Signalling molecules in jaw bones and gingival tissues of patients with Class II and Class III dentofacial deformities

OBJECTIVES: To detect signalling molecule specificities in jaw bone growth zones in skeletal class II and class III patients and compare them to those of a control group. MATERIAL AND METHODS: Twenty skeletal Class II and 20 skeletal Class III patients who underwent orthognathic surgery treatment were in the study group and five skeletal Class I patients who had impacted third molars extracted were in the control group. During the orthognathic surgery, tissue samples were taken from the tuber maxillae, ramus mandibulae anterior and posterior part together with mucosa from the gingival transitory fold in the second molar region of the lower jaw. The samples were stained to detect TGF-β, BMP2/4, FGFR1, VEGF, OC, OP and MMP2 expression. The distributions of these factors were assessed semiquantitatively. RESULTS: We observed significant expression of TGF-β, BMP2/4, OC and OP in the bone tissue of the study group. FGFR1 expression was more pronounced only in mucosa. VEGF and MMP2 were found only in some tissue samples. More apoptotic cells were observed in the bone tissue and soft tissue of the control patients than in those of the skeletal Class II and Class III patients, in which apoptotic cell frequencies were relatively equal. CONCLUSION: From bone tissue in tuber maxillae region the greater TGF-β and BMP2/4 expression is seen in Class III and control groups, comparing to Class II. In ramus mandibulae anterior part the expression of significant factors in bone tissue growth (TGF-β un BMP2/4) is higher in the control group and Class II patients, while in ramus mandibulae posterior part higher expression of TGF-β and BMP2/4 is in Class III patients, comparing to Class II, which indicates to a preserved growth potential in these jaw bone regions. More active bone extracellular matrix protein (osteocalcin and osteopontin) expression in tuber maxillae region both in class II and class III patient groups and different expression in ramus mandibulae anterior part, prove to the bone mineralization and metabolism activity changes, which, perhaps, characterize just these dentofacial deformations.publishersversionPeer reviewe

Osteopontin and osteocalcin in maxilla tissue of skeletal Class III patients

Bone extracellular matrix proteins osteopontin and osteonectin have important function during embryonic osteogenesis and are active in bone remodeling process. Knowledge about bone extracellular matrix proteins explores the mechanisms of craniofacial development and helps to understand better morphopathogenesis of severe dentofacial anomalies. Aim of the current study was to investigate an expression of osteopontin and osteocalcin in maxilla tissue in skeletal Class III patients. The study group included 10 skeletal Class III patients to whom combined orthodontic and surgical treatment was recommended. Samples of tuber maxillae tissue from ten skeletal Class III malocclusion patients were collected due the orthognatic surgery procedure. The routine histological method was followed and samples were stained by hematoxyline-eosine. Tissue samples were stained according the standard immunohistochemical methods and expression of osteocalcin and osteopontin in maxilla tissue was examined. Distribution of these factors was evaluated semiquantitetively by counting the positive structures in visual field. The trabecules of bone contained parallel located collagen fibers and irregular bone mineralization. Connective tissue proliferation in osteon channels was observed. Quantity of cells positive to osteopontin was higher than quantity of cells containing osteocalcin in all patterns extracted of maxilla tissue in patients with skeletal Class III. In few cases osteocalcin positive cells were located near the border with soft tissue - close to osteogenic cells zone, but no osteocalcin was observed deeper in bone. The intensity of osteocalcin expression was variable, and differs individually despite the relatively regular osteopontin distribution in all patterns. There were pronounced osteopontin, but not osteocalcin-containing cells with approximately similar intensity of protein expression in tuber maxillae in skeletal Class III patients.publishersversionPeer reviewe

National Trends in the Use of State-Reimbursed Lipid-Lowering Medications in Latvia (2012–2021)

Publisher Copyright: © 2023 by the authors.Background. We aimed to estimate the trends in dispensing rate and the spectrum of all state-funded lipid-lowering medications (LLMs) in Latvia over a decade. Methods. Using data from the National Health Service of the Republic of Latvia, we retrospectively analyzed all dispensed LLM-containing drug units in a ten-year period from 2012 to 2021. Results. In Latvia, 318.2 million oral and 994 subcutaneous units of LLMs were dispensed over a decade. Statins were the most dispensed LLMs (94.5%), and their use doubled from 19.7 to 43.5 million units. The proportion of high-intensity statins increased from 31.3% to 45.2%. The dispensing rate of ezetimibe increased from 184.7 thousand to 4.8 million. The share of fixed-dose statin combinations with ezetimibe grew from 0.2% to 10.0% among all statins and from 22.2% to 90.9% among all ezetimibe units. Statin use for primary and secondary prevention increased from 7.0 to 19.9 million and from 12.8 to 23.6 million units, respectively. Conclusion. The dispensing rate of statins doubled, and the use of ezetimibe increased more than 25 times in Latvia over a decade. The proportion of high-intensity statins increased from one third to almost half of all statins. Fixed-dose statin combinations with ezetimibe became frequently used.Peer reviewe

Latvian Primary Care Management of Children with Acute Infections : Antibiotic-Prescribing Habits and Diagnostic Process Prior to Treatment

Publisher Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland.Background and Objectives: Primary care physicians frequently prescribe antibiotics for acutely ill children, even though they usually have self-limiting diseases of viral etiology. The aim of this research was to evaluate the routine antibiotic-prescribing habits of primary care in Latvia, in response to children presenting with infections. Materials and Methods: This cross-sectional study included acutely ill children who consulted eighty family physicians (FP) in Latvia, between November 2019 and May 2020. The data regarding patient demographics, diagnoses treated with antibiotics, the choice of antibiotics and the use of diagnostic tests were collected. Results: The study population comprised 2383 patients aged between one month and 17 years, presenting an acute infection episode, who had a face-to-face consultation with an FP. Overall, 29.2% of these patients received an antibiotic prescription. The diagnoses most often treated with antibiotics were otitis (45.8% of all antibiotic prescriptions), acute bronchitis (25.0%) and the common cold (14.8%). The most commonly prescribed antibiotics were amoxicillin (55.9% of prescriptions), amoxicillin/clavulanate (18.1%) and clarithromycin (11.8%). Diagnostic tests were carried out for 59.6% of children presenting with acute infections and preceded 66.4% of antibiotic prescriptions. Conclusion: Our data revealed that a high level of antibiotic prescribing for self-limiting viral infections in children continues to occur. The underuse of narrow-spectrum antibiotics and suboptimal use of diagnostic tests before treatment decision-making were also identified. To achieve a more rational use of antibiotics in primary care for children with a fever, professionals and parents need to be better educated on this subject, and diagnostic tests should be used more extensively, including the implementation of daily point-of-care testing.publishersversionPeer reviewe

Suicidality and Its Relation with Physical and Mental Conditions : Results from a Cross-Sectional Study of the Nationwide Primary Care Population Sample in Latvia

Funding Information: Funding: This research was funded the National Research Program BIOMEDICINE 2014–2017 project “Assessment and reduction of the burden of major mental disorders and life-style related cognitive dysfunction”, Ministry of Education and Sciences, Republic of Latvia, number 09.1112 and the article-processing charge was funded by Riga Stradins University. Publisher Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland.Background and Objectives: Physical and mental conditions are important risk factors for suicidality. However, there is no clear understanding of these relationships and the effect of co-occurrence on suicidality. We aimed to investigate the associations between current suicidality and mental disorders, physical conditions, and health-related factors in the nationwide primary care population in Latvia. Materials and Methods: A cross-sectional study was performed within the framework of the National Research Program BIOMEDICINE 2014-2017 at 24 primary care settings across Latvia in 2015. Adult patients were evaluated over one week at each facility. Socio-demographic variables, physical condition, and health-related factors were assessed on-site by trained psychiatrists. Mental disorders and suicidality were determined using the Mini International Neuropsychiatric Interview, and assessments were conducted over the telephone within two weeks after the visit to the general practitioner. Results: Of the 1485 cases, 18.6% reported suicidality. Only current depression, any anxiety disorder, any alcohol use disorder, and physical-mental multimorbidity were significantly associated with suicidality in the multivariate logistic regression analysis. Gastrointestinal diseases were associated with current depression alone (odds ratio (OR) 10.36; 95% confidence interval (CI) 2.34-45.76) and comorbid depression with any anxiety disorder (OR 7.55; 95% CI 2.15-26.49) among persons with current suicidality. Conclusions: Screening for depression, anxiety, and alcohol use disorders regularly among patients with physical illness may be important to help recognise suicidality in primary care that could improve the quality of life of patients and prevent suicides.publishersversionPeer reviewe

Specific signaling molecule expressions in the interradicular septum in different age groups

Orthodontic teeth movement is accompanied by the remodeling of alveolar bone, including the interradicular septum. Bone contains three cell types, osteoblasts, osteocytes, and osteoclasts that are in direct contact with all of the cellular elements in the bone marrow. Marrow is the source of both bone-building osteoblasts and bone destroying osteoclasts, and the turnover of bone occurs throughout life. Bone signalling molecules have important functions during osteogenesis, and they are active in the bone remodelling process. Patients involved in orthodontic treatment belong to different age groups: therefore age must be considered as a contributing factor compromising the osteogenetic potential of bone. The aim of the current study was to investigate the specific expression of signalling molecules in the interradicular septum in different age groups. The study group included 17 patients to whom the extraction of teeth was recommended as part of further orthodontic treatment. Patients (9 males and 8 females) - were divided into 3 groups 1st group - 12-14 years old); 2nd group - 15-22 years old; 3rd group - 23 years old or older. Expression of BMP 2/4, TGF-α, IL-1, IL-8, OPG, MMP-1, MMP-2, MMP-8, MMP-9, MMP-13, NGFR, NKpB 105, osteocalcin, and osteopontin in interradicular septum tissues was examined. TUNEL staining was also completed. The distribution of these factors was evaluated semi quantitalively. In the interradicular septum bone structure, the expression levels of osteocalcin, osteoprotegerin, matrix metalloproteinases 8 and 9, and nuclear factor kappa B were determined in all samples. TUNEL staining was also done. Age related decreases in the mean values of signalling factors and the number of apoptotic cells were statistically significant. Specific to interradicular septum osteoblasts and osteoclasts factors include osteoprotegerin, osteocalcin, matrix metalloproteinase 8, matrix metallproteniase 9, and nuclear factors kappa B. The mean expression levels of these proteins and the mean TUNEL staining statistically significantly decreased with age. This is preliminary study and more patients are necessary for more precise statistical analysis in the future.publishersversionPeer reviewe

Three-dimensional evaluation of TMJ parameters in Class II and Class III patients

The aim of our study was to assess condylar parameters and condyle position within glenoid fossa of TMJ in volumetric 3D imaging in patients with Class II and Class III malocclusions. MATERIALS AND METHODS. The study group included 15 patients with severe skeletal Class II (mean age 18.0 yrs) and 14 patients with severe skeletal Class III ( mean age 19,2 yrs) with an indication for combined orthodontic and orthognathic treatment. CT examination was performed, pictures were reconstructed in three - dimensional (3D) rendering and measured in two dimension projection (2D) pictures using IAC review and Transparent bone programs to quantify following condylar and glenoid fossa parameters - glenoid fossa width and height; tuberculum articulare angle; anterior, superior and posterior joint space; height and width of condyle, height of procesus condylaris. Mean values were calculated separately for left and right side. Differences of the mean values were tested using paired t-test. RESULTS. There were statistically significant differences (p<0,05) between two study groups for all spatial measurements on both sides with larger spatial measurements in patients with Class II malocclusions. Also the height of procesus condylaris varied between groups with statistical difference. Unilateral differences were detected for width of fossa glenoidale and height of condyle. CONCLUSION. Results show that there are a tendency for smaller condyle and wider spaces between condyle and walls of glenoid fossa comparing TMJ of Class II with Class III patients.publishersversionPeer reviewe

The relationship between the severity of malposition of the frontal teeth and periodontal health in age 15-21 and 35-44

INTRODUCTION: In the recent past there has been an increase in the number of adults seeking orthodontic treatment therefore special attention to periodontal status of these patients needs more careful evaluation. Periodontal considerations in adult orthodontic treatment are increasingly important as patients become older. The aim of the study was to assess the interrelationship between the severity of malposition of frontal teeth with periodontal health considering to age in Latvian population. METHODS: The data were analyzed from a detailed crossectional study in Latvian population. Selected samples consisted of two age groups: 15-21 (n=323) and 35-44 (n=286) years old. For the assessment of periodontal health CPI scores was analyzed for upper frontal sextant. For assessment of malocclusion 2 components of ICON index were used: upper arch crowding and incisor overbite. The differences in the distribution of ICON index and CPI index between age groups were tested using Pearson chi(2)test. Statistical significance of the differences in the mean values was tested using t-test. Possible interaction between above mentioned indexes was tested by means of analysis of variance. RESULTS: Upper arch crowding and incisor overbite severity increase with age was statistical significant. There was statistically significant interrelation between upper arch crowding degree and incisor overbite and CPI scores severity in the age 15-21 and was not in the age 35-44. However comparing higher degree of the crowding and overbite severity to percent of subjects with bleeding, calculus and periodontal pockets greater percents of measurements were in older group. CONCLUSIONS: 1. Severity of upper arch crowding and overbite statistically significant increased with age with remarkable increasing of periodontal problems. 2. Interrelation between severity of upper arch crowding, incisor overbite and CPI scores was statistically significant in age group 15-21.publishersversionPeer reviewe

Correlation of temporomandibular joint clinical signs with cone beam computed tomography radiologic features in juvenile idiopathic arthritis patients

OBJECTIVE: Patients with juvenile idiopathic arthritis (JIA) have a high risk of temporomandibular joint (TMJ) involvement. Early detection of osseous destruction of the TMJ that can be seen radiographically is vital to provide appropriate treatment before significant craniofacial deformities and problems with occlusion arise. The aim of study was to evaluate whether there is a correlation between the clinical signs and cone beam computed tomography (CBCT) radiologic features of TMJ in patients with JIA. MATERIAL AND METHODS: Study group consisted of 65 patients (46 females and 19 males) aged 10 to 17 years with a confirmed JIA diagnosis and mean disease duration 2 years 9 month, all patients underwent a clinical examination of the TMJ and masticatory muscles as well as a radiological assessment of the TMJ osseous structures by CBCT. RESULTS: Majority of the patients' study population experienced 2 or 3 clinical signs with mean number 2.1 (standard deviation (SD) =1.00) and 3-5 radiological features related to the TMJ destruction with mean number 4.9 (SD=1.96). Statistically significant weak correlation only between pain and condyle surface flattening (Spearman`s Rho test (rho) =0.396; p value (p) =0.001) was found. No correlation between number of clinical signs and radiological features was found. CONCLUSIONS: There was no conclusive evidence found regarding correlation between TMJ clinical signs and radiological features of osseous destruction in patients with JIA - only weak correlation between pain and condyle surface flattening was observed. The number of clinical TMJ signs does not correlate with number of radiological features. For the clinical decision both clinical examination and CBCT would be useful in the early detection of osseous destruction of the TMJ in JIA patients.publishersversionPeer reviewe

The severity of malocclusion and need for orthodontic treatment in correspondence with the age

Awareness of the age related situation as to the malocclusion prevalence in population and orthodontic treatment need is very important and useful for planning an orthodontic care, especially taking into account the interdisciplinary aspect of the problem. The aim of this study was to investigate the degree of severity of malocclusion and the need of orthodontic treatment in three different age groups of population in Latvia. The study group comprised samples of 12-13-yr-olds (n=46), 18-yr-olds (n=32) and 35-44-yr-olds (n=278). The Index of Complexity, Outcome and Need (ICON) was used for the assessment of the results. In order to provide the accuracy use of ICON, more than 4 missing teeth and prosthetic restorations were chosen as an exclusion factor for the age group 35-44 years. A statistically significant difference was determined between the mean ICON values in 12-13 and 18 year-old age groups. Professionally defined orthodontic treatment need according to ICON score >43 was determined to be higher in the age group 18 year-olds. Overall, the tendency for orthodontic treatment complexity grade was observed to increase with the age.publishersversionPeer reviewe