Search JRPMS

JRPMS 2022

Review Article JRPMS, Vol 6, No 1, March 2022, p.1-8
The role of stem cells in oral bone regeneration
Garyfallia Kremmyda
Keywords: Bone defects, Bone regeneration, Stem cells
Oral bone regeneration has revolutionized implant dentistry by enhancing both the quantity and quality of the available bone, ultimately leading to improved treatment outcomes. In recent years, the use of stem cells for regenerative purposes has shown promising results. The aim of this study was to review the current literature concerning the clinical applications of Mesenchymal Stem Cells (MSCs) and/or Adipose Stem Cells (ASCs), for the treatment of oral osseous defects. An electronic search of Ovid Medline database was conducted. All types of human studies that applied MSCs and/or ASCs for implant site development were included. Pre-clinical and in vitro studies were excluded. Out of the initial 282 identified records, 22 were considered for inclusion. Even though most reports showed some benefit after the use of MSCs/ASCs, the review indicated that there is lack of consensus, regarding the methodology and the outcomes assessment. The clinical significance and the feasibility should be further studied with standardized techniques.
Review Article JRPMS, Vol 6, No 1, March 2022, p.9-13
Dentinogenesis imperfecta: An update
Efthimia Tsoukala, Georgia Chochtoula, Iosifina Theodorou, George I. Lambrou
Keywords: Amelogenesis, Dentin, Dentinogenesis, Metabolic disease, Osteogenesis
The term Dentinogenesis Imperfecta refers to diseases that affect the dental tissue, consisting of enamel or dentin. The disease leads to insufficient quantitative or qualitative enamel and dentin tissue formation, leading to Amelogenesis Imperfecta or Dentinogenesis Imperfecta, respectively. These diseases have a similar clinical appearance and their differential diagnosis requires good knowledge of their characteristics. They are hereditary, have a great diversity in clinical, radiological and histological appearance and require a long-term and combined treatment plan. Finally, they are often found as part of syndromes and in-depth understanding of their characteristics can help in the early diagnosis of these congenital disorders. A very common metabolic disease, in which incomplete dentinogenesis is found as a subsequent finding in more than 50% of patients, is Osteogenesis Imperfecta. In the present work, we have attempted, to review the latest data on Dentinogenesis Imperfecta, thus enabling a specialist clinician to more easily diagnose and treat these patients.
Case Report JRPMS, Vol 6, No 1, March 2022, p.14-19
Primary Multi Drug Resistant Tuberculosis (MDR TB) Osteomyelitis in Sternum associated with Xeroderma Pigmentosa: A Case Report
Arvind Vatkar, Sachin Y. Kale, Shivam Mehra, Pramod Bhor, Aditya Gunjotikar, Nikhil R. Isaacs
Keywords: Immunodeficiency, Multidrug resistant Tuberculosis, Pectoral muscle cold abscess, Xeroderma Pigmentosa
Xeroderma Pigmentosa (XP) is an autosomal recessive genetic disorder which causes defective gene repair. This makes XP patients cancer-prone and immunodeficient. A 10-year-old male child with XP was infected with MDR Tubercular Osteomyelitis of sternum. He had constitutional symptoms of TB like weight loss and loss of appetite. He had also developed an abscess in his right pectoral muscles. MRI was done to find out exact location and spread of infection. The abscess was aspirated by Z technique and sent for a Gene Xpert test. Patient was started on second line of anti-tubercular therapy. MDR TB is a growing challenge to treat with anti-tubercular therapy. The link of genetic disorders like XP and infections like TB (which increase in immuno-deficient subjects) needs to be studied further.
Review Article JRPMS, Vol 6, No 1, March 2022, p.20-26
Impact of diabetes mellitus on maxillofacial complex and orthodontic treatment
Maria Bampiolaki, Christos Zafeiris, Aliki Rontogianni, Apostolos I. Tsolakis
Keywords: Bone alterations, Diabetes mellitus, Orthodontic treatment, Temporomandibular joint
Diabetes mellitus is one of the most common metabolic disorders, diagnosed in 3% to 4% of the population. Its main characteristic is hyperglycemia caused by the body’s impaired insulin management. Two major types of diabetes mellitus exist. Type 1 is a complete lack of insulin secretion. Type 2 combines impedance to insulin action and inadequate compensatory insulin secretion. Although, most of the orthodontic patients under orthodontic treatment are young persons in good health condition, lately there has been a great rise in the number of adults seeking orthodontic treatment. Many adults suffer from systematic diseases, including diabetes mellitus. There are various oral manifestations of the disease and they are mainly detected to patients with either poorly controlled or completely uncontrolled diabetes. Moreover, diabetes mellitus seems to affect temporomandibular joint function and may cause bone alterations. Diabetes mellitus is a metabolic disorder which every single dentist encounters, hence it is essential, that he is able to recognize its signs, symptoms, diagnostic and therapeutic aspects and face the emergencies when they arise. The aim of this article is to present the way in which diabetes mellitus affects patient’s orthodontic treatment.
Mini Review JRPMS, Vol 6, No 1, March 2022, p.27-30
Sarcopenic obesity
Magdalini A. Nikolaou, Dimitris A. Nikolaou
Keywords: Multifactorial disease, Obesity, Sarcopenia
Sarcopenic obesity is considered to be the unique co-existence of two distinctive pathologies: those of sarcopenia and obesity, which affects primarily older adults. Its manifestation is not afflicted by the individual’s age, sex or body weight. There is a number of different diagnostic methods, and that goes for the therapeutic approach as well. Nutrition could be one of the key-factors of tackling sarcopenic obesity, being supported by proper physical exercise. This short review aims at providing current definitions and diagnostic as well as therapeutic interventions.
Review Article JRPMS, Vol 6, No 2, June 2022, p.31-36
Current treatment of infected arthroplasties
Elisavet Mantzila, Efstathios Chronopoulos
Keywords: Arthroplasties, Infection, Joint, Prosthetic, Treatment
Total hip and knee arthroplasties are among the most popular and common orthopaedic surgical interventions. Despite the very high success rate of those operations and the ongoing technical improvements, they still carry the risk of various complications, with the deep infections being among the most serious ones. The periprosthetic joint infection is defined as the presence of bacteria in the joint space of the artificial joint and the surrounding tissues, which is significantly associated with laboratory and histological findings and clinical signs of inflammation. Those infections, according to the time of their occurrence are characterized as acute -early postoperative, delayed and chronic. The most common microorganisms responsible for their cause are the coagulase-negative Staphyloccocal species and Staphylococcus aureus. Treatment of those infections involves a variety of combinations of procedures, both conservative and operative; the best treatment is the one which combines the elimination of the infection with the least possible complications for the patient. Debridement with retention of the prosthesis, one stage arthroplasty exchange and two stage arthoplasty exchange are the most commonly accepted surgical procedures for the treatment of this complication, whereas arthroplasty resection without reimplantation and arthrodesis are salvage procedures in order to avoid the unfortunate, but at least very rare solution of the amputation of the limb.
Mini Review JRPMS, Vol 6, No 2, June 2022, p.37-41
RANK, RANK-L and OPG system as a prognostic and severity indicator for metastatic bone disease
Anna-Louiza Chaliasou, Christos Zafeiris
Keywords: Biomarker, Metastatic bone disease, RANK/RANK-L/OPG system
Bones represent the third most common location of metastatic tumors in patients with generalized malignancy. A percentage of 83% of the patients with bone metastases will experience pain due to them and many of them will not receive adequate therapy, which will result in a decrease in their life quality. The system that is composed by the receptor activator of nuclear factor (NF)-kΒ-ligand (RANK-L), the receptor activator of nuclear factor kB (RANK) and the receptor osteoprotegerin (OPG) play a key role in the migration and growth of neoplastic cells, especially in metastatic bone disease. The aim of this review is to process the contemporary knowledge of the role of the RANK/ RANK-L/OPG system in carcinogenesis and to evaluate the potential use of the system or parts of it as biomarkers and indicators of the severity and the prognosis of metastatic bone disease. Finally, a suggestion is made for further investigation between the association of serum RANK, RANK-L and OPG levels and the severity of pain patients with metastatic bone disease endure.
Mini Review JRPMS, Vol 6, No 2, June 2022, p.42-47
The role of long non-coding RNAs in bone diseases
Cristina Elena Atudorei, Eleana Fitsi, Stavroula Rizou
Keywords: Bone, Long Noncoding RNAs, Osteoporosis, Osteoarthritis, Rheumatoid arthritis
Long non-coding RNAs (lncRNAs) have gained great attention in recent years as critical players in bone biology and bone diseases. A growing number of studies have demonstrated that lncRNAs are involved in osteogenic differentiation and thus serve a pivotal role in the process of occurrence and progression of bone-related diseases. Dysregulation of their expression seem to be implicated in skeletal tissue abnormalities, This article reviews the importance of lncRNAs in the cellular and molecular mechanisms of bone development, their regulatory role in tissue differentiation and in bone cells and we will highlight potential biomarkers and therapeutic targets for the treatment of bone diseases.
Review Article JRPMS, Vol 6, No 2, June 2022, p.48-54
Association of the B-complex vitamins with osteoporosis and osteoporotic fractures
Elpida D. Sachinidi
Keywords: Fractures, MTHFR, Osteoporosis, RANK, Vitamin B
Osteoporosis is a bone metabolic disease associated with low bone mass and deterioration of bone microarchitecture, thus increasing the risk for potential fractures. There is emerging evidence supporting the role of vitamin B in bone health and the prevention of fractures. In this review we evaluated both observational studies and studies assessing the genetic association of the group of B vitamins with the risk for osteoporosis and osteoporotic fractures. We retrieved 25 relevant studies and according to the results, future research is necessary to determine if dietary intake and supplementation of vitamin b may have a potential influence on osteoporosis and osteoporotic fractures.
Review Article JRPMS, Vol 6, No 2, June 2022, p.55-64
Communication of patients and healthcare personnel during the diagnostic radiological process
Kalliopi Alamanioti, George I. Lambrou
Keywords: Communication, Nursing staff, Physician, Patient, Radiology
Communication can be defined as an exchange of information between a sender and a receiver. Communication in medicine fosters the development of a therapeutic relationship. Communication between medical or nursing staff and patients during the process of a radiological diagnostic investigation constitutes a challenge, as the main objective of the procedure is the production of medical images. Communication between patients, doctors and nurses over the course of a radiological procedure can be divided into what takes place before, during, and after the imaging procedure. Communication before the procedure allows the involved parts, to meet, to start the therapeutic relationship, to explain the planned radiological investigation and set the groundwork for safety in the imaging procedure. During the procedure, the supportive role of the healthcare professionals is critical for succeeding in the production of clinically useful images, and to ensure the patient tolerates the investigation. After the procedure, communication aims at relaying the result, as well as supporting and guiding patients accordingly. The development of communication skills by the healthcare professionals is paramount for effective contact with patients in all three phases of the radiological diagnostic process, and should be the result of formal education. Optimal communication practices result in higher patient satisfaction levels, while every healthcare provider should factor-in the cost of achieving quality in communication.
Original Article JRPMS, Vol 6, No 3, September 2022, p.65-71
Is prehabilitation a void in management of anterior cruciate ligament injuries? A Prospective study
Harsh Kotecha, Shahish Surme, Alfven Vieira, Ameya Velankar, Laksh Agrawal, Dhruv Shah, Jaimini Chaudhari
Keywords: Anterior Cruciate Ligament Reconstruction, Knee Arthroscopy, Pre-operative Care, Pre-operative Rehabilitation
Objective: The objective of this paper is to study the effects of 12 weeks of pre surgery physiotherapy rehabilitation protocol on the outcome of arthroscopic Anterior cruciate ligament reconstruction surgery. Methods: A prospective randomised clinical study was conducted to compare the functional outcome after ACL reconstruction surgery in patients who had received 12 weeks of pre surgery physiotherapy against those who had not received the same, based on clinical outcome, Tegner Lysholm and International Knee Documentation Committee Subjective Knee Form (IKDC) Score. Results: Out of 30 participants 15 participants who received pre-rehabilitation showed better functional score in terms of Tegner Lysholm score and IKDC score following ACL reconstruction surgery compared to group 2 which is non- pre-rehabilitation group. There was a statistically significant relation between Pre-rehabilitation and better functional scores. Conclusion: A prehabilitation programme emphasizing on intensive muscle strength training, plyometric exercises and advanced neuromuscular exercises gives better outcome than no prehabilitation and should be included in standard ACL treatment protocol for patients undergoing ACLR.
Original Article JRPMS, Vol 6, No 3, September 2022, p.72-82
Diagnostic accuracy of ultrasound in rotator cuff and associated non-rotator cuff pathologies of shoulder joint compared to magnetic resonance imaging
Abhinav Gupta, Soumya Ranjan Nayak, Pravakar Bahinipati
Keywords: Imaging studies, Polytendon abnormalities, Rotator cuff tears, Shoulder MRI, Shoulder ultrasound
Objectives: The present study was carried out to evaluate diagnostic accuracy of ultrasound (US) in delineating various rotator cuff and associated non rotator cuff pathologies (RCPs) of shoulder joint compared to Magnetic Resonance Imaging (MRI). Methods: Fifty consecutive symptomatic subjects in age-group 18-75 years (mean ±SD: 56.0±13.6 years; 39-male, 11-female) were evaluated. US performer and MRI reporting radiologists were blinded to results of each-other. The sensitivity, specificity, and accuracy of US was measured for diagnosing various musculo-tendinous pathologies of shoulder against MRI gold standard. Results: MRI detected RCPs in all subjects while US was abnormal in 46(92%) cases. Supraspinatus was the most frequently affected tendon. Remarkably, 28% patient had polytendon abnormalities. US showed sensitivity of 84% and specificity of 87.5% for tendinosis; sensitivity of 78.1% and specificity of 94.4% for partial thickness tear (PTT) and 100% sensitivity and specificity for diagnosing full thickness tear. However, sensitivity of US for diagnosing PTT of infraspinatus tendon, subscapularis tendinosis and teres-minor atrophy was low. US had high specificity for diagnosing non-RCPs but sensitivity was low. Conclusions: A normal shoulder US may not rule out with certainty some rotator cuff and associated non-rotator cuff abnormalities. It is suggested to search for polytendon abnormalities which may be missed.
Review Article JRPMS, Vol 6, No 3, September 2022, p.83-87
Evaluation and appraisal of osteopenia on jaws: An update
Iosifina Theodorou, Efthymia Tsoukala, Georgia Chochtoula, George I. Lambrou
Keywords: Dental panoramic x-ray, OSTEODENT, Osteopenia, Osteoporosis
The aim of the present work is to review data of the OSTEODENT project, whose purpose was to compare dental X-rays with DXA results in order to determine the possibility of diagnosing osteopenia and osteoporosis, in advance. OSTEODENT project provided us with up-to-date data which are presented directly and briefly in this paper in order to compare techniques and methodologies that have been used by each research group. Researchers examined pre - existing dental panoramic and periapical X-rays on subjects of specific criteria, primarily women 45-70 of age. Measurements of bone density were calculated on these X-rays using pre-existing classifications, consequently they were compared to accurate bone density measurements according to DXA. Comparing the results, researchers were able to determine the accuracy, in question, of the methods used. These data have been processed by four university institutes in Europe, using pre-existing classifications, yet the aforementioned project provided the background for new merged clinical classifications as well as new documentation systems. All studies agree towards the direction that there is a larger need for further research on craniofacial imaging and metabolic bone diseases.
Review Article JRPMS, Vol 6, No 3, September 2022, p.88-92
The effect of exercise on cardiovascular function of patients with chronic kidney disease
Konstantina Kanellopoulou
Keywords: Aerobic exercise, Cardiovascular disease, Cardiovascular function, Chronic kidney disease, Renal disease
Chronic kidney disease is a growing syndrome of high prevalence, characterized by alterations in water, mineral and acid-base balance. It is strongly associated with other comorbidities, one of which being cardiovascular disease which not only is a causative factor but most importantly the result of the progression of renal disease. Sedentary life, dysregulation of blood pressure and lipid metabolism, inflammation, oxidative stress and endothelial dysfunction are considered to be the principal factors leading to cardiovascular deterioration in these patients. Aerobic exercise is a main therapeutic strategy targeting better cardiovascular outcomes in the general population with proven benefits on physical fitness status, visceral fat reduction and blood pressure control. In our review, we assessed the effects of aerobic exercise on cardiovascular function of renal disease patients and confirmed its beneficial effects on traditional risk factors of cardiovascular disease such as physical fitness status, body mass index and visceral fat reduction. However, no significant alterations in non-traditional aspects of cardiovascular disease such as inflammation, vascular function, and lipid metabolism were found because chronic kidney disease patients are rarely encouraged to exercise and there is a lack in adequate evidence from big trials to clarify the potency of aerobic exercise on these factors.
Mini Review JRPMS, Vol 6, No 3, September 2022, p.93-97
Biological action of calcium phosphate grafts on the spine
Aristeidis Papadogoulas, Panagiotis Lepetsos, Christos P. Zafeiris
Keywords: Calcium phosphate, Grafts, Hydroxyapatite, Spinal fusion, Spine
Despite the evolution in the field of grafting alternatives for spinal surgery, autologous iliac crest bone graft remains the gold standard for spinal fusion. However, donor site morbidity and limited availability stress the need for reliable substitutes. Calcium phosphate grafts, such as hydroxyapatite (HA) and tricalcium phosphate β (TCP-β), are a promising group of bone grafts in spinal surgery. The advantages of these grafts in spinal surgery are large availability, relatively rigid structure, low immunogenicity and high biocompatibility. However, they contain no living cells, no growth factors, no organic matrix and they are characterized by limited cortical stability and lack of osteogenic properties. Most studies have noticed that calcium phosphate grafts are efficient alternatives of autografts with similar fusion rates and functional outcome, in spinal fusion surgery. However, most of these studies are of low quality, lacking proper control groups. More prospective, randomized trials are needed in order to fully elucidate the optimal use of calcium phosphate grafts in spinal surgery
Review Article JRPMS, Vol 6, No 4, December 2022, p.98-105
The assessment of sarcopenia using magnetic resonance imaging
Konstantina Bisyri, George I. Lambrou
Keywords: Fat, Magnetic Resonance Imaging, Muscle, Proton density fat fraction, Sarcopenia
Sarcopenia is a quantitative and qualitative muscle disorder with multifactorial pathogenesis intertwining with aging. The negative consequences on everyday life and functional ability are significant and have as final result the reduction of overall survival. Various and advanced magnetic resonance imaging techniques make prompt detection and disease characterization feasible, thus contribute to the modification of coexistent diseases prognosis.
Review Article JRPMS, Vol 6, No 4, December 2022, p.106-110
Sarcopenia in CKD: The effect of CKD on muscle mass
Michaela Louka
Keywords: Chronic kidney disease, Muscle mass, Muscle strength, Sarcopenia
Chronic kidney disease (CKD) is associated with skeletal muscle wasting due to imbalance between muscle protein synthesis and catabolism. Physiologic dysfunction and structure abnormalities of muscle such as atrophy reduce strength or reduce endurance leading to decline in physical activity, increased burden of falls, fractures, immobility and loss of functional independence termed as “sarcopenia” and is associated with increased risk of morbidity and mortality. Several mechanism could cause loss of muscle in patients with CKD such as inflammation, metabolic acidosis, malnutrition, defective insulin signaling, activation of the ubiquitin-proteasome system (UPS), vitamin D deficiency and physical inactivity. In this review, we describe the clinical relevance of sarcopenia in CKD how CKD influences muscle metabolism and the clinical implication of sarkopenia in patients with CKD.
Review Article JRPMS, Vol 6, No 4, December 2022, p.111-114
Dynamic stabilization of the spine in osteoporotic patients
Evangelos Triantafyllou, Dimitrios Artsitas, Konstantinos Karagiannis, Christos P. Zafeiris
Keywords: Dynamic stabilization, Osteoporotic spine, Spine fusion
Dynamic stabilization is an alternative fusion technique that aims to eliminate or at least minimize the possibility of degeneration of adjacent levels. The object of dynamic stabilization systems is to allow limited movement of the spine while maintaining stability. Based on experimental and clinical data, osteoporosis is a contraindication for the application of dynamic spinal fusion systems, due to the fact that the reduced bone density disrupts the osteointegration of the pedicle screws, resulting in an increased chance of loosening, which compromise the success of the operation. For this reason, most clinical trials analyse the effects of dynamic spinal fusion include osteoporosis in the exclusion criteria.
Mini Review JRPMS, Vol 6, No 4, December 2022, p.115-120
Segmental fractures of the long bones and healing problems
Georgios Giovanidis, Paraskevas-Asimakis Velitsikakis
Keywords: Long bones, Malunion, Non-union, Segmental fractures
Healing problems of segmental fractures of long bones are some of the most common complications. The purpose of this study is to review the incidence and pathogenesis of healing problems of segmental fractures of long bones. This is a simple literature review using the Pubmed database. Papers were searched with the use of the following keywords: (“segmental fractures”) AND (“femur” OR “femoral” OR “tibia” OR “tibial” OR “humerus” OR “humeral” OR “forearm” OR “radius” OR “ulna). Moreover, the reference lists of the included papers were scanned for additional studies. Prospective or retrospective evaluating union rate and healing problems after the management of segmental fractures in long bones (femur, tibia, humerus, forearm) were included in this review. The search retrieved a total of 118 papers. After application of exclusion criteria, 30 studies were left in the present review. Successful healing of segmental fractures of long bones depends on the initial condition of the fracture, and surrounding soft tissues, since these high energy injuries may compromise the bone fragments blood supply. The rate of non-union is higher in open and severely comminuted fractures. Intramedullary nailing of segmental fractures of long bones seems to be the surgical option with the least healing problems.
Review Article JRPMS, Vol 6, No 4, December 2022, p.121-127
Trabecular bone score for the evaluation of fracture risk: A literature review
Eleftherios-Theodoros Kaloudis
Keywords: Bone Mineral Density, Bone Strength, Fracture risk, Osteoporosis, Trabecular Bone Score
Osteoporosis is a chronic disease which constitutes a major social and economic problem, increasing the burden of health’s cost worldwide. Despite the fact that the diagnosis of osteoporosis relies on Dual energy X-ray absorptiometry (DXA), important parameters of bone strength include microarchitecture of the trabecular and cortical bone. Trabecular bone score (TBS), is a novel DXA-based technique that incorporates microarchitecture in the fracture risk assessment. In our review, we assessed the current bibliography and found numerous published articles stressing the validity of this technique for the estimation of fracture risk. As shown, TBS can be used to evaluate the risk of osteoporotic fracture in postmenopausal women and men over 50 years of age, with data for men being less extensive, as well as for the management of patients with a wide range of secondary causes of osteoporosis, including diabetes mellitus, rheumatoid arthritis, use of glucocorticoids for a long period etc.