|a) BRIEF RESUME OF THE INTENDED WORK
Need for the Study
Acute myocardial infarction(AMI) is the leading cause of death for both men and women worldwide. One of the most important etiological factor being high blood levels of certain lipids such as triglycerides(TGL) & low density lipoproteins(LDL-C).
Saliva is increasingly used and well validated in diagnosing, monitoring systemic disease status & predicting disease progression.1A comprehensive review of saliva as a diagnostic fluid was published for the first time in 2001.1Bio-markers detected in saliva can be valuable in a wide range of clinical pathology, forensic medicine & sport medicine.
Salivary assays present lot of advantages when compared to blood assays, such as:
a) The sampling is very easy to do especially in a non- medical environment.
b) Multiple samples can be collected with ease providing more information than that of a single blood sample.
c) Saliva requires no special collection or storage equipment.
d) Can be used to detect markers of some systemic diseases in a non-invasive manner.
REVIEW OF LITERATURE
A study found that serum and salivary malondialdehyde, uric acid, salivary glutathione, carbonic anhydrase levels can be used as potential markers for monitoring patients with hypertension, diabetes mellitus and in patients with angina or ischemic heart diseases.2
Investigators found that lipid fractions particularly triglycerides can be assessed in saliva and may be used in combination with other lipid parameters for monitoring patients at increased risk of ischemic stroke.3
Study has found that the assessment of salivary and serum oxidative stress was a useful adjunct along with lipid profiles in prediction of ischemic stroke among Iraqi samples. 4
Another study found that whole salivary samples collected at home by the subject on a daily basis provide a non-invasive, feasible method for determining ovulation by using total cholesterol, phospholipids and high density lipoproteins as bio-markers.5
Evaluators also concluded that assessment of salivary lipid peroxidation (indicated by malondialdehyde) together with salivary lipid profile may be useful in early detection and monitoring of patients with increased risk of stroke.6
AIM AND OBJECTIVES OF THE STUDY.
To determine salivary total cholesterol, triglycerides and low density lipoproteins in a control group; group at risk and in patients with AMI.
To determine serum total cholesterol, triglycerides and low density lipoproteins in a control group; group at risk and in patients with AMI.
To evaluate the reliability of using these values as potential markers to predict or monitor patients at risk of AMI.
b) MATERIALS & METHODS
Source of Data
Patients will be selected from the out-patient department & in patient wards of Jayadeva Institute of Cardiovascular Sciences & Research and from the Department of Oral Medicine, Dayananda Sagar College of Dental Sciences.
Method of Collection of Data:
Sample size: 45
Sampling method: Random sampling
Study Design: Comparative study
3 groups of 15 each will be taken:-
Group 1: control group with no known cardiovascular disease.
Group 2: patients at a risk of having AMI.
Group 3: patients having a known history of AMI.
12 hr fasting blood samples will be collected by venepuncture from the ante-cubetal fossa and will be centrifuged. The supernatant serum will be aspirated and analysed.
Simultaneously, whole saliva samples will be collected by passive drool for 5 mins into a test tube and will be stored at -5 degree celsius and later on will be centrifuged.
Informed consent will be taken from each patient prior to the procedure.
TC/TG/LDL-C parameters will be analysed from serum samples by direct enzymatic clearance method. Similarly, the same parameters will also be analysed from centrifuged saliva samples by separate TC/TG/LDL-C kits of RANDOX company.
The observations will be tabulated, co-relation will be established by employing ANOVA and corelation statistical analysis.
Patients within the age group 35-65 yrs will be considered for this study.
Subjects with no known history of systemic diseases and apparently healthy individuals will be selected for group 1.
Subjects at an increased risk of developing AMI will be selected for group 2.
Subjects with a known history of AMI and on medication will be selected for group 3.
Patients with conditions that affect the lipid profile such as hypothyroidism, liver or kidney diseases, Cushing’s syndrome, obesity (BMI>30), a history of familial dyslipidemia and advanced periodontitis.
Patients receiving drugs such as oral contraceptives, estrogen, progestin, thyroxin and vitamin E.
Pregnant women and women in their active menstrual cycles.
Does the study require any investigation or intervention to be conducted on the patients or other animals?
Yes, blood investigations ( TC, TGL, LDL-C )
Has ethical clearance been obtained from your institution?
Yes. Ethical approval has been sought and obtained for the study from the institution.
C) LIST OF REFERENCES
Tabak LA: A revolution in biomedical assessment- the development of salivary diagnostics. Journal of Dental Education. 2001;65:30-40
Ozturk LK, Furuncuoglu H, Atala MH, Ulukoylu O, Akyuz S & Yarat A :Association between dental-oral health in young adults and salivary glutathione, lipid peroxidation and sialic acid levels and carbonic anhydrase activity. Brazilian Journal of Medical and Biological Research. 2008;41:956-959
Rawi NH & Atiyah KM: Assessment of Salivary lipid profiles in patients with ischemic stroke and patients at risk of having stroke among Iraqi sample. The Internet Journal of Third World Medicine. 2008;7:814-820
Al-Rawi NH, Jaber FH & Atiyah KM: Assessment of salivary and serum oxidative stress and antioxidants as plausible parameters in prediction of ischemic stroke among Iraqi samples. The Internet Journal of Third World Medicine. 2009;7:614-620
Alagendran , Archunan S, Neelamathi G, Anusha E, Miller R & Puspha N: Lipid fluctuations in women saliva during menstrual cycle. Journal of Cell and Tissue Research . 2009;9:1915-1919
Al-Rawi NH: Salivary lipid peroxidation and lipid profile levels in patients with recent ischemic stroke. Journal of International Dental & Medical Research. 2010;3:57-64