The effects of exenatide and insulin glargine treatments on bone turnover markers and bone mineral density in postmenopausal patients with type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) related bone fracture. The effects of glucagon-like peptide-1 receptor analogs for the treatment of T2DM on bone are controversial in human studies. This study aimed to compare the effects of GLP-1 receptor analogs exenatide and insulin glargine treatment on bone turnover marker levels and bone mineral density (BMD) in postmenopausal female patients with T2DM. Thirty female patients with T2DM who were naive to insulin and incretin-based treatments, with spontaneous postmenopause, were randomized to exenatide or insulin glargine arms and were followed up for 24 weeks. BMD was evaluated using dual-energy X-ray absorptiometry and bone turnover markers by serum enzyme-linked immunosorbent assay. The body mass index significantly decreased in the exenatide group compared to the glargine group (P < .001). Receptor activator of nuclear factor kappa-B (RANK) and RANK ligand (RANKL) levels were significantly decreased with exenatide treatment (P = .009 and P = .015, respectively). Osteoprotegerin (OPG) level significantly increased with exenatide treatment (P = .02). OPG, RANK, RANKL levels did not change with insulin glargine treatment. No statistically significant difference was found between the pre- and posttreatment BMD, alkaline phosphatase, bone-specific alkaline phosphatase, and type 1 crosslinked N-telopeptide levels in both treatment arms. Despite significant weight loss with exenatide treatment, BMD did not decrease, OPG increased, and the resorption markers of RANK and RANKL decreased, which may reflect early antiresorptive effects of exenatide via the OPG/RANK/RANKL pathway.

The Effect of Precolonoscopy Lavender Inhalation on Patient Anxiety and Comfort: A Randomized, Controlled, Double-Blinded, Single-Center Study

The purpose of this study was to determine the effect of lavender oil inhalation on the anxiety and comfort levels of patients scheduled for colonoscopy. Seventy-three experimental group patients scheduled for colonoscopy at a training and research hospital in the west of Turkey in June to September 2022 and 72 control group patients were included in this randomized, controlled, prospective study. Minimal sedation (propofol 2-3 mg/kg) was applied in both groups. Lavender inhalation was applied to the experimental group, whereas the control group patients received nursing care (vital sign monitoring, prevention of complications, and rest). The State-Trait Anxiety Inventory and the Shortened General Comfort Questionnaire were used for pre- and postprocedural data collection. Median ages were 53.00 years (47.25-59.00) in the experimental group patients and 51.00 (44.00-59.5) in the control group. Although postprocedural state anxiety scores were lower in the experimental group compared with the control group, the difference was not statistically significant ( p = .069). The general postcolonoscopy comfort score was significantly higher in the experimental group compared with the control group ( p < .001). Trait anxiety scores also increased as the number of colonoscopies increased in both groups. We conclude that lavender oil inhalation, a simple and inexpensive intervention, increases patient comfort while exhibiting a positive, albeit statistically insignificant, effect on anxiety.

The Effect of Ground and Unground Enamel on the Clinical Performance of Direct Composite Build-up After Orthodontic Treatment: Five Years of Follow-up

PURPOSE

To assess the clinical performance of restorations with ground and unground enamel for diastema closure.

METHODS AND MATERIALS

Twenty-four patients attended and received two to ten composite build-ups for diastema closure. The restorations were performed separately by grinding and not grinding the enamel on the proximal surfaces on symmetric teeth. A nanofill direct composite (Filtek Ultimate Universal Restorative System, 3M ESPE, St Paul, MN, USA) was used with a three-step etch-and-rinse adhesive (Scotchbond Multi-Purpose, 3M ESPE) for restorations. Restorations were evaluated according to the modified United States Public Health Service (USPHS) criteria at baseline and 1-, 2-, 3-, 4-, and 5-year recalls.

RESULTS

The cumulative success rate of direct composite build-up with ground and unground enamel was 100% and 88.7%, respectively. Six restorations with unground enamel failed due to fracture. No significant difference was found between the restorations with ground enamel and unground enamel with regard to the evaluation criteria.

CONCLUSION

The 5-year success rates of restorations with ground and unground enamel were excellent. The success rate of restorations with ground enamel was higher than that of restorations with unground enamel. Fracture was the reason for failure in the restorations with unground enamel.

Short-Term Comparison of Clinical Performance of Universal Adhesives with Self-Etch Mode in NCCL Restorations

OBJECTIVES

To evaluate the clinical performance of universal adhesives with self-etch mode regarding their functional monomer and HEMA contents.

METHODS

The study involved 27 patients (108 restorations) aged between 34 and 69 (mean age: 53.8). Each restoration contained one of four different universal adhesives applied in self-etch mode: G-Premio Bond (HEMA-free, MDP and 4-MET containing), Xeno Select (HEMA and MDP-free), Tetric-n-Bond Universal (HEMA and MDP-containing) and Clearfil Universal Bond Quick (HEMA, MDP and amide monomers containing). The restorations were evaluated according to the FDI criteria at baseline, 6, and 12 months. The data were statistically analyzed using Friedman's and Kruskal-Wallis tests for significance in each pair (p⟨0.05).

RESULTS

After 12 months, one restoration was lost in each of the G-Premio Bond and Clearfil Bond Quick groups. The success rate was 96.3% for both adhesives and 100% for Xeno Select and Tetric-n-Bond adhesives. There was no statistically significant difference between the four dentin adhesive groups among all the evaluation periods regarding any evaluation criteria. However, four universal adhesives showed clinically acceptable marginal discoloration and marginal deterioration in a few restorations.

CONCLUSION

Monomer contents of universal adhesives with self-etch mode had no significant effect on the success of restorations.

Investigation of Oral and Fecal Colonization with Candida Species and Associated Factors in Human Immunodeficiency Virus-Infected Children in Turkey

Objective The risk of endogenous infections in human immunodeficiency virus (HIV)-infected individuals increases with Candida species colonized in mouth and intestinal areas. The predisposing factors for colonization and the prevalence of different Candida spp. in HIV-infected Turkish children remain unknown. This study aimed to determine the colonization frequency and risk factors of colonization with Candida species in oral and fecal samples of HIV-infected pediatric patients in relation to a control group.

Methods Oral and feces samples of 22 HIV-infected and 52 healthy children were plated onto CHROMagar and CHROM-Pal-agar. Yeasts were identified by conventional methods, and strains with insufficient identification were identified by molecular techniques.

Results Candida spp. were detected in oral/fecal samples of 50%/68.2% HIV-infected and 36.5%/73.1% healthy children. The most common species was Candida albicans in oral and fecal samples of HIV-infected (31.8 and 31.8%) and healthy (26.9 and 48.1%) children. The most frequently non-albicans species in oral samples was Candida dubliniensis (18.2%) in HIV-infected children and Candida parapsilosis (3.8%) in healthy children. In feces samples, C. parapsilosis, Candida glabrata, and Candida krusei were most frequent (13.6%, each) in HIV-infected patients, and Candida kefyr (11.5%) was most frequent in controls. There was a significant association between oral C. dubliniensis colonization and HIV infection (p = 0.006). Yeast carriage was not associated with gender and viral load in HIV-infected patients.

Conclusion The isolation of C. dubliniensis from oral and fecal samples of pediatric HIV patients was done for the first time in Turkey in the present study. Additional studies are needed to clarify the factors associated with oral and fecal Candida colonization in these children.

Clinical Performance of Direct Posterior Composite Restorations in Patients with Amelogenesis Imperfecta

The objective of this study was to analyze and assess the clinical performance of direct composite restorations using a nanohybrid and a nanofill composite material for posterior teeth in patients with amelogenesis imperfecta (AI). This study involved 15 patients between the ages of 14 and 30 years suffering from amelogenesis imperfecta (AI). During the study, the patients received direct composite restorations using either the Clearfil Majesty ES-2 (Kuraray Medical Inc, Tokyo, Japan) and Clearfil Universal Bond (Kuraray) or Filtek Ultimate Universal Restorative (3M ESPE, St Paul, MN, USA) and Single Bond Universal Adhesive (3M ESPE). The evaluations of the restorations were conducted per the modified USPHS criteria at the time of baseline as well as during the first-, second-, third-, and fourth-year follow-up sessions. After four years, it was observed that the cumulative success rate of direct posterior restorations was 98.1% for Clearfil Majesty ES-2 and 92.2% for Filtek Ultimate. During the study one Clearfil Majesty ES-2 restoration and four Filtek Ultimate restorations failed. There was a significant difference between Clearfil Majesty ES-2 and Filtek Ultimate in the color match in posterior restorations after three and four years. The causes of failure included marginal discoloration and caries, as well as fracture of the restoration. Hence, it can be stated that the use of nanohybrid or nanofill composites in posterior direct restorations in patients with AI looks promising. The failure rate of Clearfil Majesty ES-2 was found to be lower than that of Filtek Ultimate restorations. Clinically, the rate of optimum restorations conducted for partial discoloration, marginal adaptation, color match, and surface texture were observed to be higher when Clearfil Majesty ES-2 was used. However, additional studies are needed to assess the clinical performance of direct posterior composite materials in patients with AI.

Clinical Performance of Direct Posterior Composite Restorations in Patients with Amelogenesis Imperfecta

The objective of this study was to analyze and assess the clinical performance of direct composite restorations using a nanohybrid and a nanofill composite material for posterior teeth in patients with amelogenesis imperfecta (AI). This study involved 15 patients between the ages of 14 and 30 years suffering from amelogenesis imperfecta (AI). During the study, the patients received direct composite restorations using either the Clearfil Majesty ES-2 (Kuraray Medical Inc, Tokyo, Japan) and Clearfil Universal Bond (Kuraray) or Filtek Ultimate Universal Restorative (3M ESPE, St Paul, MN, USA) and Single Bond Universal Adhesive (3M ESPE). The evaluations of the restorations were conducted per the modified USPHS criteria at the time of baseline as well as during the first-, second-, third-, and fourth-year follow-up sessions. After four years, it was observed that the cumulative success rate of direct posterior restorations was 98.1% for Clearfil Majesty ES-2 and 92.2% for Filtek Ultimate. During the study one Clearfil Majesty ES-2 restoration and four Filtek Ultimate restorations failed. There was a significant difference between Clearfil Majesty ES-2 and Filtek Ultimate in the color match in posterior restorations after three and four years. The causes of failure included marginal discoloration and caries, as well as fracture of the restoration. Hence, it can be stated that the use of nanohybrid or nanofill composites in posterior direct restorations in patients with AI looks promising. The failure rate of Clearfil Majesty ES-2 was found to be lower than that of Filtek Ultimate restorations. Clinically, the rate of optimum restorations conducted for partial discoloration, marginal adaptation, color match, and surface texture were observed to be higher when Clearfil Majesty ES-2 was used. However, additional studies are needed to assess the clinical performance of direct posterior composite materials in patients with AI.

The effect of different application modes of a 1-step self-etch adhesive on the clinical performance of Class I composite restorations: A randomized controlled clinical trial

OBJECTIVE

To evaluate the clinical performance of a 1-step self-etch dentin adhesive that was applied according to the manufacturers' recommendations, doubling the adhesive application time and layer in Class I cavities with a composite resin.

MATERIALS AND METHODS

A total of 39 patients aged between 14 and 43 (mean age: 19.1) years were enrolled in the study. Each patient received three restorations. In these three restorations, a 1-step self-etch adhesive was applied according to the manufacturer's recommendations (control group), by doubling the adhesive application time, and with double layers. The restorations were evaluated according to modified USPHS criteria at baseline, and 1, 2, 3, and 4-year recalls.

RESULTS

After 4 years, the success rate was 100% for restorations with the adhesive applied according to the manufacturers' recommendations, 96.9% for restorations applied by doubling the adhesive application time, and 93.8% for restorations applied with double adhesive layers. There was no significant difference between the three application methods among all the evaluation periods regarding the evaluation criteria.

CONCLUSIONS

The 4-year success rates of a 1-step self-etch dentin adhesive that was applied according to the manufacturers' recommendation, by doubling the adhesive application time, and with double layers were excellent.

CLINICAL SIGNIFICANCE

It is not recommended to double the adhesive application time nor apply a double layer of a 1-step self-etch adhesive because it does not improve the clinical performance of Class I composite restorations.

New dermatological findings of MIS-C: Can mucocutaneous involvement be associated with Severe Disease Course?

BACKGROUND

Little is known about mucocutaneous involvement in critically ill patients with the multisystem inflammatory syndrome in children (MIS-C). The aim of our study was to describe the localisation and variety of rash and to investigate whether presenting with rash at admission alters the clinical course of MIS-C.

METHODS

This prospective, observational cohort study was conducted amongst children under 18 years of age who were admitted to our paediatric intensive care unit (PICU) between May 2020 and May 2021 with a possible diagnosis of MIS-C.

RESULTS

A total of 33 children with MIS-C, 21 boys (64%), with a median age of 9.4 years (3.4-11.5) were enrolled. Twenty-four children presented with mucocutaneous symptoms (72%). Age, male gender, PICU length of stay, presenting symptoms, inotrope requirement, the existence of myocarditis or respiratory failure were higher but not significantly different in patients with rash compared to those without rash (P > 0.05). The median duration of symptoms before admission and presence of cervical lymphadenopathy were significantly higher in patients than those without rash (P < 0.05). Children with a rash had a significantly higher neutrophil count, CRP, procalcitonin, troponin levels and lower lymphocyte counts and albumin levels than those without rash (P < 0.05). Twelve children with rash (50%) had symmetrical intertriginous distribution. Two children had erythematous lesions on the areola and the surroundings. In conclusion, intertriginous involvement, periareolar erythema and other mucocutaneous manifestations might be the first alarming symptoms of moderate to severe MIS-C. Therefore, close monitoring with a multidisciplinary approach should be considered for these patients to assess potential disease progression.

The prevalence, clinical features, and related factors of dentin hypersensitivity in the Turkish population

OBJECTIVES

The purpose of this study was to identify the prevalence and predisposing and etiologic factors of dentin hypersensitivity (DH), as well as the demographic characteristics of patients.

MATERIALS AND METHODS

The 1210 patients were examined. The research was based on a two-step investigation: questionnaire and clinical examination. DH was evaluated by the response of the patient to tactile and air-blast stimuli. Loss of attachment and gingival recession of sensitive teeth was measured on the buccal and lingual surfaces. Also, the tooth wear of sensitive teeth was graded on the buccal and lingual surfaces. Comparisons of nonnormally distributed continuous variables were performed using the Mann-Whitney U test and Kruskal-Wallis one-way analysis of variance (ANOVA) and Dunn's post hoc test. Comparisons of categorical variables were performed using Pearson's chi-square, Fisher's exact chi-square, Yates's chi-square, and the Monte Carlo chi-square test.

RESULTS

One hundred twenty-four patients reported DH, showing a prevalence for self-reported DH of 10.2%. Eight hundred forty teeth were diagnosed as having DH, giving a clinical diagnosis rate of DH of 29.4%. Females (76.8%), the 31-40 years age group (26%), housewives (36.8%), and high school education level (38%) had the highest prevalence of DH as demographic properties. A cold stimulus was the most common stimuli trigger for hypersensitivity (97.1%). Occasional pain (55.5%) showed the highest prevalence in terms of frequency of DH. A higher rate of DH was found with the use of medium brushes (47.4%) and brushing twice per day (59.4%) for 1-2 min (56.2%) with the circular method (33.8%) as oral hygiene habits. The buccal surface of the lower right central incisors (5.7%) had the highest prevalence. The most affected teeth by DH were incisors (38.4%). The buccal surfaces (86.3%) of teeth showed a higher high prevalence of DH compared with the lingual surface (52.7%), similar to gingival recession (40.9% vs. 15.7%) and loss of attachment (68.3% vs. 42.6%).

CONCLUSIONS

Clinically diagnosed DH was more common than self-reported DH. Some factors related to patients such as sex (female), the 31-40 years age group, housewives, high school students, using medium brushes, brushing twice per day, and the circular brushing method were more likely to have a risk for DH. Also, buccal surfaces of teeth, gingival recession, and loss of attachment on the buccal surface of teeth should be considered as predisposing factors for DH.

CLINICAL RELEVANCE

To control and prevent DH, clinicians should consider patients' demographics, predisposing factors, and etiologic factors.

COVID-19, Anxiety, and Hopelessness: Quality of Life Among Healthcare Workers in Turkey

The aim of the study is to investigate the effects of intense anxiety and hopelessness experienced by healthcare workers during the pandemic on their quality of life. This cross-sectional, online questionnaire-based study was conducted between August 31, 2020 and October 31, 2020, with 729 healthcare workers in Turkey. The study showed that hopelessness, the weekly working time, fatigue, and the workload of healthcare workers negatively affected their quality of life, those who found the pandemic measures inadequate had a lower quality of life and higher hopelessness levels, and those who needed knowledge on various issues to improve their skills had lower quality of life and higher levels of anxiety and hopelessness. Increasing the measures to make healthcare workers feel competent and ready during the COVID-19 pandemic and meet their information needs to improve their skills will reduce their anxiety and hopelessness and improve their quality of life. Identifying the factors affecting anxiety, hopelessness, and quality of life will help achieve sustainable success in the delivery of health services and promote employee health and safety.

The association between insulin-like growth factor 1 levels within reference range and early postoperative remission rate in patients with Cushing's disease

INTRODUCTION

The relationship between growth hormone (GH)/insulin-like growth factor 1 (IGF-1) and glucocorticoids (GC) was examined in various studies. Long-term GC treatment was shown to decrease GH concentration and, interestingly, to increase IGF-1 concentration. We performed a retrospective study in order to examine how preoperative IGF-1 concentrations vary within the reference range and if tertiles of age- and sex-adjusted normal IGF-1 are predictive for early postoperative remission in the patients with Cushing's Disease (CD).

PATIENTS AND METHODS

Patients diagnosed with CD were retrospectively evaluated. After the exclusion of 67 patients, a final cohort of 250 CD patients were included. Age- and sex-adjusted normal IGF-1 levels were divided into tertiles (T1, T2 and T3). Early postoperative remission was defined as a nadir morning cortisol concentration measured within the first 3 consecutive days following surgery of less than 5 µg/dL (138 nmol/L).

RESULTS

Early postoperative remission rate was the lowest in T1 and highest in T3; 49.1% (n = 28) versus 77.3% (n = 75), p = .001, respectively. Binary logistic regression analysis showed the remission rate in T3 was three times higher than that in T1 (p = .003). Cortisol and ACTH concentration were significantly higher and GH concentrations were significantly lower in T1 compared to those in the other two tertiles.

CONCLUSIONS

As the first study evaluating the correlation between early postoperative remission rate in patients with CD and the tertiles of normal age- and sex-adjusted IGF-1 levels, we have shown that higher IGF-1 levels could predict better outcome in CD.

Evaluation of knowledge, attitudes and practices of health services vocational schools' students with regard to COVID-19

INTRODUCTION

The most critical intervention to control SARS-CoV-2 infection requires appropriate knowledge and attitude towards the virus.

OBJECTIVE

To determine the level of knowledge, attitudes and practices of students of a health services' vocational school with regard to COVID-19.

METHODS

Cross-sectional study carried out between May and June 2020 in a university of the Turkish region. Data were collected through an online survey portal.

RESULTS

Four hundred and fifty-four questionnaires were completed and returned. Students of medical laboratory techniques and first aid and emergency medicine had significantly higher knowledge scores (p < 0.001). More than 43 % of the students (n = 201) used the TV as their main source of information on COVID-19. There was a positive attitude towards preventive measures such as avoiding crowded places and maintaining hand hygiene and social distance.

CONCLUSIONS

Health services vocational school students have good knowledge and positive attitude towards COVID-19. The main sources of information were the TV and social media. For this reason, more attention should be given to these issues in the curriculum in order for science-based information sources to be used.

The effect of Covid-19 on ethical sensitivity

BACKGROUND

In the midst of the Covid-19 pandemic, healthcare workers increasingly encounter serious ethical issues that negatively affect their professionalism.

PURPOSE

The study aims to examine the ethical sensitivity levels of physicians and nurses working in surgical units during the Covid-19 pandemic and the associating factors.

METHOD

The sample of this cross-sectional online questionnaire-based study consists of 161 healthcare workers working at the surgical units in Turkish hospitals. The data were collected using the "Nurse Descriptive Information Form" developed by the researchers and the "Ethical Sensitivity Questionnaire."

ETHICAL CONSIDERATIONS

Approval was granted by the ethics committee. Verbal and written consent was received from the healthcare workers.

RESULTS

Ethical sensitivity in the dimension of conflict was found to be higher in healthcare workers who had ethical issues during the Covid-19 pandemic, who were married, who were nurses, who worked more than 45 h, and who had a work experience of 7-10 years (p < 0.05). Healthcare workers with a family member diagnosed with Covid-19 had high ethical sensitivity in the dimension of conflict (p = 0.008), while those who reported being fully competent and ready (p = 0.038) about Covid-19 were found to have low ethical sensitivity. Besides, those who experienced inadequate supplies (p = 0.045), long working hours (p = 0.038), and problems in asepsis-sterilization (p = 0.046) during the Covid-19 pandemic were found to have low sensitivity in the holistic approach dimension.

CONCLUSION

The study revealed that ethical issues during the Covid-19 pandemic, sociodemographic characteristics, knowledge-skills about Covid-19, and the problems encountered in the work environment during the pandemic affect the ethical sensitivity of healthcare workers in the dimensions of conflict and holistic approach. Therefore, it is recommended that governments and all healthcare workers, and stakeholders in the health system in our country and other countries take action to promote ethical sensitivity in response to the rapidly increasing epidemic by considering the factors that adversely affect ethical sensitivity.

Nurse Stress Scale (NSS): Reliability and validity of the Turkish version

PURPOSE

This study aims to conduct the reliability and validity study of the Turkish version of the Nurse Stress Scale (NSS), which determines the job stress of nurses.

DESIGN AND METHODS

The sample of the methodological study consisted of 349 nurses.

RESULTS

The factor load of the scale was in the appropriate range (0.32-0.79), Cronbach's α was determined as .928, and the item total score correlations ranged between 0.418 and 0.662. The test-retest reliability coefficient was determined to be r = .859.

PRACTICE IMPLICATIONS

The Turkish version of the NSS was evaluated and it was found that it could be used as a valid and reliable measurement tool in Turkish nurses. Health care service providers can use NSS to determine the work stress of nurses.

Patients' and Nurses' Perceptions of the Quality of Nursing Care in Surgical Clinics: A Multicenter Study in Turkey

BACKGROUND

The evaluation of the quality of nursing care by patients and nurses is important for improving care.

PURPOSE

The aim was to determine patients' and nurses' perceptions of the quality of nursing care in surgical clinics and influencing factors.

METHODS

The sample of this cross-sectional, descriptive, and comparative study consisted of 503 surgical patients and 308 surgical nurses. The data were collected between February 2018 and June 2019.

RESULTS

Characteristics of patients such as age, gender, complications, and nursing care scores, and the characteristics of the nurses such as being satisfied with the current clinic, their work experience in the clinic, and the number of daily surgical interventions affected the perceptions of care quality.

CONCLUSIONS

The study revealed that the patients' perceptions of the quality of care were lower than those of nurses, and some factors belonging to the patients and nurses negatively influenced the quality of care.

Does Q-MIX pretreatment improve the dentin bond durability of a two-step self-etch adhesive?

This study aims to analyze and assess the effects of three particular dentin pretreatment solutions on the bond durability of a two-step self-etch adhesive (Optibond XTR) applied to dentin after ageing for 2 years. Thirty-five third molars which were extracted (n = 5 for μTBS, n = 2 for nanoleakage) were divided into five groups: Group 1:Control (no pretreatment), Group 2:17% EDTA, Group 3:2% CHX, Group 4:17% EDTA plus 2% CHX, Group 5: Q-Mix. After the pretreatments of dentin, the dentin adhesive was applied as per the guidelines provided by the manufacturer. Half of the specimens were subjected to μTBS tests for 24 hr, while the remaining half were subjected to the tests after being kept for 2 years in water storage. Also, nanoleakage was evaluated with FE-SEM by examining silver nitrate deposits. The data obtained were evaluated using a two-way analysis of variance and Tukey Post Hoc test. The dentin pretreatments did not affect the 24 hr and 2 years μTBS values for OptiBond XTR. At 24 hr, the EDTA + CHX group (50.3 ± 4.9) showed that the highest μTBS value was obtained. Water ageing significantly reduced the μTBS results and after 2 years the highest μTBS value was obtained from the Q-Mix group (37.7 ± 5.2). Different dentin pretreatments do not alter the 24-hr μTBS and were not able to preserve the bond strength after 2 years of ageing. Q-Mix was able to slow down the regression in the strength of the dentin bond as well as nanoleakage over time.

Utility of fresh egg skin prick test and egg yolk specific immunoglobulin E for outgrowth

BACKGROUND

In children younger than 2 years, studies evaluating the value of skin prick tests (SPTs) and specific immunoglobulin E (sIgE) results to predict persistence or resolution of egg allergy (EA) are limited. In addition, the value of egg yolk (EY) sIgE and fresh egg (FE) SPTs has not been well characterized.

OBJECTIVE

To investigate the optimal decision points (ODPs) for outgrowing allergy with SPTs and sIgE tests for egg allergen preparations.

METHODS

SPTs for FE, egg white (EW), and EY, sIgE tests for EW and EY, and oral food challenges (OFCs) were performed in children with suspected EA. Reactive patients strictly avoided all dietary egg. After 1 year, EA was reevaluated with addition OFCs, SPTs, and sIgE tests.

RESULTS

A total of 81 children (median age, 7 months; age range, 2-24 months) were enrolled. Notably, 4 children with a history of anaphylaxis and 60 of 77 children with a positive challenge result underwent egg elimination. The 1-year follow-up OFC test was performed on 59 children. A total of 27 reacted to egg. No persistent patient had a follow-up SPT result for FE of 4 mm or less (positive predictive values of 100% and negative predictive value of 56% for outgrowth). The diameters of the initial SPT for FE decreased 50% or more in half of the patients who outgrew EA. The ODPs for outgrowing allergy for follow-up sIgE tests for EY and EW were 2.1 kU/L or less (positive predictive value of 86.2%) and 4.0 kU/L or less (positive predictive value of 84.6%), respectively.

CONCLUSION

A SPT diameter for FE of 4 mm or less and sIgE values of 2.1 kU/L or less for EY and 4.0 kU/L or less for EW have a good positive predictive value for outgrowth of EA in children younger than 2 years.

Clinical Performance of Direct Posterior Composite Restorations with and without Short Glass-fiber-reinforced Composite in Endodontically Treated Teeth: 3-year Results

PURPOSE

To evaluate the clinical performance of direct posterior composite restorations with and without short glass-fiber (SGF) reinforced composite in endodontically treated teeth.

MATERIALS AND METHODS

Twenty-four patients (mean age 32.5 years) were included in the study and two molars of each patient received endodontic treatment. After endodontic treatment, one tooth was restored with G-aenial Bond/fiber-reinforced composite (everX Posterior GC) using a microhybrid composite (G-aenial Posterior), and the other tooth was restored with G-aenial Bond/microhybrid composite (G-aenial Posterior). The modified USPHS criteria were used to evaluate the restorations at baseline, 1-, 2-, and 3-year follow-ups.

RESULTS

The success rate of the everX Posterior and G-aenial Posterior restorations after 3 years was 78.3% and 91.3%, respectively. Five everX Posterior restorations and two G-aenial Posterior restorations failed. Based on the criteria used in this study, no significant differences between the two restorations were found at any evaluation time.

CONCLUSION

All restorations showed acceptable clinical performance regarding all evaluation criteria, apart from the failed restorations. The main cause of restoration failure was restoration fracture. The failure rate of everX Posterior restorations was higher than G-aenial Posterior restorations.

Impulse oscillometry reference values and correlation with predictors in Turkish preschool children

Er İ, Günlemez A, Baydemir C, Kılıçbay F, Ersu R, Uyan ZS. Impulse oscillometry reference values and correlation with predictors in Turkish preschool children. Turk J Pediatr 2019; 61: 560-567. Impulse oscillometry (IOS) is a noninvasive, rapid technique requiring passive cooperation that allows for evaluation of lung function through the measurement of airway resistance and reactance. There are no available reference values for Turkish children. This study is aimed to determine the reference values of IOS parameters and to study their correlation with height, weight, body mass index, and age as predictors in healthy Turkish preschool children. Healthy children between 3-7 years of age who were selected according to ERS/ATS criteria and followed at Kocaeli University outpatient clinic performed IOS. The correlation between the anthropometric predictor variables and resistance and reactance at 5-20 hertz (R5-R20 and X5-X20), the respiratory impedance at 5 hertz (Z5), resistance area (AX) and resonance frequency (Fres) were assessed by regression analysis and stepwise method. 151 children (93 female) with the mean age of 67.9±16.2 months participated in the study. Multilinear regression analysis for IOS values of all children revealed that resistance was significantly correlated with height and reactance was significantly correlated with age (p < 0.05). For girls, height had a negative effect on R5-20, Z5, AX values, while age had a positive effect on X5-20 and a negative effect on Fres (p < 0.05). For boys, weight had a negative effect on R5- 20, Z5 values, while age had a positive effect on X15-20 and a negative effect on AX, Fres (p < 0,05). This study provided reference values of IOS in healthy Turkish children that would be a useful guide for diagnosing and following respiratory diseases in preschool children.

Predicting outgrowth of IgE-mediated cow's milk allergy: Diagnostic tests in children under two years of age

BACKGROUND

Limited studies conducted on children <2 years old and/or involving a skin prick test (SPT) for fresh milk (FM) have examined the predictive value of allergometric tests for outgrowth of cow's milk allergy (CMA). We investigated the optimal decision points for outgrowth (ODP^fo) with SPT for commercial cow's milk extract (CE) and FM and specific immunoglobulin E (sIgE) levels for milk proteins to predict outgrowing allergy in children <2 years old.

METHODS

SPTs for CE and FM, tests for sIgEs (cow's milk, casein, α-lactoalbumin, β-lactoglobulin) and oral food challenges (OFC) were performed in children referred for evaluation of suspected CMA, and 15 months after diagnosis.

RESULTS

Fifty-one children (median age, 7.5 months; range, 2-23 months) were enrolled. Five had a history of anaphylaxis and 26 of 48 children with a positive initial challenge underwent milk elimination. The last OFC was performed in 28 children of whom 13 reacted to milk. The initial SPT responses to CE and FM and milk sIgE levels of the patients with persistent CMA were higher at diagnosis, with ODP^fo of 7mm, 9mm, and 10.5kU/L, respectively; these values remained higher with ODP^fo of 4mm, 11mm, and 10.5kU/L at the last OFC.

CONCLUSION

Higher initial SPTs for FM and CE and higher initial sIgE levels for cow's milk proteins are associated with a reduced likelihood of outgrowth. Initial milk sIgE level <10.5kU/L and initial SPT for fresh milk <9mm are related to the acquisition of tolerance in the follow-up period.

Bendopnea and Its Clinical Importance in Outpatient Patients with Pulmonary Arterial Hypertension

Purpose

Bendopnea is a recently reported novel symptom in patients with heart failure (HF) defined as shortness of breath when bending forward. It has been demonstrated that bendopnea is associated with advanced symptoms and worse outcomes. The aim of this study was to assess the presence of bendopnea and its clinical importance with regards to functional status, hemodynamic and echocardiographic characteristics in outpatient pulmonary arterial hypertension (PAH) patients.

Methods

We conducted this prospective observational study of 53 patients who were admitted to our PAH clinic for routine control visits. We determined the presence of bendopnea and analyzed hemodynamic parameters, World Heart Organization (WHO) functional class, transcutaneous oxygen saturation, 6-minute walking distance (6-MWD), N-terminal pro-brain natriuretic peptide (NT-proBNP) and right ventricular (RV) function indicators in patients with and without bendopnea.

Results

Bendopnea was present 33.9% of the PAH patients. The mean age was higher in the patients with bendopnea than in those without bendopnea, but the difference was not significant (p = 0.201). The patients with bendopnea had a lower 6-MWD and higher NT-proBNP level (p < 0.001), and worse WHO functional class symptoms (p = 0.010). Mean right atrial pressure, pulmonary artery pressure, and pulmonary vascular resistance were higher in the patients with bendopnea. The patients with bendopnea had a more dilated RV end-diastolic diameter and lower tricuspid annular plane systolic excursion value (p < 0.001 and p = 0.001, respectively).

Conclusions

Bendopnea was associated with worse functional capacity status, hemodynamic characteristics and RV function in our outpatient PAH patients.

Role of hepcidin in the diagnosis of sepsis and septic shock in children

Background/aim: The purpose of this study is to compare the diagnostic value of hepcidin level with the white blood cell (WBC), C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6) levels in pediatric sepsis and septic shock. Materials and methods: A cohort of 89 individuals were divided into four groups: a healthy control group (HCG, n = 28), pediatric intensive care unit control group (PICUCG, n = 17), sepsis group (SG, n = 23), and septic shock group (SSG, n = 21). WBC, CRP, PCT, IL-6, and hepcidin levels were studied in the PICUCG, SG, and SSG, while hepcidin and IL-6 levels were studied in the HCG. Results: In distinguishing the SG and SSG from the HCG, hepcidin sensitivity and specificity were found to be 100%. Distinguishing between the PICUCG and the SG, hepcidin sensitivity was calculated as 95.6% and specificity was calculated as 100%. The sensitivity of WBC, CRP, and PCT was lower than that of hepcidin, but the sensitivity of IL-6 was higher than that of hepcidin. While the specificity of PCT and IL-6 was the same as hepcidin, the specificity of WBC and CRP was lower than that of hepcidin. Conclusion: Hepcidin is a more reliable indicator than WBC and CRP levels in distinguishing children with sepsis and septic shock from healthy children and nonseptic pediatric ICU patients.

Five-year Clinical Evaluation of a Nanofilled and a Nanohybrid Composite in Class IV Cavities

The purpose of this study was to evaluate a nanofilled and a nanohybrid composite, in combination with manufacturer-recommended etch-and-rinse adhesives, in class IV cavities. Thirty-four patients aged 14-46 years (mean age, 27.1 years) comprised the study group. Twenty-six patients received two class IV restorations and eight patients received four class IV restorations. For each patient, half the number of restorations were performed using a nanohybrid composite (Ceram X duo) and the remaining half used a nanofilled resin composite (Filtek Supreme XT), with two- (XP Bond) and three-step (Scotchbond Multipurpose) etch-and-rinse adhesives, respectively. Two experienced examiners evaluated the restorations for retention, color match, marginal discoloration, wear/loss of anatomic form, caries formation, marginal adaptation, and surface texture to compare the baseline (after placement) and annual recalls over 5 years. The cumulative success rates for the Filtek Supreme XT and Ceram X duo restorations after five years were 86.2% and 89.7%, respectively. Four Filtek Supreme XT and three Ceram X duo restorations failed. There was no statistically significant difference between the nanofilled and nanohybrid composites at any of the evaluation periods for any of the parameters evaluated. Despite the limited number of restorations, all restorations were clinically acceptable regarding retention, color match, marginal discoloration, wear or loss of anatomic form, the formation of caries, marginal adaptation, and surface texture, except the failed restorations. Fracture was the main cause of restoration failure.

Epidemiology of sepsis in intensive care units in Turkey: a multicenter, point-prevalence study

BACKGROUND

The prevalence and mortality of sepsis are largely unknown in Turkey, a country with high antibiotic resistance. A national, multicenter, point-prevalence study was conducted to determine the prevalence, causative microorganisms, and outcome of sepsis in intensive care units (ICUs) in Turkey.

METHODS

A total of 132 ICUs from 94 hospitals participated. All patients (aged > 18 years) present at the participating ICUs or admitted for any duration within a 24-h period (08:00 on January 27, 2016 to 08:00 on January 28, 2016) were included. The presence of systemic inflammatory response syndrome (SIRS), severe sepsis, and septic shock were assessed and documented based on the consensus criteria of the American College of Chest Physicians and Society of Critical Care Medicine (SEPSIS-I) in infected patients. Patients with septic shock were also assessed using the SEPSIS-III definitions. Data regarding demographics, illness severity, comorbidities, microbiology, therapies, length of stay, and outcomes (dead/alive during 30 days) were recorded.

RESULTS

Of the 1499 patients included in the analysis, 237 (15.8%) had infection without SIRS, 163 (10.8%) had infection with SIRS, 260 (17.3%) had severe sepsis without shock, and 203 (13.5%) had septic shock. The mortality rates were higher in patients with severe sepsis (55.7%) and septic shock (70.4%) than those with infection alone (24.8%) and infection + SIRS (31.2%) (p < 0.001). According to SEPSIS-III, 104 (6.9%) patients had septic shock (mortality rate, 75.9%). The respiratory system (71.6%) was the most common site of infection, and Acinetobacter spp. (33.7%) were the most common isolated pathogen. Approximately, 74.9%, 39.1%, and 26.5% of Acinetobacter, Klebsiella, and Pseudomonas spp. isolates, respectively, were carbapenem-resistant, which was not associated with a higher mortality risk. Age, acute physiology and chronic health evaluation II score at ICU admission, sequential organ failure assessment score on study day, solid organ malignancy, presence of severe sepsis or shock, Candida spp. infection, renal replacement treatment, and a nurse-to-patient ratio of 1:4 (compared with a nurse-to-patient ratio of 1:2) were independent predictors of mortality in infected patients.

CONCLUSIONS

A high prevalence of sepsis and an unacceptably high mortality rate were observed in Turkish ICUs. Although the prevalence of carbapenem resistance was high in Turkish ICUs, it was not associated with a higher risk for mortality.

TRIAL REGISTRATION

ClinicalTrials.gov ID NCT03249246 . Date: August 15, 2017. Retrospectively registered.

A simple discharge risk model for predicting 1-year mortality in hospitalised acute decompansated heart failure patients with reduced ejection fraction

OBJECTIVE

The risk stratification for prognosis in heart failure is very important for optimal disease management and decision making. The aim of this study was to establish a simple discharge 1-year mortality prediction model by integrating data obtained from demographic characteristics, clinical evaluation, laboratory biomarkers and echocardiographic evaluation of hospitalised heart failure with reduced ejection fraction (HFrEF) patients with acute decompensation.

METHODS AND RESULTS

A risk score model was developed based on β-coefficient number of variables in a multivariable logistic regression model which was created with the use of data on clinical, laboratory, imaging and therapeutic findings of 670 patients (65.4% males, 65 ± 11 years) who was hospitalised with acute decompensated HFrEF. The mean left ventricular ejection fraction (LVEF) was 26 ± 9%. Independent predictors of mortality were: age ≥75 years, sodium <130 mEq/L, hepatomegaly at admission, unable to use beta-blocker at discharge and LVEF ≤20%. The 1-year mortality rate was 7.8% in the study population. The existence of each predictor was scored as 1 point and the discharge risk score identified patients into low (0-1 points), intermediate (2-3 points) and high (4-5 points) risk individuals with 3, 15.6 and 44.4% 1-year mortality rates, respectively. The model performance evaluated by concordance index was 0.74.

CONCLUSIONS

This simple discharge risk score model for hospitalised acute decompensated HFrEF patients using easily determined demographic characteristics, clinical signs, echocardiographic and laboratory data is a valuable and an easy risk assessment tool to use at point-of-care.

Evaluation of adherence to Mediterranean diet in medical students at Kocaeli University, Turkey

Introduction This study was conducted to evaluate the eating habits of medical students at Kocaeli University in northwest Turkey in terms of their ability to apply their academic knowledge regarding healthy lifestyles to their own lives using the Mediterranean Diet Quality Index (KIDMED). Methods In this cross-sectional study, a questionnaire including demographic information and the KIDMED index was administered to 354 medical school students (206 first-year and 148 third-year students). The students' sex, body mass index, KIDMED score, place of residence, smoking habit, media screen time, and regular exercising variables were evaluated. Results The KIDMED score was -2 to 8 (3.8 ± 1.9) among all students, -1 to 8 (3.9 ± 2.0) among first-year students, and -1 to 8 (3.6 ± 1.9) among third-year students. In total, 59.1% of females and 40.9% of males among first-year students showed moderate adherence to the Mediterranean diet, and female students showed better adherence to the Mediterranean diet than males among third-year students. Conclusion Medical students at Kocaeli University in Turkey showed inadequate application of their academic knowledge about healthy living to their own lives.

Microtensile Bond Strength of CAD/CAM Resin Blocks to Dual-Cure Adhesive Cement: The Effect of Different Sandblasting Procedures

PURPOSE

To investigate the effect of sandblasting powder particles on microtensile bond strength (μTBS) of dual-cure adhesive cement to CAD/CAM blocks.

MATERIALS AND METHODS

CAD/CAM blocks (Cerasmart, VITA, and LAVA) were cut in slabs and divided into groups: group 1, no sandblasting; group 2, sandblasted with 27-μm Al₂ O₃ ; group 3, sandblasted with 30-μm CoJet; group 4, sandblasted with 50-μm Al₂ O₃ . After sandblasting, all specimens were silanized and luted using dual-cure adhesive cement (G-CEM LinkForce). After 24 hours, bonded specimens were cut into 1 ± 0.2 mm² sticks, and μTBS values were obtained (N = 30). Additionally, 132 CAD/CAM block sections were prepared for surface roughness testing and scanning electron microscopy (SEM) evaluations. Results were analyzed using Kruskal-Wallis One-way ANOVA and Dunn's Post Hoc Test (p < 0.05).

RESULTS

Group 1 exhibited significantly lower μTBS than the other groups (p < 0.05). The highest bond strength values were obtained from group 4 (p > 0.05). For LAVA, μTBS values of specimens that were sandblasted with 50-μm Al₂ O₃ powder were significantly higher than 30-μm-SiO₂ and 27-μm Al₂ O₃ (p < 0.05).

CONCLUSIONS

The sand particles investigated (27-μm Al₂ O₃ , 30-μm SiO₂ , or 50-μm Al₂ O₃ ) did not significantly affect μTBS results of CAD/CAM blocks for Cerasmart and VITA, although the results changed significantly for LAVA. The ideal bond protocol for CAD/CAM blocks is specific to the material used.

Predictors of Long-Term Mortality and Frequent Re-Hospitalization in Patients with Acute Decompensated Heart Failure and Kidney Dysfunction Treated with Renin-Angiotensin System Blockers

Background

Assessment of risk for all-cause mortality and re-hospitalization is an important task during discharge of acute heart failure (AHF) patients, as they warrant different management strategies. Treatment with optimal medical therapy may change predictors for these 2 end-points in AHF patients with renal dysfunction. The aim of this study was to evaluate the predictors for long-term outcome in AHF patients with kidney dysfunction who were discharged on optimal medical therapy.

Material/Methods

The study was conducted retrospectively. The study group consisted of 225 AHF patients with moderate-to-severe kidney dysfunction, who were hospitalized at Kocaeli University Hospital Cardiology Clinic and who were prescribed beta-blockers and ACE-inhibitors or angiotensin II receptor blockers at discharge. Clinical, echocardiographic, and biochemical predictors of the composite of total mortality and frequent re-hospitalization (≥3 hospitalizations during the follow-up) were assessed using Cox regression and the predictors for each end-point were assessed by competing risk regression analysis.

Results

Incidence of all-cause mortality was 45.3% and frequent readmissions were 49.8% in a median follow-up of 54 months. The associates of the composite end-point were age, NYHA class, respiration rate on admission, eGFR, hypoalbuminemia, mitral valve E/E’ ratio, and ejection fraction. In competing risk regression analysis, right-sided HF, hypoalbuminemia, age, and uric acid appeared as independent associates of all-cause mortality, whereas NYHA class, NT-proBNP, mitral valve E/E’ ratio, and uric acid were predictors for re-hospitalization.

Conclusions

Predictors for all-cause mortality in AHF with kidney dysfunction treated with optimal therapy are mainly related to advanced HF with right-sided dysfunction, whereas frequent re-hospitalization is associated with volume overload manifested by increased mitral E/E’ ratio and NT-proBNP levels.

Clinical Performance of Different Solvent-based Dentin Adhesives With Nanofill or Nanohybrid Composites in Class III Restorations: Five Year Results

Purpose:

To evaluate the clinical performance of water, acetone, ethanol, and ethanol-water solvent-based dentin adhesives with nanofill or nanohybrid composites in Class III restorations.

Methods and Materials:

A total of 22 patients aged between 14 and 48 years (mean age: 25.2 years) participated in the study. Each patient received four Class III restorations, which were performed using water (Scotchbond Multipurpose), acetone (Prime&Bond NT), ethanol (XP Bond) and ethanol-water (Xeno V) solvent-based dentin adhesive systems with a nanofill (Filtek Supreme XT) or nanohybrid composite (CeramX Duo). Two experienced examiners evaluated the restorations with regard to retention, color match, marginal discoloration, wear/loss of anatomic form, caries formation, marginal adaptation, and surface texture at baseline and at one-, two-, three-, four-, and five-year recalls.

Results:

The five-year survival rates were 100% for Scotchbond Multipurpose, Prime&Bond NT, and XP Bond and 81.2% for Xeno V–bonded restorations. Only three Xeno V–bonded restorations failed. With the exception of marginal discoloration, there were no statistically significant differences among the four adhesive-bonded restorations in any of the evaluation periods in terms of the evaluation criteria.

Conclusions:

With the exception of marginal discoloration and marginal integrity deterioration of Xeno V–bonded restorations, all four adhesive-bonded restorations exhibited good long-term results. However, adhesion strategy (such as self-etch or etch-and-rinse) is more important than the solvent content of dentin adhesive systems in the success of Class III restorations.

Evaluation of pulmonary functions in preschool children born late-preterm

AIM

The aim of this study was to evaluate the pulmonary functions of preschool children born late-preterm.

MATERIAL AND METHODS

Children aged between 3-7 years who were born at 340/7-366/7 weeks' gestation represented the target sample. Patients with a diagnosis of congenital cardiac, pulmonary and/or muscle diseases were excluded. Respiratory symptoms were evaluated using the modified asthma predictive index and International Study of Asthma and Allergies in Childhood criteria for children aged under and over 6 years, respectively. Skin prick tests were performed. Age-matched healthy controls were chosen according to the criteria proposed by the American Thoracic Society. Lung functions were evaluated using impulse oscillometry study in both groups. Data were recorded in the SPSS program.

RESULTS

A total of 139 late-preterms and 75 healthy controls participated in the study. The mean gestational week of the late-preterms was 35.3±0.9 weeks. The main admission diagnosis to neonatal intensive care unit was respiratory distress. In the postdischarge period, 54.1% were hospitalized for pulmonary infections at least once, and 57.8% were passive smoking currently. Aeroallergen sensitivity was detected as 25.8% in the late-preterm group; 34.5% and 15.1% were diagnosed as having asthma and non-asthmatic atopy, respectively. Impulse oscillometry study parameters of R5, R10, and Z5 were higher and X10 and X15 were lower in late-preterms than in controls (p<0.05). Late-preterms with and without respiratory distress in the postnatal period revealed no statistical differences for any parameters.

CONCLUSIONS

Our findings suggest that presence of increased peripheral airway resistance in late-preterms as compared to term-born controls.

Efficiacy of resveratrol and quercetin after experimental spinal cord injury

BACKGROUND

The aim of this study was to investigate the effect of natural antioxidants resveratrol and quercetin on oxidative stress and secondary cell damage in rats with acute spinal cord injury.

METHODS

In this experimental study, 42 male Sprague-Dawley rats were used. Spinal cord injury was performed with clip compression method at level of T4-5. The study was conducted using 6 groups: control, trauma, trauma and solvent, trauma and resveratrol, trauma and quercetin, and trauma with combined resveratrol and quercetin. All rats were euthanized 48 hours after the procedure. Effects of resveratrol and quercetin on serum and tissue total antioxidant capacity and paraoxanase activity level were examined.

RESULTS

Compared to trauma group, there was a significant increase in total antioxidant capacity and paraoxanase activity level in resveratrol, quercetin, and combined treatment groups. There was no significant difference between resveratrol and quercetin groups with regard to total antioxidant capacity and paraoxanase activity level. Total antioxidant capacity and paraoxanase activity level were significantly higher in solvent group than trauma group. In histopathological evaluation, there was a decrease in polymorphonuclear leukocyte infiltration in solvent, resveratrol, quercetin, and combined treatment groups.

CONCLUSION

Biochemical and histological staining results of present study showed that resveratrol and quercetin may be effective in preventing secondary damage in spinal cord injury.

Neutrophil gelatinase-associated lipocalin is a better biomarker than cystatin C for the prediction of imminent acute kidney injury in critically ill patients

Aims The prevention of acute kidney injury can be lifesaving for the intensive care unit patients. However, conventional methods are not sufficient for the prediction of the risk of future acute kidney injury. In this study, the promising biomarker, neutrophil gelatinase-associated lipocalin, was compared with cystatin C as an indicator for the risk of future acute kidney injury. Methods One hundred and eighty-three adult patients without chronic kidney disease or renal replacement therapy were included in this study. The plasma and urine concentrations of neutrophil gelatinase-associated lipocalin and cystatin C were assessed on the second day after intensive care unit admission and were followed for seven days to monitor the development of acute kidney injury. Acute kidney injury diagnosis was based on the risk, injury, failure, loss, end-stage renal failure criteria. Results Thirty-four per cent of the patients had acute kidney injury; 17 patients who did not fulfil criteria at the beginning, developed acute kidney injury from days 3 to 7 after admission. The mean serum creatinine on admission did not significantly differ between this and control groups (0.72 ± 0.20 and 0.83 ± 0.21; P = 0.060); however, the serum and urinary neutrophil gelatinase-associated lipocalin concentrations on the second day were significantly different (median: 75.69 [54.18-91.18] and 123.68 [90.89-166.31], P = 0.001; and median: 17.60 [8.56-34.04] and 61.37 [24.59-96.63], P = 0.001). Notably, the 48-h serum cystatin C concentration did not differ. Conclusion Neutrophil gelatinase-associated lipocalin concentrations in the urine and serum on the second day of intensive care unit admission could be used to predict the development of acute kidney injury in the following three to seven days in the intensive care unit; however, the cystatin C concentration did not have predictive value.

Effectiveness of GFAP in Determining Neuronal Damage in Rats with Induced Head Trauma

AIM

To determine whether the serum level of glial fibrillary acidic protein (GFAP), an important indicator of neuron damage, correlates with the extent of tissue damage in the rat with induced head trauma and to obtain data in order to avoid unnecessary cranial computed tomography analyses.

MATERIAL AND METHODS

Three-month-old male Sprague-Dawley rats were used. Rats were divided into 5 groups. The experimental head trauma model was examined in five groups (n=8) as follows: The control group had no intervention; Group 1: Head trauma was induced by dropping a 25 mg ball from a height of 20 cm; Group 2: Head trauma was induced by dropping a 50 mg ball from a height of 20 cm; Group 3: Head trauma was induced by dropping a 50 mg ball from a height of 80 cm; Group 4: Head trauma was induced by dropping a 100 mg ball from a height of 80 cm. Thus, according to the Newton's Law, respectively 0.05, 0.1, 0.2 and 0.4 N trauma was created. Serum GFAP levels were analyzed and the damage to cerebral tissues was evaluated in all groups.

RESULTS

We determined that number of apoptotic cells and particularly the number of GFAP (+) protoplasmic astrocytes at the perilesional region of the cortex increased in association with the increased serum GFAP level as long as the severity of the trauma increased.

CONCLUSION

Serum GFAP concentration can be used as a marker of the severity of head trauma and traumatic brain injury. However, more animal studies are required to reflect this result in clinical practice.

The effect of double-coating and times on the immediate and 6-month dentin bonding of universal adhesives

OBJECTIVE

The purpose of this study was to evaluate the effect of double-application coats and times on microtensile bond strength (μTBS) and adhesive-dentin interfaces created by dentin adhesive systems after 6 months of storage in water.

MATERIALS AND METHODS

Two-hundred sixteen extracted non-carious human third molars were selected for the study. Single-Bond Universal (SU) and All-Bond Universal (AU), Adper Easy One (Eo) Self-Etch adhesive and Adper Single-Bond 2 (Sb) etch-and-rinse adhesive were applied to a flat dentin surface using three methods (1): dentin adhesives were applied as recommended by the manufacturers; (2): two consecutive coats of dentin adhesives were applied before photo-polymerization; and (3): a single coat of adhesive was applied but with twice the manufacturers recommended application time. Microtensile bond strength was determined either immediately or after 6 months of water storage. Data were analyzed using one-way analysis of variance and Tukey's post-hoc tests.

RESULTS

At 24 h, groups 1, 2, and 3 exhibited statistically similar results for all dentin adhesive systems. For AU-Er, group 3 showed significantly higher bond strength than all group of AU-Se after 6 months.

CONCLUSION

Universal adhesives seemed more stable against water degradation than traditional two-step etch-and-rinse and all-in-one systems within the 6-month period.

Childhood urinary tract infection caused by extended-spectrum β-lactamase-producing bacteria: Risk factors and empiric therapy

BACKGROUND

This study investigated risk factors of childhood urinary tract infection (UTI) associated with extended-spectrum β-lactamase (ESBL)-producing bacteria (ESBL-positive UTI) and evaluated antimicrobial resistance as well as empiric treatment of childhood UTI.

METHODS

The records of children with positive urine culture between 1 January 2008 and 31 December 2012 were evaluated. Patients with positive urine culture for ESBL-producing bacteria were defined as the ESBL-positive group, whereas patients of the same gender and similar age with positive urine culture for non-ESBL-producing bacteria were defined as the ESBL-negative group. Each ESBL-positive patient was matched with two ESBL-negative patients.

RESULTS

The ESBL-positive and negative groups consisted of 154 and 308 patients, respectively. Potential risk factors for ESBL-positive UTI were identified as presence of underlying disease, clean intermittent catheterization (CIC), hospitalization, use of any antibiotic and history of infection in the last 3 months (P < 0.05). On logistic regression analysis, CIC, hospitalization and history of infection in the last 3 months were identified as independent risk factors. In the present study, 324 of 462 patients had empiric therapy. Empiric therapy was inappropriate in 90.3% of the ESBL-positive group and in 4.5% of the ESBL-negative group. Resistance to nitrofurantoin was similar between groups (5.1% vs 1.2%, P = 0.072); resistance to amikacin was low in the ESBL-positive group (2.6%) and there was no resistance in the ESBL-negative group.

CONCLUSIONS

Clean intermittent catheterization, hospitalization and history of infection in the last 3 months should be considered as risk factors for ESBL-positive UTI. The combination of ampicillin plus amikacin should be taken into consideration for empiric therapy in patients with acute pyelonephritis who have the risk factors for ESBL-positive UTI. Nitrofurantoin seems to be a logical choice for the empiric therapy of cystitis.

Evaluation of Dentin Defect Formation during Retreatment with Hand and Rotary Instruments: A Micro-CT Study

The purpose of this study was to compare the incidence and longitudinal propagation of dentin defects after gutta-percha removal with hand and rotary instruments using microcomputed tomography. Twenty mandibular incisors were prepared using the balanced-force technique and scanned in a 19.9 μm resolution. Following filling with the lateral compaction technique, gutta-percha was removed with ProTaper Universal Retreatment (PTUR) or hand instruments. After rescanning, a total of 24,120 cross-sectional images were analyzed. The numbers, types, and longitudinal length changes of defects were recorded. Defects were observed in 36.90% of the cross sections. A total of 73 defects were comprised of 87.67% craze lines, 2.73% partial cracks, and 9.58% fractures. No significant difference in terms of new defect formation was detected between the retreatment groups. The apical and middle portions of the roots had more dentin defects than the coronal portions. Defects in three roots of the PTUR instrument group increased in length. Under the conditions of this in vitro study, gutta-percha removal seemed to not increase the incidence of dentin defect formation, but the longitudinal defect propagation finding suggests possible cumulative dentinal damage due to additional endodontic procedures. Hand and rotary instrumentation techniques caused similar dentin defect formation during root canal retreatment.

Evaluation of children with cystic fibrosis by impulse oscillometry when stable and at exacerbation

BACKGROUND

Pulmonary function tests are important in the diagnosis and follow-up of airway disease in cystic fibrosis (CF). Conventional spirometry for which repeated forced expiration maneuver are needed is considered as the main method. Impulse oscillometry (IOS) is a non-invasive method, which needs minimal cooperation. We performed a prospective cross-sectional study to determine the pulmonary function in CF children with IOS, and evaluate the IOS measurements during acute exacerbation. We hypothesized that IOS can detect lung function impairment in CF patients and detect changes during acute exacerbations.

METHODS

CF patients aged 3-18 years were included as the study group and healthy children of the same age formed the control group. The patients were evaluated three times at 3-month intervals. Patients aged >6 years performed both spirometry and IOS while patients aged ≤6 years performed only IOS. In patients with acute exacerbation, spirometry and IOS were performed both at and after the exacerbation.

RESULTS

Forty-nine CF patients and 45 healthy children were enrolled to the study. Sixteen patients were admitted with acute exacerbation during the study. The resistance values (R5-10-15-20 Hz) as well as Z5, Fres, and AX values of the patients were higher than those of the control group, while reactance values (X5-10-15-20 Hz) were lower. R values as well as Z5, Fres, and AX values increased during exacerbation and decreased after treatment; X (10-15 Hz) values decreased during exacerbation and increased after recovery (P < 0.05).

CONCLUSIONS

IOS may be useful to evaluate pulmonary functions and detect acute exacerbations in CF patients. Pediatr Pulmonol. 2016;51:1151-1158. © 2016 Wiley Periodicals, Inc.

The predictive factors for remission of chronic spontaneous urticaria in childhood: Outcome from a prospective study

BACKGROUND

There are few studies in children on the natural course of chronic spontaneous urticaria (CSU) because of its relative infrequency in childhood.

OBJECTIVE

To estimate the rate of remission and evaluate the prognostic factors in children with CSU.

METHOD

A total of 52 children with CSU were prospectively followed over a period of three years.

RESULTS

The remission rates at 12 months and 36 months were 32.7% and 48.1%. The mean duration of disease at the first visit in the non-remission group was higher than in the remission group at the end of the study (P=0.016). The remission rate of the patients who had been treated by standard dose antihistamine was higher than that of the patients who had been treated with the high-dose antihistamine and combination medications (P=0.004, P<0.001). The treatment steps were independent prognostic factors for remission by logistic regression analysis.

CONCLUSION

Our study indicates that urticaria controlled by a standard dose of antihistamine can predict a good prognosis independently from disease duration at first visit.

The relationship between neutrophil/lymphocyte and platelet/lymphocyte ratios with oxidative stress in active Crohn's disease patients

BACKGROUND

This study investigated the relationship between the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) values with oxidative stress in active Crohn's disease (CD) patients. We investigated whether these parameters were useful for follow-up assessments of CD activity.

METHODS

Forty-nine patients with a confirmed diagnosis of CD (24 active and 25 inactive) and 38 control subjects were enrolled in the study. We measured serum activity of superoxide dismutase (SOD) using an enzyme-linked immunosorbent assay (ELISA) and malondialdehyde (MDA) levels using a spectrophotometric method. Neutrophil, lymphocyte and platelet counts were recorded, and the NLR and PLR values were calculated from these parameters.

RESULTS

Patients with active CD exhibited significantly higher serum levels of MDA (p =0.007), NLR (p =0.034), and PLR (p =0.026) than inactive CD patients. Receiver operating characteristic (ROC) curve analysis demonstrated that the optimum cut-off values of MDA, NLR, and PLR based on the differences between active and inactive patients were 0.14 µmol/L, 2.58, and 192.26, respectively. The NLR value increased in active patients with elevated MDA levels as a dependent variable (B: 0.422, p =0.029).

CONCLUSIONS

We suggest the use of MDA, PLR, and NLR values as a noninvasive test to evaluate disease activity in CD patients. NLR values may also reflect the presence of oxidative stress, and this value may be efficient and useful in determining CD activity. Hippokratia 2016, 20(4): 268-273.

Violence against emergency department employees and the attitude of employees towards violence

INTRODUCTION

This study was conducted to evaluate the occurrence of violent incidents in the workplace among the various professional groups working in the emergency department. We characterised the types of violence encountered by different occupation groups and the attitude of individuals working in different capacities.

METHODS

This cross-sectional study included 323 people representing various professional groups working in two distinct emergency departments in Turkey. The participants were asked to complete questionnaires prepared in advance by the researchers. The data were analysed using the Statistical Package for the Social Sciences (Windows version 15.0).

RESULTS

A total of 323 subjects including 189 (58.5%) men and 134 (41.5%) women participated in the study. Their mean (± standard deviation) age was 31.5 ± 6.5 years and 32.0 ± 6.9 years, respectively. In all, 74.0% of participants had been subjected to verbal or physical violence at any point since starting employment in a medical profession. Moreover, 50.2% of participants stated that they had been subjected to violence for more than 5 times. Among those who reported being subjected to violence, 42.7% had formally reported the incident(s). Besides, 74.3% of participants did not enjoy their profession, did not want to work in the emergency department, or would prefer employment in a non-health care field after being subjected to violence. According to the study participants, the most common cause of violence was the attitude of patients or their family members (28.7%). In addition, 79.6% (n=257) of participants stated that they did not have adequate safety protection in their working area. According to the study participants, there is a need for legal regulations to effectively deter violence and increased safety measures designed to reduce the incidence of violence in the emergency department.

CONCLUSION

Violence against employees in the emergency department is a widespread problem. This situation has a strong negative effect on employee satisfaction and work performance. In order to reduce the incidence of violence in the emergency department, both patients and their families should be better informed so they have realistic expectations as an emergency patient, deterrent legal regulations should be put in place, and increased efforts should be made to provide enhanced security for emergency department personnel. These measures will reduce workplace violence and the stress experienced by emergency workers. We expect this to have a positive impact on emergency health care service delivery.

Neutrophil gelatinase-associated lipocalin levels during the first 48 hours of intensive care may indicate upcoming acute kidney injury

PURPOSE

The recognition of acute kidney injury (AKI) as early as possible is important in the intensive care unit. This study proposes that serum and urine levels of neutrophil gelatinase-associated lipocalin (NGAL) may be used for this purpose.

METHODS

One hundred and seven critically ill adult patients with no previous renal failure were included. NGAL levels were measured during the first 48 hours after admission; NGAL levels were followed for 7 days and classified based on Risk, Injury, Failure, Loss, and End-Stage Renal Failure criteria.

RESULTS

The AKI incidence was 35.5%, and serum NGAL (sNGAL) and urinary NGAL (uNGAL) levels were higher in the AKI group. The area under the receiver operating characteristic curve was 0.76 (P<.001) for sNGAL and 0.75 (P<.001) for uNGAL. Seventy-one percent of AKI cases were observed within 48 hours, with 11 additional cases in the ensuing 7 days. The mean serum creatinine levels in the 11 patients were not different from non-AKI levels (P=.197), but the NGAL values were different, and the area under the receiver operating characteristic curve for sNGAL uNGAL was 1.00 (P=.014) and 0.93 (P=.02), respectively.

CONCLUSIONS

Most AKI cases were diagnosed within the first 48 hours after admission, and NGAL was useful for predicting upcoming AKI.

Evaluation of lung function on impulse oscillometry in preschool children born late preterm

BACKGROUND

There is a paucity of data on lung physiology in late-preterm children, who may be exposed to a risk of decline in lung function during childhood. In this study, we evaluated lung function in preschool children born late preterm using impulse oscillometry (IOS), and compared the results with those obtained in healthy term-born children.

METHODS

Children between 3 and 7 years of age who were born late preterm and who were being followed up at the outpatient clinic were included as the late-preterm group. Age-matched healthy term-born children served as controls. A total of 90 late-preterm and 75 healthy children were included in the study. At 5-20 Hz, resistance (R5-R20), reactance (X5-X20), impedans (Z5) and resonant frequency were measured on IOS.

RESULTS

Mean IOS R5 and R10 were significantly higher in the late-preterm group than in the control group (P < 0.05). Mean R5, R10 and Z5 were statistically higher in late-preterm children who had been hospitalized for pulmonary infection compared with the control group (P < 0.05). Mean R5, R10, R15, R20 and Z5 were significantly higher, and mean X10 and X15 significantly lower in late-preterm children with passive smoking compared with late-preterm children without passive smoking and controls (P < 0.05).

CONCLUSION

Children born late preterm had signs of peripheral airway obstruction on IOS-based comparison with healthy term-born controls. Besides the inherent disadvantages of premature birth, hospitalization for pulmonary infection and passive smoking also seemed to adversely affect lung function in children born late preterm.