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انسلاخ المبيضات اللعابي المقاس بواسطة تفاعل البوليميراز المتسلسل الكمي اللحظي كاداة تنبؤ لحصول التهاب المبيضات الفموي عند مرضى الربو المتعاطين لدواء بيكلوميتازون المستنشق == Salivary Candidal Shed Measured By Real Time Quantitative Polymerase Chain Reaction As A Predictor of Oral Candidiasis In Asthmatic Patients On Inhaled Beclomethasone Dp Therapy
Author name:
نغم قطران رحيم
Supervisor name:
رعد محي الدين حلمي
General topic:
Dentistry
Specific topic:
Oral and Maxillofacial Surgery
Degree:
Master
University:
Mustansiriyah University
Language:
English
University location:
Baghdad
First pages:
20T402 - p.pdf
Abstract:
الربو القصبي المزمن يمثل مشكله صحيه جديه في كل العالم وهو عادة يبدا في عمر الطفوله ويبقى المريض في كثير من الاحيان يتعاطى العلاجات المستنشقه مدى الحياة.انتشار الربو القصبي يزداد في كثير من دول العالم مما يجعله احد الامراض المعيقه والمهدده للحياة باعتبا | Asthma is a serious global health problem that usually starts in childhood and continues along patient’s life and most of them have to take inhaled therapy lifelong. The prevalence of asthma is rising in many countries of the world, making asthma one of the most disabling and life threatening diseases effecting patients with different age groups and social classes with variable clinical spectrums and outcomes starting from mild to severe disabling syndrome rendering nonproductive individuals to severe life threatening and sometimes fatal disease. Those patients continue inhaled steroid therapy for long duration, considered by GINA as first line treatment , however such a treatment is associated with local adverse effects on oral tissues, and one of the main concerns is the development of oral candidiasis, a chronic, potentially invasive, infection of oral tissues with fungus candida species resulting in failure of treatment. The scientific interests about such a serious complication have been raised over the past years and debates continued as the candida is considered one of the normal flora of the oral cavity in most of healthy population, however oral candidiasis in pathogenic forms still occur in immunocompromised patients including asthmatics on inhaled corticosteroid therapy.Aim of the study1. To investigate the effect of inhaled corticosteroid therapy in form of Beclomethasone Dipropionate250 microgram/dose CFC free in asthmatic patients on salivary candidal shed estimating by Real Time quantitative Polymerase Chain Reaction (RT qPCR) applied on direct unstimulated saliva samples.2. Evaluation of this shed as prediction of occurrence of oral candidiasis. Patients, Materials and MethodsThis study was conducted at Al Zahraa consultational Asthma and Allergy center - Baghdad Al Karkh Health Directorate from September 2013 to February 2014.The included patients were divided into 3 groups. Group A included asthmatic patients on inhaled Beclomethasone therapy, group B included asthmatic patients that never used any form of inhaled steroid therapy and group C was those asthmatic patients on inhaled Beclomethasone therapy who developed oral candidiasis. All patients were receiving two daily doses. The same exclusion forma was applied to choose Group D who were control healthy individuals. Each included patients and control cases were instructed to give saliva samples in the standard way and samples taken for estimation of candidal count by real time quantitative Polymerase Chain Reaction.Results During the study period, 698 patients were examined, however only 63 patients were included in the study. Those 63 were classified as follows : 28 patients were found on group, 28 were found on group B and only 7 patients were found on group C and 20 cases were selected in group D as a control.Group C patients were having the highest salivary candidal shed (mean=58.7x106 cn/ml) and longest duration of asthma (Mean=2718 days) and longest duration of Beclomethasone therapy (Mean=2224 days) and this was significantly higher than other groups (p<0.05).Group A patients were having the second highest rank after group C in regard of salivary candidal shed and both duration of asthma and Beclomethasone therapy. Inside each group, duration of asthma and duration of Beclomethasone therapy were associated with moderate positive correlation with salivary candidal shed (R>0.5).Age difference between groups were insignificant and age factor had no correlation with salivary candidal shed inside the groups.Discussion : Salivary candidal shed over the groups was directly related to the duration of inhaled Beclomethasone therapy and duration of asthma. They are significantly higher (p<0.01) as we go further from each group to the next, both appear as the reason behind increased candidal shed in groups A and C.The salivary candidal shed curve will gave us a very useful tool for follow up those patients on inhaled steroid therapy ,In addition , predict the risk of developing oral candidiasis and when to interfere prior to the establishment of Oral Candidiasis state as that we have noticed in the group C, in which it was recommended to stop inhaled steroid therapy and the patients would lose the benefits of the therapy.Conclusions1. Resting saliva samples with realtime quantitative PCR was a rapid and accurate tool in diagnosis of oral candidiasis.2. Salivary Candidal Shed could be used as a tool in predicting oral candidiasis in asthmatic patients on inhaled Beclomethasone therapy.3.Longer duration of asthma and longer duration of Beclomethasone therapy were associated with increased salivary candidal shed and established oral candidiasis have the highest amount of shed.4. Candida albicans are present in the oral cavity of any individual of our population
