IL-33/sST2 signaling pathway in pulmonary thromboembolism: A clinical observational study

BACKGROUND

Pulmonary thromboembolism (PTE) is a cardiovascular emergency that can result in mortality. In the interleukin-33 (IL-33) /soluble suppression of tumorigenicity 2 (sST2) signaling pathway, increased sST2 is a cardiovascular risk factor. This study aimed to investigate the effectiveness of biomarkers in the IL-33/sST2 signaling pathway in determining PTE diagnosis, clinical severity, and mortality.

METHOD

This study was conducted as a single-center, prospective, observational study. Patients admitted to the emergency department and diagnosed with PTE constituted the patient group (n = 112), and healthy volunteers with similar sociodemographic characteristics constituted the control group (n = 62). Biomarkers in the IL-33/sST2 signaling pathway were evaluated for diagnosis, clinical severity, and prognosis.

RESULTS

IL-33 was lower in the patient group than in the control group (275.89 versus 403.35 pg/mL), while sST2 levels were higher in the patient group than in the control group (53.16 versus 11.78 ng/mL) (p < 0.001 and p = 0.001; respectively). The AUC of IL-33 to diagnose PTE was 0.656 (95 % CI: 0.580-0.726). The optimal IL-33 cut-off point to diagnose PTE was ≤304.11 pg/mL (56.2 % sensitivity, 79 % specificity). The AUC of sST2 to diagnose PTE was 0.818 (95 % CI: 0.752-0.872). The optimal sST2 cut-off point to diagnose PTE was >14.48 ng/mL (83 % sensitivity, 71 % specificity). IL-33 levels were lower in patients with mortality (169.85 versus 332.04 pg/mL) compared to patients without mortality, whereas sST2 levels were higher in patients with mortality (118.32 versus 28.07 ng/mL) compared to patients without mortality (p > 0.001 for both). The AUC of IL-33 to predict the mortality of PTE was 0.801 (95 % CI: 0.715-0.870). The optimal IL-33 cut-off point to predict the mortality of PTE was ≤212.05 pg/mL (75 % sensitivity, 79.5 % specificity). The AUC of sST2 to predict the mortality of PTE was 0.824 (95 % CI: 0.740-0.889). The optimal sST2 cut-off point to predict the mortality of PTE was >81 ng/mL (95.8 % sensitivity, 78.4 % specificity).

CONCLUSION

In the IL-33/ST2 signaling pathway, decreased IL-33 and increased sST2 are valuable biomarkers for diagnosis and prediction of mortality in patients with PTE.

The effect of climatic and seasonal factors on the microbial keratitis profile

PURPOSE

To compare retrospective data on microbial keratitis (MK) from two different climatic regions in Turkey over 11 years.

STUDY DESIGN

Retrospective cohort.

METHODS

This retrospective cohort study included patients diagnosed with presumed MK at two referral centers. Center A was located in the subtropical region of Turkey, whereas Center B was located in a continental temperate climate zone. Clinical and laboratory data were also recorded. The results were evaluated for seasonal variations.

RESULTS

This study included data from 665 patients with presumed MK (351 and 314 patients from centers A and B, respectively). The most common predisposing factors were ocular trauma in Center A, prior ocular surgery, and systemic disease in Center B. Severe keratitis was related to prior ocular surgery, presence of systemic disease, and fungal infection at presentation. The culture positivity rate was higher in spring and lower in summer at both centers. Gram-positive bacteria were the most commonly isolated bacteria in both centers in all seasons. The fungal and mixed keratitis ratios were higher in Center A than in Center B. In Center A, filamentous fungi were common pathogens that were found year-round, and peaks were observed in July and October.

CONCLUSION

The results of this study show that climatic and seasonal factors may affect the microbial profile of keratitis. Fungal keratitis appears to be a climatic disease. Understanding the regional profile of MK can aid clinicians in their disease management.

The effect of preemptive magnesium sulfate on postoperative pain in patients undergoing mastectomy: a clinical trial

OBJECTIVE

The effects of preemptive magnesium sulfate (MgSO4) infusion on perioperative hemodynamics and postoperative analgesia in female patients who underwent mastectomy were evaluated.

PATIENTS AND METHODS

American Society of Anesthesiologists (ASA) I-II female patients aged 18 years and over who underwent mastectomy were randomized into 2 groups, including 34 individuals each. The study group (Group I) was given 50 mg/kg MgSO4 in 250 ml isotonic 30 minutes before the induction, and the control group (Group II) was given 250 ml of normal isotonic solution. Standardized anesthesia was applied. Perioperative oxygen saturation, mean arterial pressure (MAP), pulse (HR), sedation scores (ss) in the recovery unit, Verbal Numeric Rating Scale (VNRS), need for rescuer fentanyl, and analgesic needs in the surgical period were evaluated.

RESULTS

Demographic variables were similar. There was no statistical difference between the two groups in terms of the MAP, HR, and oxygen saturation values measured at entry, post-intubation, 15th, 30th, 45th, 60th minutes, and after extubation. There was a statistically significant difference between the two groups in terms of VNRS scores in the recovery unit and at the 2nd, 4th, 8th, and 12th hours during the postoperative surgical period (p=0.0001, 0.001, 0.001, 0.004, 0.021, respectively). The need for rescue analgesics in the first 2 hours of recovery was found to be lower in the study group (p=0.005). The need for postoperative analgesics in the surgical period was not statistically significant (p=0.1).

CONCLUSIONS

Preemptive use of MgSO4 reduces postoperative VNRS scores without affecting hemodynamic parameters during induction and maintenance of general anesthesia.

Effect of Nitrogen, Air, and Oxygen on the Kinetic Stability of NAD(P)H Oxidase Exposed to a Gas-Liquid Interface

Biocatalytic oxidation is an interesting prospect for the selective synthesis of active pharmaceutical intermediates. Bubbling air or oxygen is considered as an efficient method to increase the gas-liquid interface and thereby enhance oxygen transfer. However, the enzyme is deactivated in this process and needs to be further studied and understood to accelerate the implementation of oxidative biocatalysis in larger production processes. This paper reports data on the stability of NAD(P)H oxidase (NOX) when exposed to different gas-liquid interfaces introduced by N2 (0% oxygen), air (21% oxygen), and O2 (100% oxygen) in a bubble column. A pH increase was observed during gas bubbling, with the highest increase occurring under air bubbling from 6.28 to 7.40 after 60 h at a gas flow rate of 0.15 L min-1. The kinetic stability of NOX was studied under N2, air, and O2 bubbling by measuring the residual activity, the deactivation constants (kd1) were 0.2972, 0.0244, and 0.0346 with the corresponding half-lives of 2.2, 28.6, and 20.2 h, respectively. A decrease in protein concentration of the NOX solution was also observed and was attributed to likely enzyme aggregation at the gas-liquid interface. Most aggregation occurred at the air-water interface and decreased greatly from 100 to 14.16% after 60 h of bubbling air. Furthermore, the effect of the gas-liquid interface and the dissolved gas on the NOX deactivation process was also studied by bubbling N2 and O2 alternately. It was found that the N2-water interface and O2-water interface both had minor effects on the protein concentration decrease compared with the air-water interface, whilst the dissolved N2 in water caused serious deactivation of NOX. This was attributed not only to the NOX unfolding and aggregation at the interface but also to the N2 occupying the oxygen channel of the enzyme and the resultant inaccessibility of dissolved O2 to the active site of NOX. These results shed light on the enzyme deactivation process and might further inspire bioreactor operation and enzyme engineering to improve biocatalyst performance.

In Vitro efficacy of cyclosporine a and various antiseptics and antiviral drugs on adenovirus genotype 8, a common cause of epidemic keratoconjunctivitis

PURPOSE

To evaluate the in vitro efficacy of cidofovir, ganciclovir, povidone-iodine, chlorhexidine, and cyclosporine A on adenovirus genotype 8.

METHODS

Conjunctival samples were collected from patients with adenoviral conjunctivitis and cultured in A549 cells. Adenovirus diagnosis was confirmed by RT-PCR. For each drug, the 50% cytotoxic concentration (CC 50 ) was determined. Subsequently, the antiviral activity was tested at concentrations below CC 50, and the 50% inhibitor concentration (IC 50 ) of drugs was determined RESULTS: While the IC 50 of cidofovir against adenovirus genotype 8 was 3.07 ± 0.8 µM, ganciclovir, povidone-iodine, chlorhexidine, and cyclosporine A were not found to be effective against adenovirus genotype 8 at concentrations below the CC 50 value.

CONCLUSIONS

Cidofovir was found effective and the IC 50 value was within the ranges in the literature. Ganciclovir and cyclosporine A were found to be ineffective at doses below the cytotoxic dose, povidone-iodine and chlorhexidine was found to be highly cytotoxic.

The relationship between clinical findings and viral load in Adenoviral Keratoconjunctivitis

The study aimed to evaluate the relationship between clinical findings and viral load in adenoviral keratoconjunctivitis (Ad-Kc). In this cross-sectional study, 30 eyes of 30 patients with Ad-Kc were enrolled. The real-time polymerase chain reaction was performed to detect and quantify adenovirus in all samples. The patient groups were divided into three subgroups according to baseline viral loads (<10⁷, 10⁷-10⁸, >10⁸ HAdV copies/ml). The follow-up duration, HAdV DNA copy number, treatment regimen, and detailed clinical findings including uncorrected visual acuity, eyelid edema, conjunctival hyperemia, chemosis, follicular reaction, corneal involvement, conjunctival pseudomembrane, and subepithelial infiltrates (SEIs) were recorded. The study showed that a high initial viral load was associated with the development of SEIs and pseudomembrane formation (p<0.05). Clinical findings and ocular complications of Ad-Kc were found similar in treatment groups at the final visit (p>0.05). Our results showed that a high initial viral load in Ad-Kc may be predictive of inflammatory sequelae. Determination of the initial viral load in Ad-Kc may be helpful to better understand the clinical course of the disease and prevent complications.

Correction of moderate to high refractive astigmatism with extended range toric soft contact lenses in patients with different patterns of astigmatism

PURPOSE

This study aimed to evaluate the visual performance of extended range, toric soft contact lenses (TSCLs) in patients with keratoconus and moderate to high astigmatism with different astigmatic patterns.

METHODS

This was a retrospective, cross-sectional clinical study. Extended range TSCL users with astigmatism ≥3.0 D were included. Cases were categorised into three subgroups, namely regular, irregular (non-keratoconus) and keratoconic based on the topographic pattern of astigmatism. In addition, subjects were subdivided based on the degree of astigmatism.

RESULTS

Fifty five patients (82 eyes) were enrolled, of whom 28 (51%) were female. The mean age was 24.2 ± 7.5 (range: 8-41 years) years. Thirty-six eyes with regular astigmatism (43.9%), 34 eyes with irregular astigmatism (41.5%) and 12 eyes with keratoconus (14.6%) were included. The percentage improvement in visual acuity (VA) was significantly higher with contact lenses compared with spectacles in all groups (p < 0.001), with the highest improvement in subjects with keratoconus (p = 0.03). Twenty six (31.7%), 30 (36.6%) and 26 eyes (31.7%) had moderate (-3.0 to -4.24 D), moderate/high (-4.25 to -5.99 D) and high (≤-6.0 D) astigmatism, respectively. The percentage improvement in VA with contact lenses was statistically significantly higher than for spectacle wear in all groups (p < 0.001).

CONCLUSIONS

This study demonstrated that satisfactory visual outcomes can be obtained with extended range TSCLs in patients having moderate to high astigmatism with different astigmatic patterns.

The frequency of osteoporosis in patients with predialysis chronic renal failure and the factors affecting the development of osteoporosis

Background

Osteoporosis is a common public health problem in chronic kidney patients. The risk factors for osteoporosis in patients with nondialysis CKD have not been fully investigated. It is not known exactly whether the risk factors of osteoporosis in the general population are also valid for the nondialysis CKD patients. Aims: This study aims to determine the frequency of osteoporosis and the risk factors for osteoporosis in nondialysis CKD patients.

Patients and Methods

Our study was performed with 283 nondialysis stage 3-5 CKD patients. According to the BMD results, the patients were classified into groups as normal, osteopenia and osteoporosis according to World Health Organization criteria. Monocyte/high-density lipoprotein-cholesterol ratio (MHR), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) were calculated individually for all cases.

Results

According to our BMD results, 67 (24%) patients were found to have osteoporosis. In the osteoporosis patient group, compared to the normal BMD group, females were higher and the mean age was higher (P = 0.025, P = 0.028). Body mass index (BMI) and eGFR were lower in the osteoporosis group (P = 0.013). Parathyroid Hormone and Platelet-to-lymphocyte ratio in the patients in the osteoporosis group was higher than of those in the normal group (P = 0.026, P = 0.035). In the multivariate logistic regression analysis, advanced age, female gender, and low BMI were determined as independent risk factors for the development of osteoporosis in nondialysis CKD patients.

Conclusion

Advanced age, female gender and low BMI are the risk factors for osteoporosis in nondialysis CKD patients. It may be a rational approach to measure BMD for the diagnosis of osteoporosis in nondialysis CKD patients who are elderly, female and have low BMI.

Photobiocatalytic Oxyfunctionalization with High Reaction Rate using a Baeyer-Villiger Monooxygenase from Burkholderia xenovorans in Metabolically Engineered Cyanobacteria

Baeyer–Villiger monooxygenases (BVMOs) catalyze the oxidation of ketones to lactones under very mild reaction conditions. This enzymatic route is hindered by the requirement of a stoichiometric supply of auxiliary substrates for cofactor recycling and difficulties with supplying the necessary oxygen. The recombinant production of BVMO in cyanobacteria allows the substitution of auxiliary organic cosubstrates with water as an electron donor and the utilization of oxygen generated by photosynthetic water splitting. Herein, we report the identification of a BVMO from Burkholderia xenovorans (BVMO_Xeno) that exhibits higher reaction rates in comparison to currently identified BVMOs. We report a 10-fold increase in specific activity in comparison to cyclohexanone monooxygenase (CHMO_Acineto) in Synechocystis sp. PCC 6803 (25 vs 2.3 U g_DCW^–1 at an optical density of OD₇₅₀ = 10) and an initial rate of 3.7 ± 0.2 mM h^–1. While the cells containing CHMO_Acineto showed a considerable reduction of cyclohexanone to cyclohexanol, this unwanted side reaction was almost completely suppressed for BVMO_Xeno, which was attributed to the much faster lactone formation and a 10-fold lower K_M value of BVMO_Xeno toward cyclohexanone. Furthermore, the whole-cell catalyst showed outstanding stereoselectivity. These results show that, despite the self-shading of the cells, high specific activities can be obtained at elevated cell densities and even further increased through manipulation of the photosynthetic electron transport chain (PETC). The obtained rates of up to 3.7 mM h^–1 underline the usefulness of oxygenic cyanobacteria as a chassis for enzymatic oxidation reactions. The photosynthetic oxygen evolution can contribute to alleviating the highly problematic oxygen mass-transfer limitation of oxygen-dependent enzymatic processes.

Randomised controlled study of seroma rates after mastectomy with and without quilting the skin flap to pectoralis muscle

Aims

The aim of this study was to determine whether seroma formation was affected by reduction of the potential dead space with the flap fixation method and obliteration of the axillary region in patients with breast cancer who underwent either mastectomy and axillary lymph node dissection or sentinel lymph node biopsy. A total of 105 patients with breast cancer were divided into two groups according to wound closure patterns.

Patients and Methods

The operating time, postoperative pain and complications, time to drain removal, seroma formation, amount of fluid aspirated and number of aspirations were recorded prospectively.

Results

No significant difference was found between groups in the rates of seroma development (P = 0.7), complication rates (P = 0.6), time to drain removal (P = 0.5), length of hospital stay (P = 0.3) or numbers of aspiration (P = 0.7). The operating time for fixation was determined to be longer than that of the classic procedure (P = 0.02).

Conclusions

Reducing potential dead space with flap fixation and obliteration of the axillary region may be useful in decreasing the development of seroma in patients who have undergone mastectomy because of breast cancer. However, surgical technique must be careful, and appropriate patient follow-up must be conducted.

Etiological and Clinical Features in Contact Lens-Associated Microbial Keratitis

Objectives:

To determine the demographic, etiological, microbiological, and clinical characteristics and present treatment results of contact lens (CL)-associated microbial keratitis (CLAMK).

Materials and Methods:

Medical records of patients who were followed in our clinic for CLAMK between January 2014 and May 2020 were retrospectively analyzed. Demographic characteristics, symptom duration, CL and usage characteristics, risk factors, isolated microorganisms, lesion characteristics, hospital stay, recovery and follow-up times, and best corrected visual acuities (BCVA) at first and last examination were recorded.

Results:

The 22 patients (16 females, 6 males; 22 eyes) had a mean follow-up time of 13.0±18.3 months and mean age of 26.9±14.3 years. Most of the female patients (13/16) were under 35 years old. At least one risk factor associated with improper CL usage was identified in 21 patients (95.4%). The most common risk factor was sleeping with CL (n=15, 68.1%). Causative microorganisms were detected on microbiological examination in 15 cases (68.1%). The most common microorganism was Pseudomonas aeruginosa (n=8). Causative pathogens were sensitive at rates of 84.2%, 95% and 94.7% to combined vancomycin/amikacin, combined vancomycin/ceftazidime, and moxifloxacin, respectively. Mean BCVA was 0.9±1.1 logMAR in the first examination and increased to 0.59±1.1 at last examination (p=0.006). There was a negative correlation between BCVA at presentation and length of hospital stay (p=0.014).

Conclusion:

Mistakes in CL use are a frequent predisposing factor in patients with CLAMK. Informing CL users in detail about CL usage and cleaning may reduce the frequency of these mistakes and thus infections. Current antibiotic options that should be preferred in empirical treatment remain largely effective against likely pathogens. Favorable visual outcomes can be obtained in most cases with detailed diagnostic examination and appropriate treatment approaches.

The smartphone addiction, peer relationships and loneliness in adolescents

This descriptive study was carried out to examine the relationship between smartphone addiction, peer relationships, and loneliness in adolescents. The sample consisted of 500 adolescents aged between 15-18 years, who were high school students in Central Anatolia region during the 2018-2019 academic year. The data of the study was collected through a questionnaire, Smartphone Addiction Scale-Short Version (SAS-SV), Friendship Qualities Scale (FQS) and UCLA Loneliness Scale (ULS). Statistical analyses included descriptive statistics, Shapiro-Wilk, and Spearman correlation test. The SAS-SV, FQS and ULS mean scores were 27.82±11.53, 81.88±15.68, and 41.99±8.62, respectively. Results indicated there was a weak positive correlation between the companionship subscales of both FQS and ULS with SAS-SV. There was a weak negative correlation between the conflict subscales of FQS and SAS-SV. Providing a special education to adolescents and their parents to raise their awareness on the negative effects of smartphone addiction may be recommended.

Clinical and Mycological Features in Fungal Keratitis: Retrospective Single Center Study (2012-2018)

Objectives:

To present the demographic, etiological, clinical, and mycological characteristics and treatment results of fungal keratitis patients admitted to our clinic.

Materials and Methods:

The medical records of patients diagnosed with fungal keratitis between October 2012 and 2018 were reviewed. The diagnosis of fungal keratitis was confirmed mycologically and/or cytologically. Treatment response was defined as complete infiltrate resolution and re-epithelization with medical treatment and minor surgical interventions. Patients who underwent penetrating keratoplasty or evisceration due to clinical deterioration despite treatment were classified as treatment nonresponders and were compared with responders in terms of demographic, etiological, and clinical characteristics.

Results:

Seventy-two (12.8%) of 559 patients diagnosed with microbial keratitis in the 6-year period were fungal keratitis. Of these, 38 cases (38 eyes) without polymicrobial etiology were included in the study. The patients’ mean age was 44.9±19.0 years (range: 2-80) and males predominated (14 females [36.8%], 24 males [63.2%]). Trauma (63.6%) was the most common predisposing factor in patients younger than 40 years old, whereas pathologies impairing ocular surface immunity were the leading risk factor (48.1%) in patients older than 40 years. Filamentous fungi were detected in 34 (89.5%) cases, while yeasts were found in 4 (10.5%) cases. Among 26 cases with positive cultures, Aspergillus species were the most common pathogens (42.3%). Infiltrate size before treatment was larger in nonresponders (14/38, 36.8%) compared to treatment responders (19/38, 50%) (p=0.049). In addition, rates of treatment response were higher in cases in which the infiltrate was located paracentrally compared to other cases (p=0.036).

Conclusion:

Fungal keratitis is an important public health problem in our region. Ocular trauma is a leading etiology in men under the age of 40 years. In the 6-year period, we observed that the main causes of fungal keratitis were filamentous fungi, and most commonly Aspergillus species. In cases presenting with large and central lesions, aggressive treatment options should be considered and these patients should be followed up more closely.

Improved contact lens fitting after corneal cross-linking in eyes with progressive keratoconus

OBJECTIVES

The study aimed to assess the possible effects of corneal cross-linking (CXL) on contact lens (CL) fitting in patients with progressive keratoconus who initially had CL intolerance.

METHODS

A retrospective review was performed of the medical records of patients who had stopped CL wear due to discomfort prior to CXL and who were fitted with CLs after CXL. All eyes were evaluated pre- and 1, 6, 12, 24 months postoperatively. Data collected included pre- and post-CXL refraction, corneal topographic data, uncorrected visual acuity, and best-corrected visual acuity (BCVA). CL comfort was evaluatedusing theLikert scale post-CXL.

RESULTS

A total of 20 eyes from 14 patients were included in the study. Preoperative Kmax values significantly decreased by 2.8 D at 6 months and by 4.1 D at 12 months after CXL (p < 0.001 for both). CLs were prescribed on average 12 ± 2.5 months after CXL. The mean duration of successful CL wear was 10.4 ± 2.8 months during the follow-up period. Subjective CL comfort scores were satisfactory post-CXL.

CONCLUSION

CXL not only halts the progression of keratoconus but may also improve CL tolerance by providing a more regular shaped cornea in these patients. Ongoing corneal topographic changes in the late postoperative period after CXL may have a positive effect on CL fitting.

Use of new-generation hybrid contact lenses for managing challenging corneas

INTRODUCTION

To evaluate the safety and efficacy of new-generation hybrid contact lenses (HCL) among patients with irregular astigmatism.

METHODS

Medical records of 25 patients fit with new-generation HCL (Eyebrid^® and AirFlex^®) were retrospectively reviewed. The data collected included etiology of irregular astigmatism, uncorrected visual acuity, manifest refraction, spectacle-corrected visual acuity (S-CDVA), steep / flat keratometric values, corneal astigmatism, records of rigid / soft CL fitted before HCL, all parameters of the trial lenses, and the final prescribed HCL parameters and HCL-CDVA.

RESULTS

The study included 34 eyes from 25 patients (nine females and 16 males) with an average age of 29 ± 13 (ranging from 8-56) years. In total, 25 eyes with keratoconus, four with post - keratoplasty astigmatism, three with irregular astigmatism due to corneal trauma and two with residual astigmatism after radial keratotomy were fit with HCL. The mean S-CDVA (logMAR) improved significantly from 0.76 ± 0.41 to 0.14 ± 0.15 with HCL (p < 0.01). The most common indication for HCL was inability to fit with rigid gas permeable (RGP) lenses (22 eyes). The average number of lenses to successful fit was 1.4 (mode, 1; median, 1) and ideal fit was achieved with the first trial lens in 25 eyes (73%). Seven patients (nine eyes, 36%) discontinued lens use within the first 6 months because of discomfort (six eyes, 24%), ocular allergy (two eyes, 8%) and tearing of contact lens (one eye, 4%).

DISCUSSION

New-generation HCL may be a suitable option for fitting challenging corneas with irregular astigmatism that cannot be rehabilitated efficiently with rigid lenses.

The effects of morus nigra on the alveolar bone loss in experimentally-induced periodontitis

Purpose

The aim of this study is to evalute the anti-inflammatory effects of morus migra on experimentally-induced periodontitis in rats.

Materials and methods

Twenty-four Wistar-albino rats were randomly divided into three groups: control group (C, n=8), experimental periodontitis (PER, n=8), experimental periodontitis and treated with Morus nigra (MN+PER, n=8) (50 mg/kg per day for 21 days). After 21 days, the rats were sacrificed, and alveolar bones were evaluated histopathologically and histometrically analyzed to obtain level of alveolar bone loss. The detection of RANKL and OPG were immunohistochemically performed. Serum and tissue levels of MMP-8 and MMP-13 were also analyzed.

Results

Morus nigra treatment decreased tissue MMP-8 and MMP-13 levels and there were significant differences in the case of tissue levels of MMP-8 and MMP-13 between groups PER and MN+PER (p=0.035, p=0.041). There were no significant differences among all the groups serum levels of MMP-8 and MMP-13 (p=0.067, p=0.082). In the histometric evaluation, alveolar bone loss was greater in the PER group compared to C and MN groups (p=0.035). Immuno-histochemical staining of RANKL activities were found significantly lower (p=0.037) and OPG activities were found significantly higher in MN+PER group when compared to PER group (p=0.021).

Conclusion

The present study reveals that systemic administration of Morus nigra significantly inhibited the regional alveolar bone resorption and contributes to periodontal healing in the rat experimental-periodontitis models.

In Vitro Efficacy of Chlorhexidine and a riboflavin/UVA Combination on Fungal Agents of Keratitis

Purpose: Mycotic keratitis is a global ophthalmological problem because it is difficult to diagnose and treat. The aim of the current study was to evaluate the efficiency of using antifungal agents amphotericin B (AMB), voriconazole (VRC), 0.02% chlorhexidine (CHX), and a combination of riboflavin and UVA treatment against two fungal genera (Aspergillus and Fusarium) responsible for keratitis.Methods: We evaluated antifungal efficiencies of riboflavin/UVA and the antifungal drugs VRC, AMB, and CHX (alone and in combination) against fungal inocula at four concentrations. We recorded colony counts of isolates for Aspergillus terreus, A. flavus, A. fumigatus, Fusarium falciforme, F. proliferatum, and F. solani on Mueller-Hinton agar plates.Results: Fungal suspensions exposed to the following treatment combinations did not allow fungal growth: riboflavin/UVA and VRC, riboflavin/UVA and AMB, riboflavin/UVA and CHX, and CHX alone. We observed a statistically significant reduction (P < .05) in the number of colonies on agar plates when fungal suspensions were treated with riboflavin/UVA, VRC, and AMB only.Conclusions: Riboflavin/UVA treatment in combination with AMB, VRC, and CHX are capable of killing keratitis-inducing fungi (P < .05). The antiseptic CHX exerted a considerable antifungal effect on all strains we examined. Therefore, we recommend CHX as additional therapy against mycotic keratitis, particularly when keratitis is caused by multi-resistant members of Fusarium.

Effectiveness of Intraductal Meibomian Gland Probing in Addition to the Conventional Treatment in Patients with Obstructive Meibomian Gland Dysfunction

Purpose: To evaluate the effectiveness of intraductal meibomian gland probing in addition to conventional treatment for the management of obstructive meibomian gland dysfunction (O-MGD).Methods: Totally, 40 patients were divided into two groups to receive either conventional treatment alone (group 1: 40 eyes of 20 patients) or conventional treatment plus probing (group 2: 40 eyes of 20 patients). The ocular surface disease index score, Schirmer 1 test, tear film break-up time, Oxford grading of ocular surface, meibum expressibility, and quality scores were evaluated baseline and compared with the end of treatment (day 30 and day 90).Results: There was no significant difference in baseline scores between groups (All p > 0.05). All scores demonstrated significantly improvement from baseline in both group, and it was faster in group 2 (All p < 0.05).Conclusion: This study showed that intraductal meibomian gland probing seems to provide rapid symptom relief and clinical improvement for patients with O-MGD.

Mycotic Keratitis Caused by Fusarium solani sensu stricto (FSSC5): A Case Series

Owing to a lack of appropriate diagnostic and therapeutic approaches for mycotic keratitis, approximately one million cases of preventable corneal blindness are reported each year. The number of keratitis cases due to infection with Fusarium is increasing significantly worldwide, many of which are not treated adequately and in a timely manner due to frequent misdiagnosis. In the current report, we describe three cases of keratitis caused by Fusarium solani sensu stricto (FSSC5) from Turkey and The Netherlands, following ocular trauma. The etiological agent of keratitis, FSSC5, identified by sequencing of the partial tef1-α gene, exhibited low minimum inhibitory concentrations (MICs) of 1 µg/mL for amphotericin B and high MICs above the published epidemiological cutoff values for voriconazole (8 µg/mL). Patients were successfully treated with topical amphotericin B and voriconazole with complete recovery.

Corneal Collagen Cross-Linking for the Management of Mycotic Keratitis

PURPOSE

To evaluate the efficiency of corneal collagen cross-linking (CXL) in addition to topical voriconazole in cases with mycotic keratitis.

DESIGN

Retrospective case series in a tertiary university hospital.

PARTICIPANTS

CXL was performed on 13 patients with mycotic keratitis who presented poor or no response to topical voriconazole treatment.

METHODS

The clinical features, symptoms, treatment results and complications were recorded retrospectively. The corneal infection was graded according to the depth of infection into the stroma (from grade 1 to grade 3). The visual analogue scale was used to calculate the pain score before and 2 days after surgery.

MAIN OUTCOME MEASURES

Grade of the corneal infection.

RESULTS

Mean age of 13 patients (6 female and 7 male) was 42.4 ± 17.7 years (20-74 years). Fungus was demonstrated in culture (eight patients) or cytological examination (five patients). Seven of the 13 patients (54%) were healed with topical voriconazole and CXL adjuvant treatment in 26 ± 10 days (15-40 days). The remaining six patients did not respond to CXL treatment; they initially presented with higher grade ulcers. Pre- and post-operative pain score values were 8 ± 0.8 and 3.5 ± 1, respectively (p < 0.05).

CONCLUSIONS

The current study suggests that adjunctive CXL treatment is effective in patients with small and superficial mycotic ulcers. These observations require further research by large randomized clinical trials.

Outcome of ICSI with motile testicular spermatozoa obtained through microscopically assisted testicular sperm extraction in relation to the ovarian response

INTRODUCTION

To determine the relationship between AFC, basal FSH level, woman's age, the number of oocytes retrieved and the outcome of ICSI with testicular spermatozoa obtained with microscopically assisted testicular sperm extraction.

MATERIAL AND METHODS

In this retrospective cohort study, a total of 340 couples who underwent ICSI treatment with testicular sperm were enrolled. Women aged?40years and the first cycles of couples were included. ICSI was performed with motile testicular spermatozoa obtained from 89 men with obstructive azoospermia and 251 men with nonobstructive azoospermia. GnRH-antagonist protocol was used for ovulation induction. Simple linear regression was carried out to analyze relationship between the AFC, basal FSH, woman's age, the number of oocytes, and the live birth rate (LBR). Receiver operator characteristic curves (ROC) were formed to detect cut-off values below which LBR was significantly decreased. ROC curve analysis demonstrated that the cut-off level of the number of oocytes retrieved to predict the LBR was 7. According to this cut-off level, all patients were divided into two groups. Women with retrieved<7 oocytes were included in Group 1 and women with retrieved?7 oocytes were included in Group 2.

RESULTS

The mean age of men was 35.1±4.9years. The mean age, mean FSH level and mean AFC of women were 32.1±4.9years, 6.9±2.7 IU/L, 7.6±3.4, respectively. Significant correlations were found between AFC, the number of oocytes retrieved, and the LBR per ICSI cycle with testicular spermatozoa. The LBR was significantly lower in women with AFC<8 than those with AFC?8. Independently, the LBR was significantly lower in cycles with<7 oocytes retrieved compared to those with ?7. Embryo transfer was not achieved in 37 cycles with<7 oocytes (37/167, 22.1%) and 18 cycles with?7 (18/173, 10.4%) because of the absence of transfer-quality embryos (P=0.005). The LBRs were the lowest in cycles with one or two oocytes available (8.3 and 8.3%, respectively), but these rates were not statistically different than those in cycles with 3, 4, 5 and 6 oocytes (14.2, 17.2, 18.5, 17.6%, respectively, P=0.810).

CONCLUSIONS

AFC and the number of oocytes retrieved are important prognostic factors in an ICSI cycle with testicular sperm in women ?40years, yielding significantly diminished LBRs with<8 antral follicles and/or<7 oocytes retrieved.

Management of upper and lower molars that are displaced into the neighbouring spaces

Our aim was to describe our experience of retrieval of accidental displacements of upper and lower molars into neighbouring anatomical spaces. Thirteen patients were evaluated retrospectively in terms of age, sex, affected side, jaw (mandible or maxilla), surgeon's experience, whether the extracted teeth had erupted, which portion of the tooth or teeth was displaced, the anatomical space into which the fragment was displaced, postoperative complaints, timing of the retrieval, type of anaesthesia, and surgical approach. There were no significant differences in sex, affected side, which part of the tooth was displaced, whether the extracted teeth had erupted, type of anaesthesia, or timing of retrieval. We conclude that this condition should be treated, although follow-up alone may be an option. The intraoral lingual pouch approach for complications of mandibular third molars and the intraoral Caldwell-Luc operation for those in the maxilla could be successful options for retrieval.