Dry Mouth Research Articles

Salivary Gland Volume Changes and Dry Mouth Symptom Following Definitive Radiation Therapy in Oropharyngeal Cancer Patients—A Comparison of Two Different Approaches: Intensity-Modulated Radiation Therapy Versus Intensity-Modulated Radiation Therapy/Intensity-Modulated Proton Therapy Combination

Abstract: Background/Objectives: We aimed to compare the salivary gland volume changes following intensity-modulated radiation therapy (IMRT) alone versus IMRT/intensity-modulated proton therapy (IMPT) combination in oropharyngeal cancer (OPC). Methods: We retrospectively reviewed 78 OPC patients who underwent definitive RT with ipsilateral neck irradiation. RT techniques were either IMRT alone or IMRT/IMPT combination. Salivary gland volumes over time in relation to dry mouth symptom were evaluated. Results: Patients’ characteristics were well balanced between groups. The mean dose to the ipsilateral parotid gland (PG) was significantly lower in IMRT alone than in IMRT/IMPT combination, while those to the contralateral PG and submandibular glands (SMGs) were significantly higher in IMRT alone. The volume ratio of ipsilateral PG showed an initial sharp decline, reaching 0.74, and stabilized thereafter. The ipsilateral SMG showed a continuous decline until 24 months and reached approximately 0.47 by 48 months. The contralateral PG/SMG showed initial decline and subsequent recovery to the initial volume by 48 months. There were no significant differences in salivary gland volume changes between groups. Within 6 months, 60.3% of patients experienced dry mouth symptom, and the dry mouth incidence decreased to 41.0% in 12 months and remained stable thereafter. There were no significant differences in dry mouth symptom between groups. The volume reduction in the ipsilateral salivary glands was greater in patients with dry mouth symptom. Conclusions: No significant differences in salivary gland volume changes and dry mouth symptom were apparent between groups. The critical factor in salivary gland volume change was the delivered dose to the salivary glands, not the RT techniques.

Comparison of Effectiveness and Tolerability of Clonidine and Trihexyphenidyl in Clozapine-Induced Hypersalivation

Abstract Purpose/Background Clozapine-induced hypersalivation is one of the most common bothersome adverse reactions of clozapine. The management strategies for this condition remain inadequately studied and understood. The objective of the study is to compare the effectiveness and tolerability of (1) trihexyphenidyl 5 mg/d, (2) clonidine 0.15 mg/d, or (3) a reduction of clozapine dosage by 25 to 50 mg/d for managing clozapine-induced hypersalivation Methods/Procedures A randomized, open-label, non–placebo-controlled clinical trial was conducted from December 2023 to May 2024. Eligible patients were randomly assigned to 1 of 3 groups. Primary outcomes were assessed using the Drooling Severity and Frequency Scale (DSFS) and the Nocturnal Hypersalivation Rating Scale (NHRS) at baseline, week 4, and week 8. Quality of life assessed using the pharmaceutical therapy for quality of life short version and adverse drug reactions were recorded as secondary outcomes. Findings/Results A total of 67 patients were randomly assigned to 1 of 3 treatment groups. By week 8, significant reductions in DSFS and NHRS scores were observed in all groups, with clonidine showing the greatest improvement. Trihexyphenidyl was also effective, whereas reducing clozapine dose resulted in more modest improvements. Quality of life improved significantly across all groups, with the greatest improvement observed in the clonidine group. The most common adverse effects were dry mouth, constipation, drowsiness and dizziness. Implications/Conclusions Clonidine and trihexyphenidyl appear to be more effective options for managing clozapine-induced hypersalivation compared to clozapine dose reduction.

Photobiomodulation preconditioning for oral mucositis prevention and quality of life improvement in chemotherapy patients: a randomized clinical trial

BackgroundGiven the suffering experienced by cancer patients, effective solutions must be found to prevent painful and debilitating side effects of anti-cancer treatment. This trial aims to study the effect of preconditioning with photobiomodulation in preventing oral mucositis and xerostomia in cancer patients undergoing chemotherapy alone for the first time, and to examine its role in improving patients’ quality of life.Materials and methodsThis is a prospective, randomized, double-blind clinical trial including 45 patients divided into three age- and sex-matched groups. Group 1 received basic oral care instructions before undergoing chemotherapy. Group 2 received basic oral care instructions plus photobiomodulation using an intraoral 650 nm diode laser. Group 3 received basic oral care instructions plus photobiomodulation using a 650 nm diode laser intraorally and a 980 nm diode laser extraorally.ResultsAfter one week of follow-up, 73.3% of patients in Group 2 and 80% in Group 3 did not develop oral mucositis. The remaining patients in both groups experienced only mild erythema. In contrast, all patients in Group 1 developed oral mucositis, ranging from mild erythema to ulceration greater than 3 cm². After two weeks of follow-up, 80% of patients in Group 2 and 86.7% in Group 3 remained free of oral mucositis. The remaining patients in both groups experienced only mild erythema. In contrast, 93.3% of patients in Group 1 developed oral mucositis, with cases ranging from mild erythema to ulcers larger than 3 cm². There were statistically significant differences between the three groups in oral mucositis assessment scale after one week and after two weeks (p < 0.001). Specifically, ulcerative mucositis was not observed in both laser groups, while it was observed in 13.3% of patients in Group 1. However, these differences were not statistically significant (p = 0.129). Regarding Late Effects in Normal Tissue (LENT-SOMA) scale, there was a statistically significant difference between the three groups studied (p = 0.037). There was also a statistically significant difference in the Oral Health Impact Profile (OHIP-14) between the three groups studied (p = 0.003 after one week, p = 0.023 after two weeks).ConclusionPreconditioning before starting chemotherapy, whether with the intraoral red laser alone or in combination with the extraoral infrared laser, has shown significant results in preventing oral mucositis and dry mouth, and it has also played a major role in improving patients’ quality of life.Trial registrationThis trial was registered in ISRCTN registry under no ISRCTN70634383 (https://doi.org/10.1186/ISRCTN70634383) on 24/07/2023.

Encephalopathy in Sjogren’s Syndrome - A Distinct Neurological Presentation

Sjogren’s syndrome (SS) is an autoimmune disorder characterized by lymphocytic and plasma infiltration of exocrine glands, resulting in dry mouth and kerato-conjunctivitis sicca. The clinical symptoms may range from mucosal dryness to more systematic complaints. Sjogren's syndrome (SS) may be complicated by neurological manifestations.1 We report a 36-year-old woman presenting with quadriparesis, started as lower limb weakness which progressed to the upper limbs, having Guillain-Barre syndrome like pattern. MRI brain showed altered signal intensity in the brainstem, predominantly centered in the pons labelled as autoimmune brainstem encephalitis with distal RTA. With differentials as clippers, autoimmune disease and de-mylinating disease patient underwent an Autoimmune panel which showed Antinuclear Antibody showing speckled SSA/RO pattern and antibodies to SSB/LA were positive suggestive of Sjogren’s syndrome. The diagnosis was confirmed with a minor salivary gland biopsy from the lower lip which was definitive of Sjogren’s syndrome. Patient showed excellent improvement on pulsed steroid therapy. Therefore, this case illustrates a rare, heralding manifestation of Sjogren’s syndrome as brainstem encephalitis with definitely diagnosis based on minor salivary gland biopsy showing complete recovery on early detection and management.

Interplay between diabetes mellitus and salivary gland changes with their clinical implications.

Objective: Evaluate Clinical Implications of Diabetes Mellitus. Find out the correlation between salivary changes with oral changes. Study Design: Cross-sectional study. Setting: Dental OPDs of BU and JSMU. Period: January 2023 to January 2024. Methods: with sample size of 44 collected through convenience sampling. Data was collected of patients fulfilling the inclusion criteria of diagnosed and under treatment for Diabetes Mellitus, through a performa specially designed for collection of data of the study. Results: Data of 44 patients was included in the study. Out of 44, 8 patients reported with Sialorrhea, 32 with hyposalivation and 4 without any problems. The mean DMFT score was 4.27±0.87. The most common complaint was that of altered taste reported by 4 patients. Correlation test was performed and resulted in showing positive correlation of hyposalivation with dry mouth and altered taste at the level of 0.001 while negative correlation was observed between hypersalivation and dry mouth at the level of 0.05. Conclusion: The results are suggestive of constant monitoring of known cases by dentists every 6 months to help them maintain their oral health and improve their quality of life.

The Link between Udakavaha Srotas and Trishna Roga: A Comprehensive Study

According to Ayurveda, "Srotas" are passageways that help materials move throughout the body. These passageways are necessary for carrying nutrients, waste products, and other key components that keep physiological functions functioning Udakavaha Srotas specifically manages water transportation and regulation, playing a crucial role in hydration and fluid balance. These channels, rooted in the Talu (hard palate) and Kloma (possibly the right lung), can dysfunction due to dietary, emotional, and lifestyle factors, leading to symptoms like mouth dryness and persistent thirst. This dysfunction is linked to the imbalance of Vata and Pitta Doshas. Trishna Roga, characterized by excessive thirst, is closely associated with Udakavaha Srotas vitiation. The severity of Trishna Roga correlates with the extent of disruption in these water-carrying channels. Understanding Udakavaha Srotas is vital for comprehending the pathogenesis and treatment of Trishna Roga, highlighting the importance of maintaining these channels for overall health and wellness in Ayurvedic practice.

Functional disorders of the lower urinary tract: Parkinson's disease

Parkinson's disease (PD) is acommon neurodegenerative disease that is associated with considerable socioeconomic burden. Due to neurogenic detrusor overactivity, which challenges more the urinary storage phase than the voiding phase, these patients mainly suffer from urinary urgency, increased urinary frequency (both during the day-time and particularly at night-time), and incontinence. Besides dopaminergic agents, which have an effect on motor symptoms but only aslight effect on lower urinary tract dysfunction (LUTD), antimuscarinics are generally used as first-line treatment. However, treatment benefit is limited by central side effects (i.e., dry mouth, constipation, cognitive impairment), which occur in approximately 60% of treated PD patients. Moreover, simultaneous supplementation of antimuscarinics and PD medication is limited by negative interactions. Intradetrusor onabotulinumtoxinA (OnabotA) injections have emerged as an effective, minimally invasive, well-tolerated, and widely accepted treatment for refractory neurogenic detrusor overactivity incontinence. Recently, intradetrusor OnabotA injections were noted to effectively alleviate detrusor overactivity in patients with spinal cord injury and multiple sclerosis. Intradetrusor OnabotA injections seem to effectively alleviate LUTD in patients diagnosed with PD, while maintaining voluntary voiding.

A Challenging Case of Eosinophilic Fasciitis Without Classic Histopathological Findings.

Eosinophilic fasciitis (EF) is a rare dermatologic disease with clinical similarities to localized scleroderma and systemic sclerosis (SSc). Diagnosing EF is challenging due to overlapping clinical features among these conditions. Differentiating EF from localized scleroderma and SSc can be aided by laboratory tests, histopathological examination, and imaging studies. The diagnosis of EF specifically requires the exclusion of SSc and typically requires magnetic resonance imaging or en bloc fascial biopsy of affected areas. Here, the authors present a 75-year-old woman with a painful, violaceous rash on the legs and abdomen, leg swelling, and tightness around her upper abdomen. Review of systems revealed decreased appetite, unintentional weight loss, and shortness of breath on exertion. Physical examination showed a faint violaceous rash on the abdomen and legs as well as abdominal distention. The patient's clinical picture was complicated by worsening of the rash, development of chronic cough, continued unintentional weight loss, decreased appetite, early satiety, dry eyes, and dry mouth. An autoimmune process was considered, and the patient was seen by rheumatology, where an appropriate workup excluded localized scleroderma and SSc. EF was suspected and supported by magnetic resonance imaging findings showing fascial edema. En bloc fascial biopsy of the right thigh did not reveal classic EF findings.

Management of Dry Mouth.

Background: Dry mouth, or xerostomia, is a common complaint among older people. Dry mouth can result in a variety of dental complications, oral discomfort, difficulty swallowing and eating, and decreased taste sensation, all of which can adversely affect quality of life. Objective: To provide an overview of the definition, diagnosis, causes, potential complications, and treatment strategies for dry mouth. Data Sources: PubMed, Proquest, Cochrane Library, drug prescribing information, drug information databases, and manufacturers' websites were used. Search terms were "xerostomia," "dry mouth," "hyposalivation," "causes," "treatment," and "pharmacology." The resources identified included clinical practice guidelines, review articles, and original research articles. Data Synthesis: The literature described the causes and treatment strategies for managing xerostomia, including concerns for older adults, and pharmacists' involvement for providing care. Discussion: The most common cause of dry mouth in the general population and in older adults is medication use. Individual medications may cause dry mouth, primarily through anticholinergic side effects. Polypharmacy is also a cause. Other causes are dehydration, alcohol and caffeine intake, and systemic diseases such as Sjögren's disease. If not addressed, individuals experiencing chronic dry mouth are at increased risk for various oral conditions such as dental caries, periodontal disease, and infections. Interventions such as good oral hygiene methods, using saliva substitutes containing xylitol and prescription cholinergic agonists, if appropriate, can reduce symptoms and complications. Conclusion: Pharmacists can play an important role in managing dry mouth by conducting medication reviews, providing patient education for oral health practices, and recommending treatment strategies.

Association between poor oral health and deterioration of appetite in older age: results from longitudinal analyses of two prospective cohorts from the UK and USA

ObjectiveThis study investigated the association of poor oral health with appetite loss and deterioration in appetite longitudinally in older adults.DesignCross-sectional and longitudinal observational study.SettingData came from two population-based cohorts of...

Oral Frailty Indicators and Cardio- and Cerebrovascular Diseases in Older Age:A Systematic Review

Oral health indicators may contribute to the oral frailty phenotype, an age-related gradual loss of oral function together with a decline in cognitive and physical functions. The present systematic review synthetized current knowledge on the associations of oral frailty indicators and major cardio- and cerebrovascular diseases in older age, including coronary heart disease (CHD), arteriosclerosis, arrhythmias, hypertension, cardiovascular diseases not otherwise specified (NOS), and stroke. The study is registered on PROSPERO-(CRD42023397932). From database inception to March 31, 2024, six different electronic databases were consulted assessing the eligibility of 50,005 records against the inclusion criteria and 20 studies on 226,025 older adults were included. Five different indicators of oral frailty (number of teeth, periodontal disease, general oral health, dry mouth, and bite force) were related to cardio- and cerebrovascular diseases. The number of teeth was associated with all the outcomes except hypertension, followed by periodontal disease associated with CHD, arteriosclerosis, hypertension, and stroke. General oral health and dry mouth were associated with CHD/arrhythmias and CHD/stroke, respectively. Finally, bite force was associated only with cardiovascular diseases NOS. The present findings could help to assess the contribution of each oral frailty indicator to the development of cardio- and cerebrovascular diseases in older age.

A multi-center study of symptoms in patients with esophageal cancer postoperatively: A networking analysis.

This study aimed to explore symptom clusters and the inter-relationship of symptoms in esophageal cancer (EC) patients during the first week after surgery. A cross-sectional survey across multiple centers was carried out using the EORTCQLQ-OES18. Patients with esophageal cancer within a week post-surgery were recruited from the "Be Resilient to Cancer" project in Guangdong, Hunan, and Sichuan provinces between January and September 2024. Exploratory factor analysis with a priori algorithm was used to identify symptom clusters and network analysis was employed to recognize the relationship among core and bridge symptoms. The sample consisted of 501 patients with esophageal cancer, who were predominantly male (83%), married (93%) and 57% were ≥60 years. Three symptom clusters were identified: "reflux-pain", "eating", and "dysphagia-dry mouth". Acid or bile coming up (support=40.1%, confidence=1, lift=2.53), eating difficulties (support=40.1%, confidence=0.990, lift=2.408) and dry mouth (support=42.9%, confidence=0.808, lift=1.298) were marked as sentinel symptoms for these clusters, respectively. Acid indigestion or heartburn was identified as the core symptom (EI=1.142 without covariates and EI=1.153 with covariates), and dry mouth served as the bridge symptoms (EI=0.63 and EI=0.656). Addressing acid or bile coming up, eating difficulties, dry mouth are imperative to help relief symptom burden at the cluster level. Furthermore, targeting acid indigestion and heartburn are crucial to break the chains among different symptom clusters.

The complexity of managing oral dryness in general dental care.

To describe the experiences of general-practising dental professionals in managing oral dryness. The purposive selection of dentists and dental hygienists sought to create a cohort with varying years of professional experience, of both genders, and in dissimilar working regions and workplaces for one-on-one semi-structured interviews. Qualitative content analysis was used to identify themes and categories, where themes represented the interpretative aspect and categories, the descriptive aspect. Thirteen informants were interviewed (4 dentists, 9 dental hygienists; of these, 9 worked in the Swedish Public Dental Service; 4, in private dental care). Two themes emerged from the analysis. The first theme, "Challenges in managing oral dryness", comprised five categories: heterogeneity of the patient group, barriers to measuring salivary secretion, routines perceived as vague, lack of treatment options, and necessity to stay current. The second theme, "A patient-centred approach in managing oral dryness", had three categories: tailoring questions to the individual, viewing the patient holistically, and sharing decision-making. Managing patients with oral dryness is challenging.. The study suggests that a patient-centred approach, based on the individual needs of the patient, is crucial for managing patients with oral dryness in the dental situation. This study stresses the importance of a patient-centred approach in providing individual support for patients with oral dryness. Dental professionals should query all patients about perceived dry mouth. In cases of positive responses, determination of the salivary secretion rate is essential for a comprehensive diagnosis.

Effect of the Jiedu Tongluo Shengjin formulation on plasma immunoglobulin G (IgG) levels in patients with primary Sjögren’s syndrome

This study assessed the effect of Jiedu Tongluo Shengjin formulation on plasma IgG levels in pSS patients. 89 pSS patients were randomized into treatment (45 cases; 1 drop-out) and control (44 cases) groups using the random number table method. The control group received hydroxychloroquine sulfate and a placebo dose of Jiedu Tongluo Shengjin. The treatment group received hydroxychloroquine sulfate and the original Jiedu Tongluo Shengjin formulation. The treatment group showed significant decreases in SS disease activity index, TCM syndrome score, plasma IgG, and ESR, and significant increases in tear film break-up time, tear flow rate, salivary flow rate, C3, and C4 levels (p&lt;0.05). No significant changes were observed in the control group (p&gt;0.05). Jiedu Tongluo Shengjin effectively reduced eye and mouth dryness in pSS patients by improving inflammation and immune status.

2483 Hyponatremia In elderly: a systematic review and Meta-analysis

Abstract Introduction Hyponatremia is the most common electrolyte imbalance caused by serum sodium level of less than 135 mmol/L, prevailing 15 and 30% among hospitalised patients. Methods PRISMA guidelines were followed for this study. Pubmed was searched with the search term: (hyponatremia) AND (treatment OR control OR management [MeSH]) AND (elderly [MeSH]) with filters, timeline: 2000 to 21/07/2023, free full text articles and human species. Data extraction was done using Covidence app and depicted in PRISMA Flow diagram. Quality assessment was done by Cochrane Risk of Bias version 1. Odd’s ratio with 95% confidence interval was calculated for dichotomous outcomes. Mantel–Haenszel statistical method along with random effects model was used. Cochrane Q test was employed and I2 index was computed. Forest and Funnel plots were plotted. The analysis was done by Cochrane Review Manager. Results Out of 3222 results, 9 studies were included with total 980 patients. Eight were of vaptans and 1 of empagliflozin. Three studies had low risk of bias and were included in meta-analysis. Mean age and BMI were 70.55(SD = 14.5) years and 24.73(SD = 3.95) kg/m2 respectively. Most frequently occuring aetiology, comorbidity and symptom were congestive heart failure, hypertension and fatigue/malaise respectively. Mean baseline serum sodium was 124.89 mmol/L and mean rise was 9.142 mmol/L. Meta-analysis showed that placebo was significantly associated with achieving normonatremia as compared to treatment group (OR = 2.5, 95%CI:1.54,4.04, p = 0.0002,I2 = 0%). The most frequent reported side effects were nausea, dry mouth, pyrexia and thirst. Side effects both mild/moderate (OR = 1.12, 95%CI:0.69,1.81, p = 0.65, I2 = 0%) and serious (OR = 1.51, 95%CI: 0.77,2.98, p = 0.23, I2 = 0%) showed no difference between treatment and placebo groups. Treatment was not associated with rapid risk of overcorrection (OR = 1.65, 95% CI:0.57,4.81, p = 0.36, I2 = 0%). None showed osmotic demyelination syndrome. Conclusion We conclude that vaptans and Empagliflozin, although safe, show limited efficacy in hyponatremia treatment. Reference 1. Zhang X, Li XY. Eur Geriatr Med. 2020;11(4):685–692.

Down the Rabbit Hole: A Large-Scale Survey of Psychedelic Users’ Patterns of Use and Perceived Effects

ABSTRACT The ever-changing landscape surrounding legality and accessibility of psychedelics and their increasing popularity make it imperative to better understand the nature of psychedelic use by the general population. To this end, 1,486 eligible respondents (M age = 29.58, 67.1% male) residing in the United States completed an online survey designed to assess the types of psychedelics used, methods of administration and dosing, frequency of use, intentions for use, context/environments in which they are used, perceived acute effects, frequency of those effects and distress about them, and their perceived residual effects and distress about them. Respondents predominantly endorsed using MDMA, LSD, DMT, and psilocybin. The predominant methods of administration were oral. Most reported using psychedelics for recreational purposes. The most endorsed acute effects were hallucinations, increased heart rate, positive mood, and visual tracers, while the most endorsed residual effects were headaches/migraine, dry mouth, nausea, hallucinations, and anxiety. Participants were most distressed by negative mood states, vomiting, and nausea when under the acute effects of psychedelics, but mean distress ratings were low. These results can help inform clinical trials, reform policy regarding legal access to psychedelics, and track changes in these metrics as sociocultural and legal landscapes continue to shift.

Xanomeline-Trospium for Adults with Schizophrenia Experiencing Acute Psychosis: A Systematic Review and Meta-analysis of Safety and Tolerability Outcomes.

The United States Food and Drug Administration approved the xanomeline-trospium combination in September 2024 for treating schizophrenia, based in part on three double-blind, randomized placebo-controlled trials in adults with schizophrenia experiencing acute psychosis. This random-effects model pairwise meta-analysis of those three trials found that xanomeline-trospium was comparable to placebo in terms of all-cause discontinuation, discontinuation rate due to adverse events, Simpson-Angus Scale score change, Barnes Akathisia Rating Scale score change, body weight change, body mass index change, blood pressure change, serum total cholesterol change, blood glucose change, QTc interval changes, and the incidence of headache, somnolence, insomnia, dizziness, akathisia, agitation, tachycardia, gastroesophageal reflux disease, diarrhea, increased weight, and decreased appetite. However, xanomeline-trospium was associated with a higher incidence of at least one adverse event, dry mouth, hypertension, nausea, vomiting, dyspepsia, and constipation, and increased serum triglyceride compared with placebo. Notably, xanomeline-trospium demonstrated superior efficacy than placebo in improving the Positive and Negative Syndrome Scale (PANSS) total score, PANSS positive subscale score, and PANSS negative subscale score.

Regenerative fibroblasts derived from autologous skin tissue for the treatment of Sjögren’s syndrome: a case report

BackgroundSjögren’s syndrome (SS) is a systemic autoimmune disease, with major symptoms including dry mouth and dry eyes, for which there is no effective treatment. Recent studies have demonstrated that mesenchymal stem cells (MSCs) are effective in the treatment of SS, but the efficacy of allogeneic MSCs is affected by variability among different cell donors, and they are easily cleared by the immune system of the recipient. Autologous MSCs are one of the ideal options for the treatment of SS; however, their function decreases with age. Regenerative fibroblast (rFib) is a type of new MSC obtained through chemical reprogramming technology from skin fibroblasts. In this study, we report the safety and efficacy of intravenous infusion of autologous rFib in a volunteer with SS.Case reportIn March 2021, the volunteer was diagnosed with SS due to positive anti-SSB antibodies, lymphocyte infiltration in the lip gland, dry eyes, and a large area of purpura in both lower limbs. From May 2021 to November 2022, she received allogeneic Umbilical cord mesenchymal stem cells (UCMSC) therapy (5.0 × 107 UCMSCs per time, totaling 10 infusions), but her condition did not improve. In May 2023, the rFib for the volunteer was prepared, meeting the quality standard of T/CSCB0003-2021 Human Mesenchymal Stem Cells. Between October 2023 and June 2024, the volunteer received a total of 12 intravenous transfusions of autologous rFib. After the treatments, the volunteer experienced no recurrence of purpura in both lower limbs. Symptoms of dry mouth, dry eyes, and fatigue were relieved. ESR, B lymphocytes, rheumatoid factor IgM, and IgA declined, while the proportion of NK cells increased, and most of the cytokines returned to normal levels. In vitro experiments showed that rFib could significantly inhibit the proliferation of T lymphocytes after PHA stimulation. No adverse effects were associated with the use of rFib in the volunteer during the clinical trial.SummaryThe results of this clinical trial indicate that intravenous injections of autologous rFib are both safe and effective for treating SS. Autologous rFib may be more suitable for treating autoimmune diseases than allogeneic MSCs.

P-29 HONEYMOON IN LATE PREGNANCY

Abstract Introduction During pregnancy there is a partial decrease in the function of immune system which would end with suppression of autoimmune diseases, even type 1 diabetes (T1DM) (1-2). We report a pregnant women with T1DM who was suffering from severe hypoglycemia even with very low insulin dosages in her third trimester. Clinical Case A 27 year old young lady was referred to our clinic with HbA1c level of 12.7%. She had no symptom other than slight nausea and dry mouth. Her β-HCG level was 55 mIU/ml and her plasma glucose level was 435 mg/dl. She was diagnosed with T1DM about one year ago, was started with intensive insulin regimen about 80 IU/day totally, which she did not use ever since. We hospitalized her and started intravenous (IV) hydration and IV insulin, which we switched to subcutaneous insulin. She was educated by our dietitian and by our diabetes-clinic nurse. As the insulin dosages increased, it was detected that she was pregnant. She was offered for therapeutic abortus but did not accept. Her blood glucose measurements improved and she was discharged with morning: 12 IU, afternoon:8 IU, evening:15 IU insulin aspart and night:18 IU insulin detemir dosages. In the follow up, her Hba1c level decreased to 8.7 % in the 2nd month and to 6.7% at the 20th week. Her fasting blood glucose levels were between 87-102 mg/dl and 1st hour postprandial levels were between 110-137 mg/dl. She dropped from the follow up by her own decision. At her 30th pregnancy week, she came with hypoglycemia and she had decreased her insulin dosages to morning: 2 IU, afternoon: 2IU, evening: 3IU insulin aspart and no insulin detemir. Her plasma cortisol level was 18 mcg/dl, alanine aminotransferase (ALT): 12 IU/L, gamma glutamyl transferase (GGT): 28 IU/L, creatinine (Cre):0.8 mg/dl, and Hba1c:5.3%. Her abdominal ultrasonography (USG) was normal. She was diagnosed with honeymoon period in T1DM and was informed about strict blood glucose measurement. Conclusion T1DM would disappear for a long while or regress greatly in some pregnant women even in the late years of their disease (2). Insulin -free period after the pregnancy would last even two and a half years or huge reduction in insulin dosage during pregnany period would even start after 20 years of T1DM (2). In our case, the patient started to use very low insulin dosages at around 30th pregnancy week and after one and half year of her diagnosis of T1DM.

Preparation of sodium hyaluronate coated liposomes: effect of polymer molecular weight, coating concentration, amount of charged lipids and type of hydration medium on the stability

In this study, liposomes consisting of soybean phosphatidyl choline (SoyPC) and different molar concentrations (10 mol% and 20 mol%) of dioleoyl trimethylammoniumpropane (DOTAP) were prepared by the thin film hydration method and coated with sodium hyaluronate (NaHA) of different MWs (8–15 kDa, 30–50 kDa and 90–130 kDa) and concentrations (0.01–0.2% w/w) using phosphate buffer (PB) or glycerol phosphate buffer (G-PB) as the hydration medium. These NaHA coated liposomes could have a potential in the treatment of dry mouth since glycerol and NaHA are known for their lubricating and hydrating properties. The liposomes composed of SoyPC-DOTAP 20 mol%, and coated with NaHA MW 90–130 kDa, 0.05% w/w were found to be most stable during storage. The liposomes with 20 mol% DOTAP coated with NaHA MW 30–50 kDa, 0.05% w/w showed promising results as these stayed stable for at least two weeks. However, the liposomes coated with NaHA MW 8–15 kDa were generally unstable irrespective of the combinations of the investigated parameters. When the stable liposomes were introduced into artificial saliva (AS), aggregation rapidly occurred. Sodium alginate (NaAlg) coated liposomes that were prepared for comparison were found to be stable in AS. The study has demonstrated the influence of the amount of charged lipid which must be high, the polymer MW which must lay in the area 30 kDa-130 kDa and coating concentration which should be intermediate 0.05% w/w in preparing stable NaHA coated liposomes. Further studies need to be conducted to understand the instability exhibited by the NaHA coated liposomes in AS.