Levels of tissue factor pathway inhibitor in patients with inflammatory bowel disease

Endothelial dysfunction has been reported to be involved in the pathogenesis of inflammatory bowel disease (IBD) and concomitant thromboembolic complications. Inflammation stimulates the expression of tissue factor and tissue factor pathway inhibitor (TFPI) by endothelial cells. This study assessed the relationship between TFPI levels and disease activity in patients with IBD. A total of 50 consecutive adult patients with ulcerative colitis (UC), 50 patients with Crohn disease (CD), and 50 healthy controls were enrolled to the study. Plasma levels of total TFPI, free TFPI, and von Willebrand factor were measured. Associations among these levels, disease activity, and inflammatory marker levels were assessed. Total TFPI levels were higher in patients with IBD (median, 68.5 [IQR, 60.2-80.1] ng/ml) than in controls (median, 61.1 ng/ml [IQR, 54.3-74.2]; P = 0.01). Free TFPI levels were higher in patients with active UC (median, 12.8 ng/ml [IQR, 11.1-15.4]), inactive UC (median, 9.9 ng/ml [IQR, 7.3-11.5]), active CD (median, 11.7 [IQR, 9.7-14.4] ng/ml), and inactive CD (median,], 9.7 ng/ml [IQR, 8.6-11.6]) than in controls (median, 5.5 ng/ml [IQR, 4.3-7.2]; P <0.001). In the CD and UC groups, free TFPI levels correlated with the levels of inflammatory markers and disease activity. The von Willebrand factor level was higher in patients with UC (median, 143.4 IU/dl [IQR, 115.5–170.4]) and those with CD (median, 151.8 IU/dl [IQR, 112.8-189.4]) than in controls (85.1 IU/dl [IQR, 77.1-101.5]; P <0.001 for both comparisons). The anticoagulant TFPI pathway is activated during remissions and flares in patients with IBD. The free TFPI level correlates with biochemical markers of inflammation and disease activity

Serum concentration of selected biochemical markers of endothelial dysfunction and inflammation in patients with the varying activity of inflammatory bowel disease

Introduction Endothelial dysfunction leads to an increased expression of cell adhesion molecules, leukocyte diapedesis, vascular smooth‑muscle tone, excessive permeability of vascular walls, and increased procoagulant activity. Objectives We investigated whether serum levels of several endothelial and platelet activation markers correlated with disease activity in patients with inflammatory bowel disease (IBD). Patients and methods This study included 56 patients with ulcerative colitis, 66 with Crohn disease, and 40 healthy controls. We measured the complete blood count and levels of fibrinogen, C‑reactive protein, albumin, interleukin 6, tumor necrosis factor α, E‑selectin, P‑selectin, monocyte chemoattractant protein 1 (MCP‑1), soluble CD40 ligand (sCD40L), and microparticles. Results There were no significant differences in the median levels of E‑selectin, P‑selectin, MCP‑1, sCD40L, and microparticles between patients with active IBD, those with inactive IBD, and healthy controls. The clinical disease activity assessed with the Mayo scale in the ulcerative‑colitis group was weakly, positively correlated with sCD40L (R = 0.32, P = 0.02), P‑selectin (R = 0.32, P = 0.02), and inflammatory marker levels. The clinical disease activity index in the Crohn disease group was positively correlated with the markers of inflammation yet not with the markers of endothelial activity. Conclusions E‑selectin, P‑selectin, sCD40L, MCP‑1, and microparticle levels do not significantly differ between patients with the varying activity of IBD. However, due to the observed correlations, further studies of a larger patient group should be conducted to confirm our observations

Awareness of oral health prophylaxis in pregnant women

Introduction: During pregnancy, changes in the oral cavity occur due to fluctuations in hormone levels and changes in eating habits and hygiene. Objectives: To evaluate pregnant women’s awareness of oral health prophylaxis. Material and Methods: An anonymous questionnaire was completed by 341 pregnant women from Malopolskie Voivodeship. The statistical analysis was carried out in the R program (v. 3.4.3); a p-value <0.05 was considered significant. Results: Over half of the respondents did not receive oral hygiene instruction and did not take part in any prophylactic program. The main sources of oral health knowledge were the internet (66.3%), dentist (43.1%) and gynaecologist (17.9%). Respondents willingly followed the advice of healthcare workers. Approximately 32% of the surveyed women were aware of the most appropriate period for dental treatment (second trimester). Over half of the women admitted that they would receive dental care more often if more procedures were reimbursed. Approximately 71% of the women were aware of the increased susceptibility to tooth decay during pregnancy. The relationship between the presence of caries in parents and that in children was known by 42.1% of respondents, but 45% admitted they did not know how to take care of their child’s teeth properly. Conclusions: Women with a higher education level had better knowledge in the area of oral health. However, most of the respondents need to increase their knowledge in this area. Prophylactic programs should be broadly propagated, and healthcare workers should deliver essential information in daily practice

Insulin-like growth factor system in remission and flare of inflammatory bowel diseases

Insulin‑like growth factor 1 (IGF‑1) is involved in the modulation of immunity and inflammation. It also plays a role in regulating the migration of endothelial cells and production of vasoactive agents. This study assessed the concentrations of IGF‑1 and insulin‑like growth factor-binding protein 3 (IGFBP‑3) and their relationships to disease activity in patients with inflammatory bowel disease (IBD). A total of 129 adult patients with IBD (69 with Crohn disease [CD] and 60 with ulcerative colitis [UC]) were involved in the study. The control group consisted of 31 healthy volunteers. Biochemical serum analyses were performed and the associations of IGF‑1 and IGFBP‑3 with inflammatory markers and disease activity were assessed. IGF‑1 levels were decreased in patients with active UC compared with those with nonactive UC (mean [SD], 78.3 [22.7] ng/ml and 96.2 [24.5] ng/ml, respectively; P = 0.02) and controls (94.5 [26.5] ng/ml; P = 0.03). The IGF‑1 level was lower in patients with active CD compared with those with nonactive CD (mean [SD], 79.2 [24.9] ng/ml and 110.1 [43.4] ng/ml, respectively; P <0.001). The IGFBP‑3 level was lower in patients with active UC compared with those with nonactive UC (P = 0.04) and controls (P = 0.04). IGF‑1 correlated negatively with C‑reactive protein (CRP) levels (P <0.01), disease activity (P <0.05), and disease duration (P <0.05). IGFBP‑3 levels correlated negatively with CRP levels (P <0.05). The IGF system is disrupted in patients with IBD. Systemic levels of the IGF axis components are related to disease activity and duration

Zapalenie błony śluzowej jamy ustnej – wspólny problem onkologów i stomatologów

Zapalenie błony śluzowej jamy ustnej (oral mucositis – OM) spowodowane promieniowaniem jonizującym stanowi duży problem terapeutyczny. Dotyczy niemal wszystkich chorych na nowotwory regionu głowy i szyi poddanych radioterapii, jednak wciąż brakuje skutecznej metody jego leczenia. Działania lekarzy skupiają się głownie na profilaktyce, w tym na utrzymaniu właściwej higieny jamy ustnej. W 2014 roku Międzynarodowe Towarzystwo Onkologii Jamy Ustnej (International Society of Oral Oncology – ISOO) oraz Wielonarodowe Stowarzyszenie Wspomagające Leczenie Nowotworow (Multinational Association of Supportive Care in Cancer – MASCC) opracowały wytyczne dotyczące postępowania z pacjentami z OM związanym z radioterapią i chemioterapią. W 2019 roku ukazały się uaktualnienia tych wytycznych.  Prowadzone są badania dotyczące poszukiwania lekow, ktore mogłyby mieć zastosowanie w zapobieganiu oraz leczeniu OM. Problem jest istotny, gdyż może komplikować przebieg leczenia onkologicznego, pogarszać jakość życia chorych, a nawet wpływać na rokowanie przeżycia pacjenta.  W pracy opisano patogenezę zapalenia błony śluzowej jamy ustnej, obecne trendy w leczeniu oraz podkreślono rolę lekarza stomatologa w opiece nad pacjentem z objawami tego schorzenia. Zwrocono uwagę na rolę wspołpracy interdyscyplinarnej, a także na profilaktykę OM jako części przygotowania pacjenta onkologicznego do napromieniania.

Oral ulceration in patient with active Crohn’s disease

Choroba Leśniowskiego-Crohna (ChLC) jest przewlekłym procesem zapalnym, który może umiejscawiać się w każdym odcinku przewodu pokarmowego. Wbrew wcześniejszym opiniom uważa się, że zmiany patologiczne w obrębie jamy ustnej występują dość często, lecz rzadko są rozpoznawane. Przedstawiono 30-letniego chorego, u którego w czasie zaostrzenia objawów ChLC wystąpiło owrzodzenie jamy ustnej. Za pomocą badania histologicznego błony śluzowej z otoczenia wrzodu zdiagnozowano zapalenie ziarniniakowe. Zmiany typowe dla ChLC obejmowały dystalny odcinek jelita cienkiego z przetoką między pętlami jelita cienkiego oraz esicę i prostnicę, a potwierdzone były badaniem kolonoskopowym i histologicznym wycinków błony śluzowej oraz badaniem radiologicznym jelita cienkiego. Autorzy zwracają uwagę na przydatność badania stomatologicznego u chorego z zaostrzeniem ChLC. Umożliwia ono rozpoznanie zmian patologicznych błony śluzowej i potwierdzenie w ocenie histopatologicznej nieswoistego zapalenia ziarniniakowego. U chorych na ChLC owrzodzenia w jamie ustnej są przewlekłe i trudno poddają się leczeniu miejscowemu. Podstawowe znaczenie w tych przypadkach ma standardowe leczenie aktywnej ChLC.Crohn’s disease (CD) is a chronic inflammatory process with pathological changes which can involve any part of the gastrointestinal tract. Contrary to previous opinions, involvement of the oral cavity is frequent, but is rarely diagnosed. A thirty-years-old patient with deep ulceration of the oral mucosa which appeared during exacerbation of CD is presented. Granulomatous inflammation of the oral mucosa was confirmed by histopathology. Inflammatory changes typical for CD were present in the distal small bowel with ileo-ileal fistula and in the distal colon, and were confirmed by colonoscopy, histopathological examination of mucosal biopsies and double-contrast radiographic examination of the small bowel. Dental examination of a patient with active CD is helpful in the diagnosis of oral manifestations of the disease and mucosal biopsies can easily be taken for histopathological confirmation of granulomatous inflammation. In patients with CD the oral ulcerations are chronic and difficult to treat. The standard treatment of active CD plays the main role in the approach to these patients