This clinical study evaluated the efficacy of lozenges containing the probiotic Lactobacillus brevis CD2 in treating recurrent aphthous stomatitis (canker sores). 30 patients were randomly assigned to receive either the active lozenges or placebo lozenges for 7 days. The lozenges containing L. brevis CD2 significantly reduced pain levels and healed ulcers faster than the placebo. Laboratory markers of inflammation in saliva also decreased more in the active group. This is the first study to confirm the efficacy of a probiotic in treating canker sores.
Tuberculosis Treatment Symposia - The CRUDEM Foundation presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Long Island Periodontist presents "Appropriate Use of Antibiotics In Dentistry"Edward Brant DDS, MS
Periodontist who does his best when he provides Long Island with treatment for tooth and gum disease. Dentist, dental implants, laser gum treatment for periodontal disease, bone graft, gum surgery
Tuberculosis Treatment Symposia - The CRUDEM Foundation presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Long Island Periodontist presents "Appropriate Use of Antibiotics In Dentistry"Edward Brant DDS, MS
Periodontist who does his best when he provides Long Island with treatment for tooth and gum disease. Dentist, dental implants, laser gum treatment for periodontal disease, bone graft, gum surgery
Similar to Clinical Study: use of Lozenges Containing Lactobacillus brevis CD2 in Recurrent Aphthous Stomatitis: A Double-Blind Placebo-Controlled Trial
Candidiasis is a fungal infection caused by yeasts from the genus Candida. It is commonly called oral candidiasis or thrush when it affects the mouth. It is one of the common side effects associated with the long term use of steroid inhalers. Nebulizing therapy with corticosteroids is widely accepted treatment approach for patients with acute exacerbations of Chronic Obstructive Pulmonary Disease. The other side effects of steroid inhalers include hoarseness of voice and dysphonia, which are usually ignorable. We report this case of 74 year old male patient who was on metered dosage inhaler and nebulizer therapy with corticosteroid and presented with oral candidiasis. If oral thrush develops, treatment with oral fluconazole or nystatin mouth wash is beneficial. Proper patient education by the clinical pharmacist to the patient regarding safe and effective usage of inhalers and nebulizers especially corticosteroids can minimize these drug related problems.
Management of Radiation Toxicity in H & Ndrmadhup1
Management of Radiation Toxicities in head and neck cancer. Radiation is the most important mode of treatment for head and neck cancer patients. It causes both acute and late side effects. Oral mucositis an early or acute reaction which is the limiting factor in all patients. Its management guidelines has been given by MASCC and been updated time to time. Counselling is very important. General oral care and dental prophylaxis is very important before starting the treatment. High end planning in the form of IMRT may help in reducing the OM. Delineation of oral mucosa during RT may help. Use of Glutamine, Honey is also recommended. Benzydamine gargle to be used. Chlorhexidine gargles are not recommended. Proper control of Pain and infection is of para mount importance. Radiation dermatitis is also an acute side effects and its management involves general skin care, washing, topical steroids and some cream based upon aloe vera. Xerostomia is also a late complication which can be addressed by dysphagia optimized IMRT technique which has shown positive results in randomized trial. Symptomatic patient may be asked to use water frequently as well as some artificial saliva preparation in day today life. Dysphagia is another late side effect can be managed by dietary counselling. Other late side effects include Trismus, sub cutaneous fibrosis of neck and late stages lymphedema. It management includes prevention and treatment by pentoxyphylline and vitamin E.
Repeated exercises after radiotherapy is must.
A Case Report Of Pseudomembranous Candidiasis Induced By Long Term Systemic C...Ziad Abdul Majid
The purpose of this case report is to discuss the Acute Pseudomembranous Candidiasis in 24 Negroid Female Libyan patient on long term use of systemic corticosteroids therapy who came to the department of Oral Medicine, Surgery, and Diagnosis at the Faculty of Dentistry, Libyan International Medical University with the clinical appearance of Acute Pseudomembranous Candidiasis.
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Inflammatory Bowel Disease (IBD) is a multifactorial disorder with many different putative influences mediating disease onset, severity, progression and diminution. Spontaneous natural IBD is classically expressed as Crohn’s Disease (CD) and Ulcerative Colitis (UC) commonly found in primates; lymphoplasmocytic enteritis, eosinophilic gastritis and colitis, and ulcerative colitis with neuronal hyperplasia in dogs; and colitis in horses. Spontaneous inflammatory bowel disease has been noted in a
number of rodent models which differ in genetic strain background, induced mutation, microbiota influences and immunopathogenic pathways. Histological lesions in Crohn’s Disease feature noncaseating granulomatous inflammation while UC lesions typically exhibit ulceration, lamina propria inflammatory infiltrates and lack of granuloma development. Intestinal inflammation caused by CD and UC is also associated with increased incidence of intestinal neoplasia. Transgenic murine models have determined underlying etiological influences and appropriate therapeutic targets in IBD. This literature review will discuss current opinion and findings in spontaneous IBD, highlight selected transgenic rodent models of IBD and discuss their respective pathogenic mechanisms. It is very important to provide accommodation of induced putative deficits in activities of daily living and to assess discomfort and pain levels in the face of significant morbidity and/or mortality in these models. Epigenetic, environmental
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Similar to Clinical Study: use of Lozenges Containing Lactobacillus brevis CD2 in Recurrent Aphthous Stomatitis: A Double-Blind Placebo-Controlled Trial (20)
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. 2 Ulcers
described: trauma, stress, changes in the immune system, Lactobacillus brevis CD2 and 15 (8 male and 7 female) aged
sensitivity to certain types of food, or ingested substances between 10 and 35 treated with lozenges containing placebo.
such as preservative agents or cinnamaldehyde (a substance The patients were visited and enrolled in a private practice in
contained in some toothpastes), iron, zinc, and vitamin Rome, Italy.
deficiency [14–16]. The main pathogenetic event is the
inflammatory response with production of inflammatory 2.1. Treatment Plan. 1 lozenge containing Lactobacillus brevis
cytokines (IL2- IL12, IFN-γ), prostaglandin E2 (PGE2), and CD2 (Inersan—VSL Pharmaceuticals, Inc.) or placebo was
nitric oxide (NO) [17–19]. administered 4 times daily for a total period of 7 days,
The treatment of recurrent aphthous stomatitis remains including in the case of reduced symptoms. Patients were
unsatisfactory and frustrating for both patients and doctors. instructed to melt the lozenge in the mouth slowly and away
Patients are asked to brush delicately and avoid eating any from food intake.
hard, sharp, or irritating foods. Topical steroids at best reduce Each lozenge was composed of the following: lyophilized
the pain but not the rate of recurrence; moreover they can bacteria of Lactobacillus brevis CD2, at least 1 billion live bac-
cause systemic effects. Topical tetracycline and chlorhexidine teria per lozenge. Excipients: mannitol, aspartame, fructose,
may reduce the severity of the inflammation but not the talc, silicon dioxide, magnesium stearate, and banana flavour.
frequency. In severe cases, systemic steroids, thalidomide, Placebo consisted of a lozenge containing excipients only,
colchicine, pentoxifylline, azathioprine, alpha 2 interferon, supplied in the same packaging and administered in the same
and cyclosporine are considered as possible options for the way and at the same dosage as the active product.
patients, but again the side effects can be significant. 2.2. Inclusion and Exclusion Criteria. The criteria for inclu-
Previous studies have shown Lactobacillus brevis CD2, sion in the study included a history of recurrent minor aph-
administered as lozenges, to treat aphthous ulcerations on thous stomatitis (at least 3 episodes in a year), characterized
the mouth of patients affected by Behcet’s disease was
¸ by painful ulcers of 1–10 mm in diameter that had arisen no
effective in reducing the number and frequency of the ulcers more than 48 hours prior to enrolment and which generally
[20]. had an expected clinical resolution of 5 or more days.
The Lactobacillus brevis CD2 strain used for these studies Exclusion criteria for this study were patients with dia-
has specific known characteristics and is endowed with betes mellitus, alcohol and/or drug abuse, or patients who
high levels of arginine deiminase, an enzyme that plays a had undergone dental interventions or taken antibiotic ther-
fundamental role in the metabolism of arginine. Indeed, apy in the two weeks prior to enrolment. Also excluded from
many of the bacteria involved in the pathogenesis and the study were patients who had taken anti-inflammatory
in the maintenance of the inflammatory processes of steroid and nonsteroid therapy within 30 days prior to enrol-
the oral cavity (such as periodontitis, Behcet’s syndrome,
¸ ment.
recurrent aphthous stomatitis, and radio/chemotherapy- All patients were informed about the study and the
induced mucositis) require arginine for their own survival characteristics of the product and signed informed consent
and intrinsic pathogenicity. The high content of arginine at enrolment.
deiminase explains the many specific actions performed by All patients were subjected to evaluation of clinical and
this strain, in particular (i) a reduction of the availability of laboratory parameters at the start of therapy (T0), and at the
arginine within the oral cavity, thus preventing the growth end of treatment (T1).
of arginine-dependent inflammatory microorganisms; (ii)
reduced availability of arginine to arginase, with consequent 2.3. Clinical Parameters. The following clinical signs and
minor production of polyamines; (iii) reduced availability symptoms were taken into account: spontaneous pain, local
of arginine for NO-synthase, thus reducing the production burning, and perilesional erythema. The intensity of the
of nitric oxide (NO) and leading to a direct attenuation signs and symptoms was expressed as 0: absent, 1: mild, 2:
of the inflammatory processes which have damaging and moderate, 3: severe.
destructive consequences in cases of acute and chronic Moreover the total sum of the diameters of the greater
mucositis (Figure 4). individual ulcers, expressed in millimeters, was calculated at
The primary aim of this study was to evaluate the efficacy enrolment and at the end of treatment.
and time to remission with a lozenge containing at least 1 Particular attention was given to the assessment of pain:
billion Lactobacillus brevis CD2 in patients with a clinical patients were asked to score the intensity of spontaneous pain
condition related to aphthous stomatitis. based on the Numerical Rating System scale from 1 to 10,
Secondary endpoints included assessment of the varia- considering a rating from 1 to 4 as mild pain (score = 1), >4
tions of prostaglandin E2 (PEG2), Interferon-γ (IFN-γ), and to 7 as moderate (score = 2) and >7 to 10 as severe pain (score
nitrite/nitrate levels in the saliva. = 3).
A questionnaire about observed daily changes in pain was
handed out, in which patients were asked to fill in, sign and
2. Materials and Methods return at the end of treatment.
The study was conducted in a double-blind, placebo-
controlled fashion on 30 patients, 15 (7 male and 8 female) 2.4. Laboratory Parameters. Salivary samples were collected
aged between 8 and 36, treated with lozenges containing in all patients to assess PGE2, IFNγ, and nitrite/nitrate levels.
3. Ulcers 3
16 140
Number of patients
14 P = .01 120
12 P < .01
10 100
(mm)
8 14 80
6 8
4 7 60 112 121
2 1 40
0 20 54
Recovery Improvement Failure 3
0
TO (enrolment) T1(end of therapy)
CD2
Placebo CD2
Placebo
Figure 1: Clinical evaluation.
Figure 2: Sum of greater diameters.
2.4.1. Determination of INFγ and PGE2 Levels in the Saliva. 40
IFNγ (Endogen Inc., Woburn, Man, USA) and PGE2 (Assay
Total intensity score
Designs) were determined in the fluid saliva fraction using 30
ELISA kits, in accordance with the manufacturer’s instruc- 33 34
20
tions.
10 18
2.4.2. Determination of Nitrite/Nitrate Levels in the Saliva. 1
In aqueous solutions, NO reacts rapidly with O2 and accu- 0
TO (enrolment) T1(end of therapy)
mulates in the culture medium as nitrite and nitrate ions.
Twenty microliters of saliva samples or supernatants from CD2
macrophage cultures were used for nitrite measurement Placebo
by colorimetric assay based on the Griess reaction. Briefly,
5 ml of HEPES (50 mM, ph 7.4), 5 μL of FAD (5 μM), Figure 3: Intensity of spontaneous pain.
10 μL NADPH (0,1 mM), 58 μL of H2 O, and 2 μL of nitrate
reductase (0,2 IU ml−1 ) were added to 20 μL of samples,
which were then incubated for 30 minutes at 37◦ C. At the end The sum of diameters of the greater individual ulcers at
of the incubation time 10 μL of pyruvic acid (100 mM) and enrolment was 112 mm in the Lactobacillus brevis CD2 group
1 μL of LDH (1500 IU ml−1 ) were added to the samples. After and 121 mm in the placebo group; the two groups were not
10 minutes of incubation at 37◦ C, samples were mixed with statistically different at this stage (P = NA). At the end of
an equal volume of Griess reagent in a microtiter place and therapy, the sum of diameters of the greater individual ulcers
incubated at room temperature in the dark for 10 minutes. in the Lactobacillus brevis CD2 group was 3 mm, while in the
The OD was measured at 550 nm using a microenzyme- group of patients treated with placebo, it was 54 mm (P <
linked immunosorbent assay (ELISA) reader (Easy Reader .01) (Figure 2).
EAR 400; Kontron Analytic, London, UK): KNO3 dissolved The pattern and the intensity of individual clinical signs
in H2 O was used as standard and H2 O as Blank. and symptoms under review was as indicated in Table 1.
2.5. Statistical Analysis. Differences in the analyzed parame- 3.1. Patients Treated with Lactobacillus Brevis CD2
ters between active and control groups were tested using the 3.1.1. Local Burning. At enrolment burning was severe in 7
Student’s t-test. The statistical significance of the differences patients (intensity 21), moderate in 5 (intensity 10), and mild
in clinical and laboratory parameters between T0 and T1 was in 3 (intensity 3), with a total value of intensity equal to 34;
analyzed using the paired sample t-test. The statistical pro- at the end of therapy local burning persisted mildly only in 1
gram was used to perform statistical analysis and statistical patient (intensity 1) with total value of intensity equal to 1.
difference was set at P < .05.
3.1.2. Spontaneous Pain. At enrolment spontaneous pain was
3. Results severe in 6 patients (intensity 18), moderate in 6 (intensity
All patients enrolled in the study completed the trial. 12), and mild in 3 (intensity 3) with a total value of intensity
From a clinical point of view, 14 of 15 patients (93.3%) equal to 33; after treatment it persisted as mild only in 1
treated with Lactobacillus brevis CD2 showed complete patient (intensity 1) with a total value of intensity equal to
remission of the clinical symptoms and 1 patient showed a 1 (Figure 3).
remarkable improvement. In the placebo group, 7 (46.6%)
showed complete healing, while in the remaining 8 patients 3.1.3. Perilesional Erythema. At enrolment this was severe in
symptoms persisted at the end of treatment. The difference 6 patients (intensity 18), moderate in 7 (intensity 14), and
between the two groups was statistically significant (P = .01) mild in 2 (intensity 2), with a total value of intensity equal
(Figure 1). to 34; at the end of therapy perilesional erythema persisted
4. 4 Ulcers
Table 1: Summary of clinical parameters before and after administration of Lactobacillus Brevis CD2 or placebo lozenges.
Intergroup
Lactobacillus brevis CD2 (n = 15) Placebo (n = 15)
comparison
Severe Moderate Mild Absent Total Severe Moderate Mild Absent Total
(n) (n) (n) (n) Value (n) (n) (n) (n) value
before 7 5 3 0 34 8 4 3 0 35 P = .9
Burning
after 0 0 1 14 1 2 4 2 7 16 P = .03
Spontaneous before 6 6 3 0 33 7 5 3 0 34 P = na
pain after 0 0 1 0 1 3 4 1 7 18 P = .02
before 9 6 0 0 39 10 5 0 0 40 P = na
Caused pain
after 0 0 1 14 1 5 2 1 7 20 P = .02
Perilesional before 6 7 2 0 34 7 5 3 0 34 P = NA
erythema after 0 0 1 0 1 3 4 1 7 18 P = .02
Value assignment: 0: absent, 1: mild, 2: moderate, and 3: severe.
as mild only in 1 patient (intensity 1) with a total value of 3.4. Laboratory Parameters. At the end of therapy, there was a
intensity equal to 1. marked reduction in levels of PGE2, IFNγ, and nitrite/nitrate
No side effects were observed and the tolerability of the in the saliva of patients treated with Lactobacillus brevis CD2,
therapy was judged as excellent by all patients. whereas this reduction was not significant in the group of
patients who received placebo (Table 2).
3.2. Patients Treated with Placebo
4. Discussion
3.2.1. Local Burning. At enrolment burning was severe in 8
patients (intensity 24), moderate in 4 (intensity 8), and mild In the normal microflora of the mouth, it is possible to isolate
in 3 (intensity 3), with a total value of intensity equal to 35; several thousand microbial species. These microorganisms
at the end of therapy local burning persisted as severe in 2 create a dynamic equilibrium with the host immune system,
patients (intensity 6), moderate in 4 (intensity 8), and mild allowing for proper defence mechanisms against pathogens.
in 2 (intensity 2), with a total value of intensity equal to 16. Some of these bacteria have a rich array of enzymes which
enables them, through metabolic activities, to modify their
3.2.2. Spontaneous Pain. At enrolment pain was severe in 7 surrounding environment.
patients (intensity 21), moderate in 5 (intensity 10), and mild Some lactic acid bacteria, and in particular the Lacto-
in 3 (intensity 3), with a total value of intensity equal to bacillus brevis CD2 species, are rich in arginine deiminase
34; after treatment spontaneous pain persisted as severe in which catalyzes the irreversible conversion of arginine to
3 patients (intensity 9), moderate in 4 (intensity 8), and mild citrulline and ammonia, therefore decreasing the availability
in 1 (intensity 1), with a total value of intensity equal to 18 of arginine and consequently ornithine, the starting material
(Figure 3). of the polyamine biosynthetic pathway. Moreover, arginine
deiminase competes with nitric oxide synthase (NOS) for the
common substrate, arginine, to downregulate the produc-
3.2.3. Perilesional Erythema. at enrolment this was severe in 7 tion of nitric oxide (NO), which represents a multifunctional
patients (intensity 21), moderate in 5 (intensity 10) and mild messenger molecule, able to modulate the production of
in 3 (intensity 3), with a total value of intensity equal to 34; inflammatory cytokines, PGE2 and metalloproteinase, thus
after therapy it persisted as severe in 3 patients (intensity 9), explaining the anti-inflammatory effects of Lactobacillus
moderate in 4 (intensity 8) and mild in 1 (intensity 1), with Brevis CD2 (Figure 4).
a total value of intensity equal to 18. The main symptom of which patients complain is intense
No side effects were observed and the tolerability of pain; this is inevitably associated with considerable difficulty,
therapy was judged as excellent by all patients. and sometimes outright inability, in swallowing both solid
and liquid foods. Even speech may be impaired, especially
3.3. Development of Pain. The data provided by patients during the period of greater intensity of the stomatitis,
about the development of pain over time revealed a complete because the pain increases. It is evident that pain is the main
regression of pain in 14 of 15 patients treated with Lacto- component of the considerable discomfort these patients
bacillus brevis CD2 by the third day of treatment, while this suffer from. Such discomfort may also create significant
occurred in only 5 of 15 patients treated with placebo (P = social problems for the patient from both professional and
.001). Of the remaining ten patients treated with placebo, 2 personal standpoints. For this reason, our study focused
had complete regression of symptoms within 5 days from primarily on the rapidity of response and reduction of pain.
the start of the treatment, while pain persisted at the end of The results obtained from the study show that there is a rapid
therapy in 8 patients. disappearance of pain after just 2-3 days of treatment. Only
5. Ulcers 5
Table 2: E Summary of laboratory parameters before and after administration of Lactobacillus Brevis CD2 or placebo lozenges.
L. brevis CD2 Placebo Intergroup comparison
Nitrite/Nitrate (μM) (T0) 42.38 ± 4,58 39.76 ± 5.08 P = .14
(T1) 7.5 ± 1.5 27.5 ± 3.5 P < .01
PGE2 (ng ml−1 ) (T0) 1.89 ± 0.2 1.77 ± 0.2 P = .11
(T1) 0.40 ± 0.05 1.02 ± 0.3 P < .01
IFNγ (pg ml−1 ) (T0) 32.25 ± 4.2 30.85 ± 4.2 P = .36
(T1) 9.57 ± 1.7 21.07 ± 2.9 P < .01
T0: before treatment; T1: after treatment.
Arginine metabolism require palliative therapy for pain-like anesthetics, tissue,
caustic, and cortisone adhesives. The use of immunosuppres-
Arginine sive and anti-inflammatory drugs has demonstrated varying
degrees of success in severe cases of recurrent aphthous
Nitric-oxide synthase Arginine deiminase
stomatitis. Drugs commonly used include corticosteroids,
Arginase dapsone, colchicine, thalidomide, pentoxifylline, low-dose
interferon-α, and levamisole [8].
UREA Nitric-oxide (NO•) NH3 Because of their anti-inflammatory action, steroids are
most often used in the treatment of recurrent aphthous
+ + +
stomatitis but their long-term administration can cause
Ornithine Citrulline adverse reactions such as atrophy of the oral mucosa and
minor resistance to infections. One must always take into
consideration both the efficacy and the possible side effects of
Polyamines Inflammation a medicine when choosing therapy, bearing in mind also that
no therapy guarantees a total or long-term cure for recurrent
Figure 4 aphthous stomatitis.
The results obtained in this study demonstrate the
safety and clinical efficacy of a product which, thanks
to its unique characteristics, would seem to address fully
one patient who took the lozenge containing Lactobacillus those requirements of effectiveness, rapidity, tolerability
brevis CD2 had continuing pain after 3 days of treatment (complete absence of side effects), and convenience (oral
against 10 patients in the placebo group. administration) that could make it a valid therapeutic option
The improvement in pain levels and especially the speed in the treatment of recurrent aphthous stomatitis.
with which this improvement occurred is certainly the most
interesting aspect that has emerged from this study and is
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