Type I cardiorenal syndrome in patients with acutely decompensated heart failure: the importance of new renal biomarkers

OBJECTIVE

Type 1 cardiorenal syndrome (CRS) is an acute renal failure in patients with acute decompensated heart failure with an incidence of 24% to 45%. The aim of our study was to investigate the significance of new renal biomarkers to predict type 1 CRS.

PATIENTS AND METHODS

The study included 111 patients with acute decompensated heart failure diagnosed at the Istanbul Medical Faculty Emergency Department between 2014 and 2016, and 24 healthy volunteers. All urine samples were stored at -80°C after centrifugation. Samples were run according to the instructions of TIMP-2, ILGF-7, KIM-1, and IGFBP-7 ELISA kits. Diuretic treatments were then administered with intravenous administration of at least 80 mg furosemide per day. Follow-up biochemical and spot urine specimens were taken after 72 hours. For statistical analysis, SPSS version 21.0 statistical software was used. Significance was evaluated at p<0.05.

RESULTS

The baseline creatinine level was measured as 1.33 ± 0.39 mg/dL in the heart failure group. It was seen that 67% (75) of the patients had increased creatinine levels and developed type 1 CRS. ILGF-7, TIMP-2, and (ILGF-7 * TIMP-2) values were significantly higher in patients with cardiorenal syndrome when we separated the two groups as patients with and without cardiorenal syndrome (0.40 (0.25-0.71), p1: 0.049/2.40 (1.42-3.70), p2: 0.003/1.15 (0.29-2.43), p3: 0.001).

CONCLUSIONS

Renal tubular markers reveal promising developments in the pathophysiology of cardiorenal syndrome in light of recently obtained data. Renal tubular biomarkers may have the potential to be a predictor of heart failure and cardiorenal syndrome.

Evaluation of maxillary sinus anatomical variations and pathologies in elderly, young, posterior dentate and edentulous patient groups with cone-beam computed tomography

BACKGROUND

The aim of this study was to evaluate the frequency of maxillary sinus pathologies and anatomic variations in elderly and edentulous patients by using cone-beam computed tomography (CBCT).

MATERIALS AND METHODS

The study included elderly and young patient groups. The elderly group involved posterior edentulous and dentate patients. CBCT images were assessed, and the presence of any pathological findings, septa, accessory maxillary ostium, and Haller cell in each maxillary sinus were recorded according to the groups. Chi-square test was used to analyse the intergroup differences (p < 0.05).

RESULTS

There was no statistically difference between the young and elderly groups regarding the presence of a pathology (p = 0.077) and septa (p = 0.37), whereas accessory ostium (p = 0.009) was more common and Haller cell (p = 0.000) was less common in the elderly group when compared to the young group. There was no significant difference between the edentulous and dentate group regarding the presence of a pathology (p = 0.39), septation (p = 0.69) and Haller cell (p = 0.75); accessory ostium rate was found to be increased (p = 0,015) in edentulous patients.

CONCLUSIONS

It was observed that the frequency of accessory maxillary ostium was increased in elderly, especially in edentulism. And the frequency of Haller cell was found to be decreased in elderly patients.

Evaluation of localisation of mandibular foramen in patients with mandibular third molar teeth using cone-beam computed tomography

BACKGROUND

It is important to know the correct anatomical location of the mandibular foramen to obtain successful anaesthesia of inferior alveolar nerve and to prevent injury to the mandibular vessels and nerve, during a variety of oral and maxillofacial surgical procedures. The aim of this study is to evaluate localisation of the mandibular foramen in patients with the third molars using cone-beam computed tomography (CBCT).

MATERIALS AND METHODS

Cone-beam computed tomography was used to determine the location of the mandibular foramen in 67 patients (totally 99 sides) with unilateral or bilateral impacted mandibular third molars.

RESULTS

The distance from the posterior border of the mandibular ramus to mandibular foramen did not differ significantly among the other angulations. But the difference between vertical and horizontal angulation of the impacted mandibular third molars according to 'fd' values (the shortest distance between mandibular foramen and the posterior border of mandibular ramus) was found to be statistically significant (p < 0.05).

CONCLUSIONS

The present study provides new information to the literature concerning relationship between the location of the mandibular foramen and the mandibular third molars.

Retrospective morphometric analysis of the infraorbital foramen with cone beam computed tomography

OBJECTIVE

The aim of our study is to examine the morphometric characteristics of the infraorbital foramen (IOF) and its anatomic localization by using cone-beam computerized tomography (CBCT).

MATERIALS AND METHODS

In our study, the anatomic characteristics of the IOF were identified by studying retrospectively the CBCT images of one hundred twenty-five (125) patients. These characteristics were assessed statistically in terms of age, gender, and right-left side.

RESULTS

In our study, 42% of them had IOF in circular form and 58% in oval form. Of them 66.90% of those in oval form were in oblique direction, 28.30% of them were in vertical direction, and 4.80% of them were in horizontal direction. The mean vertical diameter of the IOF was found as 3.71 ± 0.61 mm and its mean horizontal diameter was found as 3.17 ± 0.56 mm. The mean distance of IOF to midline were measured as 25.10 ± 2.17 mm, distance to upper edge of the orbita was measured as 41.91 ± 2.77 mm, distance to infraorbital edge was measured as 5.63 ± 1.77 mm, distance to the lateral nasal wall was measured as 9.32 ± 2.68 mm, distance to spina nasalis anterior was measured as 17.97 ± 3.99 mm, thickness of the soft tissue on the foramen was measured as 11.52 ± 2.40 mm, and distance between the right and the left IOF was measured as 50.20 ± 3.90 mm. Accessory foramen was found in 56.60% ratio.

CONCLUSION

This study reveals that CBCT may guide for local anesthesia applications and for other invasive procedures in order to prevent the damage of the neurovascular structures during maxillofacial surgery by identifying the distances of anatomic points such as IOF having surgically importance.

Evaluation of the anatomical variation in the nasal cavity and paranasal sinuses of patients with cleft lip and palate using cone beam computed tomography

OBJECTIVE

The aim of this study was to evaluate the frequency of anatomical variation in nasal cavity and paranasal sinuses by comparing a unilateral cleft lip and palate (UCLP) group with a non-syndromic control group using cone beam computed tomography (CBCT).

SUBJECTS AND METHODS

This study included 24 UCLP patients in the UCLP group and 24 non-syndromic patients in the control group. Coronal CBCT images were taken in all patients and were evaluated for anatomical variation. The measurements obtained in this study were analysed using chi-square and Fisher's exact tests to compare the two groups statistically.

RESULTS

In the UCLP group, there were statistically lower frequencies of pterygoid process pneumatisation (p<0.05), higher wing pneumatisation (p<0.05), and sphenoid sinus over pneumatisation (p<0.05), and statistically higher frequencies of anterior nasal septal deviation (p<0.05) compared to the control group.

CONCLUSION

A higher incidence of anterior nasal septal deviation was found in UCLP patients compared to the patients in the control group. It is likely that for this reason, UCLP patients might be predisposed to sinusitis. In UCLP patients, the incidence of neurovascular structures in the sphenoid sinus was lower than that in non-syndromic control patients (Tab. 1, Fig. 6, Ref. 33).

Rapid identification of Streptococcus pneumoniae in blood cultures by using the ImmuLex, Slidex and Wellcogen latex agglutination tests and the BinaxNOW antigen test

Rapid identification of Streptococcus pneumoniae in blood culture (BC) bottles is important for early directed antimicrobial therapy in pneumococcal bacteraemia. We evaluated a new latex agglutination (LA) test on BC bottles, the ImmuLex™ S. pneumoniae Omni (Statens Serum Institut, Denmark), and compared the performance with the Slidex® pneumo-Kit (bioMérieux, France) and the Wellcogen™ S. pneumoniae (Remel, UK) LA tests, as well as the BinaxNOW® S. pneumoniae (Alere, USA) antigen test. The four tests were directly applied on 358 positive BC bottles with Gram-positive cocci in pairs or chains and on 15 negative bottles. Valid test results were recorded in all cases for ImmuLex and BinaxNOW and in 88.5 % (330/373) and 94.1 % (351/373) of cases for Slidex and Wellcogen, respectively. Based on bottles positive for S. pneumoniae by conventional methods, the sensitivity of ImmuLex was 99.6 %, similar to the other tests (range, 99.6-100 %). Based on bottles positive for non-pneumococcal pathogens, the specificity of ImmuLex was 82.6 %, in comparison to 97.6 % for Slidex (p < 0.01) and 85.4 % for Wellcogen (p = ns). The BinaxNOW test had a lower specificity (64.1 %) than any LA test (p < 0.01). On BC bottles positive for α-haemolytic streptococci, ImmuLex was positive in 12/67 (17.9 %) cases, Slidex in 2/59 (3.4 %) cases, Wellcogen in 11/64 (17.2 %) cases and BinaxNOW in 25/67 (37.3 %) cases. In conclusion, the ImmuLex test provides a valid and sensitive technique for the rapid detection of S. pneumoniae in BC bottles, similar to the other compared methods. However, the specificity was sub-optimal, since the test may cross-react with other Gram-positive bacteria.

The Uni-Gold™ Streptococcus pneumoniae urinary antigen test: an interassay comparison with the BinaxNOW® Streptococcus pneumoniae test on consecutive urine samples and evaluation on patients with bacteremia

The performance of the recently commercialized Uni-Gold™ Streptococcus pneumoniae test for the detection of pneumococcal antigen in urine was studied in a multicenter study. First, we studied the interassay agreement between Uni-Gold™ and the BinaxNOW® S. pneumoniae urinary antigen test on 337 consecutive urine samples sent to the laboratory for the detection of pneumococcal antigen. The two tests performed similarly (κ = 0.82): both tests positive in 27 cases, both tests negative in 299 cases, and with divergent test results in 11 cases. Secondly, the tests were run on urine samples from 203 patients with bacteremia, including 51 patients with pneumococcal bacteremia. The sensitivities and specificities were 67 and 86 % for Uni-Gold™, and 57 % and 94 % for BinaxNOW®, respectively. The false-positivity rate was significantly higher for Uni-Gold™ compared with BinaxNOW® in patients with Escherichia coli bacteremia (15 vs. 2.1 %, p = 0.04), and tended to be higher in patients with bacteremia with alpha-hemolytic streptococci (32 vs. 11 %, p = 0.13). When cases with E. coli and alpha-hemolytic streptococci were excluded from the analysis, the overall false-positivity rate was 9/85 (11 %) for Uni-Gold™ and 6/85 (7.1 %) for BinaxNOW®. In conclusion, the study showed that Uni-Gold™ was not inferior to BinaxNOW® for the detection of pneumococcal urinary antigen in patients with pneumococcal bacteremia. The specificity of Uni-Gold™ was suboptimal due to false-positive results in cases with E. coli and alpha-hemolytic streptococci bacteremia. However, in patient populations usually subjected to testing for pneumococcal urinary antigen, such as pneumonia and meningitis patients, bacteremia with these pathogens is uncommon. The diagnostic usefulness of the Uni-Gold™ test should be further evaluated.

Dental Panoramic Radiography in the Diagnosis of Osteoporosis

Osteoporosis is common in the elderly and the dentist is often the only healthcare professional that they visit regularly. Since dental panoramic radiographs (DPRs) are widely used for routine examinations when planning treatment, this study evaluated whether the presence of osteoporosis might be apparent in a population of patients who underwent DPR. The mandibular cortical index (MCI) and a new method of measuring the mandibular radiographic density (m-RD), which used DPR that incorporated an aluminium step-wedge, were compared with the total vertebral bone mineral density (v-BMD) of the lumbar vertebrae measured using dual energy X-ray absorptiometry (DXA) in 25 osteoporotic women. Although there was only a weak correlation between m-RD and v-BMD, significant correlation was found between MCI and v-BMD. Since both m-RD and MCI were related to v-BMD, dental radiographic density and MCI may be useful in clinical dental practice to identify osteoporotic women with previously undetected low BMD.