Lactate and base deficit combination score for predicting blood transfusion need in blunt multi-trauma patients.

BACKGROUND: Lactate and base deficit (BD) values are parameters evaluated as indicators of tissue perfusion and have been used as markers of severity of injury and mortality. OBJECTIVES: The aim of the study was to determine the relationship between combined score (CS) and blood transfusion need within 24 h and comparison of the variables between transfusion and non-transfusion group, correlation lactate with BD and with physiological, laboratory parameters, and determining the major risk factors of patients for the need for blood transfusion. METHODS: The study included a total of 359 patients (245 males, median age: 40, min-max: 18-95) with blunt multi-trauma. De-mographics data, laboratory parameters (hemoglobin [Hb], hematocrit [Htc], lactate, BD, pH), physiologic parameters (systolic blood pressure [SBP], diastolic blood pressure [DBP], heart rate [HR], respiratory rate [RR]), shock index (SI), and revised trauma score (RTS) were recorded. Logistic regression method was used to create the CS formula using lactate and BD values. According to this formula, the probability value of 0.092447509 was calculated for the need for blood transfusion within 24 h. If CS was higher than the probability value, the need for blood transfusion within 24 h was considered. Furthermore, univariate analysis was used to determine major risk for blood transfusion need in 24 h, and the receiver operating characteristic curves were performed to compare CS, lactate, BD, SI and RTS. RESULTS: The comparison between transfusion and non-transfusion group there was significance between SBP, DBP, HR, RR, SpO2, Glasgow coma scale, Hb, Htc, lactate, BD, pH, SI and RTS (for each p<0.05). Lactate value has a positive correlation with SI, HR and has a negative correlation with BD, RTS, SBP, and DBP. BD values has a positive correlation with RTS, SBP, DBP, Hb, and Htc and has a negative correlation with SI, HR, and RR. The main risks for blood transfusion need were SI, lactate, BD, SBP, and SpO2%. CS was 0.09 in 100 (27.85%) patients and 41 with high CS had blood transfusion within 24 h (p<0.001; OR21.803, sensitivity 83.7%, specificity 81%,positive predictive value 41%, and negative predictive value 96.9%). A ROC curve showed that CS (AUC: 86.) was more significant than SI and RTS for the need for blood transfusion. CONCLUSION: CS is effective for predicting blood necessity in 24 h for blunt multi-trauma patients.

Investigation of Intestinal Protozoon Prevalence in Immunocompromised Patients at a University Hospital

Objective: Immunocompromised patients are at a greater risk of developing intestinal parasite infections. In this study, we examined the presence of Enterocytozoon bieneusi, Encaphalitozoon intestinalis and other intestinal protozoa in stool samples of immunosuppressed patients. Methods: A total of 100 stool samples were obtained from patients receiving chemotherapy because of solid organ tumour with haematological malignancies and those receiving immunosuppressive treatment because of rheumatic diseases, organ transplant patients and patients receiving treatment for HIV-related infections. Stool samples were examined by using the native-lugol method in which the stool concentration, modified Kinyoun acid-fast and trichrome staining methods and parasite presence were analysed. The stool samples were also examined for the presence of Enterocytozoon bieneusi and Encephalitozoon intestinalis using an indirect fluorescent antibody method. Results: Intestinal parasites were detected in 12% of all patients. The distribution of intestinal parasites in patients were 7% Blastocystis spp., 2% Blastocystis spp. + Dientamoeba fragilis, 1% Blastocystis spp. + Entamoeba coli, 1% Blastocystis spp. + Giardia intestinalis and 1% G. intestinalis. Microsporidia spp. were detected in 4% of all patients by the IFAT method and in 8% of all patients by calcoflour staining method. Conclusion: In our study, the most prevalent parasite detected in the immunosuppressed patients was Blastocystis spp. The pathogenesis of Blastocystis spp. remains to be controversial, and their role in immunocompromised patients continues to remain unknown. Although these rates detected in our study are similar to the prevalence in the normal population, it is important to study these microorganisms in immunocompromised patients in terms of the associated decreasing morbidity and mortality rates.

Comparison of Endotracheal Intubation Skills With Video Laryngoscopy and Direct Laryngoscopy in Providing Airway Patency in a Moving Ambulance.

BACKGROUND: Early and successful management of the airway in the prehospital and hospital settings is critical in life-threatening situations. OBJECTIVE: We aimed to perform endotracheal intubation (ETI) by direct laryngoscopy (DL) and video laryngoscopy (VL) on airway manikins on a moving track and to compare the properties of intubation attempts. METHODS: Overall, 79 participants with no previous VL experience were given 4 h of ETI training with DL and VL using a standard airway manikin. ETI skill was tested inside a moving ambulance. The number of attempts until successful ETI, ETI attempt times, time needed to see the vocal cords, and the degree of convenience of both ETI methods were recorded. RESULTS: Overall, 22 of 79 individuals were men; mean age was 30.3 ± 4.5 years. No difference was found in the comparison of the two methods (p = 0.708). Time needed to see the vocal cords for those who were successful in their first attempt were between 1 and 8 s in both methods. In the VL method, time needed to see the vocal cords (p = 0.001) and the intubation time (p < 0.001) in the first attempt were shorter than in the DL method. The VL method was easier (p < 0.001). The success rate was 97.5% in DL and 93.7% in VL. CONCLUSIONS: The VL method is rapid and easier to see the vocal cords and perform successful ETI. Therefore, it might be preferred in out-of-hospital ETI applications.

The investigation of Strongyloides stercoralis seroprevalence in immunosupressed patients in Turkey

Background/aim: In immunosuppressed patients, strongyloidiasis can be lifethreatening because of hyperinfection or dissemination. Therefore, diagnosis of S. stercoralis is important in immunosuppressed patients with chronic strongyloidiasis. In this study, our objective was to investigate the presence of S. stercoralis antibodies by an ELISA method in immunosuppressed patients. Materials and methods: A total of 100 immunosuppressed patients' sera were included in the study. Forty-two of the patients were receiving immunosuppressive therapies for cancer or being treated for hematopoietic malignancies, 38 of the patients were receiving immunosuppressive drugs for rheumatic diseases, 14 were receiving immunosuppressive therapies for liver transplantation. Two of the patients were being treated for HIV infection and 4 were being treated for hypogammaglobulinemia. As control group, 50 individuals without a known disease were included in the study. The presence of IgG antibodies against S. stercoralis was investigated with a commercial ELISA kit. Results: S. stercoralis antibody test was positive in 4 of 100 (4%) sera from immunosuppressed patients. All control patients were negative for S. stercoralis. Conclusions: Strongyloidiasis can be a lifelong chronic infection if not treated. In patients who are going to receive immunosuppressive therapy, it should be tested before treatment, as it can become a disseminated and life-threatening infectious disease.

Refractory Giardiasis in an Immunosuppressed Patient in Turkey.

Giardiasis is an infection of the small intestine caused by the protozoan parasite Giardia duodenalis. In immunocompetent patients the infection is usually self-limited and no treatment may be needed. Immunodeficiency, however, is a predisposing factor for the development of severe Giardia infection. In this report, a case of recurrent giardiasis refractory to nitroimidazoles and nitazoxanides presented. A 28-year-old male patient with hypogammaglobulinemia admitted to our hospital because of chronic diarrhoea. Microscopic examination of stool revealed a high number of Giardia trophozoites and cysts. Treatment with higher doses and a longer course of metronidazole, trimethoprim-sulfamethoxazole, ornidazole and albendazole failed. Administration of nitazoxanide, which has been reported to be effective against Giardia duodenalis refractory to nitroimidazoles, was commenced, but his symptoms persisted and stool samples demonstrated Giardia trophozoites and cysts again.

Clinical Evaluation of Complications in Implant-Supported Dentures: A 4-Year Retrospective Study.

BACKGROUND Implants that can be used in the prosthetic rehabilitation of full and partial edentulous patients are now frequently used due to advances in dentistry. Despite advanced methods of applications, failures and complications can still be seen. The aim of our study was to evaluate clinical prosthetic values and complications that occurred during 4-year follow-up in implant-supported restorations. MATERIAL AND METHODS This retrospective study included 40 patients who received oral rehabilitation with an implant-supported prosthesis. A total of 162 implants were placed: 99 in the maxilla and 63 in the mandible. The prosthetic and surgical data were recorded. Data including prosthetic complications and implant loss were recorded and statistically analyzed using Cox proportional hazard regression analysis. RESULTS In total, 159 implants (98.14%) survived, 3 implants (1.86%) failed, and 100% of the protheses were successful. There were 62 dental implants used as abutments for removable dentures and 97 for fixed dentures. The most frequent prosthetic complications after placement of an implant-supported prosthesis were loss of retention, mucositis, abutment screw loosening, and fracture. Patient satisfaction after prosthesis use was also evaluated, showing that satisfaction was systematically increased. CONCLUSIONS To minimize the frequency of complications, protocols must be established from diagnosis to the completion of treatment and follow-up of implant-supported prostheses, especially in terms of adequate technical steps and careful radiographic evaluation of the components.

Aggressive periodontitis associated with Kindler syndrome in a large Kindler syndrome pedigree.

Talo-Yildirim T, Acun-Kaya F, Taskesen M, Dündar S, Bozoglan A, Tekin GG, Akdeniz S. Aggressive periodontitis associated with Kindler syndrome in a large Kindler syndrome pedigree. Turk J Pediatr 2017; 59: 56-61. Kindler syndrome (KS) is a rare genetic disorder. The clinical features include aggressive periodontal disease and severe desquamative gingivitis. Five individuals with KS were assessed by oral examination, radiographic analysis and periodontal measurements. All the patients' indexes were recorded prior to periodontal treatment and at the end of the 1th, 3th , 6th, 9th and 12th month respectively. All the patients had improvement of periodontal status and enhancement in index scores. The affected individuals were previously screened for FERMT1 mutations. KS patients' periodontal disease activity could be taken under control with regular follow-up.

Associations of alveolar bone loss and interleukin-1ß levels in one- and two-stage surgical procedures: a randomized prospective trial.

OBJECTIVE: Dental implants have been widely and successfully used in recent years as an alternative treatment for removable and fixed dental prostheses. The aim of this randomized prospective study was to determine the alveolar bone loss rate (ABLR) and IL-1ß levels in one- and two-stage surgical procedures. MATERIALS AND METHODS: This study included 40 patients with a single missing tooth in the posterior mandible; dental implants were inserted using a one-stage surgical procedure (Group I) or a two-stage surgical procedure (Group II). All clinical periodontal parameters were recorded; peri-implant crevicular fluid (PICF) samples were collected before loading (T0) and during the third (T1) and sixth (T2) months after loading. ABLR values were evaluated at T0 and T2 by using dental tomography. PICF was analysed after T2 samples were collected. The study was registered through clinicaltrials.gov; identifier NCT03045458. RESULTS: This study found that, the probing pocket depth was found to be significantly higher in Group I than Group II at both T1 and T2 (p < .05). There was no significant difference in other clinical parameters between the groups (p > .05). There was a significant difference between Group I ABLR values at T0 and T2 (p < .05). The PICF IL-1ß levels were not significantly different between groups (p > .05). CONCLUSIONS: Within the limitations of the short observational period and small sample size of this study, two-stage implant placement shows comparable clinical outcomes to implants placed using a one-stage placement protocol.

A Case of Extensive Wound Myiasis Caused by Lucilia sericata (Diptera: Calliphoridae) in a Patient with Maxillary Sinus Squamous Cell Carcinoma, in Turkey.

The larvae causing myiasis can lead extensive tissue destruction, invasion into deep tissues and secondary infections. Poor hygiene, low socioeconomic condition and presence of open wounds are the most important predisposing factors. This case report describes destructive wound myiasis in a 58-year-old male patient diagnosed with maxillary sinus squamous cell carcinoma who lives in a rural area in Ankara, Turkey. Approximately 200 larvae were collected and identified as Lucilia sericata by morphological examination. Myiasis should be considered especially when the patient has open extensive lesions such as malignant wounds.

The effects of pulsed and sinusoidal electromagnetic fields on E-cadherin and type IV collagen in gingiva: a histopathological and immunohistochemical study.

BACKGROUND: The potential beneficial effects of extremely low frequency pulsed and sinusoidal electromagnetic fields have been shown on many tissues. Gingival epithelium plays an important role in immunosurveillance of the periodontal tissues. The epithelium acts as a mechanical barrier through cell junctions such as E-cadherin. OBJECTIVES: Investigation of the effects of extremely low frequency magnetic fields on gingiva. MATERIAL AND METHODS: Twenty-seven male Wistar albino rats were used. The rats were divided into three groups: control group (n = 9), SEMF group (n = 9), PEMF group (n = 9). The SEMF and PEMF (pulse time: 25 µsn, pulse frequency: 50 Hz) groups were subjected to 1.5 mT, 50 Hz, exposure 6 h a day, 5 days a week for 28 days in methacrylate boxes. The gingival tissue pieces processed for routine histological and immunohistochemical examination and tissue sections were stained with H-E and Masson trichrome. In addition, E-cadherin and type IV collagen expressions were examined immunohistochemically. RESULTS: Intraepithelial lymphocytes and proliferation of epithelial cells increased in both electromagnetic field groups. The over-expressions of E-cadherin on gingival epithelium was detected in the PEMF and SEMF groups. The expression level of type IV collagen was not significant between the control and electromagnetic field treated groups, except for a significant increase in the basal cell layer of the PEMF group, as compared to the control and SEMF groups. CONCLUSIONS: PEMF and SEMF have a local pro-inflammatory effect on gingiva, leading to an increase in E-cadherin level but not type IV collagen. Both PEMF and SEMF can be used as a supportive device in the treatment of gingival diseases, especially those which lead to defects in the epithelial barrier.

Identification of interleukin 2, 6, and 8 levels around miniscrews during orthodontic tooth movement.

The aim of this study was to identify the levels of interleukin (IL)-2, IL-6, and IL-8 around miniscrews used for anchorage during canine distalization. Sixteen patients (eight males and eight females; mean age, 16.6 ± 2.4 years) who were treated with bilateral upper first premolar extractions were included in the study. Thirty-two maxillary miniscrew implants were placed bilaterally in the alveolar bone between the maxillary second premolars and first molars as anchorage units for maxillary canine distalization. Three groups were constructed. The treatment, miniscrew, and control groups consisted of upper canines, miniscrew implants, and upper second premolars, respectively. Peri-miniscrew implant crevicular fluid and gingival crevicular fluid (GCF) were obtained at baseline (T1) and at 1 (T2), 24 (T3), and 48 (T4) hours, 7 (T5) and 21 (T6) days, and 3 months (T7) after force application. Paired sample t-tests were used to determine within-group changes and Dunnett's t and Tukey's honestly significant difference tests for between-group multiple comparisons. During the 3 month period, IL-2 levels significantly increased (P < 0.01) but only in the treatment group after 24 hours. IL-6 levels were unchanged at all times points in the three groups. IL-8 levels increased significantly at 1 (P < 0.05), 24 (P < 0.01), and 48 (P < 0.01) hours in the treatment group and at 24 (P < 0.05) and 48 (P < 0.01) hours in the miniscrew group. It appears that miniscrews can be used for anchorage in orthodontics when correct physiological forces are applied.

Genotoxic biomonitoring study of population residing in pesticide contaminated regions in Göksu Delta: micronucleus, chromosomal aberrations and sister chromatid exchanges.

Pesticides are widely used throughout the world in agriculture to protect crops and in public health to control diseases. Nevertheless, exposure to pesticides represents a potential risk to humans. This paper describes a study of possible genetic damage in the people living in regions contaminated with complex mixture of pesticides in Göksu Delta. In this study, used methods were chromosomal aberration (CA), sister chromatid exchange analysis (SCE) in the peripheral blood lymphocytes, and micronucleus (MN) assay in the buccal epithelial cells. In the present investigation, 32 affected subjects consist of 16 smoking and 16 non-smokings and an equal number of control subjects were assessed for genome damage. Micronucleus (MN), Broken egg (BE), Karyorrhexis (KR), Karyolysis (KL) and Binucleus (BN) frequencies were higher in affected subjects than in controls. Smoking had a statistically significant effect on the Micronucleus, Karyorrhexis and Binucleus frequencies for both the control and the exposed group. Also smoking and exposure affected the frequency of sister chromatid exchange and chromosomal aberrations compared with control groups.

Interleukine-1beta and tumor necrosis factor-alpha levels in the human gingival sulcus during orthodontic treatment.

OBJECTIVE: To test whether interleukine 1beta (IL-1beta) and tumor necrosis factor-alpha (TNF-alpha) levels differ from each other in different treatment levels. MATERIALS AND METHODS: Eighteen patients, nine female and nine male (aged 16-19 years; mean 17.4 +/- 1.8 years), participated in this study. Each subject underwent a session on professional oral hygiene and received oral hygiene instructions. Two months later, a fixed orthodontic appliance was placed. The patients were seen at baseline, at days 7 and 21 and at the 3rd and 6th month as the leveling of the teeth occurred. Records of the baseline scores for the distalization forces were taken at the 6th month. Days 7 and 21 after 6 months of treatment were also recorded. RESULTS: There were increases in the volume of gingival crevicular fluid (GCF) and in the concentrations of IL-1beta and TNF-alpha. CONCLUSIONS: Leveling and distalization of the teeth evoke increases in both the IL-1 and TNF-alpha levels that can be detected in GCF.

Interleukins 2, 6, and 8 levels in human gingival sulcus during orthodontic treatment.

INTRODUCTION: The aims of this study were to determine levels of interleukins 2, 6, and 8 during tooth movement, and test whether they differ from each other with leveling and distalization forces used in various treatment stages of standard orthodontic therapy. METHODS: Fifteen patients (9 female, 6 male; ages, 15-19 years; mean age, 16.7 +/- 2.3 years) participated in this study. Each underwent a session of professional oral hygiene and received oral hygiene instructions. Two months later, a fixed orthodontic appliance was placed. The patients were seen at baseline, at days 7 and 21, and as the teeth were leveled. Records of the baseline scores for the distalization forces were taken at the sixth month. Scores of days 7 and 21 after 6 months of the distalization treatment were also recorded. RESULTS: Increases were seen in the volume of gingival crevicular fluid and the concentrations of interleukins 2, 6, and 8. CONCLUSIONS: Leveling and distalization of the teeth evoke increases in interleukins 2, 6, and 8 levels in the periodontal tissues that can be detected in gingival crevicular fluid.