Clinical and morphological evaluation of permanent first molars in Turkey

Aim

The aim of this study was to investigate the pit and fissure morphology of the permanent first molars (PFMs) in the dentition of 7- to 12-year-old patients in Turkish children.

Patients and Methods

The study was conducted on 706 patients who attended the Dokuz Eylul University Child Clinic. Examinations of the patients were carried out with dental unit light, mouth mirror, and probe by two dentists. Age, gender, plaque scores, pit and fissure morphology, caries, restorations, and missing teeth were recorded.

Results

Of the 706 patients included in this study, 441 (62.5%) of them have affected PFMs. Intermediate type fissure morphology (57.5%) was seen as the most common type. A positive correlation was observed between the age and the caries experience (p = 0.000). Patients with deep pits and fissure morphology have more caries affected teeth than patients with shallow pit and fissure morphology, and the difference was statistically significant (p = 0.000). Patients with deep pits and fissure morphology have significantly more plaque accumulation on PFMs compared to the patients with shallow and intermediate fissure morphology (p = 0.000).

Conclusions

Despite the limitations of the study, we can conclude that the patients with deep pit-fissure morphology are more susceptible to caries development and plaque accumulation than the patients with shallow and intermediate type pit and fissure morphology.

Prevalence and Associates of Frailty Status in Different Stages of Chronic Kidney Disease: A Cross-Sectional Study

OBJECTIVES

Frailty is a state of homeostenosis associated with adverse outcomes. Chronic kidney disease (CKD) increases considerably by aging and shares the common risk factors with frailty. We aimed to examine the prevalence and independent associates of frailty status in CKD patients.

DESIGN

In this single-centre, cross-sectional study, we used the five-item Fatigue, Resistance, Ambulation, Illnesses and Loss of Weight (FRAIL) scale to evaluate frailty. A binary logistic regression analysis model including the parameters found to have relationship with frailty in univariate analyses was used to detect independent associates of frailty status. Odds ratio (OR) and 95% confidence interval (CI) were given.

PARTICIPANTS

Study included 148 patients aged 18-80. Sixty (60) patients were end stage renal disease (ESRD) patients on maintenance hemodialysis (HD) (at least for 3 months) and 88 were stage 3-4 CKD patients. Thirty-seven (37) patients (42%) were eGFR G3a, 31 patients (35.3%) were eGFR G3b and 20 patients (22.7%) were eGFR G4 in stage 3-4 CKD patients.

MEASUREMENTS

Demographics, etiology of CKD, comorbidities, regular drugs, dialysis-related and laboratory data were recorded. FRAIL scale was scored as follows; 0=robust, 1-2=prefrail, and ≥3= frail. The frailty status was compared between frail+prefrail group vs robust (non-frail) group.

RESULTS

The prevalences of prefrailty and frailty were 68.3% and 3.3% in HD group and 53.4% and zero in stage 3-4 CKD group, respectively (p = 0.025). In the multivariate logistic regression analysis, being in HD group (OR=3.87, 95% CI= 1.06-14.19, p=0.04), older age (OR=1.09, 95% CI= 1.04-1.13) and female sex (OR=9.13, 95%CI= 2.82-29.46) were independent risk factors for frailty (p<0.001, for both).

CONCLUSION

Prefrailty and frailty are quite common among HD and CKD stage 3-4 patients. Being an HD patient is an independent risk factor for non-robust (frail or prefrail) status. Our findings point out a remarkably high prevalence of frailty severity (prefrailty/frailty) phenotype among patients with advanced CKD stages.

The prognostic value of ischemia-modified albumin in patients with sepsis

Background

Sepsis is a significant contributor of mortality all over the world. Emergency departments have a critical role for diagnosing a suspected sepsis in a patient, since early and proper administration of antibiotics may decrease mortality significantly. But, the unavailability of an objective and reliable diagnostic test is the major challenge of this critical issue.

Aims

The aim of this study is to evaluate the prognostic value of a novel biomarker, the ischemia-modified albumin (IMA) in patients with sepsis and septic shock in emergency department.

Subjects and Methods

This prospective, observational study included 81 patients with sepsis or septic shock and 75 controls. Sociodemographic characteristics of the patients, site of infection, IMA levels, other biomarkers (procalcitonin, pH, lactate), mortality at 24-h and 28-day were evaluated.

Results

The serum IMA levels in patient and control groups were 117.8 ± 85 IU/g and 115.8 ± 134.0 IU/g, respectively (P = 0.072). There was a weak but statistically significant positive correlation between IMA and lactate levels (P = 0.009). The mortality rates of patient group at 24-h and 28 days were 21% and 79%, respectively, but serum IMA levels were not found to be a prognostic marker to predict mortality.

Conclusion

The main reason for the similarity between groups regarding IMA levels was thought to be associated with the distribution of the acute and chronic health problems other than sepsis in the control group. Emergency department physicians should not only depend on serum IMA levels for predicting the prognosis of patients with sepsis or septic shock.

[Hepatocellular Carcinoma Cells with Downregulated ZEB2 Become Resistant to Resveratrol by Concomitant Induction of ABCG2 Expression]

In hepatocellular carcinoma (HCC), the presence of cancer stem cells (CSCs) have been linked to drug resistance, epithelial-mesenchymal transition (EMT), and cancer relapse. This study investigates the expression profile of ZEB1, ZEB2, ABCG2 in HCC-CSCs, and the role of EMT promoter ZEB2 in cells treated with resveratrol. The expression of ZEB1, ZEB2 and ABCG2 transcripts were analyzed in CD133^(+)/CD44^(+) cells isolated from the PLC/PRF/5 cell line. ZEB2-dependent ABCG2 gene expression and the effects of resveratrol on proliferation, cell cycle and apoptosis were explored in SNU398 cell clones. An inverse correlation between ZEB1/ZEB2 and ABCG2 levels were observed both in CSCs and in ZEB2-knock-down cells. The resveratrol treatment significantly decreased cell viability, while promoting cell cycle arrest in ZEB2-independent manner. Interestingly, resveratrol-treated cells with low levels of ZEB2 were resistant to apoptosis. The interplay of expression levels of ABCG2 and ZEB family EMT transcription factors may play a role in establishing CSC-like phenotype in HCC cells resistant to resveratrol.

Successful Treatment With Granulocyte Transfusion and Early Neutrophil Engraftment in Allogeneic Transplant Patients With Febrile Neutropenia: Does Granulocyte Transfusion Effect on Neutrophil Engraftment?

Background: Febrile neutropenia is very severe and urgent early complication after bone marrow transplantation before engraftment. Infection delays engraftments in these periods. Aim: In this study we evaluated the effect and outcome of granulocyte transfusion on febrile neutropenia and neutrophil engraftment in patients receiving allogeneic transplantation. The reasons for the use of the granulocyte transfusion were prolonged febrile neutropenia episode. Methods: Between 2015-2017, 16 patients receiving allogeneic bone marrow transplantation (BMT) were treated with granulocyte transfusion at the time of febrile neutropenia before engraftment. Sixteen patients (9 AML, and 7 ALL) underwent allogeneic transplantation. Nine of them transplanted from match sibling donors, 1 from unrelated donor, and 6 from mismatch family donor (haploidentic transplantation). They had febrile neutropenia after transplantation, before engraftment. They were given antimicrobial therapy. Granulocyte was collected from unrelated and same blood groups donors. We started granulocyte transfusion for 3-4 days. Results: Mean infused granulocyte counts were 3 × 1010 (1.2-4.8 × 1010)/d, and about 15%-20% of transfused granulocyte was monocyte. Before the granulocyte transfusion, on the 12th to 19th days of transplantation, their neutrophil counts were 0.02-0.09 × 103/dL. Twenty-four hours after granulocyte transfusion, mean neutrophil counts were 0.7 × 103/dL (0.4-1.2 × 103/dL). Neutrophil counts were 2.2 × 103/dL (1.7-2.6 × 103/dL) after 48 hour. After 72 hours, neutrophil counts were 3.2 × 103/dL (2.0- 4.6 × 103/dL). After 4th days of granulocyte transfusion, neutrophil counts were normal level (>0.5 × 103/dL) in 12 patients, and less than normal level (<0.5 × 103/dL) in 4 patients. Conclusion: Granulocyte transfusions during the febrile neutropenia, helped to better overcome febrile neutropenia periods in allogeneic transplant patients before engraftment. In addition, granulocytes transfusion also may help early neutrophil engraftments. The useful effect of granulocyte transfusion on neutrophil engraftment may be cause of cytokine (G-CSF) injection to donor before collection of granulocyte. Increased cytokine (G-CSF–GM-CSF–IL-3) level of transfused neutrophil and monocyte can also effect the neutrophil engraftment.

The Comparison of Melphalan Administration on Day −3 With Administration on Day −1 on Neutrophil and Platelet Engraftment in Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplantation

Background: High dose chemotherapy followed by ASCT is the most important step of MM treatment. Melphalan, an alkylating agent, is the most preferable drug for conditioning regimens and dosage and timing is important with regard to side effects or engraftment timing. Engraftment time is determinative on infections and hospitalization duration. Aim: To compare of the neutrophil and thrombocyte engraftment time in patients with multiple myeloma who received melphalan 200 mg/m2 single dose on day −3 and day −1 as conditioning regimen. Methods: We compared the neutrophil and thrombocyte engraftments retrospectively in patients with multiple myeloma who received melphalan 200 mg/m2 single dose on day −3 and day −1 as conditioning regimen. There were 29 patient receiving melphalan on day −1 and 42 patient on day −3. Results: Administration of melphalan on day −3 was better than on day. Neutrophil engraftment time and hospitalization duration was shorter in patients who received melphalan on day −3 than patients who received melphalan on day −1. In day −3 group, there was no failure neither in neutrophil nor in thrombocyte engraftment but 1 patient could just get thrombocyte engraftment on day 33. In day −1 group, 2 patients could not get engraftment. Conclusion: Administration of melphalan on day −3 is better than on day −1 in terms of neutrophil engraftment and hence in terms of hospitalization duration.

The relationship between the type of unstable intertrochanteric femur fracture and mobility in the elderly

Background

The purpose of this study was to assess the impact of uniform anti-rotational proximal femoral intramedullary nail (APFN) use on patient mobility status with the treatment of two different unstable intertrochanteric femur fracture groups of geriatric patients.

Methods

The study included patients aged > 65 years who underwent surgery with APFN. Group 1 comprised AO classification, AO/OTA 31-A22, and A23 patients, and group 2, A31 and A32 patients. The demographic data of the patients, postoperative complications, follow-up, mortality status, postoperative reduction, tip-apex distance (TAD), and the Parker-Palmer mobility (PPM) score were evaluated.

Results

There were no statistically significant differences between the groups in terms of gender, affected side, time from trauma to surgery, ASA score, anesthesia type, duration of hospitalization, duration of surgery, TAD values, reduction values, or mortality rate. The average age of patients in group 2 was significantly higher than that of patients in group 1 (p < 0.05). The mobility scores of group 1 patients were significantly higher than those of group 2 (p < 0.05).

Conclusions

While no relationship was found between the TAD values and the reduction status of the cases, the PPM scores of the AO 31 A3 cases were determined to be significantly worse. Therefore, fractures with a preoperative classification of AO type 31 A3 can be expected to have worse results than A2 ITF fractures. The fracture type seems to have as great an effect as other factors on the postoperative mobility score.

Immunohistochemical investigation of P16, P53 and Ki-67's prognostic values in diffuse large B-Cell lymphomas

AIM

The aim of this study is to determine the immunohistochemical properties of Ki-67, P53 expression and loss of P16, and to assess their relationship with both clinical parameters and patient survival in DLBCL.

METHOD

Forty patients, diagnosed at the Pathology Department of our institute with nodal DLBCL were selected as the study group. The relationship between P16, P53, Ki-67 expressions and clinical and laboratory parameters like age, gender, performance status, Eastern Cooperative Oncology Group (ECOG), clinical stage, presence of B-symptoms, bone marrow involvement, International Prognostic Index (IPI) score, lactate dehydrogenase (LDH) level, extranodal extension, relapse, C-reactive protein (CRP), sedimentation, number of leukocytes in patients and patient survival were then statistically evaluated.

RESULTS

Our results display no statistically significant correlation between P53 expression and loss of P16, Ki-67 proliferation index and clinical parameters and overall survival (p > 0.05). The only statistically significant relationship was between loss of P16 and stage (p 0.05).

CONCLUSION

According to the results of our study, the loss of P16, P53 gene expression and Ki-67 proliferation index have no effect on life expectancy of patients with DLBCL (Tab. 2, Fig. 2, Ref. 29).

Combination of paracetamol or ketamine with meperidine enhances antinociception

OBJECTIVES

Dealing with pain is one of the most important issues of medicine. All of the studies aim to find a drug or combination of drugs in order to have more effective analgesia and less side effects. In this study, we aimed to investigate the antinociceptive effects of combination of paracetamol or ketamine with meperidine.

METHODS

In this study, we evaluated the systemic antinociceptive effects of meperidine, paracetamol, and ketamine one by one with their combinations. We used 50 mice (weighing 25-30 g), which were divided into 5 groups with each group consisting of 10 mice. Meperidine was applied to animals with increasing doses and their tail flick latencies (TFL) were noted at 20, 40, 60, 90, 120, 180, and 240 min. The same protocol was repeated after the combination of meperidine with paracetamol or ketamine.

RESULTS

There was no analgesic effect on low doses of ketamine and paracetamol at TFL measurements. But the combination of low doses of these drugs with meperidine significantly increased TFL (p < 0.05).

CONCLUSION

It was observed that meperidine + ketamine and meperidine + paracetamol combinations have potent analgesic effect.

Androgenetic alopecia is associated with increased arterial stiffness in asymptomatic young adults

BACKGROUND

Association of androgenetic alopecia (AGA) with increased incidence of hypertension, a strong risk factor for coronary artery disease, has been suggested. However, there are no data on arterial stiffness measures of asymptomatic young adults with AGA.

OBJECTIVE

In this study, we aimed to investigate the association of the AGA with arterial stiffness assessed by cardio-ankle vascular index (CAVI), in asymptomatic young men.

METHODS

A total of 162 asymptomatic men aged between 18 and 45 years were consecutively enrolled to the study. Subjects were considered to have AGA if they have ≥3 grade vertex alopecia according to Hamilton-Norwood scale. Arterial stiffness was assessed by CAVI and defined as abnormal if CAVI is ≥8.

RESULTS

Frequency of abnormal CAVI was higher in patients with AGA (29.3% vs. 10.0%, P = 0.003). Subjects with AGA had higher mean CAVI than subjects without AGA (7.56 ± 0.93 vs. 7.15 ± 0.79, P = 0.004). Binary logistic regression analysis demonstrated that presence of AGA (OR, 5.6; 95% CI, 1.7-20.0, P = 0.006), age (OR, 1.1; 95% CI, 1.0-1.2, P = 0.03) and diastolic blood pressure (OR, 1.1; 95% CI, 1.0-1.3, P = 0.005) were independently associated with abnormal CAVI.

CONCLUSION

We concluded that, AGA might be an indicator of arterial stiffness in asymptomatic young adults.

Comparison of chemotherapy and hematopoietic stem cell transplantation pre and postterm DMFT scores: a preliminary study

AIMS

Chemotherapy is frequently used as a conditioning regimen to destroy malignant marrow cells before transplantation. Xerostomia, dysphagia, altered taste perception, mucositis, soft-tissue ulceration, and infection are common adverse oral effects of chemotherapy. The study was aimed to compare decayed, missing, filled teeth (DMFT) scores before and after hematopoietic stem cell transplantation (HSCT) and chemotherapy.

MATERIALS AND METHODS

Thirty-six patients undergoing HSCT were included in the study. A pre-HSCT dental treatment protocol was implemented that consisted of restoration of all active carious lesions, treatment of periodontal infections, and extraction of all teeth with advanced periodontal disease. Upon completion of dental treatment, the importance of rigorous and effective oral hygiene was reemphasized, and patients were recalled 6 months later. DMFT scores were calculated prior to the initiation of HSCT treatment and 6 months after transplantation.

STATISTICAL ANALYSIS USED

Regression analysis was used to evaluate the effects of HSCT and chemotherapy on DMFT scores.

RESULTS

Wilcoxon T test showed a statistically significant difference in DMFT scores before and after HSCT ( P < 0.001).

CONCLUSIONS

DMFT scores were found to increase after chemotherapy and HSCT, suggesting that the risk of infection is higher among HSCT patients when compared to other individuals. The results emphasize the need for dental examinations as an integral part of examination and treatment planning for patients undergoing HSCT and chemotherapy.

The impact of pretransplant hypoalbuminemia on survival in patients with leukemia who underwent allogeneic hematopoietic stem cell transplantation (alloHSCT): a nutritional problem?

OBJECTIVE

Serum albumin level is considered to be a marker reflecting the nutritional status in both healthy subjects and patients with malignancies. In this study we sought to investigate the association between pretransplantation serum albumin levels and prognosis among patients with leukemia who underwent allogeneic hematopoietic stem cell transplantation (alloHSCT).

METHODS

We retrospectively analyzed the data of 102 patients who underwent alloHSCT from 2004 to 2010. Pretransplant serum albumin, D-dimer, creatinine, and fibrinogen levels drawn within 10 days before transplantation were obtained from patient files. All parameters were divided into 2 groups: normal levels (group 1) versus abnormal levels (group 2). Our normal range of serum albumin is 3.2-5.2 g/dL; patients with pretransplantation albumin level ≥3.2 g/dL were included in group 1 versus group 2 with <3.2 g/dL.

RESULTS

The patients included 42 (41.1%) female and 60 (58.9%) male patients. The diagnoses were acute myeloblastic leukemia in 65 (63.7%) and acute lymphoblastic leukemia in 37 (36.3%). The median age was 26.0 years (range, 13-57). Univariate and multivariate analysis showed that patients with serum albumin levels <3.2 g/dL experienced significantly lower overall survival (OS) compared with ≥3.2 g/dL (hazard ratio [HR] 2.32 [range, 1.23-4.54] and HR 2.70 [range 1.38-5.26], respectively; P = .009). The median (range) OS in group 2 was 230.0 (184.0-544.0) days versus 570.5 (249.5-1,101.0) days in group 1 (P = .007). For disease free survival (DFS) evaluation, univariate and multivariate analysis showed that patients with serum albumin levels <3.2 g/dL had significantly lower values compared with patients with serum albumin ≥3.2 g/dL. (HR 2.17 [range 0.98-4.76] and HR 2.85 [range, 1.25-6.66], respectively; P = .046). The median (range) DFS in group 2 was 184.0 (61.0-524.0) days versus 445.0 (199.0-917.5) days in group 1 (P = .045). Among the patient characteristics the presence of infection was a significant independent variable for worse OS (HR 2.12 [range, 0.98-4.36], P = .036). The other parameters-age, sex, donor status, time to transplant interval, conditioning regimens, HLA status, and number of total infused CD34(+) cells-showed no significant effect on OS and DFS (P = .05).

CONCLUSIONS

Pretransplantation decreased serum albumin levels were associated with poor survival in patients with leukemia who underwent alloHSCT.

Langerhans cell sarcoma of the nasopharynx: a rare case

Langerhans cell sarcoma, a tumour with markedly malignant cytological features that originates from Langerhans cells, is a very rare disease. We report the first case of 39-year-old male with Langerhans cell sarcoma arising in the nasopharynx. We chose the 2-chlorodeoxyadenosine (2-CDA) regimen as first-line chemotherapy, and clinical improvement of Langerhans cell sarcoma was obtained. After the fourth cycle of 2-CDA therapy, however, disease progression was observed, and we administered ESHAP regimen (etoposide, carboplatin, cytarabine, methylprednisolone) as a second-line therapy. After we administered two cycles of ESHAP, however, the patient developed aggressive progression and he died. The importance of immunohistochemical findings is obvious in Langerhans cell sarcoma diagnosis. Considering that Langerhans cell sarcoma behaves in a very malignant fashion, a more aggressive treatment approach is necessary for patients with Langerhans cell sarcoma.