Student-Led Curricular Development in the Biomedical Science Master's Program Using Virtual Dissection

The Anatomage table is a virtual dissection technology increasingly used to supplement anatomy education while its efficacy and integration is still being evaluated. To address the gap in student curricular leadership in such technological integration, previous master's and current medical students led a curricular development effort to design, create, and incorporate hands-on Anatomage learning activities into a master's level anatomy course during the 2021-2022 academic year. To assess changing perspectives regarding the table's role in curriculum integration and content retention, surveys were conducted before and after voluntary participants completed the learning activities. Overall, participants had a more positive perspective on the integration of the Anatomage table into the curriculum and its use to retain material compared to non-participants. Participants were significantly more likely to feel motivated to learn anatomy while interacting with the table. Compared to peers who only experienced the table in didactic lecture, activity participants were significantly more likely to perceive that the table helped them learn the skeletal system, a perception supported by significantly higher scores on skeletal anatomy exam questions. Less positive perspectives were observed overall for the muscular system, demonstrating the efficacy of the table varied with content. This research contributes to our understanding of virtual technology in anatomy education, and, although the integration of student-developed activities was complex, various educational features and pedagogical approaches were successfully utilized to establish a novel supplemental resource that contributes to multimodal learning and an academic foundation that prepares learners for their future careers in biomedical sciences and medicine.

Clinical Evaluation of Three Types of CAD/CAM Inlay/ Onlay Materials After 1-Year Clinical Follow Up

OBJECTIVE

To evaluate the clinical performance and the marginal adaptation of inlay/ onlay restorations made of lithium of a new lithium disilicate strengthened, lithium alumino-silicate glass-ceramic (LAS) material compared with a conventional lithium-disilicate glass-ceramic (LDS) and new-generation polymer-based CAD/CAM resin composite (CS) materials over one year.

MATERIALS AND METHODS

Seventy-five inlay-onlay restorations were placed in 35 patients. The restorations were assigned and randomized to three groups as LDS, LAS, and CS. Clinical evaluations were performed after one week, six months, and one year after the cementation, according to the modified United States Public Health Services (USPHS) criteria. The marginal quality analyses of 21 samples (n=7) were assessed under a scanning electron microscope. The data were analyzed by using Friedman, Wilcoxon Signed Ranks, Chi-square and Paired t-tests (p⟨0.05).

RESULTS

No statistically significant difference (p⟩0.05) was found between groups in the modified USPHS, gingival index, and plaque index evaluations, and the total success rate was 100% for three groups after one year. Following SEM evaluations in all groups, continuous margin percentages were decreased, but these results were not statistically significant (p⟩0.05).

CONCLUSIONS

Lithium disilicate-strengthened lithium aluminosilicate glass-ceramics can be considered a reliable material for an option for posterior onlay/inlay restorations.

A critical evaluation of TRPA1-mediated locomotor behavior in zebrafish as a screening tool for novel anti-nociceptive drug discovery

Current medications inadequately treat the symptoms of chronic pain experienced by over 50 million people in the United States, and may come with substantial adverse effects signifying the need to find novel treatments. One novel therapeutic target is the Transient Receptor Potential A1 channel (TRPA1), an ion channel that mediates nociception through calcium influx of sensory neurons. Drug discovery still relies heavily on animal models, including zebrafish, a species in which TRPA1 activation produces hyperlocomotion. Here, we investigated if this hyperlocomotion follows zebrafish TRPA1 pharmacology and evaluated the strengths and limitations of using TRPA1-mediated hyperlocomotion as potential preclinical screening tool for drug discovery. To support face validity of the model, we pharmacologically characterized mouse and zebrafish TRPA1 in transfected HEK293 cells using calcium assays as well as in vivo. TRPA1 agonists and antagonists respectively activated or blocked TRPA1 activity in HEK293 cells, mice, and zebrafish in a dose-dependent manner. However, our results revealed complexities including partial agonist activity of TRPA1 antagonists, bidirectional locomotor activity, receptor desensitization, and off-target effects. We propose that TRPA1-mediated hyperlocomotion in zebrafish larvae has the potential to be used as in vivo screening tool for novel anti-nociceptive drugs but requires careful evaluation of the TRPA1 pharmacology.

Measurement of oxidatively induced DNA damage and its repair, by mass spectrometric techniques

Oxidatively induced damage caused by free radicals and other DNA-damaging agents generate a plethora of products in the DNA of living organisms. There is mounting evidence for the involvement of this type of damage in the etiology of numerous diseases including carcinogenesis. For a thorough understanding of the mechanisms, cellular repair, and biological consequences of DNA damage, accurate measurement of resulting products must be achieved. There are various analytical techniques, with their own advantages and drawbacks, which can be used for this purpose. Mass spectrometric techniques with isotope dilution, which include gas chromatography (GC) and liquid chromatography (LC), provide structural elucidation of products and ascertain accurate quantification, which are absolutely necessary for reliable measurement. Both gas chromatography-mass spectrometry (GC-MS) or liquid chromatography-mass spectrometry (LC-MS), in single or tandem versions, have been used for the measurement of numerous DNA products such as sugar and base lesions, 8,5'-cyclopurine-2'-deoxynucleosides, base-base tandem lesions, and DNA-protein crosslinks, in vitro and in vivo. This article reviews these techniques and their applications in the measurement of oxidatively induced DNA damage and its repair.

Determination of DNA damage after exposure to inhalation anesthetics in human peripheral lymphocytes and sperm cells in vitro by comet assay

In this study, genotoxic activities of four halogenated anesthetics (halothane, isoflurane, sevoflurane and desflurane) were investigated in human peripheral blood lymphocytes (PBLs) and sperm cells in vitro by alkaline comet assay. For this purpose, sperm or lymphocyte suspension was exposed to different concentrations (0.1 mM, 1 mM, 10 mM and 100 mM) of anesthetic agents and 1% dimethyl sulfoxide (DMSO) or phosphate-buffered saline (PBS) as controls. The DNA strand breaks as well as alkali-labile sites were measured as percentage tail intensity with comet assay. The results of this study demonstrate that all analyzed drugs were capable of inducing DNA damage on PBLs in a dose-dependent manner in vitro. However, the results in sperm cells were slightly different since we did not observe any genotoxic effect for desflurane in any of the exposure doses, and the genotoxic effect of halothane was not dose dependent. This experimental study points out to the presence of DNA damage after exposure to halogenated anesthetics in both PBLs and sperm cells, although this effect seems to be higher in PBLs.

Sublingual versus vaginal misoprostol for cervical ripening PRIOR TO manual vacuum aspiration under local anaesthesia: A randomized study

OBJECTIVE

To compare the effectiveness of sublingual and vaginal misoprostol application for cervical ripening prior to manual vacuum aspiration (MVA) under local anaesthesia for voluntary termination of pregnancy between 7 and 10 weeks of gestation.

MATERIALS AND METHODS

Prospective randomized study in which 72 women were randomly assigned to administration of either 400 microg vaginal misoprostol 3 hours prior to or 200 microg sublingual misoprostol 2 hours prior to the surgical procedure. We took the preoperative cervical dilatation that was achieved as the main outcome measure. The duration of the procedure, intra-operative blood loss, pain perception before and during the operation, patients' satisfaction, side effects and duration of post-operative bleeding were secondary outcome measures.

RESULTS

A similar pre-operative cervical dilatation was achieved in the sublingual and the vaginal groups (6.9 +/- 1.6 mm and 6.6 +/- 1.1 mm, respectively; p = 0.3). The duration of the operation, intra-operative blood loss, and patients' satisfaction did not differ between the two groups. Pain scores were significantly higher in the sublingual group than in the vaginal group, both after administration of misoprostol (p = 0.02) and during the procedure (p = 0.02). Nausea and vaginal spotting were significantly more frequent (p = 0.01 and p = 0.003, respectively), but post-operative bleeding significantly shorter (p = 0.003) in the sublingual group.

CONCLUSION

Administration of 200 microg sublingual misoprostol 2 hours before suction curettage under local anaesthesia was as effective as 400 microg vaginal misoprostol 3 hours before that procedure with regard to achieving cervical dilatation. It resulted in higher pre-operative and intra-operative pain scores without changing patients' satisfaction.

Prevalence and Risk Factors of Allergies in Turkey (PARFAIT): results of a multicentre cross-sectional study in adults

The Prevalence and Risk Factors of Allergies in Turkey (PARFAIT) study was planned to evaluate the prevalence of and risk factors for asthma and allergic diseases in Turkey. The present analysis used data from 25,843 parents of primary school children, obtained from a cross-sectional questionnaire-based study. A total of 25,843 questionnaires from 14 centres were evaluated. In rural areas, the prevalences asthma, wheezing, allergic rhinitis and eczema in males were: 8.5% (95% confidence interval (CI) 7.9-9.1%), 13.5% (95% CI 12.8-14.2%), 17.5% (95% CI 16.7-18.2%) and 10.8% (95% CI 10.2-11.4%), respectively; and in females were: 11.2% (95% CI 10.9-11.8%), 14.7% (95% CI 14.3-15.1%), 21.2% (95% CI 20.4-22.0%) and 13.1% (95% CI 12.4-13.8%), respectively. In urban areas, the corresponding prevalences in males were: 6.2% (95% CI 5.8-6.6%), 10.8% (95% CI 10.3-11.3%), 11.7% (95% CI 11.4-12.0%) and 6.6% (95% CI 6.2-7.0%), respectively; and in females were: 7.5 % (95% CI 7.9-7.1%), 12.0% (95% CI 11.7-12.3%), 17.0% (95% CI 16.4-17.6%) and 7.3% (95% CI 6.9-7.7%), respectively. Having an atopic first-degree relative or any other atopic diseases had significant effects on the prevalence of allergic diseases. Housing conditions, such as living in a shanty-type house, visible moulds at home and use of wood or biomass as heating or cooking material were associated with one or more allergic diseases. Although genetic susceptibility is strongly associated, country- and population-based environmental factors may contribute to increased prevalence rates of allergic diseases.

ADRA2A polymorphism and smoking in a Turkish population

Adrenoceptors (ARs) consist of nine subtypes, which are involved in a wide spectrum of physiological functions and are the site of action for a considerable percentage of currently prescribed therapeutics. All AR subtypes (except α1D) can be polymorphic because of the genetic variations in the coding and non-coding regions. Sixteen sequence variations were identified in α-adrenergic 2A (ADRA2A) gene. Among them, ADRA2A C1291G polymorphism is one of the most important polymorphisms, which plays a major role in regulating neurotransmitter release, blood pressure, lipolysis, insulin secretion, and platelet aggregation. A C–G transversion results in an MspI restriction fragment length polymorphism located at 1291 bp upstream of the origin of transcription. Because Medline search showed no study showing the allelic frequencies, and no information is available on inter-individual variability of ADRA2A C1291G polymorphism in Turkish population, we genotyped 203 healthy Turkish subjects. Because of large genetic variation of the polymorphism, we aimed to find out the distribution of C1291G polymorphism in Turkish population. Furthermore, we evaluated the possible association between the C1291G polymorphism in the ADRA2A receptor gene and smoking. The frequencies for the 1291C and 1291G alleles were 64% and 36%, respectively. The genotype frequencies for C1291C, C1291G, and G1291G were 35.5%, 57.6%, and 6.9%, respectively, in Turkish population. The allelic frequencies (1291C and 1291G) and G1291G homozygous variant genotype were similar to those reported in different Caucasian populations; however, C1291C and C1291G genotypes were different. We also observed that the frequency of the G allele was slightly higher in smoker subjects and lower among controls. The ADRA2A G allele may play a role in the predisposition to smoking. There is a need for expanding genotype and haplotype studies because of its importance in various physiological disorders and to confirm the association of this polymorphism with smoking.

Successful treatment of multidrug resistant Acinetobacter baumannii meningitis

Background: Acinetobacter baumannii is a major cause of nosocomial infections in many hospitals and appears to have a propensity for developing multiple antimicrobial resistance rapidly. Cases: We report two cases with post-surgical meningitis due to multidrug resistant A. baumannii which were successfully treated with high-dose intravenous meropenem therapy. Conclusions: Multidrug resistant Acinetobacter spp. in intensive care units are a growing concern. High-dose meropenem is used in the treatment of these infections.

Determination of birefringence dispersion in nematic liquid crystals by using an S-transform

An analysis of the transmittance signal of the 5CB-coded nematic liquid crystal by using an S-transform is presented. The transmittance spectrum of this liquid crystal is acquired in the 1.26-2.22 microm(-1) region at room temperature. The dispersion curve of birefringence is obtained for 5CB by this analysis, and data are fitted to the Cauchy formula, whereby the dispersion parameters are extracted. The result is found to be in favorable accordance with the Merck catalog value.

Brain stem abscesses in childhood

BACKGROUND

Solitary brain stem abscess is a rare condition with high mortality and morbidity. These lesions were considered to be invariably fatal before 1974 when advanced diagnostic tools were not available. Recently, the diagnosis and prognosis of brain stem abscesses have been modified by the introduction of modern radiological tools, and several patients with a favorable outcome have been reported since then. Because the pons is the most common site of the abscesses, involvement of the sixth and seventh nerves is frequent. The midbrain is the second most likely location, and medullary abscesses are distinctly rare. Treatment of a brain stem abscess includes medical therapy alone, open microsurgical intervention, or stereotactic aspiration.

CASE REPORT

We report a case of a 7-year-old girl with a solitary brain stem abscess. Her neurological examination revealed involvement of the cranial nerves and pyramidal tracts. Microsurgical exposure and aspiration of the abscess resulted in rapid improvement in her neurological condition and radiological resolution of the lesion. We discuss this uncommon case to draw attention to the importance of early diagnosis and adequate treatment, and we review the relevant literature.

Relationships between epidural fibrosis, pain, disability, and psychological factors after lumbar disc surgery

Failed back surgery syndrome (FBSS) is an important complication of lumbar disc surgery. Epidural fibrosis is one of the major causes of FBSS. However, most patients with epidural fibrosis do not develop symptomatic complaints from scarring. The purpose of this prospective study was to evaluate the relationships among the severity of epidural fibrosis, psychological factors, back pain and disability after lumbar disc surgery. Twenty-nine surgically managed patients (13 women, 16 men) were included in this study. In all patients, the presence and severity of epidural fibrosis was determined with contrast-enhanced magnetic resonance imaging (MRI). A pain visual analog scale (VAS) and Oswestry Disability Questionnaire (ODQ) were completed before and after surgery. Subjects were grouped by their type of herniation (protrusion, free fragment), MRI findings and results of the mini form of the Minnesota Multiphasic Personality Inventory (MMPI), and the groups were compared for their VAS and ODQ scores. Our results disclosed that neither the postoperative VAS scores nor the postoperative ODQ scores differed significantly among the epidural fibrosis severity groups. Moreover, postoperative VAS scores were positively correlated with the scores of the mini MMPI. These findings indicate that epidural fibrosis may be considered as a radiological entity independent of patients' complaints. Furthermore, the mini MMPI should be included in the assessment and planning of the reoperations in FBSS patients, because of the importance of psychological factors in postoperative pain and disability.

Lipid peroxidation and glutathione levels after cortical injection of ferric chloride in rats: effect of trimetazidine and deferoxamine

Intracortical injection of iron salts causes seizures. Oxidation of lipids in neural membranes by reactive oxygen species is involved in the mechanism responsible for iron-induced seizures as a model of posttraumatic epilepsy. In this study, we examined the effect of trimetazidine (TMZ) and deferoxamine (DFO) on lipid peroxidation after cortical injection of 5 microliters of an aqueous solution containing 100 mM of ferric chloride (FeCl3) in rats. Animals were divided into four groups (n = 7 each) and treated as follows: group 1, saline injection into the cortex (control group); group 2, iron injection into the cortex (injury group); group 3, iron injection into the cortex plus TMZ; group 4, iron injection into the cortex plus DFO. The animals were killed 3 h after injections, and the levels of malondialdehyde (MDA), a lipid peroxidation product, and reduced glutathione (GSH) were measured. A significant elevation of MDA was observed in group 2 (P < 0.05). MDA levels were found to be lower in both the TMZ-treated (P < 0.05) and DFO-treated (P < 0.05) groups than in the injury group. Tissue GSH levels were significantly decreased in group 2 (P < 0.05). GSH levels were increased in the TMZ-treated (P < 0.05) and DFO-treated (P < 0.05) groups compared to the injury group. The results of our study suggest that lipid peroxidation is a critical event in iron-induced epilepsy and that treatment with TMZ and DFO is effective in preventing the formation of free radicals and reducing lipoperoxides in brain tissue.

Whipple's disease confined to the central nervous system: case report and review of the literature

Whipple's disease confined exclusively to the CNS without systemic involvement appears to be very rare, with only 8 cases reported in the literature. We present here a further case of primary cerebral Whipple's disease in which the neurological symptoms were seen in the absence of systemic involvement and emphasize the importance of diagnosing this treatable disease.

Neuroprotective effect of magnesium on lipid peroxidation and axonal function after experimental spinal cord injury

STUDY DESIGN

An experimental study examining the neuroprotective effect of magnesium on axonal function and lipid peroxidation in a rat model of acute traumatic spinal cord injury.

OBJECTIVE

To determine the effectiveness of postinjury treatment with magnesium on evoked potentials and lipid peroxidation after spinal cord injury (SCI).

SETTING

Pamukkale University, Denizli, Turkey.

METHODS

Spinal cord injury occurred in 30 rats with an aneurysm clip at T9 and the rats were randomly assigned to undergo subcutaneous administration of one of the following at 1 h after injury: (1) Physiological saline (n = 10); (2) MgSO4, 300 mg/kg (n = 10) and (3) MgSO4, 600 mg/kg (n = 10). Spinal somatosensory evoked potentials (SSEPs) were recorded before injury, 30 min after injury and 3 h after injections. Rats were killed 24 h after the injury, and malondialdehyde (MDA) levels were measured.

RESULTS

Following SCI, there were significant decreases in the amplitudes of P1 and N1 (P<0.001) and only high-dose magnesium improved the SSEPs (P<0.01). On the other hand, there was significant difference in lipid peroxide content between high-dose magnesium treated group and both of saline treated and low-dose magnesium treated groups (P<0.01).

CONCLUSION

These results suggest that magnesium has a dose-dependent neuroprotective effect on SSEPs and lipid peroxidation after experimental spinal cord injury.

Carotid artery occlusion due to bacterial paranasal sinusitis

Complications of paranasal sinusitis still continue to be a serious health problem. We present an orbita-related complication of sinusitis in a patient with diabetic ketoacidosis. It was not a rhinocerebral mucormycosis, but a bacterial sinusitis-induced development of left cavernous sinus thrombophlebitis and carotid artery occlusion. We discuss the diagnosis, surgical options, and clinical outcome.

Spinal extradural compression caused by granuloma of brucellosis

A rare case of extradural brucellosis granuloma in the thoracic region is presented. In spite of medical treatment, total paraplegia with sphincter disturbance developed. Delayed neurosurgical intervention resulted in significant clinical recovery. Magnetic resonance imaging was useful in obtaining detailed information and to decide on surgery.