Critical care for lung cancer patients: surgical treatment during COVID-19 pandemic.

BACKGROUND: During the COVID-19 pandemic, some factors have led to changes in the management of patients with lung cancer. In our study, we aimed to present our surgical treatment approach to patients with NSCLC during the COVID-19 pandemic. METHODS: Patients who underwent surgery for NSCLC in our thoracic surgery clinic between March 2020 and March 2021 were evaluated retrospectively. The patients operated on were retrospectively evaluated in terms of sex, age, tumor staging, lung resection type, histopathological type, COVID-19 status, length of stay, complications, and mortality. RESULTS: Thirty-five patients, 27 men and 8 women, underwent surgery for lung cancer. The 2 most common types of surgery were lobectomy (in 32 patients) and pneumonectomy (in 3 patients). According to cancer staging based on 8th TNM, 14 patients were stage 2B, 12 patients were stage 2A, and 9 patients were stage 3A. The morbidity rate was 14 %. No postoperative mortality was observed. Nine patients had a history of COVID- 19 before surgery. No significant difference was found in terms of complications in patients with a preoperative history of COVID-19. In the postoperative period, COVID-19 was observed in no patient in our clinic. CONCLUSION: We think that surgical treatments should not be postponed for diseases such as lung cancer, where the mortality rate is high and early diagnosis and treatment are very important. There will be no delay or inadequacy in the treatment of patients if the rules determined during the COVID-19 pandemic and other types of pandemic possibly occurring in the future are followed (Tab. 1, Ref. 23).

Clinical and biochemical effects of erbium, chromium: yttrium, scandium, gallium, garnet laser treatment as a complement to periodontal treatment.

OBJECTIVE: The purpose of this study was to investigate the clinical effects of erbium, chromium: yttrium, scandium, gallium, garnet (Er, Cr: YSGG) laser treatment as a complementary to scaling and root planning (SRP) during the treatment of chronic periodontitis and gingival crevicular fluid (GCF) interleukin-1 beta (IL-1ß), interleukin-6 (IL-6), and interleukin-35 (IL-35) levels. MATERIALS AND METHODS: Forty patients with chronic periodontitis were divided into two equal groups at random to receive SRP alone and SRP followed by Er, Cr: YSGG laser treatment, which are control and test groups, respectively. Clinical attachment level (CAL), probing depth (PD), bleeding on probing (BOP), gingival index (GI), and plaque index (PI) were measured for all patients in both groups at baseline and again at the end of the 1st, 3rd, and 6th months following the treatment. Levels of GCF IL-1ß, IL-6, and IL-35 were analyzed by enzyme-linked immunosorbent assay. RESULTS: After periodontal treatment, CAL, PD, BOP, GI, and PI, which are clinical parameters analyzed, decreased significantly (P < 0.05) in both test and control groups. GCF volume, IL-1 ß, IL-6, and IL-35, levels in both groups proved statistically significant reductions compared to the baseline (P < 0.05), but no substantial variations were detected among both groups. CONCLUSION: According to these results, we can suggest that IL-35 may be related to the pathogenesis of periodontitis and that Er, Cr: YSGG laser can be used as an adjunct to SRP in periodontal treatment.

The effects of irrigation volume to the heat generation during implant surgery.

BACKGROUND: To evaluate the effects of the amount of irrigation on heat generated during implant site preparation. MATERIAL AND METHODS: Ten freshly dissected sheep mandibles were sectioned into 30 equal bone blocks and transferred into a heat-controlled water tank. Implant socket preparations were performed with four consecutive drills. Temperature measurements were performed with a thermocouple inserted into the bone immediately before the preparation and after the drilling using three different physiologic saline irrigation set-ups: 1- No irrigation, 2- 12 ml/min and 3- 30 ml/min irrigation volume. The temperature differences between three different irrigation set-ups for implant drills 1, 2, 3 and 4, and the temperature differences between the drills for three different irrigation set-ups were separately compared. RESULTS: The temperature difference of no irrigation group was significantly higher than 12 ml/min and 30 ml/min groups for all four drills (p<0.05), whereas no statistically significant difference was found between 12 ml/min and 30 ml/min irrigation groups. (p>0.05) The temperature difference of drill 1 is significantly higher than drills 2, 3 and 4 for no irrigation group. (p<0.05) The temperature differences of drill 1, 2 and 3 were significantly higher than the temperature difference of drill 4 for 12 ml/min irrigation group. (p<0.05) Conclusions: The heat generated during drilling is not directly proportional to the coolant volume. Given that certain amount of irrigation is applied, implant sites can be prepared safely without the need for additional irrigation, which may result in reduced visibility of the surgical site and therefore a suboptimal surgery.

Oro-dental characteristics of three siblings with Papillon-Lefevre syndrome.

Papillon-Lefevre syndrome (PLS) is a rare autosomal recessive disorder, showing oral and dermatological manifestations in the form of aggressive periodontitis, leading to the premature loss of both primary and permanent teeth at a very young age and palmar-plantar hyperkeratosis. It was first described by two French physicians, Papillon and Lefevre in 1924. Immunologic, genetic, or possible bacterial etiologies have been thought to account for etiopathogenesis of PLS. Severe gingival inflammation and periodontal destruction occurred after the eruption of primary teeth. This condition should warn the physicians and dentists as a one of the important sign for the diagnosis of PLS. There have been over 250 cases reported in literature about PLS, but a few of these were in the same family. This study presents oro-dental characteristics, dental treatments, and follow-up of three siblings (age of sisters are 13, 6, and 4 years) with PLS, which is rarely seen in the same family.

Effects of alpha-tocopherol on gingival expression of inducible nitric oxide synthase in the rats with experimental periodontitis and diabetes.

BACKGROUND: The aim of this study was to investigate effects of α-tocopherol and/or insulin on the number of gingival inducible nitric oxide synthase (iNOS) positive cells in rats with experimental periodontitis with or without streptozotocin (STZ)-induced diabetes. MATERIALS AND METHODS: A total of 60 Sprague-Dawley rats were divided into three groups: Group I: The group without diabetes; Group II: The group with STZ-induced diabetes; Group III: The group with STZ-induced diabetes receiving insulin therapy. All animals received anesthesia, and 3/0 silk suture was inserted around the mandibular molar teeth. All groups were divided into subgroups receiving saline (Groups IA, IIA, IIIA) and α-tocopherol injection (Groups IB, IIB, IIIB). After a period of 3 weeks, all rats were sacrificed, and the number of gingival iNOS positive cells was analyzed using image analysis software. RESULTS: Applying α-tocopherol suppressed the number of gingival iNOS positive cells in Groups IB, IIB, and IIIB compared to application of saline (Groups IA, IIA, and IIIA) (P < 0.05). Numbers of gingival iNOS positive cells were found to be similar in the Groups I and III (P > 0.05). CONCLUSIONS: Within limitations of the current study, this is the first study one may suggest that α-tocopherol may reduce oxidative damage in the gingiva of the rats with periodontitis with or without STZ-induced diabetes and increase effects of insulin.

Effects of erbium-and chromium-doped yttrium scandium gallium garnet and diode lasers on the surfaces of restorative dental materials: a scanning electron microscope study.

AIM: The aim of this study is to evaluate the potential effects of laser irradiation, which is commonly performed in periodontal surgery, on the surfaces of restorative materials. MATERIALS AND METHODS: Five different restorative dental materials were used in this study, as follows: (1) Resin composite, (2) poly acid-modified resin composite (compomer), (3) conventional glass ionomer cement (GIC), (4) resin-modified glass ionomer cement (RMGIC), and (5) amalgam. Four cylindrical samples (8 mm diameter, 2 mm height) were prepared for each restorative material. In addition, four freshly extracted, sound human incisors teeth were selected. Two different laser systems commonly used in periodontal surgery were examined in this study: A 810 nm diode laser at a setting of 1 W with continuous-phase laser irradiation for 10 s, and an erbium-and chromium-doped yttrium scandium gallium garnet (Er, Cr: YSGG) laser at settings of 2.5 W, 3.25 W, and 4 W with 25 Hz laser irradiation for 10 s. Scanning electron microscopy (SEM) analysis was performed to evaluate the morphology and surface deformation of the restorative materials and tooth surfaces. RESULTS: According to the SEM images, the Er, Cr: YSGG laser causes irradiation markings that appear as demineralized surfaces on tooth samples. The Er, Cr: YSGG laser also caused deep defects on composite, compomer, and RMGIC surfaces because of its high power, and the ablation was deeper for these samples. High-magnification SEM images of GIC samples showed the melting and combustion effects of the Er, Cr: YSGG laser, which increased as the laser power was increased. In amalgam samples, neither laser left significant harmful effects at the lowest power setting. The diode laser did cause irradiation markings, but they were insignificant compared with those left by the Er, Cr: YSGG laser on the surfaces of the different materials and teeth. CONCLUSION: Within the limitations of this study, it can be concluded that Er, Cr: YSGG laser irradiation could cause distortions of the surfaces of restorative materials. Diode lasers can be preferred for periodontal surgery.

Interleukin-33 could play an important role in the pathogenesis of periodontitis.

BACKGROUND AND OBJECTIVE: Interleukin-33 (IL-33) controls T-helper type 2 (Th2) cytokines and the development of mast cells. This study aimed to investigate the expression of IL-33 and its association with RANKL and osteoprotegerin (OPG) in periodontal health and experimental periodontitis. MATERIAL AND METHODS: Eighteen Wistar rats were assigned to two study groups of nine animals each: ligature only (LO) and nonligated (NL). Silk sutures were placed subgingivally, surrounding the right lower first molars. The animals were killed on day 11 after ligature placement, and the alveolar bone loss at the first molars was determined histometrically. Periodontal tissues were examined histopathologically to evaluate the differences between the groups. The expression of IL-33, RANKL and OPG was detected immunohistochemically. RESULTS: The LO group showed significantly greater alveolar bone loss compared with the NL group (p < 0.05). The numbers of osteoclasts, osteoblasts and inflammatory cells were significantly higher in the LO group compared with the NL group (p < 0.05). Osteoblastic activity was significantly lower in the LO group than in the NL group (p < 0.05). There was significantly higher expression of IL-33 and RANKL and a greater number of OPG-positive cells in the LO group (p < 0.05). IL-33 expression showed a positive correlation with RANKL expression and with the number of mast cells (p < 0.05). CONCLUSION: The experimental periodontitis group exhibited increased expression of IL-33 and RANKL compared with the healthy group. Additionally, there was a positive correlation between these expressions. According to these results, IL-33 could be associated with the pathogenesis of periodontal disease.

The microbiologic profile of diabetic foot infections in Turkey: a 20-year systematic review: diabetic foot infections in Turkey.

The causative pathogens in diabetic foot infections differ in studies of European compared with Asian populations. The purpose of this study was to determine the causative microorganisms and their antibiotic sensitivity patterns in diabetic patients with a foot infection in Turkey, a country at the crossroads of these two continents. We performed a comprehensive literature search to identify all published studies pertaining to DFIs in patients cared for in Turkey. To assess changes in causative organisms and their antibiotic sensitivity patterns over time, we compared the results of just the most recent 5 years (2007-2011) with those of the past 20-years (1989-2011). We identified 31 studies meeting our inclusion criteria. Overall, these studies reported 2,097 patients, from whom 1,974 microorganisms were isolated. The total percentage of gram-negative and gram-positive aerobic bacteria were similar in each of the assessed periods. The rate of isolation of Staphylococcus aureus during the entire period, compared with just the past 5 years, was 23.8% and 19.1%, respectively, while the rate of methicillin-resistant S. aureus was 7.8% and 5.7%, respectively. The isolation rate of Pseudomonas aeruginosa was 13.7% for the entire period and 14.9% for the past 5 years. While linezolid, vancomycin and teicoplanin were the most active agents against gram-positive microorganisms, imipenem and cefoperazone-sulbactam were the most active against gram-negative microorganisms. This systematic review demonstrated few substantial changes in diabetic foot microbiology over the past 20 years. The data may help develop and update local clinical guidelines regarding antibiotic therapy for diabetic foot infections in Turkey. Further studies, especially with optimal culture methods, would be useful to validate these findings.

Boric acid inhibits alveolar bone loss in rats by affecting RANKL and osteoprotegerin expression.

BACKGROUND AND OBJECTIVE: The goal of the present study was to evaluate the effects of systemic boric acid on the levels of expression of RANKL and osteoprotegerin (OPG) and on histopathologic and histometric changes in a rat periodontitis model. MATERIAL AND METHODS: Twenty-four Wistar rats were divided into three groups of eight animals each: nonligated (NL); ligature only (LO); and ligature plus treatment with boric acid (BA) (3 mg/kg per day for 11 d). A 4/0 silk suture was placed in a subgingival position around the mandibular right first molars; after 11 d the rats were killed, and alveolar bone loss in the first molars was histometrically determined. Periodontal tissues were examined histopathologically to assess the differences among the study groups. RANKL and OPG were detected immunohistochemically. RESULTS: Alveolar bone loss was significantly higher in the LO group than in the BA and NL groups (p < 0.05). The number of inflammatory infiltrate and osteoclasts in the LO group was significantly higher than that in the NL and BA groups (p < 0.05). The numbers of osteoblasts in LO and BA groups were significantly higher compared with NL group (p < 0.05). There were significantly more RANKL-positive cells in the LO group than in the BA and NL groups (p < 0.05). There was a higher number of OPG-positive cells in the BA group than in the LO and NL groups (p < 0.05). CONCLUSION: The present study shows that systemic administration of boric acid may reduce alveolar bone loss by affecting the RANKL/OPG balance in periodontal disease in rats.

The protective effects of acetyl L-carnitine on testis gonadotoxicity induced by Cisplatin in rats.

BACKGROUND: Cisplatin, an effective antineoplastic agent, damages normal cells in a manner related to chemotherapy. Acetyl L-carnitine protects cells against mitochondrial and nuclear damage induced by chemotherapy. AIMS: Animal experiment. STUDY DESIGN: The aim of this study was to examine the protective effects of acetyl L-carnitine on cisplatin-induced gonadotoxicity in testicular structures. Twenty-four male Wistar albino rats were divided into four Groups (n=6): Group 1 (control) was administered saline; Group 2 was administered acetyl L-carnitine; Group 3 was administered cisplatin; and Group 4 was pre-treated with acetyl L-carnitine before cisplatin administration. METHODS: After 72hr of treatment with cisplatin, the rats were sacrificed, and the testicular tissues were removed. Morphometric, histomorphologic and immunohistochemical analyses were conducted. RESULTS: At the end of the experiment, Group 3 was characterised by statistically significant weight loss, a degenerative appearance of the seminiferous tubules in the peripheral region, separation of spermatogenic cell series from the tubular wall, cellular debris in the lumen and central interstitial oedema. Sperm morphology appeared to be abnormal. Tubular diameter and wall thickness decreased, and the number of TUNEL- and active caspase-positive cells increased compared with the other Groups. The histological findings in Group 4 were better than those in Group 3. CONCLUSION: It was concluded that the prophylactic use of acetyl L-carnitine protects against cisplatin-induced testicular tissue damage.