Stress-induced Complications Research Articles

Review of Dental Management Considerations for Patients with Cardiovascular Conditions

Context: Cardiovascular diseases (CVDs) are among the leading causes of mortality globally, posing unique challenges for dental practitioners. Effective dental care for these patients requires careful planning and adherence to guidelines to prevent complications such as infective endocarditis (IE), excessive bleeding, or cardiovascular emergencies during procedures. Evidence Acquisition: This review synthesizes evidence from clinical guidelines and peer-reviewed studies on managing patients with cardiovascular conditions in dental settings. Focus areas include antibiotic prophylaxis, anticoagulant management, stress reduction, and emergency preparedness. Results: Key strategies include tailored antibiotic prophylaxis, cautious management of anticoagulants, and minimizing systemic risks through procedural modifications. Dentists must also be prepared to address stress-induced complications and manage emergencies like angina or arrhythmias during procedures. Conclusions: Interdisciplinary collaboration between dentists and cardiologists is essential for optimizing the safety and outcomes of dental treatments for cardiovascular patients. By adhering to evidence-based protocols, dentists can significantly enhance both oral and systemic health in this patient population.

Health Promoting Effect of Phyllanthus emblica and Azadiractha indica against Advanced Glycation End Products Formation

Oxidative stress is linked with inflammation, diabetic complications, and advanced glycation end products formation. Intake of flavonoid-rich foods has been reported to have a beneficial effect on human health. The aim of this study was to verify the therapeutic potential of Phyllanthusemblica and Azadiractha indica against glycation and other oxidative stress-induced complications such as inflammation using in vitro study. Ethanol extracts of Phyllanthus emblica fruit pulp and dried leaf of Azadiractha indica were prepared to investigate in vitro anti-inflammatory and anti-glycating potentials. In a DPPH assay, the EC50 value of extract of P. emblica and A. indica was found to be 1532.36 ± 0.17 and 1380.61 ± 0.27 µg/mL, respectively. The FRAP value of P. emblica and A. indica extract was 86.6 and 32.12 µg ascorbic acid/100 mg dry weight of the extract. The maximum percentage of H2O2 scavenging activity was 71.30% and 67.38%, respectively. Extracts of P. emblica and A. indica showed maximum inhibition of heat-induced BSA denaturation by 62.42% and 53.00%, heat-induced denaturation of egg albumin, by 50.84%% and 44.31%, and heat-induced hemolysis by 54.44% and 50.21%. Both extracts (600 µg/mL) significantly reduced the browning, structural changes, aggregation, and AGEs formation. Our biophysical studies confirmed the AGEs formation was inhibiting the potential of extracts. Thus, our findings confirm that these extracts are a rich source of antioxidants and may be utilized to prevent the oxidative stress-induced destruction of biomolecules, glycation, and in the therapy of a variety of health problems, including inflammation. Further, a combination of extracts of P. emblica and A. indica may be extremely useful in preventing and treating health problems.

Protective Effects of Ginger Extract against Glycation and Oxidative Stress-Induced Health Complications: An In Vitro Study

Protein glycation and oxidative stress lead to severe health complications in various diseases including diabetes mellitus. The intake of flavonoid-rich foods has been confirmed previously to have a positive effect on human health. Ginger is an important source of flavonoids and is one of the most widely used traditional medicines in many Asian countries. The aim of this study was to verify the therapeutic potential of methanolic extract from ginger against glycation and other oxidative stress-induced complications using in vitro study. In this study, quantitative estimations of antioxidant components such as total phenolic and flavonoids were determined by UV–visible spectrophotometry. The anti-inflammatory action of the ginger extract was checked by determining its protective action against the denaturation of proteins, anti-proteinase activity and its membrane stabilization effect. The anti-inflammatory action of ginger extract was found to be comparable with reference standard drugs. The antiglycating effect of ginger extract was investigated by placing bovine serum albumin (BSA) with glucose in the presence and absence of ginger extract for two weeks at 37 °C. The incubated samples were analyzed for the number of glycation products, secondary structural changes, aggregation and advanced glycation end products (AGEs) formation by checking browning intensity, determination of aggregation index and Congo red assays. Our findings demonstrated that ginger extract (600 µg/mL) significantly reduced the browning, secondary structural changes, aggregation and AGEs formation. Thus, it can be concluded from these results that ginger extract is a wealthy source of antioxidants and can be used to prevent the glycation and oxidative stress-induced damage of biomolecules in various health complications including inflammation.

Cinnamomum zeylanicum (Darchini): A Boon to Medical Science and a Possible Therapy for Stress-Induced Ailments.

Plants have been an imperative source of medicine and drugs for therapy of different ailments in humans from the early history until today. Many phytochemicals present in plants act as antioxidants and are utilized as health-protecting agents. Cinnamon, a widely used spice and folk medicine obtained from Cinnamomum zeylanicum, is an effective therapy for various diseases because of its antioxidant and protective efficacy. In the present review, we investigate the beneficial effects of cinnamon on stress-induced ailments. The data regarding therapeutic effects of cinnamon on stress-induced conditions were systematically collected from PubMed, ScienceDirect, Google Scholar, and the Web of Science databases published in the English language from 2000 until July 2018 with the following terms: cinnamon, antioxidant properties, anti-inflammatory, and multifaceted plant. The articles reviewed demonstrated that free radicals play a significant role in the pathophysiology of oxidative stress-associated diseases; therefore cinnamon, with its free radical scavenging activity, represents a promising therapeutic option for ameliorating these debilitating conditions. In this context, the use of cinnamon and its derivatives might be a beneficial way to reduce oxidative stress-induced complications. However, more studies are needed at the molecular level to understand the pathophysiology of the clinical conditions observed as a result of oxidative stress.

Severe psychological stress impairs choroid plexus gateway activity for leukocyte trafficking

Severely stressful conditions can trigger changes in brain homeostasis, yet the underlying mechanism and the implications of this response to post traumatic mental pathologies are not fully understood. Recent findings have shown that different immune system activation profiles can determine the outcome of psychological stress on brain function, and identified the brain’s choroid plexus (CP) as an important immunological interface between the brain and the blood circulation. Accordingly, we hypothesized that post-traumatic stress-induced complications associated with cognitive impairments, might involve CP dysfunction as a gateway for leukocyte trafficking into the central nervous system (CNS). Here, using a mouse model of severe psychological stress, we found a decrease in CP-mediated cellular immune surveillance within the cerebrospinal fluid compartment. This process could be experimentally reversed via systemic administration of glucocorticoid receptor blockers in a mechanism that involved restoration of CP gateway activity for leukocyte trafficking, and was accompanied by alleviation of post traumatic anxiety behavior. Similarly, transient depletion of regulatory T cells circumvented stress-induced CP suppression, facilitated recruitment of immunoregulatory leukocytes to the brain parenchyma and mitigated stress related behavior. Together, these results suggest that stress-induced mental complications are an outcome of disrupted CNS-immune cross-talk, and propose a new therapeutic target for treatments of psychological stress.

Rutin alleviates chronic unpredictable stress-induced behavioral alterations and hippocampal damage in mice.

Chronic stress results in neurological complications like depression, cognitive dysfunction, and anxiety disorders. In our previous study, we observed that Urtica dioica leaf extract attenuated chronic stress-induced complications. Further, we observed that Urtica dioica contained a great amount of the flavonoid rutin in it. Hence, we aimed to evaluate the effect of rutin on 21days chronic unpredictable stress (CUS) mouse model. CUS led to a decline in locomotion & muscle coordination abilities, cognitive deficits, anxiety, and depression. These neurobehavioral outcomes were associated with neurodegeneration in the CA3 region of the hippocampus as found by H&E staining. Rutin efficiently rescued the CUS-induced behavioral deficits by reducing depression, anxiety, improving cognition, and locomotor & muscle coordination skills. Further, rutin treatment protected the CUS-induced hippocampal neuronal loss. This study establishes the neuroprotective effect of rutin in chronic stress.

Tolerance of High‐Intensity Focused Ultrasound Ablation in Patients with Hepatocellular Carcinoma

BackgroundHigh-intensity focused ultrasound (HIFU) ablation is a relatively new, noninvasive way of ablation for treating hepatocellular carcinoma (HCC). Emerging evidence has shown that it is effective for the treatment of HCC, even in patients with poor liver function. There is currently no data on the safety limit of HIFU ablation in patients with cirrhosis. However, this information is vital for the selection of appropriate patients for the procedure. We analyzed HCC patients who had undergone HIFU ablation and determined the lower limit of liver function and other patient factors with which HCC patients can tolerate this treatment modality.MethodsPreoperative variables of 100 patients who underwent HIFU ablation for HCC were analyzed to identify the risk factors in HIFU intolerance in terms of stress-induced complications. Factors that may contribute to postablation complications were compared.ResultsThirteen (13 %) patients developed a total of 18 complications. Morbidity was mainly due to skin and subcutaneous tissue injuries (n = 9). Five patients had first-degree skin burn, one had second-degree skin burn, and three had third-degree skin burn. Four complications were grade 3a in the Clavien classification and 14 were below this grade. Univariate analysis showed that age (p = 0.022) was the only independent factor in HIFU intolerance.ConclusionsHIFU ablation is generally well tolerated in HCC patients with cirrhosis. It is safe for Child-Pugh A and B patients and selected Child-Pugh C patients. With this new modality, HCC patients who were deemed unsalvageable by other surgical means in the past because of simultaneous Child-Pugh B or C disease now have a new hope.

Thymoquinone and vitamin E supplementation improve the reproductive characteristics of heat stressed male mice

Previous studies have shown that dietary supplementation with antioxidants such as vitamin E affects the reproduction parameters in heat stressed males mice. Nevertheless, the impact of thymoquinone (TQ) on the reproductive system during head stress is still poorly studied. Therefore, the aim of current study was to investigate changes in the reproductive parameters during heat stress and the impact of vitamin E (positive control) and TQ during this period. Forty male mice were distributed into four groups: group I was a control group that was orally supplemented with distilled water; group 2 was subjected to HS (at a humidity of 50 to 55% and a temperature of 42°C) for 75 days; Group 3 was subjected to HS and orally supplemented with vitamin E (20 IU/kg/day for 75 days) and group 4 was subjected to HS and orally supplemented with TQ (5 mg/kg body weight/day for 75 days). We found that HS significantly increased free radicals (FR) without significant effect on the testosterone level. Additionally, semen analysis of the heat stressed mice revealed a significant decrease in sperm concentration, sperm velocity straight line (SVSL), sperm velocity curved line (SVCL), and sperm velocity average path (SVAP). Moreover, histopathological examination of seminiferous tubules of heat stressed mice presented maturation arrest in the germinal layers. Notably, supplementation with either TQ or vitamin E completely restored the FR levels, semen quality and histopathological changes that were induced by HS. Our data revealed the beneficial impacts of TQ and vitamin E supplementation in improving heat stress-induced complications. Key words: Free radicals, heat stress, semen quality, testis, thymoquinone (TQ), vitamin E.

Tolerance of radiofrequency ablation by patients of hepatocellular carcinoma

Radiofrequency ablation (RFA) is currently an effective method for ablation of hepatocellular carcinoma (HCC). Early reports have indicated that RFA is safe and virtually free from major complications. Unlike partial hepatectomy for HCC on patients with cirrhosis, there are no data on the safety limit of RFA. However, information is vital for selection of appropriate patients for the procedure. In this study, we analyzed results from use of RFA on HCC patients and determined the lower limit of liver function with which HCC patients can tolerate RFA. Preoperative variables of 310 patients who underwent RFA for HCC were analyzed to identify the risk factors in RFA intolerance in terms of morbidity associated with stress-induced complications. Thirty-nine (12.6%) patients developed intolerance of RFA. Postoperative morbidity was mainly because of intractable ascites (n = 13), hyperbilirubinemia (n = 10), massive pleural effusion (n = 7), and other complications (n = 14). Multivariate analysis revealed that serum albumin level (P = 0.001), serum bilirubin level (P = 0.000), tumor number (P = 0.002), and RFA duration (P = 0.017) all played a role in this issue. Simple data such as serum bilirubin, serum albumin level, and tumor number can be used to predict HCC patients' tolerance of RFA. Avoidance of excessive RFA time and careful monitoring of patients at risk are important means of reducing the postoperative morbidity rate.

Glutathione level regulates HNE-induced genotoxicity in human erythroleukemia cells

4-Hydroxy- trans-2-nonenal (HNE) is one of the most abundant and toxic lipid aldehydes formed during lipid peroxidation by reactive oxygen species. We have investigated the genotoxic effects of HNE and its regulation by cellular glutathione (GSH) levels in human erythroleukemia (K562) cells. Incubation of K562 cells with HNE (5–10 μM) significantly elicited a 3- to 5-fold increased DNA damage in a time- and dose-dependent manner as measured by comet assay. Depletion of GSH in cells by l-buthionine-[S,R]-sulfoximine (BSO) significantly increased HNE-induced DNA damage, whereas supplementation of GSH by incubating the cells with GSH-ethyl ester significantly decreased HNE-induced genotoxicity. Further, overexpression of mGSTA4-4, a HNE-detoxifying GST isozyme, significantly prevented HNE-induced DNA damage in cells, and ablation of GSTA4-4 and aldose reductase with respective siRNAs further augmented HNE-induced DNA damage. These results suggest that the genotoxicity of HNE is highly dependent on cellular GSH/GST/AR levels and favorable modulation of the aldehyde detoxification system may help in controlling the oxidative stress-induced complications.

Diuretic, Hypotensive, and Hypocholesterolemic Effects of Eclipta alba in Mild Hypertensive Subjects: A Pilot Study

The combined effect of dried Eclipta alba leaf powder (3 g/day) in encapsulated form on blood pressure, diuresis, and lipid profile of 60 mildly hypertensive male subjects in the age group of 40-55 years was studied. The subjects were divided into two groups, i.e., a control (placebo) and the Eclipta group, and were given six capsules (500 mg each) per day in three equal doses for a period of 60 days. Clinical parameters, viz., blood pressure, urine volume, electrolytes (Na and K) in serum and urine, lipid profile, and plasma lipid peroxides, were analyzed before and after the feeding trials. The findings revealed that the Eclipta-supplemented group showed a marked reduction in mean arterial pressure by 15%, total cholesterol (17%), low-density lipoprotein fraction (24%), triglycerides (14%), very-low-density lipoprotein fraction (14%), and plasma lipid peroxides (18%). Results also revealed a remarkable increase in urine volume (34%), urine sodium (24%), serum vitamin C (17%), and serum tocopherols (23%) of the Eclipta group. In conclusion, it would appear that E. alba is diuretic, hypotensive, and hypocholesterolemic and helps in the alleviating oxidative stress-induced complications in hypertensives.

Indian herb ‘Sanjeevani’ (Selaginella bryopteris) can promote growth and protect against heat shock and apoptotic activities of ultra violet and oxidative stress

Selaginella bryopteris is a lithophyte with remarkable ressurection capabilities. It is full of medicinal properties, hence also known as 'Sanjeevani' (one that infuses life). For lack of credible scientific evidence the plant is not in active use as a medicinal herb. We provide scientific evidence for why S. bryopteris is known as 'Sanjeevani'. The aqueous extract of S. bryopteris possesses growth-promoting activity as well as protective action against stress-induced cell death in a number of experimental cell systems including mammalian cells. Treatment of the cells in culture with 10% aqueous extract enhanced cell growth by about 41% in Sf9 cells and 78% in mammalian cells. Pre-treatment of cells with the Selaginella extract (SE) (1-2.5%) protected against oxidative stress (H2O2) -induced cell death. The killing potential of ultra violet (UV) was also significantly reduced when the cells were pre-treated with SE for 1 h. Thermal radiation suppressed cell growth by about 50%. Pre-treatment of cells with SE for 1 h afforded complete protection against heat-induced growth suppression. SE may possess anti-stress and antioxidant activities that could be responsible for the observed effects. Chemical analysis shows that SE contains hexoses and proteins. Taken together, S. bryopteris extract may help in stress-induced complications including those due to heat shock.

Surgical correction of clubfeet

Takotsubo cardiomyopathy is an apical ballooning syndrome, which can be triggered by stress. Only few case reports describe the onset of Takotsubo as a complication of neurosurgery procedures.A case of a 53 year-old female with a spinal neurinoma and surgery-associated Takotsubo cardiomyopathy is demonstrated. The patient developed typical signs of a myocardial infarction with circulation depression and ST elevation, but normal cardiac enzymes at the end of surgery. Cardiac catheterization and levocardiography confirmed the absence of any critical coronary disease but the presence of a typical apical ballooning and midventricular hypokinesis. The patient recovered completely under supportive conservative and cardiological therapy, showing regular left ventricular pump function.Interventions in neurosurgery and perioperative care should be kept as stress free as possible. Due to the possibility of neurogenic mechanisms related to cardiomyopathy, Takotsubo cardiomyopathy as an entity of stress-induced complications should be taken into consideration.