Polarized Light as an Adjuvant to Drug Therapy for the Treatment of Refrectory Oral Erosive Lichen Planus: A Case Report

Oral lichen planus is a chronic inflammatory disease of unknown etiology, associated with a malignant transformation in 1.2% of cases. It can be predominantly white and therefore almost always asymptomatic, or with the presence of large erosions in different areas of the oral cavity. In this case the pathology can be disabling, causing severe chewing difficulties and compromising the patient's quality of life. The gold standard for the treatment of this pathology is the use of topical cortisones combined with nystatin. The use of photodynamic therapy for the treatment of these lesions is also documented in the scientific literature. Polarized light is a light with a very wide wavelength variability, created for the treatment of erosive and ulcerative skin lesions and then also introduced in other fields, such as in oral medicine. It has an excellent analgesic and bio stimulating effect. We propose a case of erosive lichen planus refractory to systemic cortisone therapy, present for 4 years without remission, successfully treated with 6 15-minute sessions of phototherapy with polarized light, using a Bioptron device at 25 watts of power. After an important improvement, the therapy was concluded with gel based on ozonated olive oil (Ialozon, Gemavip, Cagliari, Italy) and topical cortisone, due to the impossibility of continuing the therapies in the study (lockdown). Polarized light is very easy to use, has no side effects, does not require special eye protection and has proven to be very effective in the clinical resolution of refractory lesions to drug therapy

PHOTODYNAMIC THERAPY AS SUPPORT OF PHARMACOLOGICAL THERAPY IN A CASE OF PARTICULAR REFRACTORY ORAL LICHEN PLANUS: A CASE REPORT.

Aim: Lichen planus (LP) is a chronic autoimmune mucocutaneous condition, primarily affecting the oral and genital mucous membrane, skin, nails, and scalp. The oral lichen planus (OLP) affects approximately 2% of the population. OLP, in general, may arise in > 70% of persons with skin lesions. The frequency of malignant change ranges from 0.4% to 3.3%. OLP is seen worldwide, mostly in the fifth to sixth decades of life, and is twice as prevalent in women as in men. OLP has demonstrated numerous systemic connotations such as diabetes mellitus (DM), hypertension, metabolic syndrome (MS), thyroid diseases, psychosomatic ailments, chronic liver disease, gastrointestinal diseases, and genetic susceptibility to cancer. The treatment options for OLP are numerous and include topical and systemic agents. Topical corticosteroids remain the mainstay of therapy. Case report: A 62-year-old woman came to our observation for a lesion present for about 1 year extended to the hard palate and the upper vestibular gingival mucosa. In the anamnesis she reported osteoporosis and gastro-esophageal reflux. On objective examination there were erosion areas of different width and depth interspersed with erythematous and rare areas white patterns. The patient also reported the formation of bubbles that in a very short time exploded. The negative Nickolsky sign on physical examination did not testify for a diagnosis of vesicular-bullous disease. An incisional biopsy was performed in the palatine area. The subsequent histological evaluation and immunofluorescence were significant for the diagnosis of lichen planus bullous. Topical therapy prescribed with Clobetasol 0.05% 2 times a day and topical Nystatin (100.000 ul/ ml) 3-4 times a day for 3 weeks brought an evident improvement; however an erosive lesion persisted in the area 22-23. It was decided to proceed with a photodynamic support therapy with 460 nm diode light, 4 watts (FlashMax P4 CSM Dental, Copenhagen, Denmark) and 3% hydrogen peroxide. Mucous surface was wetted with hydrogen peroxide then illuminated with diode light 20 times for 3 seconds, subsequently the hydrogen peroxide was removed with a sterile gauze. This treatment was repeated 3 times every 7 days. Results: One week later there was an important clinical improvement, the subsequent therapeutic sessions allowed an almost complete remission of the lesion unresponsive to corticosteroid treatment. Numerous invasive and non- invasive therapeutic methods including local and systemic corticosteroids, laser therapy, and surgical intervention for the treatment of OLP are suggested. Extended use of corticosteroids for chronic OLP may have certain local and systemic complications, which includes opportunistic candidiasis, mucosal atrophy, adrenal insufficiency, gastrointestinal disorders, hypertension, and diabetes. To surmount the side effects of steroid therapy, photodynamic therapy (PDT) has been proposed as an alternative treatment strategy for OLP. PDT uses a photosensitizing agent which, when activated by the energy of light, creates a photodynamic reaction that is cytotoxic. A systematic review of the literature assessed the effectiveness of PDT in the management of OLP. PDT also showed an increase in the bactericidal activity of hydrogen peroxide in a case of refractory hairy tongue. Conclusions: Photodynamic therapy appears to have some effect in the symptomatic treatment of OLP in adult patients. However, further randomized controlled trials with standardized PDT parameters are needed

Fatty Acid Profile and Antimicrobial Activity of Rubus ulmifolius Schott Extracts Against Cariogenic Bacterium Streptococcus mutans

Abstract: The wild edible species Rubus ulmifolius is normally known as a source of several functional- natural compounds used in the traditional diet in several parts of the world. At present, few data are available in the literature about the biological property of its leaves, normally rich in phenolic acids, fatty acids, and other organic compounds with potential antimicrobial activity. Following this hypothesis, we have investigated the antibacterial activity of different dried leaved extracts against the main cariogenic bacterium, Streptococcus mutans. Standard antimicrobial-antibiofilm methods (MIC, MBC, MBIC) were performed to evaluate each extract's antimicrobial profile. In addition, the fatty acids (FA) quali-quantitative profile of R. ulmifolius leave extracts was assessed by reversed-phase HPLC-DAD/ELSD analysis. The results showed that the behavior of this bacterium with different extracts was strictly related to extraction method type, even though it was not related to fatty acid amount and composition, in fact, all the extracts showed similar, qualitative FA patterns, characterized by a concentration in the range from (25 to 36) % of saturated compounds. The methanolic extract showed the better result as antibacterial MIC 6.25 %. These preliminary results encourage further studies for the use of R. ulmifolius in mouthwashes or toothpaste with great anticaries activity

Myrtus polyphenols, from antioxidants to anti-inflammatory molecules: Exploring a network involving cytochromes P450 and Vitamin D

Inflammatory response represents one of the main mechanisms of healing and tissue function restoration. On the other hand, chronic inflammation leads to excessive secretion of pro-inflammatory cytokines involved in the onset of several diseases. Oxidative stress condition may contribute in worsening inflammatory state fall, increasing reactive oxygen species (ROS) production and cytokines release. Polyphenols can counteract inflammation and oxidative stress, modulating the release of toxic molecules and interacting with physiological defenses, such as cytochromes p450 enzymes. In this paper, we aimed at evaluating the anti-inflammatory properties of different concentrations of Myrtus communis L. pulp and seeds extracts, derived from liquor industrial production, on human fibroblasts. We determined ROS production after oxidative stress induction by H 2 O 2 treatment, and the gene expression of different proinflammatory cytokines. We also analyzed the expression of CYP3A4 and CYP27B1 genes, in order to evaluate the capability of Myrtus polyphenols to influence the metabolic regulation of other molecules, including drugs, ROS, and vitamin D. Our results showed that Myrtus extracts exert a synergic effect with vitamin D in reducing inflammation and ROS production, protecting cells from oxidative stress damages. Moreover, the extracts modulate CYPs expression, preventing chronic inflammation and suggesting their use in development of new therapeutic formulations

Efficacy of ozonated water as a PS in photodynamic therapy: A tool for dental caries management? An in vitro study

Background: The most prevalent noncommunicable disease in the world is dental caries; and when it is not adequately treated, it is usually associated with tooth loss or severe dental lesions. In fact, expensive care or tooth extraction may be necessary due to the negative effects dental caries have on general health. This is due to its frequent pain and secondary bacterial infections. The aim of this study was to investigate the activity of ozonated water as such and in combination with appropriate light radiation so as to perform a photodynamic treatment (PDT) against the cariogenic bacterium Streptococcus mutans. Design and methods: This work has been performed in vitro by using an S. mutans strain mainly structured in a biofilm status, reproducing the natural condition of the tooth infection. The ozone was tested at three different concentrations by using a commercial device able to generate different O3 formulations in water. The PDT treatment requires an appropriate light wavelength, evaluated in this work through the UV-Vis adsorption spectrum of the ozonated water. Results: The obtained results suggested an effective and synergic property of O3 and light at 460–470nm against this microorganism. The most antibiofilm activity was observed using a concentration of ozone of 0.06mg/L alone as well as with PDT treatment. Conclusions: The results are encouraging for additional research and in vitro/in vivo fresh experimental investigations to perform an exhaustive antimicrobial treatment protocol against the S. mutans tooth infection

The Best Peptidomimetic Strategies to Undercover Antibacterial Peptides

Health-care systems that develop rapidly and efficiently may increase the lifespan of humans. Nevertheless, the older population is more fragile, and is at an increased risk of disease development. A concurrently growing number of surgeries and transplantations have caused antibiotics to be used much more frequently, and for much longer periods of time, which in turn increases microbial resistance. In 1945, Fleming warned against the abuse of antibiotics in his Nobel lecture: “The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant”. After 70 years, we are witnessing the fulfilment of Fleming’s prophecy, as more than 700,000 people die each year due to drug-resistant diseases. Naturally occurring antimicrobial peptides protect all living matter against bacteria, and now different peptidomimetic strategies to engineer innovative antibiotics are being developed to defend humans against bacterial infections

Mouthwash Based on Ozonated Olive Oil in Caries Prevention: A Preliminary In-Vitro Study

(1) Background: Ozone (O3) proved to oxidize organic and inorganic compounds, and its efficacy against bacteria, viruses and fungi plasma membranes was of interest. Ozone vehicle can be a gaseous form, ozonated water or ozonized oil. The aim of this in-vitro study was to evaluate the efficacy of ozonated olive oil against Streptococcus mutans. (2) Methods: Two different commercial mouthwashes were tested: Ialozon Blu (IB) (Gemavip, Cagliari, Italy), with ozonated olive oil, and Ialozon Rose (IR) (Gemavip, Cagliari, Italy), with ozonated olive oil, hyaluronic acid and vitamin E. All formulates were analyzed in a dilution range from 2- to 256-folds in saline solution, as to reproduce the salivary dilution. Streptococcus mutans CIP103220 strain was used for the antimicrobial susceptibility test, and the Kirby-Bauer inhibition method was performed to evaluate the Minimum Inhibitory (MIC), Minimum Bactericidal (MBC), and Minimum Biofilm Inhibitory Concentration (MBIC). (3) Results: Both formulates showed the same antimicrobial activity. MIC, MBC, and MBIC were observed for dilution factors of 1/32, 1/8 and 1/8, respectively. The mean value of inhibition zone diameter was 16.5 mm for IB, and 18 mm for IR. (4) Conclusions: The results suggested that ozonized olive oil formulates were able to inactivate Streptococcus mutans avoiding the salivary dilution effect in the oral cavity

Usefulness of salivary sampling for the molecular detection of a genetic variant associated with bipolar disorders

Under certain conditions, the hyperthymic temperament traits associated with an increased risk of developing bipolar disorders may in fact produce adaptive responses. The purpose of this study is to see if the type of biological material used for genetic analysis (saliva or blood) affects the detection of mutations in the CACNA1C (RS1006737) gene. The first experimental group consisted of Sardinian migrants (“volunteers”) in South American and European megacities. The second experimental group consisted of older healthy subjects with hyperactivity and novelty-seeking characteristics from Cagliari, Italy. The genetic procedure included DNA extraction, real-time PCR, and the Sanger method. Nonetheless, the authors believe that saliva is the most appropriate biological material, given its many advantages. In contrast to blood, saliva can be collected by any type of healthcare provider after following a few simple instructions

Evaluation of “Caterina assay”: An Alternative Tool to the Commercialized Kits Used for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Identification

Abstract: Here we describe the first molecular test developed in the early stage of the pandemic to diagnose the first cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Sardinian patients in February–March 2020, when diagnostic certified methodology had not yet been adopted by clinical microbiology laboratories. The “Caterina assay” is a SYBR®Green real-time reverse-transcription polymerase chain reaction (rRT-PCR), designed to detect the nucleocapsid phosphoprotein (N) gene that exhibits high discriminative variation RNA sequence among bat and human coronaviruses. The molecular method was applied to detect SARS-CoV-2 in nasal swabs collected from 2110 suspected cases. The study article describes the first molecular test developed in the early stage of the declared pandemic to identify the coronavirus disease 2019 (COVID-19) in Sardinian patients in February–March 2020, when a diagnostic certified methodology had not yet been adopted by clinical microbiology laboratories. The assay presented high specificity and sensitivity (with a detection limit ≥50 viral genomes/µL). No false-positives were detected, as confirmed by the comparison with two certified commercial kits. Although other validated molecular methods are currently in use, the Caterina assay still represents a valid and low-cost detection procedure that could be applied in countries with limited economic resource

Mouthwash Formulation Co-Delivering Quercetin and Mint Oil in Liposomes Improved with Glycol and Ethanol and Tailored for Protecting and Tackling Oral Cavity

: The aim of this work was the simultaneous loading of quercetin and mint essential oil (mint oil) in phospholipid vesicles specifically tailored to obtain an antibacterial and antioxidant mouthwash. The vesicles were prepared using soy lecithin and Tween 80 as bilayer components, and a mixture of phosphate buffer solution (33%), propylene glycol (33%) and ethanol (33%) as dispersing phase. The formation of regularly shaped, spherical and unilamellar vesicles was confirmed by cryogenic transmission electron microscopy analyses. Similarly, light scattering results disclosed that the size of the vesicles increased by increasing the concentration of mint oil, but at the same time the high amount of mint oil ensured high stability, as the size of these vesicles remained unchanged during 12 months of storage. All tested formulations were highly biocompatible towards epithelial cells and capable of counteracting oxidative cell damages caused by hydrogen peroxide. Moreover, the vesicles prepared with the highest concentration of mint oil inhibited the proliferation of the cariogenic Streptococcus mutans (S. mutans) and Lactobacillus acidophilus (L. acidophilus)