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Selcuk A, Baysan A, Yesillik S, Demirel F, Kartal O, Gulec M, Musabak U, Sener O. Adverse reactions in venom immunotherapy protocols: conventional versus ultra-rush. Ann Med 2022; 54:2321-2325. [PMID: 36111408 PMCID: PMC9487973 DOI: 10.1080/07853890.2022.2112969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Venom immunotherapy (VIT) is an effective treatment in the patients at high risk of anaphylaxis or life-threatening systemic reactions due to Hymenoptera venom allergy. But, systemic and large local reactions can be observed, especially during the build-up phase of VIT. We evaluated the safety of conventional and ultra-rush build-up protocols. MATERIALS AND METHODS Two protocols in 71 patients (39 conventional and 32 ultra-rush protocols) with honeybee and wasp venom allergy were evaluated retrospectively. Patients were diagnosed and selected for VIT according to the criteria established by the European Academy of Allergy and Clinical Immunology. The severity of systemic reactions was evaluated according to the criteria of Mueller. RESULTS Build-up phases were tolerated in 66.2% (n = 47) without any reaction. Allergic adverse reactions were observed in 33.8% (n = 24): large local reactions 22.5% (n = 16) and systemic reactions 11.3% (n = 8). There was no significant difference in the number of adverse reactions comparing patients receiving conventional and ultra-rush protocol. In addition, no association was found between allergic adverse reactions and the following factors: sex, previous systemic sting reactions, honeybee and wasp venom extract. CONCLUSION We found that both protocols were tolerated in patients with honeybee and wasp venom allergy. Ultra-rush protocol will be preferred for patients and clinicians because of its advantages in terms of time and costs.KEY MESSAGESVIT is the only curative treatment method that reduces the risk of severe reactions after a bee sting and improves the quality of life in patients with Hymenoptera venom allergy.Ultra-rush VIT protocol has advantages such as few injection and time savings.Both ultra-rush and conventional VIT are safe treatments to prevent potentially life-threatening reactions in patients with honeybee and wasp venom allergy.
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Affiliation(s)
- Ali Selcuk
- Department of Immunology and Allergy, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Abdullah Baysan
- Department of Immunology and Allergy, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Sait Yesillik
- Department of Immunology and Allergy, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Fevzi Demirel
- Department of Immunology and Allergy, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Ozgur Kartal
- Department of Immunology and Allergy, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Mustafa Gulec
- Department of Immunology and Allergy, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Ugur Musabak
- Department of Immunology and Allergy, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Osman Sener
- Department of Immunology and Allergy, Gulhane Training and Research Hospital, Ankara, Turkey
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Abstract
Mastocytosis is a rare group of disorders characterized by abnormal accumulation of mast cells in the skin, bone marrow, and internal organs. In particular, patients with systemic mastocytosis are at an increased risk of frequent and severe episodes of anaphylaxis. Hymenoptera venom allergy is the most common trigger of anaphylaxis in these patients. Immunotherapy is an effective and safe therapy recommended for patients with mastocytosis and venom allergy. Although this therapy can be administered according to different protocols, the preferred protocol for patients with mastocytosis remains unclear. Systemic side effects can occur, in particular, during the up-dosing phase of immunotherapy, making progression to the maintenance phase of therapy challenging. This case report presents the diagnosis and ultrarush immunotherapy process ended with anaphylaxis of a 33-y-old male patient with Apis mellifera allergy.
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Affiliation(s)
- Ali Selcuk
- Allergy and Immunology Department, Malatya Training and Research Hospital, Malatya, Turkey
| | - Abdullah Baysan
- Allergy and Immunology Department, Sultan II. Abdulhamid Han Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Sleibi A, Tappuni AR, Karpukhina NG, Hill RG, Baysan A. A comparative evaluation of ion release characteristics of three different dental varnishes containing fluoride either with CPP-ACP or bioactive glass. Dent Mater 2019; 35:1695-1705. [PMID: 31563405 DOI: 10.1016/j.dental.2019.08.113] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 08/13/2019] [Accepted: 08/31/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To compare ion release characteristics of three different dental varnishes either containing CPP-ACP and fluoride (CPP-ACPF, MI Varnish GC, Japan), bioactive glass and fluoride (BGAF, Dentsply Sirona USA) or fluoride alone (NUPRO White, Dentsply Sirona USA) using fluoride-Ion Selective Electrode (F-ISE), Inductively Coupled Plasma-Optical Emission Spectroscopy (ICP-OES), X-ray diffraction (XRD), Fourier Transform Infrared Spectroscopy (FTIR), 19F and 31P Magic Angle Spinning-Nuclear Magnetic Resonance (MAS-NMR). METHODS A thin layer (0.0674±0.0005g) of each varnish (20×25mm in area) was spread on a roughened glass slide (n=7). They were separately immersed in 10ml Tris buffer (0.06M, pH=7.30), and changed after 1, 2, 4, 6, 24 and 48h. Fluoride-ion concentration at each time using the F-ISE, whilst calcium and phosphate release were investigated using ICP-OES. XRD, FTIR. MAS-NMR analyses were also performed before and after immersion. RESULTS The cumulative F-ion release was significantly higher in CPP-ACPF (1.113mmol/g)>BGAF(0.638)>F(0.112) (p<0.001). The cumulative calcium and phosphorus were higher in the CPP-ACPF (0.137mmol/g, 0.119) than BGAF (0.067, 0.015) (p<0.001) respectively. The XRD and 19F MAS-NMR confirmed the presence of NaF peaks in all cases before immersion. There were less prominent signal and appearance of fluorapatite crystals after immersion. 19F MAS-NMR revealed CaF2 formation after immersion in both CPP-ACPF and BGAF. 31P MAS-NMR showed phosphate signals in both CPP-ACPF and BGAF before immersion. FTIR failed to show any signs of apatite formation. SIGNIFICANCE Both CPP-ACP and bioactive glass enhanced ion release without compromising the bioavailability of fluoride. The CPP-ACPF varnish had the most promising ion release.
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Affiliation(s)
- Ahmed Sleibi
- Institute of Dentistry, Queen Mary University of London, Turner Street, EI 2AD, London, United Kingdom; College of Dentistry, Mustansiriyah University, Baghdad, Iraq.
| | - A R Tappuni
- Institute of Dentistry, Queen Mary University of London, Turner Street, EI 2AD, London, United Kingdom
| | - Natalia G Karpukhina
- Dental Physical Sciences Unit, Institute of Dentistry, Queen Mary University of London, Mile End Road, EI 4NS, London, United Kingdom
| | - Robert G Hill
- Dental Physical Sciences Unit, Institute of Dentistry, Queen Mary University of London, Mile End Road, EI 4NS, London, United Kingdom
| | - A Baysan
- Institute of Dentistry, Queen Mary University of London, Turner Street, EI 2AD, London, United Kingdom
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4
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Malik H, Baysan A. Organic is not better! Br Dent J 2019; 227:175-176. [DOI: 10.1038/s41415-019-0628-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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5
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Pereira LC, Nascimento JCR, Rêgo JMC, Canuto KM, Crespo-Lopez ME, Alvarez-Leite JI, Baysan A, Oriá RB. Apolipoprotein E, periodontal disease and the risk for atherosclerosis: a review. Arch Oral Biol 2018; 98:204-212. [PMID: 30503976 DOI: 10.1016/j.archoralbio.2018.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 09/25/2018] [Accepted: 11/10/2018] [Indexed: 12/26/2022]
Abstract
The association between cardiovascular and periodontal diseases is characterized by chronic inflammatory processes, with a high prevalence worldwide and complex genetic-environment interactions. Although apolipoprotein E4 (ApoE4), one of the isoforms coded by a polymorphic APOE gene, has been widely recognized as a risk factor for cardiovascular diseases and as an immunoinflammatory factor, less is known regarding how ApoE4 affects atherosclerosis in periodontitis patients. The aim of this review was to investigate the potential underlying mechanisms related to APOE4 that could increase the risk of periodontal disease and, ultimately, of atherosclerosis. There have only been a few studies addressing apoE polymorphisms in patients with chronic periodontitis. To date, no studies have been performed that have assessed how ApoE4 affects atherosclerotic disease in chronic periodontitis patients. Although clinical studies are warranted, experimental studies have consistently documented the presence of periodontal pathogens, which are usually found in the oral cavity and saliva, in the atherosclerotic plaques of ApoE-deficient mice. In addition, in this review, the potential role of the APOE4 allele as an example of antagonistic pleiotropy during human evolution and its relation to oral health is discussed.
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Affiliation(s)
- L C Pereira
- Laboratory of the Biology of Tissue Healing, Ontogeny and Nutrition, Department of Morphology and Institute of Biomedicine, School of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil
| | - J C R Nascimento
- Laboratory of the Biology of Tissue Healing, Ontogeny and Nutrition, Department of Morphology and Institute of Biomedicine, School of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil
| | - J M C Rêgo
- Laboratory of the Biology of Tissue Healing, Ontogeny and Nutrition, Department of Morphology and Institute of Biomedicine, School of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil
| | - K M Canuto
- Laboratory of the Biology of Tissue Healing, Ontogeny and Nutrition, Department of Morphology and Institute of Biomedicine, School of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil
| | - M E Crespo-Lopez
- Laboratory of Molecular Pharmacology, Institute of Biological Sciences, Federal University of Para, Belém, PA, Brazil
| | - J I Alvarez-Leite
- Institute of Biological Sciences, Department of Biochemistry and Immunology, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - A Baysan
- Institute of Dentistry, Barts and the London, School of Medicine and Dentistry, Queen Mary University, London, UK
| | - R B Oriá
- Laboratory of the Biology of Tissue Healing, Ontogeny and Nutrition, Department of Morphology and Institute of Biomedicine, School of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil.
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Sleibi A, Tappuni A, Mills D, Davis GR, Baysan A. Comparison of the Efficacy of Different Fluoride Varnishes on Dentin Remineralization During a Critical pH Exposure Using Quantitative X-Ray Microtomography. Oper Dent 2018; 43:E308-E316. [PMID: 30457948 DOI: 10.2341/18-014-l] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES: The objective of this in vitro study was to quantify the amount of mineral change in demineralized dentin at pH 5.5 after the application of dental varnishes containing fluoride with casein phosphopeptide-amorphous calcium phosphate, fluoride and bioglass, or fluoride alone. METHODS AND MATERIALS: A total of 12 extracted human sound mandibular premolar root samples were coated with an acid-resistant varnish, leaving a 2 × 3 mm window at the outer root surface. These root specimens were then randomly divided into four groups and separately subjected to the demineralizing cycle at a pH of 4.8 for five days to create artificial caries-like lesions in dentin. Subsequently, each sample was imaged using quantitative x-ray microtomography (XMT) at a 15-μm voxel size. Each test group then received one of the following treatments: dental varnish containing casein phosphopeptide-amorphous calcium phosphate and fluoride (CPP-ACP, MI varnish, GC Europe), bioglass and fluoride (BGA, Experimental, Dentsply Sirona), or fluoride alone (NUPRO, Dentsply Sirona), as well as a control group, which received no treatment. These samples were kept in deionized water for 12 hours. The thin layer of varnish was then removed. All samples including the nonvarnish group were subjected to the second demineralizing cycle at pH 5.5 for five days. The final XMT imaging was then carried out following the second demineralizing cycle. XMT scan was also carried out to varnish samples at 25 μm voxel size. The change in mineral concentration in the demineralized teeth was assessed using both qualitative and quantitative image analysis. RESULTS: There was an increase in radiopacity in the subtracted images of all varnish groups; a significant increase in mineral content, 12% for the CPP-ACP and fluoride ( p≤0.05 and p≤0.001), 25% BGA ( p≤0.001), and 104% fluoride alone varnish ( p≤0.001). There was an increase in the size of radiolucency in the lesion area with a significant decrease in mineral content in the nonvarnish group, 10% ( p≤0.05 and p≤0.001). CONCLUSIONS: There was encouraging evidence of a remineralization effect following the application of dental varnish on dentin and also an observed resistance to demineralization during the acidic challenge in all cases. However, a dental varnish containing fluoride alone appeared to have a much greater effect on dentin remineralization when compared with CPP-ACP with fluoride and bioglass with fluoride.
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Bozo Ö, Demirtepe-Saygılı D, Güneş S, Çenesiz GZ, Baysan A. Does Problem Focused Coping Buffer the Effects of Trait Anxiety on Depressive Symptoms of Chronic Urticaria Patients? J Gen Psychol 2018; 145:64-78. [PMID: 29345527 DOI: 10.1080/00221309.2017.1420622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The present study examined the moderating role of problem-focused coping in trait anxiety-depressive symptoms' relationship in patients with chronic urticaria (CU). Eighty-eight CU patients, who applied to an outpatient clinic of Clinical Immunology and Allergic Diseases, filled out a questionnaire set including State-Trait Anxiety Inventory, Ways of Coping Inventory, and Beck Depression Inventory. The results suggested that CU patients high on trait anxiety reported more depressive symptoms, and the ones using more problem-focused coping (PFC) strategies reported less depressive symptoms. Also, PFC strategies moderated trait anxiety-depressive symptoms relation. Accordingly, PFC strategies did not lead to any significant difference in CU patients who were low on trait anxiety in terms of the level of depressive symptoms. However, CU patients with high trait anxiety experienced significantly less depressive symptoms if they used more PFC strategies. The findings were discussed in the light of the relevant literature.
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Affiliation(s)
- Özlem Bozo
- a Orta Dogu Teknik Universitesi , Psychology , Ankara , Turkey
| | | | - Seren Güneş
- a Orta Dogu Teknik Universitesi , Psychology , Ankara , Turkey
| | - Gaye Zeynep Çenesiz
- c Yuzuncu Yil Universitesi , Department of Education Sciences , Van , Turkey
| | - Abdullah Baysan
- d Haydarpaşa Sultan Abdülhamid Han Eğitim ve Araştırma Hastanesi , Division of Immunology and Allergy , Istanbul , Turkey
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Muşabak UH, Demirel F, Yeşillik S, Baysan A, Selçuk A, Kartal Ö, Güleç M, Öktenli Ç, Şener O. Adults with common variable immunodeficiency: a single-center experience. Turk J Med Sci 2017; 47:1-12. [PMID: 28263469 DOI: 10.3906/sag-1503-22] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 12/18/2015] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND/AIM In this study, we aimed to assess the clinical and immunological findings of our patients with common variable immunodeficiency (CVID). MATERIALS AND METHODS We analyzed the records of 31 adult patients with CVID (12 females, 19 males). The patients were classified into clinical and immunophenotypic subgroups for statistical comparisons. RESULTS Our patients had some clinical signs in considerable frequencies, such as low body weight (45.2%), urinary tract infections (41.9%), various dermatoses (35.5%), and oral aphthae (32.3%). The histological findings in the biopsy specimens of the gastrointestinal tract (nodular lymphoid hyperplasia, villous atrophy, and lymphocytic infiltrates at mucosa) were significantly associated with splenomegaly, hepatomegaly, or low body weight (P = 0.005, 0.045, and 0.007, respectively). The patients with low CD4/CD8 ratios had lower IgG levels and a lower percentage of CD19+ B cells, but a higher percentage of activated T cells (P = 0.023, 0.011, and 0.028, respectively). CONCLUSION In adults with CVID, there existed some clinical signs at considerable frequencies, but these are not overemphasized in the literature. The CD4/CD8 ratio is an important factor in antibody production and the clinical presentation of CVID. It seems that the adaptive immune system is on alert and subclinical immune activation insidiously continues in patients with CVID.
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Affiliation(s)
- Uğur Haci Muşabak
- Division of Immunology and Allergic Diseases, Lösante Hospital, Ankara, Turkey
| | - Fevzi Demirel
- Division of Immunology and Allergic Diseases, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Sait Yeşillik
- Division of Immunology and Allergic Diseases, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Abdullah Baysan
- Division of Immunology and Allergic Diseases, Sultan Abdulhamid Han Training and Research Hospital, İstanbul, Turkey
| | - Ali Selçuk
- Division of Immunology and Allergic Diseases, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Özgür Kartal
- Division of Immunology and Allergic Diseases, Gülhane Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Mustafa Güleç
- Division of Immunology and Allergic Diseases, Güven Hospital, Ankara, Turkey
| | - Çağatay Öktenli
- Department of Internal Medicine, Anadolu Medical Center, Kocaeli, Turkey
| | - Osman Şener
- Division of Immunology and Allergic Diseases, Gülhane Training and Research Hospital, Health Sciences University, Ankara, Turkey
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Sin BA, Öztuna D, Gelincik A, Gürlek F, Baysan A, Sin AZ, Aydın Ö, Mısırlıgil Z. Quality-of-life in insect venom allergy: validation of the Turkish version of the “Vespid Allergy Quality of Life Questionnaire” (VQLQ-T). SpringerPlus 2016; 5:583. [PMID: 27247880 PMCID: PMC4864742 DOI: 10.1186/s40064-016-2246-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 04/27/2016] [Indexed: 11/10/2022]
Abstract
Purpose Methods Results Conclusions
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Kartal O, Musabak U, Yesillik S, Sagkan RI, Pekel A, Demirel F, Baysan A, Selçuk A, Güleç M, Şener O. Erratum to: Killer-cell immunoglobulin-like receptor and human leukocyte antigen-C genes in common variable immunodeficiency. Wien Klin Wochenschr 2015; 128:305. [PMID: 26567003 DOI: 10.1007/s00508-015-0894-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ozgur Kartal
- Division of Immunology and Allergic Diseases, Gulhane Military Medical Academy and School of Medicine, 06018, Ankara, Turkey.
| | - Ugur Musabak
- Division of Immunology and Allergic Diseases, Gulhane Military Medical Academy and School of Medicine, 06018, Ankara, Turkey
| | - Sait Yesillik
- Division of Immunology and Allergic Diseases, Gulhane Military Medical Academy and School of Medicine, 06018, Ankara, Turkey
| | - Rahsan I Sagkan
- Division of Immunology and Allergic Diseases, Gulhane Military Medical Academy and School of Medicine, 06018, Ankara, Turkey
| | - Aysel Pekel
- Division of Immunology and Allergic Diseases, Gulhane Military Medical Academy and School of Medicine, 06018, Ankara, Turkey
| | - Fevzi Demirel
- Division of Immunology and Allergic Diseases, Gulhane Military Medical Academy and School of Medicine, 06018, Ankara, Turkey
| | - Abdullah Baysan
- Division of Immunology and Allergic Diseases, Gulhane Military Medical Academy and School of Medicine, 06018, Ankara, Turkey
| | - Ali Selçuk
- Division of Immunology and Allergic Diseases, Gulhane Military Medical Academy and School of Medicine, 06018, Ankara, Turkey
| | - Mustafa Güleç
- Division of Immunology and Allergic Diseases, Gulhane Military Medical Academy and School of Medicine, 06018, Ankara, Turkey
| | - Osman Şener
- Division of Immunology and Allergic Diseases, Gulhane Military Medical Academy and School of Medicine, 06018, Ankara, Turkey
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Demirel F, Gulec M, Kartal O, Yesıllik S, Baysan A, Musabak U, Sener O. Allergic reaction to chlorpheniramine maleate. Ann Allergy Asthma Immunol 2015; 115:150-2. [PMID: 26250772 DOI: 10.1016/j.anai.2015.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 05/11/2015] [Accepted: 05/16/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Fevzi Demirel
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Gulhane Military Medical Academy and Medical School, Ankara, Turkey.
| | - Mustafa Gulec
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Gulhane Military Medical Academy and Medical School, Ankara, Turkey
| | - Ozgur Kartal
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Gulhane Military Medical Academy and Medical School, Ankara, Turkey
| | - Sait Yesıllik
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Gulhane Military Medical Academy and Medical School, Ankara, Turkey
| | - Abdullah Baysan
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Gulhane Military Medical Academy and Medical School, Ankara, Turkey
| | - Ugur Musabak
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Gulhane Military Medical Academy and Medical School, Ankara, Turkey
| | - Osman Sener
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Gulhane Military Medical Academy and Medical School, Ankara, Turkey
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Kartal O, Musabak U, Yesillik S, Sagkan RI, Pekel A, Demirel F, Baysan A, Selçuk A, Güleç M, Şener O. Killer-cell immunoglobulin-like receptor and human leukocyte antigen-C genes in common variable immunodeficiency. Wien Klin Wochenschr 2015; 128:822-826. [PMID: 25860853 DOI: 10.1007/s00508-015-0769-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 02/16/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND We aimed herein to investigate the killer-cell immunoglobulin-like receptor (KIR) genes and human leukocyte antigen (HLA)-C alleles in patients with common variable immunodeficiency (CVID), and to reveal their differences from those in healthy population. METHODS In all, 18 patients who have been diagnosed with CVID and 15 living donors of kidney transplant recipients were enrolled in the study. Polymerase chain reaction-sequence-specific primer (PCR-SSP) typing method was used in molecular genetic analysis. The frequencies of the genes in the study groups were statistically compared with each other using chi-square or Fisher exact tests, whichever were appropriate. RESULTS Although there was no significant difference between both study groups with respect to distribution of KIR and HLA-C2 group genes, HLA-Cw7 allele frequency in patients with CVID was significantly lower than that in healthy population (P = 0.008). CONCLUSION This present study results support that HLA-Cw7 allele, an inhibitor of KIR ligand, may play a role in the pathogenesis of CVID.
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Affiliation(s)
- Ozgur Kartal
- Division of Immunology and Allergic Diseases, Gulhane Military Medical Academy and School of Medicine, 06018, Ankara, Turkey.
| | - Ugur Musabak
- Division of Immunology and Allergic Diseases, Gulhane Military Medical Academy and School of Medicine, 06018, Ankara, Turkey
| | - Sait Yesillik
- Division of Immunology and Allergic Diseases, Gulhane Military Medical Academy and School of Medicine, 06018, Ankara, Turkey
| | - Rahsan I Sagkan
- Division of Immunology and Allergic Diseases, Gulhane Military Medical Academy and School of Medicine, 06018, Ankara, Turkey
| | - Aysel Pekel
- Division of Immunology and Allergic Diseases, Gulhane Military Medical Academy and School of Medicine, 06018, Ankara, Turkey
| | - Fevzi Demirel
- Division of Immunology and Allergic Diseases, Gulhane Military Medical Academy and School of Medicine, 06018, Ankara, Turkey
| | - Abdullah Baysan
- Division of Immunology and Allergic Diseases, Gulhane Military Medical Academy and School of Medicine, 06018, Ankara, Turkey
| | - Ali Selçuk
- Division of Immunology and Allergic Diseases, Gulhane Military Medical Academy and School of Medicine, 06018, Ankara, Turkey
| | - Mustafa Güleç
- Division of Immunology and Allergic Diseases, Gulhane Military Medical Academy and School of Medicine, 06018, Ankara, Turkey
| | - Osman Şener
- Division of Immunology and Allergic Diseases, Gulhane Military Medical Academy and School of Medicine, 06018, Ankara, Turkey
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Gulec M, Selcuk A, Kartal O, Demirel F, Yesillik S, Baysan A, Musabak U, Sener O. Anti- IgE treatment in asthma: is atopy essential? World Allergy Organ J 2015. [PMCID: PMC4406564 DOI: 10.1186/1939-4551-8-s1-a150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Kartal O, Demirel F, Baysan A, Gulec M, Yesillik S, Uyanýk M, Musabak U, Sener O. An unexpected allergic reaction with
Saccharomyces boulardii
: a case report. Clin Transl Allergy 2014. [PMCID: PMC4127795 DOI: 10.1186/2045-7022-4-s3-p100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Ozgur Kartal
- Division of Immunology and Allergic DiseasesGulhane Military Medical Academy and Medical SchoolTurkey
| | - Fevzi Demirel
- Division of Immunology and Allergic DiseasesGulhane Military Medical Academy and Medical SchoolTurkey
| | - Abdullah Baysan
- Division of Immunology and Allergic DiseasesGulhane Military Medical Academy and Medical SchoolTurkey
| | - Mustafa Gulec
- Division of Immunology and Allergic DiseasesGulhane Military Medical Academy and Medical SchoolTurkey
| | - Sait Yesillik
- Division of Immunology and Allergic DiseasesGulhane Military Medical Academy and Medical SchoolTurkey
| | - Metin Uyanýk
- Department of Clinical ChemistryGulhane Military Medical Academy and Medical SchoolTurkey
| | - Ugur Musabak
- Division of Immunology and Allergic DiseasesGulhane Military Medical Academy and Medical SchoolTurkey
| | - Osman Sener
- Division of Immunology and Allergic DiseasesGulhane Military Medical Academy and Medical SchoolTurkey
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Caliskaner Z, Kartal O, Baysan A, Yesillik S, Demirel F, Gulec M, Sener O. A case of textile dermatitis due to disperse blue on the surgical wound. Hum Exp Toxicol 2011; 31:101-3. [DOI: 10.1177/0960327111424300] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Z Caliskaner
- Division of Immunology and Allergic Diseases, Gulhane Military Medical Academy and Medical School, Ankara, Turkey
| | - O Kartal
- Division of Immunology and Allergic Diseases, Gulhane Military Medical Academy and Medical School, Ankara, Turkey
| | - A Baysan
- Division of Immunology and Allergic Diseases, Gulhane Military Medical Academy and Medical School, Ankara, Turkey
| | - S Yesillik
- Division of Immunology and Allergic Diseases, Gulhane Military Medical Academy and Medical School, Ankara, Turkey
| | - F Demirel
- Division of Immunology and Allergic Diseases, Gulhane Military Medical Academy and Medical School, Ankara, Turkey
| | - M Gulec
- Division of Immunology and Allergic Diseases, Gulhane Military Medical Academy and Medical School, Ankara, Turkey
| | - O Sener
- Division of Immunology and Allergic Diseases, Gulhane Military Medical Academy and Medical School, Ankara, Turkey
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16
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Smith B, Baysan A, Fenlon M. Association between Oral Health Impact Profile and General Health scores for patients seeking dental implants. J Dent 2009; 37:357-9. [DOI: 10.1016/j.jdent.2009.01.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Revised: 12/27/2008] [Accepted: 01/09/2009] [Indexed: 11/24/2022] Open
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Baysan A, Beighton D. Assessment of the ozone-mediated killing of bacteria in infected dentine associated with non-cavitated occlusal carious lesions. Caries Res 2007; 41:337-41. [PMID: 17713332 PMCID: PMC2790727 DOI: 10.1159/000104790] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Accepted: 01/10/2007] [Indexed: 11/19/2022] Open
Abstract
The ability of ozone to kill micro-organisms associated with non-cavitated occlusal caries was investigated. The occlusal surfaces were treated with ozone (n = 53) or air (n = 49) for 40 s, and the underlying infected dentine was exposed. There was no significant difference between the number of bacteria recovered from the ozone-treated and the control sites (p > 0.1). Treatment of the exposed dentine with ozone resulted in a just significant (p = 0.044) reduction in bacterial counts. Ozone treatment of non-cavitated occlusal lesions for 40 s failed to significantly reduce the numbers of viable bacteria in infected dentine beneath the demineralized enamel.
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Affiliation(s)
- A Baysan
- Infection Research Group, King's College London Dental Institute, London, UK.
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Baysan A, Yel L, Gollapudi S, Su H, Gupta S. Arsenic trioxide induces apoptosis via the mitochondrial pathway by upregulating the expression of Bax and Bim in human B cells. Int J Oncol 2007; 30:313-8. [PMID: 17203211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Arsenic trioxide (As2O3) has been approved for the treatment of acute promyelocytic leukemia (APML) and it is a promising candidate for the treatment of patients with lymphoproliferative disorders, such as relapsed or refractory multiple myeloma and myelodysplastic syndromes. The effects of As2O3 on B cells, specifically which do not express Bcl-2, have not been studied. In this study, we have demonstrated that As2O3, at clinically achievable therapeutic concentrations, induces apoptosis in Bcl-2 negative human B cell line Ramos. As2O3-induced apoptosis is associated with reduced mitochondrial transmembrane potential (delta psi), enhanced generation of intracellular reactive oxygen species (ROS), release of cytochrome c and apoptosis-inducing factor (AIF) from mitochondria into cytoplasm, activation of caspases, and upregulation of Bax and Bim expression. Exogenous glutathione (GSH) reverses the As2O3-induced apoptosis in a dose-dependent manner. Altogether, these data indicate that As2O3 induces apoptosis in B cells, regardless of Bcl-2 expression, via the mitochondrial pathway by enhancing oxidative stress.
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Affiliation(s)
- Abdullah Baysan
- Cellular and Molecular Immunology Laboratory, Division of Basic and Clinical Immunology, University of California, Irvine, CA 92697, USA
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Song H, Yel L, Baysan A, Young T, Gupta S. Combined immunodeficiency in a patient with chromosome 1q42.1q42.3 deletion. J Allergy Clin Immunol 2005. [DOI: 10.1016/j.jaci.2004.12.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Cinar E, Ateskan U, Baysan A, Mas MR, Comert B, Yasar M, Ozyurt M, Yener N, Mas N, Ozkomur E, Altinatmaz K. Is late antibiotic prophylaxis effective in the prevention of secondary pancreatic infection? Pancreatology 2003; 3:383-8. [PMID: 14526147 DOI: 10.1159/000073653] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2003] [Accepted: 05/30/2003] [Indexed: 02/05/2023]
Abstract
BACKGROUND Secondary infection of the inflamed pancreas is the principal cause of death after severe acute pancreatitis (AP). Although patients are not always managed early in the course of AP in clinical practice, prophylactic antibiotics that were used in experimental studies in rats were always initiated early after induction of pancreatitis. The effectiveness of antibiotics initiated later is unknown. AIM The aim of this study was to compare the effectiveness of ciprofloxacin and meropenem initiated early versus later in the course of acute necrotizing pancreatitis (ANP) in rats. METHODS 100 Sprague-Dawley rats were studied. ANP was induced in rats by intraductal injection of 3% taurocholate. Rats were divided randomly into five groups: group I rats received normal saline as a placebo, group II and IV rats received three times daily meropenem 60 mg/kg i.p. at 2 and 24 h, respectively and group III and V rats received twice daily ciprofloxacin 50 mg/kg i.p. at 2 and 24 h, respectively, after induction. At 96 h, all rats were killed for quantitative bacteriologic study. A point-scoring system of histological features was used to evaluate the severity of pancreatitis. RESULTS Meropenem and ciprofloxacin initiated 2 h after induction of pancreatitis significantly reduced the prevalence of pancreatic infection (p < 0.001 and p < 0.04, respectively) as compared to controls. Neither of the antibiotics initiated later during the course of AP caused a significant decrease in pancreatic infection in rats (p > 0.05). Although the rats treated early infected less frequently than the rats treated later, the comparison reached statistical significance only in the meropenem group (p < 0.02). CONCLUSION Early antibiotic treatment reduces pancreatic infection more efficiently than late antibiotic treatment in ANP in rats.
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Affiliation(s)
- Esref Cinar
- Department of Infectious Diseases, Gulhane School of Medicine, Ankara, Turkey
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21
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Lo E, Holmgren C, Yoshida M, Sato Y, Otsuka Y, Mitomi T, Baysan A, Lynch E. Br Dent J 2001; 191:246-246. [DOI: 10.1038/sj.bdj.4801152a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
Root caries is a widespread problem and can be quite serious in older populations. The restoration of root carious lesions is often difficult. Compared to enamel caries, there has been limited research into the pharmaceutical management of primary root caries lesions (PRCLs), and many of these studies have been carried out in vitro, with limited numbers of clinical trials. Fluoride is presently a cornerstone in dentifrice formulations for cost-effective and anticaries therapy. It is generally accepted that fluoride ions promote remineralization of tooth substances and reduce the rate of demineralization. The use of a dentifrice with a high fluoride content may be considered to reverse PRCLs, since more fluoride is required for the remineralization of roots than for enamel. This paper reviews the effects of dentifrices with high fluoride contents on the management of root caries.
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Affiliation(s)
- E Lynch
- Restorative Dentistry and Gerodontology, Queen's University Belfast, Northern Ireland.
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Baysan A, Lynch E, Ellwood R, Davies R, Petersson L, Borsboom P. Reversal of primary root caries using dentifrices containing 5,000 and 1,100 ppm fluoride. Caries Res 2001; 35:41-6. [PMID: 11125195 DOI: 10.1159/000047429] [Citation(s) in RCA: 129] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
This study compared the ability of two sodium fluoride dentifrices, one containing 5,000 ppm fluoride (Prevident 5000 Plus) and the other 1,100 ppm fluoride (Winterfresh Gel), to reverse primary root caries lesions (PRCLs). A total of 201 subjects with at least one PRCL each entered the study and were randomly allocated to use one of the dentifrices. After 6 months, 186 subjects were included in statistical analyses. At baseline and after 3 and 6 months, the lesions were clinically assessed and their electrical resistance measured using an electrical caries monitor. After 3 months, 39 (38.2%) of the 102 subjects in the 5,000 ppm F- group and 9 (10.7%) of 84 subjects using the 1,100 ppm F- dentifrice, had one or more PRCLs which had hardened (p = 0.005). Between baseline and 3 months, the log10 mean +/- SD resistance values of lesions for subjects in the 1,100 ppm F- group had decreased by 0.06+/-0.55, whereas those in the 5,000 ppm F- group had increased by 0.40+/-0.64 (p<0.001). After 6 months, 58 (56.9%) of the subjects in the 5,000 ppm F- group and 24 (28.6%) in the 1,100 ppm F- group had one or more PRCLs that had become hard (p = 0.002). Between baseline and 6 months, the log10 mean +/- SD resistance values of lesions for subjects in the 1,100 ppm F- group decreased by 0.004+/-0.70, whereas in the 5,000 ppm F- group, they increased by 0.56+/-0.76 (p<0.001). After 3 and 6 months, the distance from the apical border of the root caries lesions to the gingival margin increased significantly in the 5,000 ppm F- group when compared with the 1,100 ppm F- group. The plaque index in the 5,000 ppm F- group was also significantly reduced when compared with the 1,100 ppm F- group. The colour of the lesions remained unchanged. It was concluded that the dentifrice containing 5,000 ppm F- was significantly better at remineralising PRCLs than the one containing 1,100 ppm F-.
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Affiliation(s)
- A Baysan
- Department of Adult Oral Health, St. Bartholomew's and the Royal London School of Medicine and Dentistry, UK.
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Baysan A, Whiley RA, Lynch E. Antimicrobial effect of a novel ozone- generating device on micro-organisms associated with primary root carious lesions in vitro. Caries Res 2000; 34:498-501. [PMID: 11093025 DOI: 10.1159/000016630] [Citation(s) in RCA: 133] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The aims of this present study were (1) to assess the antimicrobial effect of ozone from a novel ozone-generating device (Heolozone, USA) [0.052% (v/v) in air delivered at a rate of 13.33 ml.s(-1)] on primary root carious lesions (PRCLs) and (2) to evaluate the efficacy of ozone specifically on Streptococcus mutans and Streptococcus sobrinus. In study 1, 40 soft PRCLs from freshly extracted teeth were randomly divided into two groups to test the antimicrobial effect on PRCLs from exposure to ozonated water for either 10 or 20 s. Half of a lesion was removed using a sterile excavator. Subsequently, the remaining lesion was exposed to the ozonised water for a period of either 10 or 20 s (corresponding to 0. 069 or 0.138 ml of ozone, respectively). Using paired Student t tests, a significant (p<0.001) reduction (mean +/- SE) was observed in the ozone-treated groups with either a 10-second (log(10) 3.57+/-0.37) or 20-second (log(10) 3.77+/-0.42) ozone application compared with the control groups (log(10) 5.91+/-0.15 and log(10) 6.18+/-0.21, respectively). In study 2, 40 sterile saliva-coated glass beads were randomly divided into two groups for each micro-organism. One glass bead was put into each bijou bottle with 3 ml of Todd-Hewitt broth. S. mutans and S. sobrinus were inoculated anaerobically overnight. Each glass bead was then washed with 2 ml of phosphate-buffered saline. Immediately, 10 s of ozone gas was applied to each glass bead in the test groups. There was a significant (p<0.0001) reduction (mean +/- SE) in ozone-treated samples for S. mutans (log(10) 1.01+/-0.27) and S. sobrinus (log(10) 1.09+/-0.36) compared with the control samples (log(10) 3.93+/-0.07 and log(10) 4.61+/-0.13, respectively). This treatment regime is an effective, quick, conservative and simple method to kill micro-organisms in PRCLs. Ozone gas application for a period of 10 s was also capable of reducing the numbers of S. mutans and S. sobrinus on saliva-coated glass beads in vitro.
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Affiliation(s)
- A Baysan
- Department of Conservative Dentistry, St. Bartholomew's and the Royal London School of Medicine and Dentistry, London, UK
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Lynch E, Baysan A, Ellwood R, Davies R, Petersson L, Borsboom P. Effectiveness of two fluoride dentifrices to arrest root carious lesions. Am J Dent 2000; 13:218-20. [PMID: 11763936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
PURPOSE To compare the effectiveness of Prevident 5000 Plus (5,000 ppm F) and Colgate Winterfresh Gel (1100 ppm F) to arrest root carious lesions. MATERIALS AND METHODS 201 subjects with at least one root carious lesion were recruited from dental school patients. They were randomly assigned to use either Prevident 5000 Plus (5000 ppm F) or Colgate Winterfresh Gel (1100 ppm F) as sodium fluoride in the same silica base. Measurements of lesion hardness, area, distance from the gingival margin, cavitation and plaque were recorded at baseline and after 3 months by a single examiner. RESULTS After 3 months 38% of subjects using Prevident 5000 Plus and 10% using Winterfresh Gel had one or more lesions that had become hard (P < 0.001). Non-cavitated lesions at baseline were more likely to become hard than cavitated lesions. Compared to the Winterfresh group there was significant increase in the distance from the base of the lesion to the gingival margin and plaque scores were reduced in those using Prevident 5000 Plus.
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Affiliation(s)
- E Lynch
- Dental School, Royal Victoria Hospital, Queen's University, Belfast, Northern Ireland, United Kingdom.
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Baysan A, Whiley R, Wright PS. Use of microwave energy to disinfect a long-term soft lining material contaminated with Candida albicans or Staphylococcus aureus. J Prosthet Dent 1998; 79:454-8. [PMID: 9576322 DOI: 10.1016/s0022-3913(98)70161-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STATEMENT OF PROBLEM Soft lining materials have been found to be more susceptible to microbial adhesion than acrylic resin base materials. Denture hygiene is essential to maintain the serviceability of the denture, and microwave energy has been suggested for denture disinfection. PURPOSE The purpose of this study was to determine the effectiveness of microwave energy in the disinfection of a long-term soft lining material. MATERIAL AND METHODS A long-term soft lining material was contaminated with known microorganisms and the reduction of organism counts after test disinfection regimes calculated. The disinfection regimes were microwaving for 5 minutes, leaving dry overnight, and soaking overnight in a dilute sodium hypochlorite solution. The test microorganisms were Candida albicans or Staphylococcus aureus. RESULTS For both organisms, soaking in sodium hypochlorite reduced the number of viable adherent microorganisms recovered significantly more than exposure to microwave energy, which led to greater reduction than leaving the lining material dry overnight (p < 0.001, Wilcoxon nonparametric signed rank test). CONCLUSION With reference to the tested microorganisms, disinfection of Molloplast-b soft lining material in dilute sodium hypochlorite solution proved to be more effective than exposure to microwave energy, which in turn was more effective than leaving the lining dry overnight.
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Affiliation(s)
- A Baysan
- St. Bartholomew's and the Royal London, School of Medicine and Dentistry, United Kingdom
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Abstract
STATEMENT OF PROBLEM Construction of dentures with permanent soft linings is time-consuming in the laboratory and extra costs are related to equipment and materials used. PURPOSE The purpose of this in vitro study was to determine whether using microwave energy to activate the polymerization of a silicone rubber denture soft lining material affected its properties. MATERIAL AND METHODS Tear energy and adhesive properties were measured in a tensile testing machine by using a pants leg tear test and peel specimens. Tear energy was measured for specimens polymerized conventionally (control) and for 3, 5, and 10 minutes in a microwave. Data were analyzed with one-way analysis of variance and a two-sample Student t test. RESULTS The multiple comparison test failed to show a significant difference in tear energy between 3 minutes microwave activation and conventional heat curing. However, 3 minutes microwave activation revealed a significantly stronger material when compared with 5 minutes and 10 minutes (p < 0.05). Application of a two-sample Student t test failed to demonstrate a significant difference between microwave energy and conventional heat activation groups in the adhesion test. In adhesion testing, all specimens presented cohesive failure. CONCLUSIONS This method of polymerization does not compromise the strength of a soft lining material and its adhesion to polymethyl methacrylate. This study suggests the use of 3 minutes 650 W microwave energy for processing a silicone soft lining material.
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Affiliation(s)
- A Baysan
- Department of Prosthetic Dentistry, St. Bartholomew's and Royal London School of Medicine and Dentistry, United Kingdom
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