Milica Petrovic

RP-HPLC assay of doxycycline in human saliva and gingival crevicular fluid in patients with chronic periodontal disease

A reversed-phased HPLC method with fluorescence detection was optimized and validated for determination of DOXY in human saliva and gingival crevicular fluid (GCF) with tetracycline as internal standard. Single step extraction with acetonitrile for both types of samples was performed. The separation was achieved at Zorbax Extend-C18 analytical column at 30°C. Mobile phase was consisted of an aqueous phase containing magnesium acetate, ammonium acetate, Na₂EDTA, triethyl-ammonium acetate buffered to pH 7.5 with ammonium hydroxide solution and acetonitrile. The volume ratio of the buffered water mixture of salts and acetonitrile was 86:14. Fluorescence detector was set at λex=380 nm and λem=520 nm. Under the optimized experimental conditions, good linearity was found in the range of 5.0-250.0 ng/mL for GCF with LOD of 1.63 ng/mL and LOQ of 4.93 ng/mL and 20.0-500.0 ng/mL for saliva with LOD of 6.36 ng/mL and LOQ of 19.28 ng/mL. This method was successfully applied for determination of DOXY in saliva and GCF obtained from patients with chronic periodontal disease.

Comparative Analysis of Smoking Influence on Periodontal Tissue in Subjects with Periodontal Disease

The aim of the study: The aim of the study was clinical and cytological examination of gingival changes in smokers and non-smokers. Further, specific goals of this study were health promotion in patient, particularly in smokers. Methods: The anamnesis was taken and clinical examination was conducted on the patients who came on Dental Clinic. During the clinical examination, plaque index (Pl)16, gingival index Löe-Silness (Gi) and the community periodontal index of treatment needs (CPITN)17 were done. After diagnosis was established, participants divided into group I –smokers, and group II – non-smokers. The gingival smears were taken for cytological analysis, dried on air, and stained by haematoxylin-eosin method. Results: The values of gingival index (GI)- Löe-Silness and periodontal index (CPITN) were higher in the group of smokers, but plaque index was also higher with statistically significant difference of their values between examined group, with maximum level of significance (p<0,001). The size of nucleus (area, Ferret’s diameter and perimeter) was higher in the group of smokers, but differences were not statistically significant. In the group of non-smokers density of nucleus was higher than in non-smokers group, but difference was not statistically significant. Conclusion: The values of examined indices showed higher values in smokers group. This finding could show that the level of oral hygiene is higher in the non smokers group. The size of nucleus (area, Ferret’s diameter and perimeter) was higher in the group of smokers, but differences were not statistically significant. Teamwork of many different speciality experts is required for better periodontal health of smokers.

GINGIVAL INFLAMMATION AS A SIGN OF DIABETIC SYSTEMIC CHRONIC COMPLICATIONS

Introduction: Diabetes mellitus (DM) is a chronic metabolic disorder and the high level of blood glucose has profound effects on various systems of the human body. DM increases the risk of periodontal disease and the severe periodontal disease often coexists in diabetic patients with poor glycemic control. The aim of the study was to analyse periodontal health in patients with diabetes mellitus type 2 related to diabetic complications and glycohemoglobin A1c values. Methodology: One hundred patients with periodontitis and type 2 DM participated in the study. According to the glycohemoglobin A1c value they were divided in 4 groups: group 1 (4%-6% normal), group 2 (6.1%-7% good), group 3 (7.1%-8% moderately poor), group 4 (> 8% poor metabolic control). The presence of chronic systemic microvascular diabetic complications (retinopathy, nephropathy and neuropathy) was recorded and periodontal assessments (Plaque, Gingival, Calculus and Periodontal Disease Index) performed. The results were statistically analysed using MS Office Excel, program SPSS, 15.0 version. Results: Gingival index values depended on the level of HbA1c values and higher values of the Gingival and Periodontal Disease Index were noticed as the value of glycohemoglobin A1c was rising (p<0,001). Gingival index values were higher in diabetics with diabetic chronic microvascular complications (p<0.001). Conclusion: It is observed that pronounced gingival inflammation in diabetics is associated with systemic diabetic complications and poor glycemic control.

Kidney failure as an unusual initial presentation of biclonal gammopathy (IgD multiple myeloma associated with light chain disease)--a case report.

INTRODUCTION Immunoglobulin D (IgD) myeloma is a rare disease, about 2% of all myelomas, even rarer when accompanied with another multiple myeloma in biclonal gammopathy. We presented a case of biclonal gammopathy-as-sociated manifestation of IgD myeloma and light chain disease in a patient who initially had renal failure. CASE REPORT 37-year-old male approximately one month before hospitalization began to feel malaise and fatigue along with decreased urination. Laboratory analysis revealed azotemia. A dialysis catheter was placed and hemodialysis started. The patient was then admitted to our hospital for further tests and during admission, objective examination revealed pronounced paleness with hepatosplenomegaly and hypertension (170/95 mmHg). Laboratory analysis showed erythrocyte sedimentation rate 122 mm/h, expressed anemic syndrome (Hb 71 g/L) and renal failure dialysis rank: creatinine 1,408 micromol/L, urea 31.7 mmol/L. There was two M components in serum protein electrophoresis: IgD lambda and free light chain lambda. Proteinuria was nephrotic rank (5.4 g/24 h), whose electrophoresis revealed 2 M components--massive in alpha 2 fraction of 71%; 7% in the discrete beta fraction, beta 2M / serum 110 mg / L, in urine 1.8 mg/L--extremely high; IgL kappa I lambda index 1:13 (reference value ratio 2:1). The findings pointed to double myeloma disease: IgD myeloma and Bence Jones lambda myeloma. Bone biopsy confirmed IgD myeloma lambda 100% infiltration medulla predominantly plasmablasts. The treatment continued with hemodialysis 3 times per week with chemotherapy protocol bortezomib, doxorubicin, dexamethasone. After 4 cycles of chemotherapy, there was a decrease of IgD, lamda-light chains, reduction in proteinuria (1.03 g/24 h), so hemodialysis was reduced to once per week. Six months after treatment initiation the patient underwent autologous bone marrow transplantation. In a 2-year follow-up period double myeloma disease showed complete remission. CONCLUSION The presented rare form of double myeloma disease with initial renal insufficiency underscores the importance of careful observation and teamwork that can alter the course of this serious disease.

The role of growth factors in extraction wound healing

Zarastanje rane je složeni proces koji uključuje hemostazu, inflamaciju, proliferaciju i remodelaciju tkiva. Faktori rasta su prirodni biološki posrednici koji regulišu najznačajnije ćelijske procese uključene u regeneraciju tkiva, kao što su DNA sinteza, angiogeneza, metabolička aktivnost, migracija, hemotaksa, proliferacija, diferencijacija i sinteza matriksa. Najznačajniji faktori rasta koji učestvuju u zarastanju ekstrakcione rane i regeneraciji koštanog tkiva su: trombocitni faktor rasta-PDGF, transformacioni faktor rasta-TGF β ,faktor rasta sličan insulinuIGF, koštani morfogenetski proteini-BMP-2, BMP – 7 , vaskularni endotelijalni faktor rasta, VEGF, ,fibroblastni faktor rasta-FGF. Faktori rasta pojavljuju se u različitim koncentracijama u različito vreme, pa se na osnovu njihovog prisustva može proceniti starost rane. Osim zarastanja rane faktori rasta mogu se primeniti za bolju oseointegraciju implanata,augmentaciju alveolarnog grebena, alveolita itd. Studije fizioloških procesa u kojima faktori rasta imaju regulatornu ulogu ukazuju da ovi molekuli retko kada svoje aktivnosti vrše u biološkoj izolaciji. Proučavanje interakcije između faktora rasta u alveolarnoj kosti može pružiti objašnjenje o sposobnosti tkiva da zaraste i pod nepovoljnim uslovima, kao što suinfekcija i zračenje

Perioral and sublingual hematoma: Oral anticoagulation therapy complication: Case study

Introduction. Anticoagulation therapy includes drugs which prevent intravascular formation and spreading of a thrombus. Heparin and dicoumarin preparation are in use. Heparin preparations are commonly used when a rapid anticoagulant effect is required, they are administered intravenously, act immediately performing the inhibition of thromboplastin activation, prothrombin to thrombin conversion, and the effect of thrombin to fibrinogen. Oral anticoagulation therapy (OAT) includes drugs - antagonists of vitamin K, which is responsible for the synthesis of prothrombin complex factors - II, VII, IX and X. They are derived from coumarin and indandione. One of the most frequently used drugs from the OAT group is warfarin. It is a competitive inhibitor of vitamin K required for the carboxylation of the residues of PK factor glutamic acid. The results of this inhibition lead to the unsuccessful formation of gama carboxyglutamic acid and the production of functionally inert coagulation proteins. The aim of this study was to show a rare but dangerous complication of an inadequate application of oral anticoagulation therapy. Case study. Patient S.S., male, aged 79, was admitted to the Oral Surgery Department, Clinic of Dentistry of the Faculty of Medicine in Nis on October 5, 2012 due to a severe general condition with massive hematoma in the facial area. Anamnestic data showed that during the previous couple of days, the patient was voluntarily taking a whole tablet of Farin instead of the prescribed dose. The patient started receiving intravenous low-molecular-weight heparin therapy (Fraxarin 0.3/12h) along with the antibiotic therapy. In the following period, the patient reported daily at the Oral Surgery Department for regular check-ups. The hematoma was absorbed and the swelling was completely gone within the next 7 to 10 days.

Closure of persistent oro-nasal fistula with removable obturator denture

Introduction. Cleft lip and cleft palate are relatively common congenital deformities. Patients with clefts require multidisciplinary treatment approach and a team which may include a maxillofacial surgeon, orthodontist, speech therapist, pediatrician, prosthetician, psychologist, as well as the relevant experts who may be of help in restoring the function of the orofacial system. Case report. The paper describes a case of prosthetic rehabilitation of an edentulous female patient with oronasal fistula, after multiple surgical interventions performed in various medical institutions in order to treat her cleft primary and secondary palate. Conclusion. Well planned prosthetic treatment of adult patients with cleft palate and total edentulousness can produce satisfactory results in view of both function and esthetics.