Challenges in managing a patient with central post stroke pain

Objective: This is a case illustration of the challenges in managing a patient with central post stroke pain secondary to right thalamic bleed. We describe in detail the events of this case management and the challenges that we had encountered. Method: We report a case of a 68-yearold lady who had right thalamic bleed secondary to hypertensive crisis in 2015 and was further complicated with central post stroke pain over the hemiparetic side. In our report, we describe in detail the challenges in managing the patient to improve her function to achieve a better quality of life. Conclusion: This article illustrates the importance of a multidisciplinary approach and knowledge of various methods in managing a patient with central post stroke pain

Periodontal parameters and salivary levels of receptor activator of NF-kB Ligand and osteoprotegerin in obese periodontitis patients

This study aimed to assess levels of salivary receptor activator of nuclear factor kappa-B (RANKL) and osteoprotegerin (OPG) protein biomarkers in obese patients with periodontitis. Subjects were divided into two groups: group-I consisted of 30 non-obese subjects with periodontitis, while group-II consisted of 30 obese patients with periodontitis. The periodontal examination, including periodontal pocket depth (PPD), clinical attachment loss (CAL), plaque score (PS), and gingival bleeding index (GBI), were evaluated. Salivary RANKL and OPG were estimated in both study groups using an enzyme-linked immunosorbent assay. Levels of RANKL protein were significantly higher in the obese group than the non-obese group, while levels of OPG protein were significantly higher in the non-obese group than the obese group. The periodontal parameters PPD, CAL, and PS, except for GBI, showed a significant difference between the two groups. The mean PPD scores were significantly higher in the obese group than the non-obese group, while the CAL scores in the obese group were significantly higher than the non-obese group. Only the salivary OPG levels were significantly associated with CAL. There is an association of OPG and CAL in both obese and non-obese with periodontitis

Levels of PIVKA-II and alpha-fetoprotein in unresectable hepatocellular carcinoma compared to healthy controls and predictive values of both markers with radiological responses after loco-regional interventions

Background The significance of the current study was to determine normative levels of PIVKA-II and AFP in patients with unresectable HCC and healthy participants. The second goal was to assess the roles of PIVKA-II and AFP in predicting radiological response after loco-regional therapy. Methods This prospective cohort study enrolled consecutive samples of HCC patients and healthy controls. Venous blood samples were obtained at baseline and after interventions to determine serum levels of PIVKA-II and AFP using the chemiluminescent microparticle immunoassay method. Radiologic responses were determined based on the WHO criteria. Results Fifty-four HCC patients (mean age 58.9 years, 49 males) and 40 healthy controls (mean age 33.5 years, 26 males) were recruited. The median serum levels of PIVKA-II and AFP in HCC vs. healthy controls were 988.4 vs. 24.2 mAU/ml and 13.6 vs. 1.7 ng/ml, respectively (both p < 0.001). With ROC curve analysis, the area under the curve (AUC) for PIVKA-II was 0.95 95% CI [0.90–0.99], and for AFP it was 0.98, 95% CI [0.95–1.0]). The cut-off value for PIVKA-II was 41.4 mAU/ml, and AFP was 4.8 ng/ml. PIVKA-II levels correlated significantly with radiological responses (r = 0.64, p = 0.02) but not AFP (r = 0.09, p = 0.2). Conclusion PIVKA-II and AFP levels are distinctive between unresectable HCC and healthy controls. However, PIVKA-II, not AFP, can predict the radiological response after loco-regional therapy

A Randomized Controlled Trial Evaluating the Levels of the Biomarkers hs-CRP, IL-6, and IL-8 in Patients with Temporomandibular Disorder Treated with LLLT, Traditional Conservative Treatment, and a Combination of Both

Temporomandibular disorders (TMDs) are a type of idiopathic orofacial pain. Inflammation, particularly elevated circulating levels of high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and interleukin-8 (IL-8), has been linked to pain symptoms. The purpose of this study was to compare hs-CRP, IL-6, and IL-8 biomarkers and pain intensity with different treatment strategies (LLLT, standard conservative treatment, and combination) for TMD patients. Methods: A total of 32 participants were randomly included in the study and divided into three groups (Group I, Group II, and Group III) referred from the Dental Clinic, School of Dental Science, HUSM. Patients received LLLT (Groups II and III) in five sessions for the duration of 10 days. Patients in Groups I and III received standard conservative TMD treatment (diet and stress counseling, jaw exercises, physical therapy, which was a hot towel application) by the principal investigator. All blood samples for biomarkers were performed before starting treatments and directly after finishing the treatment protocols, where all results were recorded. Results: The result showed a significant difference in the mean IL-8 (p = 0.001) between the three intervention groups (LLLT, standard treatment, and combined treatment). IL-6 showed an increase in the mean of IL-6 levels from baseline to post-treatment with a better mean in the LLLT treatment group without any significant differences. Additionally, there were no significant mean differences found between the groups and in the group for the hs-CRP biomarker. Conclusions: A statistically non-significant difference was found in hs-CRP and IL-6 before and after LLLT, conservative, and combined treatment strategies of TMD. A statistically significant difference was observed in the mean levels of IL-8 between the LLLT intervention group and the combined treatment group. Although there was no statistically significant correlation between pain intensity and biomarkers, a statistically significant difference was found in pain intensity before and after LLLT, conservative, and combined treatment strategies. TMJ degeneration could be exacerbated by elevated IL-8 levels. Thus, this can be an important biomarker to mark or identify the painful condition of TMJ

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 &lt; 0.05) in the CKD group than in the non-CKD group and showed significant reduction (p &lt; 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&rsquo; periodontal health needs to be screened for early dental interventions and monitored accordingly

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

Levels of interleukins in patients with chronic kidney disease and periodontitis: a systematic review

Aim: To systematically review the in vivo clinical studies available in the literature evaluating the effect of interleukin (IL) in patients with chronic kidney disease (CKD) and chronic periodontitis (CP). Materials and Methods: A search was initially performed using Scopus, PubMed, and Web of Science databases published from the year 2003 to 2020. Among the keywords used in the search were “periodontal diseases,” “interleukin,” “chronic kidney diseases,” and “inflammation.” After relevant articles were found, a critical assessment was made to select those that met the criteria for the systematic review. Among the inclusion criteria needed for the papers were randomized clinical trials, longitudinal clinical trials, clinical studies, no sample size limits, and only English language articles. Case reports, conference abstracts, and unpublished data were excluded for this study. Result: Based on the keywords, 16 of the relevant articles were listed and seven of them were selected for a systematic review. Conclusion: After reviewing the articles based on their results and conclusion, it can be concluded that serum IL level increased significantly in patients with CKD and CP and periodontal therapy can significantly reduce the level of serum IL. Moreover, the effect of modern periodontal therapy in CKD and CP is still unknown and inflammatory gene expression profile in patients with CKD will still need to be evaluated within different population

Pharmacological inhibition of endoplasmic reticulum stress mitigates osteoporosis in a mouse model of hindlimb suspension

Abstract Hindlimb suspension (HLS) mice exhibit osteoporosis of the hindlimb bones and may be an excellent model to test pharmacological interventions. We investigated the effects of inhibiting endoplasmic reticulum (ER) stress with 4-phenyl butyrate (4-PBA) on the morphology, physicochemical properties, and bone turnover markers of hindlimbs in HLS mice. We randomly divided 21 male C57BL/6J mice into three groups, ground-based controls, untreated HLS group and 4-PBA treated group (HLS+4PBA) (100mg/kg/day, intraperitoneal) for 21 days. We investigated histopathology, micro-CT imaging, Raman spectroscopic analysis, and gene expression. Untreated HLS mice exhibited reduced osteocyte density, multinucleated osteoclast-like cells, adipocyte infiltration, and reduced trabecular striations on micro-CT than the control group. Raman spectroscopy revealed higher levels of ER stress, hydroxyproline, non-collagenous proteins, phenylalanine, tyrosine, and CH2Wag as well as a reduction in proteoglycans and adenine. Furthermore, bone alkaline phosphatase and osteocalcin were downregulated, while Cathepsin K, TRAP, and sclerostin were upregulated. Treatment with 4-PBA partially restored normal bone histology, increased collagen crosslinking, and mineralization, promoted anti-inflammatory markers, and downregulated bone resorption markers. Our findings suggest that mitigating ER stress with 4-PBA could be a therapeutic intervention to offset osteoporosis in conditions mimicking hindlimb suspension