Paraoxonase activity in type 2 diabetes mellitus malay patients in Hospital Universiti Sains Malaysia (HUSM)

Introduction: Paraoxonase (PON) is an enzyme associated with high-density lipoprotein (HDL). PON is involved in the detoxification of lipid peroxides and play a role in decreasing oxidative stress which are related with the risk for complication in diabetes mellitus type 2(T2 DM) patients that is strongly associated with their diabetic control. The ability of PON to protect low density lipoprotein (LDL) against oxidation has been shown to vary between the three polymorphic forms (A, AB, B). PON with phenotype B is less efficient in protecting LDL against oxidation. Objectives: The purpose of this study was to determine the PON1 activities, PON1 phenotypic polymorphism, lipid profile and oxidized LDL (oxLDL) in T2 DM among Malay population and healthy control group, their relation with diabetic complications and the correlation between PON activities and lipid profile. Methods: A total of 99 subjects were chosen for three groups (healthy control, good control diabetes mellitus (HbA1c ≤ 6.5%) and poor control diabetes mellitus(HbA1c > 6.5%) (each group n=33). Fasting serum were analysed for PON, salt stimulated PON, arylesterase (AREase) activities, lipid profile and oxLDL. The phenotypes assesment for PON can be A, B, AB based on the ratio of salt stimulated PON to the AREase activity. Results: The basal PON and salt stimulated PON activities were not statistically significant among the three groups. AREase activity was lower in T2 DM patients compared to healthy control.Majority of subjects were AB phenotype and none of the healthy control subjects with B phenotype. Diabetic patients with chronic kidney disease (CKD) showed significantly lower salt stimulated PON activity when compared to those without CKD. Lipid profile analyses for poor control diabetic group showed significantly lower in total cholesterol (TC), HDL and LDL level and higher in triglyceride (TG) level compared to healthy control. A positive correlation between the HDL levels and basal PON activity in poor control diabetic and a positive correlation between the TC and HDL with salt stimulated PON activity in poor control group. OxLDL level was not statistically significant among the three groups however the PON to oxLDL ratio (PON/oxLDL) shows significantly higher in healthy control compared to poor control diabetic group. Conclusion: AREase activity was lower in T2 DM patients compared to healthy control and majority of subjects (Malay population) were AB phenotype. Poor control T2 DM group had lesser PON/oxLDL ratio when compared with healthy control and good control T2DM although PON and oxLDL levels not significant. Thus it could relate with the risk of complications in poor control T2 DM

Antimicrobial activity of propolis from Trigona thoracica towards cariogenic bacteria

Propolis is an important bee product which consists of resinous mixture produce by the honeybees from various plant sources. Propolis produced by stingless bee (Trigona thoracica), commonly known as ‘Kelulut’ in Malaysia, is also known to have medicinal values. The Trigona thoracica bees are widely distributed throughout Malaysia. The properties of propolis from Trigona thoracica have been investigated in vitro and in vivo. It is renowned to have various biological activities as the antimicrobial, antiproliferative, antiinflammatory and anticancer. Currently, there is limited scientific studies that show antimicrobial activities of propolis against the oral pathogens. Thus, this study is carried out to evaluate the antimicrobial activities of ethanol extracts of propolis (EEP) from Trigona thoracica against cariogenic bacteria (S.mutans & S.sobrinus). This study is performed using the agar well diffusion assay to screen the antimicrobial activity of EEP from Trigona thoracica expressed as mean of inhibition diameter and minimum inhibitory concentration (MIC) of EEP will be determined by the broth microdilution method. The mean of inhibition diameter and MIC between EEP and standard antibiotic (metronidazole) against S.mutans and S.sobrinus is not statistically different. In conclusion, EEP from Trigona thoracica has antimicrobial properties against cariogenic bacteria

Nexus between periodontal disease and chronic kidney disease: a narrative review

Background: Several decades of research have established the relationships between systemic diseases and periodontal diseases. Chronic kidney disease (CKD) is a chronic medical condition in which the homeostatic and emunctory activity of the kidneys is progressively declines. Periodontitis is a complex, polymicrobial disease that involves both the host and the environment. Tissue destruction is primarily associated with the host’s hyperresponsiveness, resulting in the release of inflammatory markers. Aim: This paper reviewed the evidence linking CKD, inflammatory markers, and periodontal disease and the effect of periodontal therapy on inflammatory markers and kidney function as well as dental parameters. Setting and Design: The sources of data were compiled and reviewed from MEDLINE, SCOPUS and Web of Sciences from 2010 to 2021. Result and Discussion: This review identifies biologically plausible bidirectional nexus between periodontitis and CKD. Periodontitis has emerged as non-traditional risk factor of CKD and vice versa. In addition, inflammatory markers are considered to play a role in the linkages between periodontitis and CKD. Recent study, has linked an increase in the production of inflammatory markers to a poorer renal outcome in patients with CKD. Periodontal therapy is effective in lowering the inflammatory markers levels and periodontal parameters as well as halting the progression of CKD. Conclusion: Understanding these links may help in identifying high-risk individuals and providing essential care at an early stage

Potential Effects of Non-Surgical Periodontal Therapy on Periodontal Parameters, Inflammatory Markers, and Kidney Function Indicators in Chronic Kidney Disease Patients with Chronic Periodontitis

Chronic kidney disease (CKD) and chronic periodontitis (CP) contribute to the increased level of inflammatory biomarkers in the blood. This study hypothesized that successful periodontal treatment would reduce the level of inflammatory biomarkers in CKD patients. This prospective study recruited two groups of CP patients: 33 pre-dialysis CKD patients and 33 non-CKD patients. All patients underwent non-surgical periodontal therapy (NSPT). Their blood samples and periodontal parameters were taken before and after six weeks of NSPT. The serum level of high-sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6), and periodontal parameters were compared between groups. On the other hand, kidney function indicators such as serum urea and estimated glomerular filtration rate (eGFR) were only measured in CKD patients. Clinical periodontal parameters and inflammatory markers levels at baseline were significantly higher (p < 0.05) in the CKD group than in the non-CKD group and showed significant reduction (p < 0.05) after six weeks of NSPT. CKD patients demonstrated a greater periodontitis severity and higher inflammatory burden than non-CKD patients. Additionally, CKD patients with CP showed a good response to NSPT. Therefore, CKD patients’ periodontal health needs to be screened for early dental interventions and monitored accordingly

Interferences of HbA1c analysis in Hospital Universiti Sains Malaysia – 3 years study

Haemoglobin A1c (HbA1c) is used to monitor glycaemic control and predict diabetic complications. Measurement of HbA1c can be interfered by haemoglobin (Hb) variant and other Hb derivatives include carbamylated Hb and elevated labile A1c. This study is to determine the percentages and type of interferences during HbA1c analysis and the percentages of nonreportable HbA1c results. This is a cross-sectional study using retrospective data of HbA1c. The HbA1c is measured on Biorad D10 using the ion-exchange high-performance liquid chromatography method. The data were analyzed using descriptive statistics. A total of 26,560 patients were included. The result showed the presence of interferences of 2269 (8.56%). The most common causes of the interferences were the Hb variant (8.48%) followed by carbamylated Hb and labile A1c (0.03% each). The non-reportable HbA1c results were 0.46% with the Hb variant contributed most of the causes. By knowing the presence of interferences particularly the Hb variant, the HbA1c results hopefully are interpreted with caution and correct management can be given to the patients

The assessment of interleukin-1 in chronic kidney disease patients with periodontitis following non-surgical periodontal therapy

Introduction: Chronic kidney disease (CKD) and periodontitis have an impact on patient’s morbidity and mortality. Periodontitis increases the inflammatory burden, which has been shown to impair renal function by altering serum inflammatory levels. Interleukin-1 (IL-1) has immunomodulatory properties that affect immunological responses of the host. Little is known regarding IL-1 alteration in CKD patients after non-surgical periodontal therapy (NSPT). Therefore, this study was aimed to assess and compare the level of IL-1 at baseline and after receiving NSPT. Materials & Methods: The study included twenty CKD patients with periodontitis (Group 1), twenty non-CKD patients with periodontitis (Group 2) and twenty healthy subjects (Group 3). During each visit, a blood sample was collected and the serum IL-1 concentration was analysed using enzyme-linked immunosorbent assay. Results: Our findings showed that IL-1 level was significantly higher (p<0.05) in Group 1 [Mean (SD) = 0.91(0.39)]pg/ml as compared to Group 2 [Mean (SD)= 0.79(0.27)]pg/ml and Group 3 [Mean (SD) = 0.57(0.39)]pg/ml. Following NSPT, there was significant reduction (p<0.05) in IL-1 level in Group 1 and Group 2. The eGFR has improved from [Mean (SD)= 25.25 (9.93)] mL/min/1.73m2 to 30.3(11.73) mL/min/1.73m2 post NSPT. Discussion: This study found that CKD patients with periodontitis exhibited a more severe systemic inflammatory response than non-CKD patients and healthy subjects. NSPT reduced the inflammatory markers and delay the progression of CKD. IL-1 is a promising inflammatory marker for monitoring CKD progression. Therefore, multicentre and larger sample size studies are needed in the future

The assessment of interleukin-10 and periodontal parameters in chronic kidney disease patients with inflammation of the gum and tooth-supporting tissues following periodontal therapy

Introduction: Chronic kidney disease (CKD) is characterized by kidney structure and function abnormalities. CKD also includes permanent nephron loss and a decline in glomerular filtration rate. Most CKD patients have periodon¬titis, a chronic inflammatory disease of the gums and tooth-supporting tissues. Periodontitis is linked to CKD due to the hyper-inflammatory state in both conditions. Interleukin-10 (IL-10) is an inflammatory marker with immuno¬modulatory properties influencing the host’s immune responses. Little is known regarding the effect of periodontal therapy on inflammatory markers and periodontal parameters in CKD patients with periodontitis. Therefore, this study aimed to compare the levels of IL-10 and periodontal parameters before and after receiving periodontal ther¬apy. Methods: Twenty CKD patients with periodontitis (Group 1) and twenty non-CKD patients with periodontitis (Group 2) participated in this study. A blood sample was collected during each visit. Serum IL-10 concentration was analysed using an enzyme-linked immunosorbent assay. The periodontal parameters such as periodontal probing depth, clinical attachment loss, gingival bleeding index and plaque score were also measured. Results: Our findings revealed that IL-10 level was significantly higher (p<0.05) in Group 1 [Mean (SD) = 1.301(0.29)pg/ml] than in Group 2 [Mean (SD)= 0.81(0.27)pg/ml]. Following periodontal therapy, there was a significant reduction (p<0.05) in IL-10 levels and periodontal parameters in both groups. Conclusion: Periodontal therapy has shown improvement in both inflammatory markers and periodontal parameters. IL-10 is a promising inflammatory marker for monitoring the pro¬gression of CKD. Therefore, multicentre and larger sample size studies are needed in the future

Comparison of Vitamin D Levels, Bone Metabolic Marker Levels, and Bone Mineral Density among Patients with Thyroid Disease: A Cross-Sectional Study

Thyroid hormones have a catabolic effect on bone homeostasis. Hence, this study aimed to evaluate serum vitamin D, calcium, and phosphate and bone marker levels and bone mineral density (BMD) among patients with different thyroid diseases. This cross-sectional study included patients with underlying thyroid diseases (n = 64, hyperthyroid; n = 53 euthyroid; n = 18, hypothyroid) and healthy controls (n = 64). BMD was assessed using z-score and left hip and lumbar bone density (g/cm2). The results showed that the mean serum vitamin D Levels of all groups was low (&lt;50 nmol/L). Thyroid patients had higher serum vitamin D levels than healthy controls. All groups had normal serum calcium and phosphate levels. The carboxy terminal collagen crosslink and procollagen type I N-terminal propeptide levels were high in hyperthyroid patients and low in hypothyroid patients. The z-score for hip and spine did not significantly differ between thyroid patients and control groups. The hip bone density was remarkably low in the hyperthyroid group. In conclusion, this study showed no correlation between serum 25(OH)D levels and thyroid diseases. The bone markers showed a difference between thyroid groups with no significant difference in BMD