Amitriptyline was prescribed in a dose of 10mg, increased to 25mg after 2 weeks; thereafter increase in dose to 50 mg was optional. The primary outcome was > 50% reduction in headache days, and secondary outcomes were the reduction in severity of headache, abortive drug, and side effects. Forty-one patients were included in group I and 42 in group II, and their baseline characteristics were comparable. A higher proportion of group II patients had more than 50% reduction in headache days at 3 months (76.2 vs 31.7%; P < 0.001) compared to group I. More than 50% reduction in headache severity was also greater in group II compared to group I at 3 months (47.6% vs 19.5%; P = 0.01). Side effects were comparable, and none had to be withdrawn. A higher proportion of patients was shifted from group I to group II. Combination of rTMS and amitriptyline is safe and more effective in CM compared to rTMS alone.

Prevalence of Periapical Abscesses in Patients with Hypertension: A Cross-sectional Study of a Large Hospital Population

IntroductionHypertension is a common major systemic disease and 1 of the most significant causes of mortality worldwide. Persistent hypertension is 1 of the risk factors for stroke, heart attack, heart failure, and arterial aneurysm and is a leading cause of chronic kidney failure. Common medications used to treat hypertension include beta blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and calcium channel blockers. The purpose of this study was to assess the prevalence of periapical abscesses in patients with different types of hypertension conditions and to evaluate the effect of commonly used antihypertensive medications on the prevalence of periapical abscesses. MethodsThe integrated data of hospital patients were used. Data from the corresponding diagnosis codes for hypertensive conditions and periapical abscess were retrieved by searching the appropriate query in the database. The odds ratio (OR) of periapical abscesses, its association with hypertensive conditions, and the intake of 4 antihypertensive medications were calculated and analyzed statistically. ResultsThe prevalence of periapical abscesses in patients with hypertensive conditions was 1.2% compared with 0.558% in the general patient population of the hospital. The OR for the prevalence of periapical lesions in patients with hypertension was 2.32. For primary hypertension, the OR was 2.02; for hypertensive heart disease, the OR was 2.68; for hypertensive chronic kidney disease, the OR was 2.1; for hypertensive heart and chronic kidney diseases, the OR was 4.16; for secondary hypertension, the OR was 4.16; and for hypertension crisis, the OR was 5.64. For patients treated with beta blockers, the OR was 2.58; for patients treated with angiotensin-converting enzyme inhibitors, the OR was 2.73; for patients treated with angiotensin II receptor blockers, the OR was 1.93; and for patients treated with calcium channel blockers, the OR was 2.79. The differences were statistically significant (P < .0001). The OR for the prevalence of periapical abscesses in patients treated with angiotensin II receptor blockers was significantly lower than that of patients treated with either beta blockers or calcium channel blockers (P < .00001). ConclusionsUnder the conditions of this study, it appears that the prevalence of perapical abscesses is significantly higher in hypertensive patients. The prevalence of periapical abscesses is higher in patients with secondary hypertension than in those with primary hypertension. Angiotensin II receptor blockers may significantly lower the prevalence of periapical abscesses in hypertensive patients.

World Health Organization High Priority Pathogens: Ophthalmic Disease Findings and Vision Health Perspectives.

Recent Ebola epidemics, the ongoing COVID-19 pandemic, and emerging infectious disease threats have highlighted the importance of global infectious diseases and responses to public health emergencies. Ophthalmologists are essential health care workers who provide urgent and emergent vision care services during outbreaks and address the ocular consequences of epidemic and pandemic infectious diseases. In 2017, the World Health Organization (WHO) identified high priority pathogens likely to cause a future epidemic with the goal of guiding research and development to improve diagnostic tests, vaccines, and medicines. These measures were necessary to better inform and respond to public health emergencies. Given the ocular complications associated with emerging infectious diseases, there is a need to recognize the ophthalmic sequelae for future vision health preparedness for potential future outbreaks. The WHO High Priority pathogens list provides a roadmap for ophthalmologists and subspecialty providers that will guide strategic areas of research for clinical care and preparedness for future pandemic threats. This review summarizes these key viral pathogens, summarizes major systemic disease findings, and delineates relevant ocular complications of the WHO High Priority pathogens list, including Crimean-Congo hemorrhagic fever, Filovirus diseases (Ebola virus disease and Marburg hemorrhagic fever), human Coronaviruses, Lassa Fever, Nipah virus infection, Zika, and Rift Valley fever.

Whole Alga, Algal Extracts, and Compounds as Ingredients of Functional Foods: Composition and Action Mechanism Relationships in the Prevention and Treatment of Type-2 Diabetes Mellitus.

Type-2 diabetes mellitus (T2DM) is a major systemic disease which involves impaired pancreatic function and currently affects half a billion people worldwide. Diet is considered the cornerstone to reduce incidence and prevalence of this disease. Algae contains fiber, polyphenols, ω-3 PUFAs, and bioactive molecules with potential antidiabetic activity. This review delves into the applications of algae and their components in T2DM, as well as to ascertain the mechanism involved (e.g., glucose absorption, lipids metabolism, antioxidant properties, etc.). PubMed, and Google Scholar databases were used. Papers in which whole alga, algal extracts, or their isolated compounds were studied in in vitro conditions, T2DM experimental models, and humans were selected and discussed. This review also focuses on meat matrices or protein concentrate-based products in which different types of alga were included, aimed to modulate carbohydrate digestion and absorption, blood glucose, gastrointestinal neurohormones secretion, glycosylation products, and insulin resistance. As microbiota dysbiosis in T2DM and metabolic alterations in different organs are related, the review also delves on the effects of several bioactive algal compounds on the colon/microbiota-liver-pancreas-brain axis. As the responses to therapeutic diets vary dramatically among individuals due to genetic components, it seems a priority to identify major gene polymorphisms affecting potential positive effects of algal compounds on T2DM treatment.

Uveitis as an Open Window to Systemic Inflammatory Diseases.

Spondyloarthritis (Spa), Behçet’s disease (BD) and sarcoidosis are major systemic inflammatory diseases worldwide. They are all multisystem pathologies and share a possible ocular involvement, especially uveitis. We hereby describe selected cases who were referred by ophthalmologists to our internal medicine department for unexplained uveitis. Physical examination and/or the use of laboratory and imaging investigations allowed to make a diagnosis of a systemic inflammatory disease in a large proportion of patients. In our tertiary referral center, 75 patients have been diagnosed with Spa (n = 20), BD (n = 9), or sarcoidosis (n = 46) in the last two years. There was a significant delay in the diagnosis of Spa-associated uveitis. Screening strategies using Human Leukocyte Antigen (HLA)-B27 determination and sacroiliac magnetic resonance imaging in patients suffering from chronic low back pain and/or psoriasis helped in the diagnosis. BD’s uveitis affects young people from both sexes and all origins and usually presents with panuveitis and retinal vasculitis. The high proportion of sarcoidosis in our population is explained by the use of chest computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography CT that helped to identify smaller hilar or mediastinal involvement and allowed to further investigate those patients, especially in the elderly. Our results confirm how in these sight- and potentially life-threatening diseases a prompt diagnosis is mandatory and benefits from a multidisciplinary approach.

Enhancement of osteoporotic bone regeneration by strontium-substituted 45S5 bioglass via time-dependent modulation of autophagy and the Akt/mTOR signaling pathway.

Osteoporosis (OP) is a major systemic bone disease leading to an imbalance in bone homeostasis which remains a challenge in the current treatment of bone defects. Our previous studies on strontium (Sr) doping apparently stimulated osteogenesis of bioceramics, which suggested a promising strategy for the treatment of bone defects. However, the potential effects and the underlying mechanisms of Sr-doping on osteoporotic bone defects still remain unclear. Autophagy is a conventional self-degradation process of cells involved in bone homeostasis and regeneration under physiological and pathological conditions. Therefore, it is essential to design appropriate biomaterials and investigate the associated osteogenic mechanisms via autophagy. Based on this hypothesis, Sr-doped 45S5 bioglass (Sr/45S5) was fabricated, and ovariectomy bone marrow-derived mesenchymal stem cells (OVX-BMSCs) were applied as the in vitro cell culture model. First, the optimal Sr-doping concentration of 10 mol% was screened by cell proliferation, ALP staining, alizarin red S staining and the real-time PCR assay. Then, the results of western blot (WB) analysis showed that Sr-induced osteogenic differentiation of OVX-BMSCs was associated with time-dependent modulation of autophagy and related to the AKT/mTOR signaling pathway. Meanwhile, the autophagy in Sr-induced osteogenic differentiation of OVX-BMSCs was detected by WB, immunofluorescence staining and transmission electron microscopy. Furthermore, the effect of osteogenic differentiation of OVX-BMSCs has been significantly inhibited by the administration of autophagy inhibitors and the AKT/mTOR pathway inhibitors, respectively, in the early and late periods of osteogenic differentiation. Finally, the results of the model of femoral condyle defects in OVX-rats indicated that Sr10/45S5 granules remarkably enhanced bone regeneration which provided the evidences in vivo. Our research indicates that Sr-doping provides a promising strategy to promote osteogenic differentiation of OVX-BMSCs and bone regeneration in osteoporotic bone defects via early improvement of autophagy and late activation of the Akt/mTOR signaling pathway.

14329 Primary cutaneous coccidioidomycosis mimicking foliculitis: Case report

Coccidioidomycosis is the oldest of the major systemic mycoses disease, itś caused by the dimorphic fungus Coccidioides immitis and Coccidioides posadasii, ocurring mainly in semi desert areas. Up to 98% of all clinical presentations correspods to the primary pulmonary coccidioidomycosis, the remaining 2% corresponds to the primary cutaneous form. Clinically causes nodules sometimes with ulceration and in some other cases presenting verrucosum injuries, occurring 15-20 days after traumatic inoculation.