Bilateral ballism in a patient with diabetes mellitus and chronic renal failure

Acute movement disorder associated with bilateral basal ganglia lesions is an increasingly recognized syndrome in patients with end-stage renal disease, especially in the setting of diabetes mellitus. The exact mechanism of the basal ganglia lesions is unclear. We report a patient with end-stage diabetic nephropathy admitted to our clinic with acute onset bilateral ballistic movements.     

Intentional replantation of a hopeless tooth with the combination of platelet rich plasma, bioactive glass graft material and non-resorbable membrane: a case report

Abstract –  Intentional replantation can be an alternative choice for periodontally involved hopeless tooth at least for a period of time. This technique may help to restore an original tooth to function in the mouth instead of replacing it with prosthesis. The combination of one or more techniques currently available for periodontal therapy may have the potential to enhance clinical results as compared to any of the techniques used alone. In this case report, intentional replantation was combined with regenerative techniques. A very popular agent, platelet rich plasma was used in combination with bioactive glass graft material and non-resorbable PTFE membrane. The technique and one year results of treatment were discussed radiographically and clinically.     

Plasma and gingival crevicular fluid phenytoin concentrations as risk factors for gingival overgrowth

BACKGROUND: Gingival enlargement is one of the side effects associated with the administration of phenytoin. The mechanism by which phenytoin induces gingival enlargement is not well understood. This study was conducted to investigate the relationship between plasma and gingival crevicular fluid (GCF) phenytoin concentrations and the degree of gingival overgrowth in patients with similar gingival and plaque indices and also to determine the risk factors for gingival enlargement. METHODS: Eighteen patients taking phenytoin in regular doses > or =6 months prior to the investigation participated in the study. Gingival enlargement was evaluated with two indices to score vertical and horizontal overgrowth. The gingival index (GI), plaque index (PI), gingival bleeding time index (GBTI), probing depth (PD), and clinical attachment level (CAL) were also evaluated. GCF and plasma phenytoin concentrations were determined by using high-performance liquid chromatography (HPLC). RESULTS: There was no significant difference between responders and non-responders for PD, CAL, PI, GI, and GBTI. Phenytoin was detected in all of the GCF and plasma samples using the HPLC analysis method. The mean concentration of phenytoin in GCF was significantly greater than the concentration of phenytoin in plasma. No significant difference was observed for the concentration of GCF phenytoin between responders and non-responders. However, the concentration of plasma phenytoin was significantly higher in responders than non-responders. CONCLUSION: This study showed that plasma phenytoin level appeared to be a risk factor for phenytoin-induced gingival overgrowth.     

Colitis-induced oxidative damage of the colon and skeletal muscle is ameliorated by regular exercise in rats: the anxiolytic role of exercise

Epidemiological studies have shown that exercise protects the gastrointestinal tract, reducing the risk of diverticulosis, gastrointestinal haemorrhage and inflammatory bowel disease, while many digestive complaints occurring during exercise are attributed to the adverse effects of exercise on the colon. In order to assess the effects of regular exercise on the pathogenesis of colitis, Sprague-Dawley rats of both sexes were either kept sedentary or given exercise on a running wheel (0.4 km h(-1), 30 min for 3 days week(-1)). At the end of 6 weeks, under anaesthesia, either saline or acetic acid (4%, 1 ml) was given intracolonically. Holeboard tests were performed for the evaluation of anxiety at 24 h before and 48 h after induction of colitis. Increased 'freezing time' in the colitis-induced sedentary group, representing increased anxiety, was reduced in the exercised colitis group (P < 0.05). On the third day following the colonic instillation, the rats were decapitated under brief ether anesthesia and the distal 8 cm of the colons were removed. In the sedentary colitis group, macroscopic and microscopic damage scores, malondialdehyde level and myeloperoxidase activity were increased when compared to the control group (P < 0.01-0.001), while exercise prior to colitis reduced all the measurements with respect to sedentary colitis group (P < 0.05-0.001). The results demonstrate that low-intensity, repetitive exercise protects against oxidative colonic injury, and that this appears to involve the anxiolytic effect of exercise, suggesting that exercise may have a therapeutic value in reducing stress-related exacerbation of colitis.     

Plasma homocysteine levels in patients treated with levodopa: motor and cognitive associations

OBJECTIVE: The aim of this study was to determine whether hyperhomocysteinemia caused by levodopa used in idiopathic Parkinson's disease (IPD) is associated with cognitive or physical impairments. The role of folate and vitamin B12 levels in this context was also ascertained. METHODS: Thirty-nine patients who had been followed with the diagnosis of IPD in our clinic for > 2 years and 28 healthy control subjects with similar demographic features were included in the study. The homocysteine, folic acid and vitamin B12 levels and the results of the short test of mental status (STMS) and the clock drawing test of IPD patients were compared with those of the controls. Subsequently, the patients with a homocysteine level of >14 micromol/l were compared with those having a homocysteine level of <14 micromol/l by means of detailed neuropsychometric test batteries. RESULTS: Homocysteine levels were significantly higher in the patient group in comparison with the controls. There was a negative correlation between hyperhomocysteinemia and the levels of vitamin B12 and folate. On the other hand, a positive correlation between hyperhomocysteinemia and the levodopa dose was detected. There was a positive correlation between hyperhomocysteinemia and unified Parkinson's disease rating scale (UPDRS) motor section. The critical dose of levodopa was observed to be 300 mg/d. In terms of cognitive and frontal functions, no significant difference was detected between the patients and control group. The subgroup with a homocysteine level of >14 micromol/l had a significantly poorer performance in frontal and memory tests. DISCUSSION: In patients with IPD who are detected to have hyperhomocysteinemia, the assessment of the cognitive performance, folic acid and vitamin B12 levels and the supplementation of folic acid and vitamin B12 to the treatment regimen might be appropriate.     

Pomegranate peel extract prevents liver fibrosis in biliary-obstructed rats

Punica granatum L. (pomegranate) is a widely used plant that has high nutritional value. The aim of this study was to assess the effect of chronic administration of pomegranate peel extract (PPE) on liver fibrosis induced by bile duct ligation (BDL) in rats. PPE (50 mg kg(-1)) or saline was administered orally for 28 days. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT) and lactate dehydrogenase (LDH) levels were determined to assess liver function and tissue damage. Proinflammatory cytokines (tumor necrosis factor-alpha and interleukin 1 beta) in the serum and antioxidant capacity (AOC) were measured in plasma samples. Samples of liver tissue were taken for measurement of hepatic malondialdehyde (MDA) and glutathione (GSH) levels, myeloperoxidase (MPO) activity and collagen content. Production of reactive oxidants was monitored by chemiluminescence assay. Serum AST, ALT, LDH and cytokines were elevated in the BDL group compared with the control group; this increase was significantly decreased by PPE treatment. Plasma AOC and hepatic GSH levels were significantly depressed by BDL but were increased back to control levels in the PPE-treated BDL group. Increases in tissue MDA levels and MPO activity due to BDL were reduced back to control levels by PPE treatment. Similarly, increased hepatic collagen content in the BDL rats was reduced to the level of the control group with PPE treatment. Thus, chronic PPE administration alleviated the BDL-induced oxidative injury of the liver and improved the hepatic structure and function. It therefore seems likely that PPE, with its antioxidant and antifibrotic properties, may be of potential therapeutic value in protecting the liver from fibrosis and oxidative injury due to biliary obstruction.     

Effects of statins on experimental colitis in normocholesterolemic rats

OBJECTIVE: The results of previous studies suggest that statins have a direct anti-inflammatory effect that is not directly related to their cholesterol-lowering activity. The aim of this study was to investigate the effect of simvastatin (SIM) and fluvastatin (FLU) on trinitrobenzene sulfonic acid (TNBS)-induced colonic inflammation in rats. MATERIAL AND METHODS: The drugs were given for 3 days (0.1 and 1 mg/kg day-1; intraperitoneally) after induction of colitis. The lesions in the distal colon were scored at the macroscopic and microscopic level. Tissue malondialdehyde (MDA) and glutathione (GSH) levels, myeloperoxidase (MPO) activity and collagen content were assessed and formation of reactive oxygen species and peroxynitrite was monitored by chemiluminescence (CL) assay. Trunk blood was collected for the measurement of serum tumor necrosis factor (TNF)-alpha level. RESULTS: Treatment with SIM reduced the lesion score of the colitis group at macroscopic level (p<0.05), but there was no effect of treatment with FLU. The increase in colonic MDA level of the colitis group was reduced by both drugs at all doses (p<0.05-0.001). The decrease in GSH and the an increase in MPO activity in the colitis group were reversed by SIM at all doses (p<0.01), but FLU had no effect. An increase in colonic lucigenin CL value in the colitis group was reduced by SIM and FLU at all doses (p<0.001) and an increase in peroxynitrite ratio in the colitis group showed a significant reduction in SIM-treated groups; FLU reduced this effect at a dose of 1 mg/kg (p<0.01). An increase in tissue collagen content and serum TNF-alpha level in the colitis group was reversed by both drugs at all doses (p<0.001). CONCLUSIONS: SIM and FLU seemed to be beneficial in a TNBS-induced rat colitis model through the prevention of lipid peroxidation, superoxide generation, cytokine production and neutrophil accumulation.     

Serum and gingival crevicular fluid levels of ciprofloxacin in patients with periodontitis

BACKGROUND: The use of antibiotics as an adjunctive therapy in the treatment of periodontal diseases is of special interest to dental practitioners. In addition to using an appropriate antibacterial agent, clinicians may find it useful to determine the local and systemic concentrations of antibiotics in infected periodontal sites to reduce the levels of bacteria. The purpose of this study was to determine the serum and gingival crevicular fluid, or GCF, concentrations of systemic ciprofloxacin in patients with periodontitis. METHODS: Ten subjects with chronic periodontitis received ciprofloxacin (500 milligrams) twice daily for five days. The authors collected GCF and serum samples immediately after administering the first dose (baseline = 0 hours) and at consecutive time points. The orifice method was used for GCF sampling, and 5 milliliters of venous blood was drawn for serum analysis. The authors used high-performance liquid chromatography to determine ciprofloxacin concentrations in GCF and serum. RESULTS: The authors found that ciprofloxacin concentrations in GCF were significantly higher than concentrations in serum at two, four, seven, 24 and 120 hours. Ciprofloxacin reached the maximum concentration, or Cmax (3.72 micrograms/ mL), in GCF two hours after the initial dose was administered. The concentration decreased to 2.06 microg/mL 24 hours after the initial administration of the drug. Serum Cmax was 2.58 microg/mL at 1.5 hours, and the concentration decreased to 0.26 microg/mL at 24 hours. CONCLUSION: The results of this clinical study show that ciprofloxacin is found in GCF and its concentration in GCF is significantly higher than that in serum. CLINICAL IMPLICATIONS: Ciprofloxacin may be useful in treating patients with periodontitis because it reaches higher concentrations in GCF than in serum.     

Beta-glucan ameliorates methotrexate-induced oxidative organ injury via its antioxidant and immunomodulatory effects

Methotrexate is an antifolate that is widely used in the treatment of rheumatic disorders and malignant tumors. The efficacy of methotrexate is often limited by severe side effects and toxic sequelae, where oxidative stress is noticeable. In the present study, the possible protective effect of beta-glucan in methotrexate-induced toxicity was investigated. Following a single dose of methotrexate injection (20 mg/kg), either saline or beta-glucan (50 mg/kg; orally) was administered for 5 days. After decapitation of the rats, trunk blood was obtained and the ileum, liver and kidney were removed to measure tissue malondialdehyde (MDA) and glutathione (GSH) levels, myeloperoxidase (MPO) activity and collagen content, as well as histological examination. Methotrexate caused a significant decrease in GSH levels, while MDA levels, MPO activity and collagen content were increased in all the tissues (P<0.05-0.001). On the other hand, administration of beta-glucan following methotrexate abolished the depletion of GSH and inhibited the increases in MDA, MPO activity and collagen content, while the histological analysis revealed that beta-glucan attenuated the tissue damage. Stimulation index, an indicator of oxidative burst in the neutrophils, was decreased by methotrexate (P<0.001), while beta-glucan abolished this effect. Furthermore, increased leukocyte apoptosis and cell death in methotrexate-treated animals were inhibited by beta-glucan (P<0.05). Thus, the findings of the present study suggest that beta-glucan, through its antioxidant and immunoregulatory effects, may be of therapeutic value in alleviating the leukocyte apoptosis, oxidative tissue injury and thereby the intestinal and hepatorenal side effects of methotrexate treatment.     

Sleeve gastrectomy–induced endocrine changes in the remnant stomachs of premenopausal and postmenopausal rats: role of the estrogen receptors

BackgroundAlthough alterations in the plasma levels of leptin, glucagon-like peptide-1, and gastrin were linked with bariatric surgery outcomes, gastric production of these peptides was not elucidated before.ObjectiveThe aim was to evaluate the impact of estrogen depletion and estrogen receptors (ERs) on sleeve gastrectomy (SG)-induced alterations in gastric hormone production, gastric mucosal integrity, and bone mass.SettingPhysiology Research Lab at the University.MethodsFemale Sprague-Dawley rats underwent ovariectomy or sham operation (control), and 2 months later SG or sham SG was performed. Rats received either nonselective agonist 17 β, ER-α agonist, ER-β agonist, or vehicle for 3 weeks. Trunk blood and gastric tissues were collected for biochemical measurements, while histopathologic examination was performed in gastric and femur samples.ResultsIn the presence of intact ovaries, SG-induced weight loss was accompanied by reductions in the gastric synthesis of leptin and gastrin, while gastric glucagon-like peptide-1 was additionally decreased when SG was performed at the postmenopausal state. SG elevated the depleted serum estradiol levels of menopause, implicating a beneficial effect, but the occurrence of severe gastric mucosal injury was triggered. On the other hand, using ER agonists upregulated gastrin-expressing cells, ameliorated gastric injury, and improved bone loss.ConclusionsSG, either at premenopausal or postmenopausal state, resulted in considerable loss in bone mass, along with reductions in the gastric levels of gastrin and leptin. Functional status of the ovaries needs to be taken into consideration when monitoring the outcomes of SG, and ER agonists could be of value in controlling SG-induced complications.