Efficacy of curcumin gel as an adjunct to scaling and root planing on salivary procalcitonin level in the treatment of patients with chronic periodontitis: a randomized controlled clinical trial.

THE AIM OF THE STUDY: To evaluate the effect of curcumin gel combined with scaling and root planing (SRP) on salivary procalcitonin in periodontitis treatment. MATERIALS AND METHODS: seventy patients were selected from the Department of Oral Medicine and Periodontology, Faculty of Dentistry, Mansoura University, and sixteen patients were excluded. Patients in groups II and III included stage II grade A periodontitis. The participants were classified into three groups: group I as a negative control group (individuals with healthy gingiva), group II (SRP) were treated with SRP, and group III (curcumin gel) which was applied weekly for four weeks after SRP. Clinical indices (plaque index (PI), gingival index (GI), clinical attachment level (CAL), and probing depth (PD)) and saliva samples for procalcitonin (PCT) assessment using an enzyme-linked immunosorbent assay (ELISA) test were collected and measured at both baselines and after six weeks. RESULTS: This randomized controlled clinical trial registered on ClinicalTrials.gov (NCT05667376) and first posted at 28/12/2022 included Fifty-four patients (20 male; 34 female). Regarding the age and sex distribution, there was no statistically significant difference between the three studied groups (p > 0.05). There was no significant statistical difference regarding PI, GI, PPD, and CAL between group II and group III at baseline p (> 0.05). However, there was a significant statistical difference regarding the clinical parameters at baseline of both group II and group III as compared to group I (p ≤ 0.05). At six weeks after treatment, group III showed greater improvement in the PI, PD, and CAL as opposed to group II (p ≤ 0.05). Regarding PCT values, at baseline, there wasn't a statistically significant difference between group II and group III (p > 0.05). However, there was a significant statistical difference between group II, group III, and group I (p ≤ 0.05). At six weeks after treatment, there was a statistically significant decrease in PCT levels of both group II and III (p ≤ 0.05). CONCLUSION: The application of curcumin gel was found to have a significant effect on all clinical indices as opposed to SRP.

Is vitamin B12 deficiency a risk factor for gastroparesis in patients with type 2 diabetes?

BACKGROUND: Diabetic gastroparesis is a severe diabetic complication refers to delayed gastric emptying in the absence of mechanical obstruction of the stomach. Vitamin B12 affects the dynamics of autonomic nervous system and its deficits has been linked to cardiovascular autonomic neuropathy therefore, vitamin B12 deficiency was hypothesized to be implicated in the development of diabetic gastroparesis. This study was conducted to explore the possible association between vitamin B12 deficiency and gastroparesis in patients with type 2 diabetes (T2D). METHODS: A total of 100 T2D patients with diabetes duration > 10 years and 50 healthy controls matched for age and sex were recruited for this study. T2D patients were divided into 2 groups: patients with gastroparesis and patients without gastroparesis. The diagnosis of gastroparesis was based on Gastroparesis Cardinal Symptom Index (GCSI) Score ≥ 1.9 and ultrasonographic findings including gastric emptying ˂ 35.67% and motility index ˂ 5.1. Anthropometric measurements, plasma glucose, glycosylated hemoglobin (HbA1c), lipids profile, vitamin B12 and transabdominal ultrasonography were assessed. RESULTS: The frequency of vitamin B12 deficiency in total patients with T2D was 35% (54.5% in patients with gastroparesis vs. 11.1% in patients without gastroparesis, P < 0. 001). Vitamin B12 level was negatively correlated with GCSI Score whereas, it was positively correlated with gastric emptying and motility index. Vitamin B12 deficiency was an independent predictor for gastroparesis in patients with T2D; it predicts gastroparesis at a cut off value of 189.5 pmol/L with 69.1% sensitivity and 64.4% specificity, P = 0.002. CONCLUSIONS: Beside the known risk factors of diabetic gastroparesis, vitamin B12 deficiency is an independent predictor of diabetic gastroparesis in patients with T2D.

Is netrin-1 a reliable inflammatory marker for periodontitis?

Background: The current study tested netrin-1 as a reliable inflammatory marker of periodontal disease. Methods: Gingival crevicular fluid (GCF) samples were taken at baseline from 30 systemically healthy individuals. Fifteen subjects had stage II grade A or B periodontitis, and 15 were periodontally and clinically healthy. Whole-mouth periodontal parameters [probing depth (PD), clinical attachment loss (CAL), plaque index (PI), and gingival index (GI)] were recorded. The GCF samples were re-collected, and clinical parameters were re-recorded after six weeks following full-mouth scaling and root planing (SRP) in the periodontitis group. Results: Netrin-1 GCF levels were significantly lower in periodontitis patients than periodontally healthy individuals at baseline with a significant increase in netrin-1 GCF levels after SRP (P<0.05). Conclusion: Netrin-1 may have a significant role in the inflammatory process of chronic periodontitis; thus, it could be a promising anti-inflammatory marker in periodontal disease.

Angiogenic markers predict kidney injury and obstetric complications in women with preeclampsia and pregnancy-related acute kidney injury.

Pregnancy-related acute kidney injury (PRAKI) particularly on top of preeclampsia (PE) represents a major cause of maternal and fetal morbidity and mortality. Reliable diagnostic tools are needed to further evaluate the diagnosis and prognosis of PRAKI. Our objective was to study the diagnostic and prognostic value of angiogenic markers (e.g., stromal cell-derived factor 1 (SDF-1), vascular endothelial growth factor (VEGF), alarmins as uric acid) in women with PE and PRAKI. This prospective study included three groups; PRAKI, PE patients, and healthy controls that were compared regarding serum levels of the studied markers correlated to renal, maternal, and fetal outcomes. SDF-1, VEGF, and uric acid levels were significantly different between the three included groups and predicted PRAKI diagnosis. Patients with hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome exhibited the highest titers of SDF-1 and VEGF. A positive correlation was found between SDF-1 and renal recovery. Conclusively, serum assays of SDF-1, VEGF, and uric acid may add a diagnostic value in PRAKI and PE.

Acute kidney injury during pregnancy and puerperium: an Egyptian hospital-based study.

INTRODUCTION: While acute kidney injury (AKI) in pregnancy is currently a rare entity in developed countries, it is still a common occurrence in developing countries, representing a major cause of maternal and fetal morbidity and mortality. Scarce data are published regarding pregnancy-related acute kidney injury (PRAKI) in Middle Eastern and African countries. The aim of this work is to report on the frequency, the underlying causes, and the outcomes of patients with PRAKI in an Egyptian tertiary care hospital. METHODS: This is a prospective observational study that included 40 patients representing all women who presented to the Mansoura Nephrology and Dialysis Unit with PRAKI over two years. All patients were followed up for three months after hospital discharge to assess renal outcome, and till the end of pregnancy to assess the maternal and fetal outcomes. RESULTS: PRAKI was reported  in about 1% of women who presented to the obstetrics service, and accounted for 14% of all AKI patients who presented to the renal service in our hospital. Preeclampsia (PE) and obstetric hemorrhage were the commonest causes of PRAKI. Maternal mortality occurred in 22.5% of PRAKI patients. The majority of survivors (62.5%) fully recovered, while the remaining (37.5%) individuals became dialysis dependent. Unfavorable fetal events occurred in 24 pregnancies (60%). CONCLUSION: In our hospital in Mansoura, Egypt, PRAKI represents a relevant burden with potential ominous outcomes obstetric hemorrhage and preeclampsia were the major causes. Further research is needed to understand the causes and improve the outcomes of pregnancy-related AKI.

Elevated Serum Levels of Ischemia Modified Albumin and Malondialdehyde are Related to Atherogenic Index of Plasma in a Cohort of Prediabetes.

BACKGROUND: Prediabetes, defined as impaired glucose tolerance and/or impaired fasting glucose, is a risk factor for future type 2 diabetes, dyslipidemia, cardiovascular disease and all-cause mortality. High serum levels of ischemia modified albumin (IMA) and malondialdehyde (MDA) as oxidative stress markers were determined in diabetes, however, no studies have investigated these markers together in prediabetes. The aim of the present study was to investigate the circulating levels of both IMA and MDA in a cohort of prediabetic adults. The possible associations between both markers and the atherogenic index of plasma (AIP) were also evaluated. METHODS: This study enrolled 100 adults with prediabetes and 50 healthy controls matched for age and sex. Anthropometric measurements, fasting and 2-hour post load glucose, glycosylated hemoglobin (A1c), lipids profile, fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), high sensitivity C-reactive protein (hs-CRP), AIP, IMA and MDA were assessed. RESULTS: IMA, MDA, hs-CRP and AIP were significantly higher in adults with prediabetes than in healthy controls. Male gender, fasting and post load glucose, A1c, fasting insulin, TGs, HDL-C, hs- CRP, AIP and MDA were independent predictor variables of IMA, whereas male gender, WC, fasting and post load glucose, A1c, fasting insulin, TC, TGs, LDL-C, HDL-C, hs-CRP and AIP were independent predictor variables of MDA. CONCLUSION: The elevation of IMA concomitantly with MDA reflecting the antioxidant status in prediabetes, and their associations with hs-CRP and AIP should reinforce the idea of screening and treatment of prediabetes.

Relationship between vitamin A deficiency and the thyroid axis in clinically stable patients with liver cirrhosis related to hepatitis C virus.

Vitamin A deficiency (VAD) and altered thyroid function are commonly encountered in patients with liver cirrhosis. The link between vitamin A metabolism and thyroid function has been previously identified. The aim of this study was to explore the association between VAD and the thyroid axis in clinically stable patients with cirrhosis related to hepatitis C virus (HCV). One hundred and twelve patients with clinically stable HCV-related cirrhosis and 56 healthy controls matched for age, sex, and socioeconomic status were recruited for this study. Vitamin A status, liver function, thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), reverse triiodothyronine (rT3), anti-thyroid peroxidase antibodies (anti-TPO), and thyroid volume were evaluated. The prevalence of VAD among patients with HCV-related cirrhosis was 62.5% compared with 5.4% among controls (P < 0.001). Patients with HCV-related cirrhosis had significantly higher FT4, FT3, TSH, and thyroid volume than did healthy controls. Of the 112 patients initially recruited, 18 were excluded (patients with subclinical hypothyroidism and/or anti-TPO positive), so a total of 94 patients with HCV-related cirrhosis were divided into 2 groups according to vitamin A status: VAD and normal vitamin A. Patients with VAD had significantly lower vitamin A intake and serum albumin and higher serum bilirubin, FT4, FT3, and TSH than patients with normal vitamin A status. Multiple logistic regression analysis revealed that VAD was associated with Child-Pugh score (ß = 0.11, P = 0.05) and TSH (ß = -1.63, P = 0.02) independently of confounding variables. We conclude that VAD may be linked to central hyperthyroidism in patients with clinically stable HCV-related liver cirrhosis.

Protective effect of adipose-derived mesenchymal stem cells against acute kidney injury induced by ischemia-reperfusion in Sprague-Dawley rats.

Acute kidney injury (AKI) is a complex clinical condition associated with significant morbidity and mortality and lacking effective management. Ischemia-reperfusion injury (IRI) remains one of the leading causes of AKI in native and transplanted kidneys. The aim of this study was to evaluate the efficacy of adipose-derived mesenchymal stem cells (ADSCs) in the prevention of renal IRI in rats. The study was conducted on male Sprague-Dawley rats (n=72) weighing 250-300 g. Rats were randomly assigned to three main groups: i) Sham-operated control group (n=24); ii) positive control group, in which rats were subjected to IRI and were administered culture media following 4 h of IRI (n=24); and iii) ADSC group (n=24), in which rats were administered 1×106 ADSCs via the tail vein following 4 h of IRI. Each main group was further divided according to the timing after IRI into four equal-sized subgroups. Renal function was tested via the measurement of serum creatinine levels and creatinine clearance. In addition, malondialdehyde (MDA) levels were determined in serum and renal tissue homogenate as an indicator of oxidative stress. Histopathological changes were analyzed in different regions of the kidney, namely the cortex, outer stripe of the outer medulla (OSOM), inner stripe of the outer medulla (ISOM) and inner medulla. In each region, the scoring system considered active injury changes, regenerative changes and chronic changes. The ADSCs were assessed and their differentiation capability was verified. IRI resulted in a significant increase in serum creatinine, serum and tissue MDA levels and a significant reduction in creatinine clearance compared with those in sham-operated rats,. These changes were attenuated by the use of ADSCs. The prominent histopathological changes in the cortex, ISOM and OSOM were reflected in the injury score, which was significantly evident in the positive control group. The use of ADSCs was associated with significantly lowered injury scores at days 1 and 3; however, no significant effect was observed on day 7. These results indicate that the use of ADSCs ameliorates renal injury and dysfunction associated with IRI in rats.

Possible role of nitric oxide in hepatic injury secondary to renal ischemia-reperfusion (I/R) injury.

Hepatic injury secondary to renal I/R injury has been documented in several studies. This study aimed to investigate the role of NO in hepatic injury secondary to renal I/R in rat model. Sprague-Dawley rats (n = 48) were divided into 4 equal groups; sham-operated, I/R injury group (45 min of bilateral renal ischemia), L-arginine group (I/R with 300 mg/kg L-arginine, 20 min before ischemia), L-NAME group (I/R with 50 mg/kg L-NAME, 20 min before ischemia). L-NAME (NO synthase inhibitor) caused significant elevation in serum creatinine, BUN, liver enzymes, liver histopathological damage score (p ≤ 0.05) and MDA production (p ≤ 0.001); on the other hand significantly decreased NO and GSH levels (p ≤ 0.05). L-arginine significantly decreased serum creatinine, BUN and GSH (p ≤ 0.05) and caused significant elevation in liver enzymes and NO (p ≤ 0.05), and also in MDA levels (p ≤ 0.001) in liver tissues. We conclude that endogenous NO might have protective effect against hepatic injury induced by renal I/R injury and inhibition of this endogenous NO by L-NAME or exogenous administration of NO (by L-arginine) might be harmful.

Carotid Intima Media Thickness Is Independently Associated with Male Gender, Middle Age, and IGF-1 in Metabolically Healthy Obese Individuals.

Background/Aims. The effect of benign obesity on subclinical cardiovascular disease is still questionable. The purpose of this study was to assess carotid intima media thickness (CIMT), as a marker of subclinical atherosclerosis, and to evaluate its relation to age, sex, and IGF-1 in metabolically healthy obese (MHO) subjects. Methods. A total of 75 MHO subjects and 80 age, and sex matched healthy nonobese control subjects were included in the study. Body mass index (BMI), waist circumference (WC), blood pressure, fasting plasma glucose, fasting insulin, HOMA-IR, lipid profile, insulin like growth factor-1 (IGF-1), and CIMT were assessed in all subjects. Results. MHO subjects had significantly higher CIMT and lower IGF-1 than healthy nonobese controls. Mean CIMT was significantly higher in MHO men age subgroup range from 30 to 50 years than in their age range matched (premenopausal) MHO women subgroup. In MHO subjects, CIMT was positively correlated with age, BMI, WC, SBP, HOMA-IR, TG, and LDL-C, and negatively correlated with IGF-1. Regression analysis revealed that middle age, male sex and IGF-1 remained independently associated with CIMT in MHO subjects. Conclusion. CIMT is elevated and IGF-1 is reduced in MHO subjects, and CIMT is independently associated with male gender, middle age, and IGF-1. Definition of healthy obesity may be broadened to include IMT measurement.

Hepatitis C virus genotype distribution in Egyptian diabetic patients: a preliminary study.

BACKGROUND AND STUDY AIMS: There is controversy regarding whether a specific hepatitis C virus (HCV) genotype is associated with diabetes mellitus. This study aimed to investigate HCV genotype distribution in diabetics and its relation to some clinical and laboratory variables in HCV-positive diabetic versus non-diabetic Egyptians in East Delta. PATIENTS AND METHODS: The study included 100 HCV-positive patients of which 66 were diabetic in addition to 35 healthy adults as a control group. Clinical assessment, laboratory measurements of plasma glucose, insulin, C-peptide, C-reactive protein (CRP), tumour necrosis factor-α (TNF-α) and liver functions (alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyltransferase (GGT)) as well as HCV genotype determination were done, and AST/platelet ratio index (APRI) and Homoeostasis Model of Assessment-Insulin Resistance (HOMA-IR) were calculated. RESULTS: The main results were the presence of HCV genotype 3, in 31.8% of the diabetic group and in 26.5% of the non-diabetic group, while the remainder of cases had genotype 4, the predominant genotype in Egypt. This is the first report of the presence of HCV genotype 3 in about 30% of an Egyptian cohort. However, there was no significant difference in genotype distribution between both groups. Further, there were significantly higher values of HOMA-IR, insulin and C-peptide in HCV-positive groups in comparison to the control group, while TNF-α was significantly higher in the HCV-positive diabetic group. However, there were no significant differences between both genotypes regarding these parameters. CONCLUSION: Although this study reveals for the first time the presence of HCV genotype 3 in a significant percentage of a group of Egyptian patients, where the majority were diabetic, the association between diabetes and certain HCV genotypes could not be confirmed on the basis of our findings. Hence, taking into consideration the impact of such a finding on the treatment decisions of those patients, further studies are warranted to explore these findings to a greater extent.

Helicobacter pylori infection might be responsible for the interconnection between type 1 diabetes and autoimmune thyroiditis.

BACKGROUND: Higher serological prevalence rates of helicobacter pylori (H. pylori) infection have been reported in patients with type 1 diabetes (T1DM) and autoimmune thyroiditis (AT). Patients with T1DM are at increased risk for developing other autoimmune diseases, most commonly AT. It is unknown whether H. pylori infection could explain the high prevalence of thyroid autoantibodies and AT in T1DM. The aim of the current study was to evaluate anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-Tg) autoantibodies in correlation with anti-H. pylori IgG and IgA in young patients with T1DM. METHODS: Anti-H. Pylori IgG, IgA, anti-TPO and anti-Tg antibodies titers were measured in 162 euthyroid patients with T1DM and 80 healthy controls matched for age, sex and socioeconomic status. RESULTS: Seroprevalence of H. pylori was significantly higher in patients with T1DM than in healthy controls; 79% vs. 51.2%, p < 0.001. Anti H. pylori IgG was positive in 61.1% of patients with T1DM and 30% of controls, p < 0.001, anti H. pylori IgA was positive in 74% of patients with T1DM and 32.5% of controls, p < 0.001. Thyroid autoimmunity was also significantly higher in patients with T1DM than in controls; 56.7% vs. 6.2%, p < 0.001. Anti-TPO was positive in 25.3% of patients with T1DM and 3.7% of controls, p < 0.001, anti-Tg was positive in 47.5% of patients with T1DM and 6.2% of controls, p < 0.001. With simple and multiple regression analysis anti-H. pylori IgG and IgA titers were positively and significantly correlated with Anti-TPO and anti-Tg titers in patients with T1DM. CONCLUSION: our results support the idea of a connection between H. pylori infection and the occurrence of anti-TPO, anti-Tg autoantibodies and AT in young patients with T1DM. So, H. pylori infection could be considered as an environmental trigger for development of AT in T1DM. Young patients with T1DM should be screened for H. pylori infection.

Elevated serum neutrophil elastase is related to prehypertension and airflow limitation in obese women.

BACKGROUND: Neutrophil elastase level/activity is elevated in a variety of diseases such as atherosclerosis, systolic hypertension and obstructive pulmonary disease. It is unknown whether obese individuals with prehypertension also have elevated neutrophil elastase, and if so, whether it has a deleterious effect on pulmonary function. OBJECTIVES: To determine neutrophil elastase levels in obese prehypertensive women and investigate correlations with pulmonary function tests. METHODS: Thirty obese prehypertensive women were compared with 30 obese normotensive subjects and 30 healthy controls. The study groups were matched for age. MEASUREMENTS: The following were determined: body mass index, waist circumference, blood pressure, lipid profile, high sensitivity C-reactive protein, serum neutrophil elastase, and pulmonary function tests including forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and FEV1/FVC ratio. RESULTS: Serum neutrophil elastase concentration was significantly higher in both prehypertensive (405.8 ± 111.6 ng/ml) and normotensive (336.5 ± 81.5 ng/ml) obese women than in control non-obese women (243.9 ± 23.9 ng/ml); the level was significantly higher in the prehypertensive than the normotensive obese women. FEV1, FVC and FEV1/FVC ratio in both prehypertensive and normotensive obese women were significantly lower than in normal controls, but there was no statistically significant difference between the prehypertensive and normotensive obese women. In prehypertensive obese women, there were significant positive correlations between neutrophil elastase and body mass index, waist circumference, systolic blood pressure, diastolic blood pressure, total cholesterol, triglyceride, low density lipoprotein cholesterol, high sensitivity C-reactive protein and negative correlations with high density lipoprotein cholesterol, FEV1, FVC and FEV1/FVC. CONCLUSION: Neutrophil elastase concentration is elevated in obese prehypertensive women along with an increase in high sensitivity C-reactive protein which may account for dyslipidemia and airflow dysfunction in the present study population.

Erythropoietin and soluble CD44 levels in patients with primary open-angle glaucoma.

PURPOSE: To investigate the levels of erythropoietin (EPO) and soluble CD44 (sCD44) in the aqueous and plasma of human eyes with primary open-angle glaucoma (POAG), and to correlate their concentration with severity of glaucoma. METHODS: A total of 30 patients with POAG and 25 patients with senile cataract (control group) of matched age and gender were included in the study prospectively. Aqueous samples were obtained by paracentesis from glaucoma and cataract patients who were undergoing elective surgery. Aqueous and corresponding plasma samples were analysed for EPO and sCD44 concentrations by enzyme-linked immunosorbent assay. RESULTS: The EPO and sCD44 levels were significantly higher in aqueous of POAG patients with respect to the comparative group of cataract patients (P < 0.001). No significant difference in the levels of EPO and sCD44 in plasma of POAG and cataract patients. A high positive correlation was found between EPO and sCD44 in aqueous of POAG patients (P < 0.001). Significant correlation was found between EPO or sCD44 levels and severity of visual field loss in mild and moderate stages (P < 0.001). CONCLUSION: Increased levels of aqueous EPO and sCD44 may be associated with POAG. In addition, EPO and sCD44 may be useful proteins levels in aqueous of POAG patients as a result of glaucoma damage and not a cause. EPO and sCD44 concentrations in aqueous are a possible biomarkers for visual field loss in patients with POAG.

Lens cadmium, lead, and serum vitamins C, E, and beta carotene in cataractous smoking patients.

PURPOSE: To investigate the association between smoking and subcapsular cataract and blood levels of cadmium and lead, and serum levels of vitamins C, E, and beta carotene in the middle-age male population. SUBJECTS AND METHODS: The present study comprised 60 cataractous male patients aged 44-55 years who attended Mansoura University Ophthalmic Center. They were divided into two groups: the first group was comprised of 15 patients who had never smoked before with minimal exposure to cigarette smoking (control group), while the second group was comprised of 45 age and body mass index-matched smokers. Blood cadmium and lead concentrations were measured and their levels in the cataractous lenses were also estimated. The levels of some antioxidants, such as serum vitamins C, E, and beta carotene, were determined. RESULTS: Cadmium had a statistically significant higher concentration in blood and lenses of smokers compared with that of non smokers (p < 0.0001). There was a significantly high accumulation of cadmium in the lenses of cataractous smokers reaching about a four-fold increase in heavy smokers (15.4 +/- 0.4 micromol/g) and nearly a three-fold increase in light smokers (10.1 +/- 0.4 micromol/g) when compared to that of nonsmokers (3.7 +/- 0.9 micromol/g). Regarding vitamins E, C, and beta carotene, a highly significant reduction was observed in smokers when compared with nonsmokers. There was a highly positive correlation between blood cadmium concentrations and lens cadmium levels, and blood lead concentrations and lens lead levels in heavy smokers. CONCLUSION: Cadmium present in high concentrations among smokers was associated with the presence of cataracts, through induction of oxidative stress as evidenced by reduction of levels of some antioxidant studied in this work, such as vitamins E, C, and beta carotene. Thus, education of health care professionals and the public about the cataractogenic effect of cadmium is mandatory. Intake of various antioxidants may be helpful in reducing the risk of cataract formation.