Daniel Bautista

Application of a capsaicin rinse in the treatment of burning mouth syndrome

Objective: To examine the efficacy of a new topical capsaicin presentation as an oral rinse in improving the symptoms of burning mouth syndrome (BMS). Study design: A prospective, double-blind, cross-over study was made of 30 patients with BMS. There were 7 dropouts; the final study series thus comprised 23 individuals. The patients were randomized to two groups: (A) capsaicin rinse (0.02%) or (B) placebo rinse, administered during one week. After a one-week washout period, the patients were then assigned to the opposite group. Burning discomfort was scored using a visual analog scale (VAS): in the morning before starting the treatment, in the afternoon on the first day of treatment, and at the end of the week of treatment in the morning and in the afternoon. The same scoring sequence was again applied one week later with the opposite rinse. Results: The mean patient age was 72.65 ± 12.10 years, and the duration of BMS was 5.43 ± 3.23 years on average. Significant differences in VAS score were recorded in the capsaicin group between baseline in the morning (AM1) or afternoon (AA1) and the end of the week of treatment (AA7)(p=0.003 and p=0.002, respectively). Conclusion: The topical application of capsaicin may be useful in treating the discomfort of BMS, but has some limitations. Key words: Burning mouth syndrome, stomatodynia, capsaicin, treatment, clinical management.

Oral manifestations in a group of adults with autism spectrum disorder

Objective: A number of studies have evaluated the oral health of patients with autism spectrum disorder (ASD), though most have involved children, and no specific oral manifestations have been described. The present study describes the buccodental disorders and hygiene habits in a group of adults with ASD. Study Design: A prospective case-control study was made of a group of patients with ASD (n=30), with a mean age of 27.7±5.69 years, and of a healthy age- and gender-matched control group (n=30). An evaluation was made of the medical history, medication, oral hygiene habits and oral diseases, with determination of the CAOD, CAOS and OHI-S oral hygiene scores. Results: Most of the patients in the ASD group used two or more drugs and were assisted in brushing 2-3 times a day. The most frequent manifestations were bruxism, self-inflicted oral lesions and certain malocclusions. The CAOD and CAOS scores were significantly lower than in the controls. Conclusions: Adults with ASD and assisted dental hygiene presented fewer caries than the non-disabled population. However, bruxism, ogival palate and anterior open bite were frequent in the patients with ASD. Key words:Autism spectrum disorder, caries, dental hygiene, oral manifestations.

Association between red blood cell distribution width and the risk of future cardiovascular events.

In patients with acute myocardial infarction (AMI), high red blood cell distribution width (RDW) seems to predict further cardiovascular events, although the mechanism and its possible relation with anaemia and inflammation remains uncertain. We determined in 119 AMI patients before hospital discharge RDW, along with haemoglobin, haematimetric indices and inflammatory parameters (fibrinogen, C-reactive protein, plasma viscosity, neutrophil count). In the follow-up period (21 ± 11 months), 30 patients (25%) developed a recurrent cardiovascular event. In the lineal regression analysis, MCH and neutrophil count were independent determinants for RDW (beta coefficient = -0.544 p < 0.001; beta coefficient: 0.279 p = 0.001, respectively). The logistic regression analysis showed that RDW >14% increases the risk of future events by 6 times; OR 6.19 IC 95% (2.1-18.5); even after adjusting for anaemia, mean corpuscular haemoglobin (MCH) <27 pg/L, fibrinogen >400 mg/dL and neutrophil count >5.7 (103/μL). Our results confirm that RDW, an available and inexpensive measurement reported in routine blood cell counts, seems to be an independent predictor for recurrent cardiovascular events in AMI patients. As we found no association of RDW with either anaemia or inflammatory parameters, the mechanism responsible for increased RDW deserves further research.

Rheological blood behavior is not only influenced by cardiovascular risk factors but also by aging itself. Research into 927 healthy Spanish Mediterranean subjects

It is not well-established whether the alterations that the hemorheological profile undergoes with aging are an effect of concomitant cardiovascular risk factors or are due to age itself. To clarify this issue, we investigated the effect of age on blood rheology in a population of 927 healthy subjects from eastern Spain aged between 16-85 years, divided into four age groups (<30, 30-44, 45-50, ≥60 years) with and without cardiovascular risk factors. We determined blood viscosity, corrected blood viscosity (BVc), plasma viscosity (PV), erythrocyte aggregation (EA), erythrocyte deformability (EEI60) and fibrinogen, along with glucose and plasma lipids. We found that corrected blood viscosity (p = 0.007), plasma viscosity, erythrocyte aggregation, fibrinogen, glucose, and plasma lipids increased with age (p < 0.001). When subjects with cardiovascular risk factors were excluded, the effect of age on blood rheology persisted for all the cited parameters (p < 0.028). EEI60 increased with age (p = 0.033), and it was attributable to a concomitant increase in mean corpuscular volume (p < 0.001). In the Pearsons correlations, age was related to all the parameters analyzed (P < 0.019). The logistic regression analysis revealed that PV ≥1.30 mPa·s, BVc ≥4.90 mPa·s and EA1 ≥8.3 were associated with age ≥60 years (*p = 0.049, *p = 0.013, *p = 0.045, respectively). These results indicate that, although the presence of cardiovascular risk factors influences rheological properties, aging itself is associated with deterioration of rheological blood behavior, mostly related to inflammatory and lipidic changes.

Red Blood Cell Distribution Width in Patients With Cryptogenic Stroke

Background: There is no information about a possible association of red blood cell distribution width (RDW) with cryptogenic stroke (CS). We aimed to analyze the association of RDW with CS. Patients and Methods: One hundred and sixty-three patients with CS were included along with 186 healthy controls. Fibrinogen, leukocytes, hemoglobin, and erythrocyte indices were evaluated. Results: Patients showed higher RDW, leukocyte count, and body mass index (BMI) than controls (P < .05). No differences were observed in the erythrocyte indices or in glucose, cholesterol, and triglycerides levels (P > .05). When patients with anemia were excluded from the study (6 controls and 5 cases), the differences between cases and controls persisted (P = .005). Multivariate logistic regression revealed that, after adjusting for potential confounders (anemia, age > 40 years, gender, and fibrinogen >382 mg/dL, total cholesterol >240 mg/dL, and BMI > 28.7 kg/m2), RDW >14% was the only parameter that independently increased the risk of CS. Conclusion: The RDW >14% increased the risk of CS by 2.5-fold, irrespectively of anemia, inflammation, and lipidic profile.

Efect of periodontal disease and non surgical periodontal treatment on C-reactive protein. Evaluation of type 1 diabetic patients.

Objectives: The purpose of this study was to analyze how anti-infectious periodontal treatment affects C reactive protein (CRP) values in patients with type 1 diabetes, and correlate baseline CRP levels with periodontal disease severity. Study Design: A cohort of fifty three subjects with type 1 diabetes and moderate to severe periodontitis were recruited. Periodontal parameters were measured, and blood samples were obtained to evaluate high-sensitivity C-reactive protein (hs-CRP). Group 1 was treated with scaling, root planning, and systemic administration of doxycycline. Group 2 received only scaling and root planning. Results: Hs-CRP was reduced after periodontal treatment in group 1 (-0.22 mg/l) and 2 (-0.21 mg/l ) but this reduction was not statistically significant, even in the patients with the best response to periodontal treatment. However, significant correlation appeared between hs-CRP and mean probing pocket depth (PPD) (p=0, 01) and mean clinical attachment level (CAL) (p=0,03). Conclusions: Non-surgical periodontal treatment couldn’t reduce hs-CRP values, however, it was found an association between advanced periodontitis and elevated blood hs-CRP levels in patients with type 1 diabetes. It can be speculated that periodontal disease increases production of pro-inflammatory mediators in patients with type 1 diabetes, but other producing sources of these pro-inflammatory substances may exist. Key words:Periodontal disease, periodontitis, diabetes mellitus type 1, periodontal therapy, C reactive protein.

Association between high red blood cell distribution width and metabolic syndrome. Influence of abdominal obesity.

To theEditor. The association between high red blood cell distribution width (RDW) and cardiovascular events and heart failure has been reported [4, 7]. The link between elevated RDW and cardiovascular disease (CVD) risk may be due to an underlying chronic inflammation mediated by proinflammatory cytokines that could influence erythrocyte maturation [4]. The metabolic syndrome (MS) is a chronic inflammatory disorder that increases the risk of cardiovascular events and death [5]. A recent study [6] has found an association between RDW and MS with doubtful results, as the association is weak, lower than that for cardiovascular events and iron, vitamin B12 and folic acid, which may influence RDW have not been determined either. We have performed a case-control study evaluating the association between RDW and MS as well as with the several components of MS, i.e., abdominal obesity, low HDL cholesterol, hypertension, hypertriglyceridemia and glucose intolerance. The study was performed in accordance with the ethical guidelines for Clinical Hemorheology and Microcirculation [2]. We included 61 patients with MS classified according to the NCEP ATPIII criteria modified by Grundy et al. [5] and 94 controls without MS. We determined RDW along with iron, vitamin B12, folic acid, erythrocyte indices, glucose, lipids, fibrinogen, hs-CRP and neutrophil count. A cut-off point of 14% corresponding to the control group mean plus one SD was considered for high RDW; 358 mg/dL for high fibrinogen and 28.61 pg for low MCH. No differences in RDW nor in vitamin B12, folic acid, iron, or erythrocyte indices were observed (p> 0.05). Hematocrit was statistically higher in patients than in controls (p= 0.022) as were hs-CRP, fibrinogen and neutrophils count (p< 0.001) (Table 1).

Association of metabolic syndrome and its components with hyperuricemia in a Mediterranean population.

Several studies have found an association between hyperuricemia and metabolic syndrome (MS), although there are discrepancies as to which MS components play a pivotal role in this association. We aimed to investigate the association between serum uric acid (SUA) levels and MS in a Mediterranean population (eastern Spain). We performed a case-control study of 71 patients with MS and 122 healthy controls. MS was defined according to the revised National Cholesterol Education Program Adult Treatment Panel III modified criteria. Hyperuricemia was defined as SUA levels >6.55 mg/dL. We determined biochemical, lipidic and inflammatory parameters along with uric acid. Patients with MS showed a higher risk of hyperuricemia than those without MS (OR: 2.87 95% CI: 1.48- 5.55; p = 0.002). In turn, the unadjusted logistic regression analysis showed that hyperuricemia is associated with a higher risk of presenting all the MS components, except hypertension; i.e., hypertriglyceridemia, low HDL-cholesterol, abdominal obesity and glucose intolerance were predictors for hyperuricemia (OR: 3.15, 95% CI: 1.61- 6.15, p = 0.001; OR: 4.07, 95% CI: 1.77- 9.33, p = 0.001; OR: 2.81, 95% CI: 1.41- 5.58, p = 0.003 and OR: 2.82, 95% CI: 1.46- 5.45, p = 0.002 respectively). The adjusted logistic regression analysis revealed that only low HDL-cholesterol and glucose intolerance were independent predictors for hyperuricemia (OR: 2.71, 95% CI 1.06- 6.97, p = 0.038; OR: 2.14, 95% CI 1.01- 4.56, p = 0.049, respectively). In our geographical area, the patients with MS showed a nearly 3-fold risk of hyperuricemia than those without. Among all the MS components, low-HDL-cholesterol and high glucose independently increased more than twice the risk of hyperuricemia, and are the pivotal components involved in hyperuricemia.

Are abdominal obesity and body mass index independent predictors of hemorheological parameters

There is an association between obesity and rheological blood behavior [2, 4–7]. In this sense we have read with interest the recently published article by Brun et al. [1] in this journal. The authors evaluate, in a population of 430 subjects, the relationship between abdominal obesity and body mass index (BMI) with blood viscosity, and conclude that both anthropometric parameters are associated with increased blood viscosity but by different mechanisms, where the waist to hip ratio is a better predictor for blood viscosity than BMI. It is striking that in this study the authors do not indicate the variables included in the stepwise multivariate regression model, where plasma lipids, glucose and fibrinogen do not seem to have been included, being important from a rheological point of view. It seems that only the waist to hip ratio (WHR) and BMI were taken into account as predictors of blood viscosity. In order to clarify this issue and to know not only the relationship between the above mentioned anthropometric parameters with blood viscosity, but also with the rest of hemorheological variables (i.e. corrected blood viscosity at 45% hematocrit, plasma viscosity, erythrocyte aggregation and erythrocyte deformability), we analyzed the association of BMI and waist circumference with hemorheological parameters, and also with glucose, plasma lipids and fibrinogen in 395 healthy subjects (199 males/196 females, aged: 44.13± 12.61). We preferred to use waist circumference rather than WHR because it seems to be a stronger predictor of cardiovascular risk [3]. Anthropometric, lipidic, fibrinogen and hemorheological parameters were determined as previously [9]. A multivariate regression analysis was performed to explore the association of native blood viscosity, corrected blood viscosity, plasma viscosity, erythrocyte aggregation and erythrocyte deformability

Psoriasis and hemorheology. Influence of the metabolic syndrome

Psoriasis is a systemic inflammatory disorder with increased cardiovascular risk which has been partly attributed to the increased prevalence of the metabolic syndrome (MS). However, the contribution of rheological alterations to cardiovascular risk has been scarcely investigated. In 91 psoriasis patients and in 101 healthy volunteers, we determined the rheological profile (fibrinogen, blood viscosity and erythrocyte aggregation), along with lipidic and inflammatory parameters. Patients showed statistically higher BMI, waist, triglycerides, insulin, c-reactive protein (CRP), neutrophils, lower HDL-cholesterol and a higher MS prevalence (p<0.05). When subjects with MS were excluded from the study, patients with psoriasis still showed a worse inflammatory, lipidic and rheological profile in the above-mentioned variables compared with controls without MS (p<0.05). The logistic regression analysis revealed that abdominal obesity and fibrinogen>384 mg/dL were independent predictors of psoriasis (OR 3.75 95% CI 1.77-7.94, p<0.001; OR 2.95 95% CI 1.14-7.64, p=0.025), respectively. Patients on biologics, showed less inflammation and a better rheological profile than those not on biological treatment. In conclusion, patients with psoriasis show an altered rheological profile, which may contribute to increased cardiovascular risk. Although the presence of MS worsens this profile, psoriasis per se shows rheological alterations due to both inflammation and altered metabolic parameters. Anti TNF-α treatment markedly improves the rheological profile by mostly decreasing inflammation.