Eye care in intensive care in COVID-19 era: a prospective observational study from Turkey.

OBJECTIVE: There has been an increase in intensive care applications due to respiratory failure of COVID-19 infection. Management of respiratory failure includes a range of additional interventions, including high-flow nasal oxygen, noninvasive and invasive ventilation and prone position. These interventions contain risk factors for the development of ocular complications. This study aimed to elucidate the ocular pathologies that occurred in COVID-19 patients hospitalized in the intensive care unit. PATIENTS AND METHODS: Patients who completed 24 hours in the intensive care unit were included in the study. Age, gender, duration of hospitalization before intensive care unit, comorbid diseases and APACHE 2 scores of COVID-19 patients admitted to intensive care unit were recorded. SOFA scores, presence of sedation and muscle relaxant, oxygen therapy (conventional oxygen therapy, high flow nasal oxygen therapy, noninvasive ventilation, invasive ventilation) and presence of prone position were recorded. All patients were evaluated daily for ocular findings. Routine eye care protocol was applied to all patients. RESULTS: Seventy patients were followed for a total of 596 days in the intensive care unit. Pathological ocular findings were observed during hospitalization in 59 of the patients followed. The incidence of chemosis in patients who underwent IMV was significantly higher compared to other methods (p<0.001). CONCLUSIONS: In this study, we observed that despite our routine eye care protocols, invasive mechanical ventilation applications predispose corneal surface damage in patients followed up in the intensive care unit with COVID-19 infection.

Evaluation of potential drug-drug interactions in intensive care unit.

OBJECTIVE: Potential drug-drug interactions (pDDIs) and adverse drug reactions (ADRs) may be frequently observed in critically ill patients because of multiple drug use. It is important to identify pDDIs before their progression to ADRs. This study aimed to determine the prevalence and effect of pDDIs and possible ADRs in intensive care patients. PATIENTS AND METHODS: In this retrospective cross-sectional study, the medical records of patients in the intensive care unit (ICU) of Bursa Uludag University Faculty of Medicine Hospital between January 1, 2018, and December 31, 2018, were examined. Medication orders were recorded on days 2, 5, and 10. pDDIs, defined using the lexi-interact (UpToDate, 2020), were classified based on the significance level. RESULTS: A total of 144 patients were included in this study, and from the 395 medication orders, 1,776 had pDDIs. Of these interactions, 23.5% were major (n = 418), 71.4% were moderate (n = 1268), and 5.1% (n = 90) were minor. The majority of patients (96.9%) had at least one pDDI. There was a strong correlation between the number of drugs on days 2, 5, and 10 and the number of pDDIs (p < 0.001, ρ = 0.7; p < 0.001, ρ = 0.72; p < 0.001, ρ = 0.73, respectively). No significant correlation was found among the number of pDDIs, the APACHE II score, and the duration of ICU stay. CONCLUSIONS: The prevalence of pDDIs was high and there was a strong correlation between the number of drugs and pDDIs. Detection of potential interactions through clinical decision support systems and checker tools should be used to increase patient safety.

ALDH1A3 is epigenetically regulated during melanocyte transformation and is a target for melanoma treatment.

Despite the promising targeted and immune-based interventions in melanoma treatment, long-lasting responses are limited. Melanoma cells present an aberrant redox state that leads to the production of toxic aldehydes that must be converted into less reactive molecules. Targeting the detoxification machinery constitutes a novel therapeutic avenue for melanoma. Here, using 56 cell lines representing nine different tumor types, we demonstrate that melanoma cells exhibit a strong correlation between reactive oxygen species amounts and aldehyde dehydrogenase 1 (ALDH1) activity. We found that ALDH1A3 is upregulated by epigenetic mechanisms in melanoma cells compared with normal melanocytes. Furthermore, it is highly expressed in a large percentage of human nevi and melanomas during melanocyte transformation, which is consistent with the data from the TCGA, CCLE and protein atlas databases. Melanoma treatment with the novel irreversible isoform-specific ALDH1 inhibitor [4-dimethylamino-4-methyl-pent-2-ynthioic acid-S methylester] di-methyl-ampal-thio-ester (DIMATE) or depletion of ALDH1A1 and/or ALDH1A3, promoted the accumulation of apoptogenic aldehydes leading to apoptosis and tumor growth inhibition in immunocompetent, immunosuppressed and patient-derived xenograft mouse models. Interestingly, DIMATE also targeted the slow cycling label-retaining tumor cell population containing the tumorigenic and chemoresistant cells. Our findings suggest that aldehyde detoxification is relevant metabolic mechanism in melanoma cells, which can be used as a novel approach for melanoma treatment.

Aldehyde dehydrogenases inhibition eradicates leukemia stem cells while sparing normal progenitors.

The vast majority of patients with acute myeloid leukemia (AML) achieve complete remission (CR) after standard induction chemotherapy. However, the majority subsequently relapse and die of the disease. A leukemia stem cell (LSC) paradigm has been invoked to explain this failure of CR to reliably translate into cure. Indeed, LSCs are highly enriched in CD34+CD38- leukemic cells that exhibit positive aldehyde dehydrogenase activity (ALDH+) on flow cytometry, these LSCs are resistant to currently existing treatments in AML such as cytarabine and anthracycline that, at the cost of great toxicity on normal cells, are highly active against the leukemic bulk, but spare the LSCs responsible for relapse. To try to combat the LSC population selectively, a well-characterized ALDH inhibitor by the trivial name of dimethyl ampal thiolester (DIMATE) was assessed on sorted CD34+CD38- subpopulations from AML patients and healthy patients. ALDH activity and cell viability were monitored by flow cytometry. From enzyme kinetic studies DIMATE is an active enzyme-dependent, competitive, irreversible inhibitor of ALDH1. On cells in culture, DIMATE is a powerful inhibitor of ALDHs 1 and 3, has a major cytotoxic activity on human AML cell lines. Moreover, DIMATE is highly active against leukemic populations enriched in LSCs, but, unlike conventional chemotherapy, DIMATE is not toxic for healthy hematopoietic stem cells which retained, after treatment, their self-renewing and multi-lineage differentiation capacity in immunodeficient mice, xenografted with human leukemic cells. DIMATE eradicates specifically human AML cells and spares healthy mouse hematologic cells.

Experimental Escherichia coli epididymitis in rats: assessment of testicular involvement in a long-term follow-up.

The objective of this study was to investigate spermatogenesis and testicular inflammation in a rat model of unilateral Escherichia coli epididymitis in a long-term follow-up. Unilateral epididymitis was induced in 30 Sprague-Dawley rats by injecting E. coli into the right ductus deferens. Oral antimicrobial treatment with sparfloxacin (50 mg kg(-1) body weight/7 days) was administered in half of the animals 24 h after infection. Five treated and five untreated rats were killed at 2 weeks, 3 months and 6 months after infection. Spermatogenesis was investigated using a histological semi-quantitative score. The presence of inflammatory cells (B- and T lymphocytes, macrophages and granulocytes) in the testicular tissues was evaluated by immunohistochemistry. The testes were sterile at all times. Over the course of 6 months, spermatogenesis underwent significant incremental impairment on the inoculated side as compared to the contralateral side (P < 0.001). However, overall spermatogenesis scores were not significantly different between treated and untreated animals (P > 0.3 at each time point). Finally, loss of testicular architecture on the inoculated side was not associated with any cellular inflammatory response. Thus, adjuvant therapies need to be studied, and research is necessary on how to prevent deterioration of testicular function in bacterial epididymitis.

Effect of a chronic nail-biting habit on the oral carriage of Enterobacteriaceae.

BACKGROUND/AIMS: Nail biting is a common oral habit in children and young adults. However, its effect on the oral carriage of Enterobacteriaceae is unclear. The purpose of the study was to evaluate the differences in prevalence of Enterobacteriaceae in saliva samples from subjects with and without a nail-biting habit. METHODS: Saliva samples were taken from 25 subjects who were nail-biters and 34 subjects with no oral habit. The mean chronological age for all subjects was 13.5 +/- 1.9 years. The saliva samples were studied microbiologically. A Pearson chi-squared test was performed to compare the prevalence of Enterobacteriaceae in the saliva samples of the subjects with and without nail-biting habits. RESULTS: Statistically significant differences were found in the prevalence of Escherichia coli and total Enterobacteriaceae between both groups (P < 0.001). E. coli, Enterobacter aerogenes, Enterobacter cloacae and Enterobacter gergoviae were found in the saliva samples of 19 of the 25 nail-biting subjects (76%), whereas E. coli, E. aerogenes and E. cloacae were detected in the saliva samples of only nine of the 34 subjects who were not nail-biters (26.5%). CONCLUSION: According to the results of the present study, the Enterobacteriaceae were more prevalent in the oral cavities of children with nail-biting habits than in children with no oral habit.

The effects of overbite on the maxillary and mandibular morphology.

The aim of this study was to investigate the differences in the maxillary and mandibular morphology related to the overbite. A total of 80 untreated subjects were divided into 4 groups with normal overbite, edge-to-edge bite, open bite, or deep bite and were compared with one another. Differences between the overbite groups and between genders were assessed by means of variance analysis and the least significant difference test. In addition, correlation coefficients between the overbite and other variables were calculated. The results showed that there are statistically significant differences in the maxillary and mandibular morphology among the overbite groups.

An investigation of mandibular morphology in subjects with different vertical facial growth patterns.

In the present study, mandibular morphology was investigated on lateral cephalometric head films and dental casts of 60 subjects (30 females and 30 males) who had different vertical facial growth patterns. The sample had a mean age of 13.5 years, with a range of 11 to 15.5 years. The subjects were divided into three groups with regard to vertical facial growth by using the SN/GoGn angle to define low-angle, normal, and high-angle groups. In addition, each group was divided into two subgroups according to sex. The effects of the SN/GoGn angle and gender on mandibular morphology were investigated by means of analysis of variances. Tan Go, IMPA, SL, and EL measurements were found to be related to SN/GoGn, and the measurements of Go-Gn, Symphysis depth, and Intermolar width to be related to sex.

Longitudinal cephalometric changes in the maxilla, mandible and maxillary-mandibular relationship between 10 and 14 years of age.

In the present study, longitudinal growth changes in the maxilla, mandible, and maxillary-mandibular relationship occurring between the ages of 10 and 14 years were evaluated in 19 female and 15 male subjects. All subjects had a clinically-acceptable occlusion, a normal growth pattern, and none had undergone orthodontic treatment. Serial cephalometric radiographs were taken at the ages of 10, 11, 12, and 14 years. The effects of age and sex on the sagittal growth of the jaws were studied by means of variance analysis. The results show that A-Ptm, B-Ptm, Pg-Ptm, A'-Ptm, B'-Ptm, and S-N-Pg measurements were affected by age, and the measurements A-Ptm, A'-Ptm, Wits and ANB by sex. Duncan's multiple range test was applied to those measurements where F values were found to be statistically significant. As a result, it was observed that the greatest growth changes occurred between 12 and 14 years old.

The effect of rapid maxillary expansion on conductive hearing loss.

The effects of rapid maxillary expansion (RME) on conductive hearing loss were investigated in 14 subjects (11 females and 3 males). The subjects ranged in age from 10 years 4 months to 16 years 9 months (mean age 12 years 11 months +/- 1 year 9 months) and had narrow maxillary arches and conductive hearing loss. Hearing levels were determined by means of pure-tone audiometric records. Three records were taken for each subject. The first was taken before RME, the second after sufficient midpalatal suture opening was achieved (mean = 15 days), and the third after the retention period (mean = 4.5 months). All the audiometric records were assessed by an otolaryngologist. Changes in both hearing level and air-bone gap were investigated by means of analysis of variance. It has been determined that hearing improved at a statistically significant level (P < 0.05) after the active treatment period, but that the improvement reversed at the end of the retention period. Five patients experienced significant and stable hearing improvement over the duration of this study.

A study on the pharyngeal size in different skeletal patterns.

In the present study, pharyngeal size was investigated on the lateral cephalometric head films of 90 subjects, 45 males and 45 females, having different ANB angles. All of the subjects were aged 13 to 15 years. The films were taken at natural head position, and all were divided into three groups according to the ANB angle: ANB angles smaller than 1 degree, between 1 degree and 5 degrees, and larger than 5 degrees. In addition, each group was also divided into two subgroups according to sex. The effects of the ANB angle and sex on the pharyngeal size were investigated by means of variance analysis. It has been observed that two measurements, hy-apw4 and oropharynx area measurements, were affected by the change of ANB angle, and two other measurements, t-ppw and hy-apw2 measurements, by the sex; and that hy-apw4 measurement and oropharynx area became smaller with the increase of ANB angle.

[Investigation of pre- and post-treatment cephalometric measurements of the subjects treated by Edgewise technique]. / Edgewise teknikle tedavi edilen bireylerde tedavi öncesi ve sonrasi sefalometrik ölçümlerin incelenmesi.

In this study, pre and posttreatment cephalometric measurements of twenty-four cases, of which twelve had Angle Class I and twelve had Angle Class II, division 1 malocclusion were studied. Dental, skeletal and soft tissue changes were observed in both class I and class II, 1 malocclusions treated by Edgewise Technique with extraction.

[Tracing and measuring errors in the roentgenographic cephalometry]. / Röntgenografik sefalometrik çizim ve ölçüm hatalari.

In the present study, thirty cephalometric films which had been used in three different investigations using almost the same parameters were selected and divided into two groups. Twenty-three parameters in the first group and nine parameters in the second, which were used in two and three investigations respectively, were statistically compared. Paired t test was used in the first group and variance analysis in the second group. In conclusion, a lot of parameters exhibited statistically significant variability, while some of them were not.