Predictive factors for mortality in intensive care patients with Fournier's gangrene: five years' experience from a single center in Turkey.

OBJECTIVE: The aim of this study was to analyze mortality-related factors and scoring systems in order to better manage the treatment process of patients monitored in the intensive care unit (ICU) due to Fournier's gangrene (FG). PATIENTS AND METHODS: The study included 28 male patients who were monitored in the surgical ICU with the diagnosis of FG between December 2018 and August 2022. The patients' comorbidities, acute physiological and chronic health evaluation scoring system II (APACHE II), Fournier gangrene severity index (FGSI), sequential organ failure assessment (SOFA) scores, and laboratory data were evaluated retrospectively. RESULTS: Of the patients, 67.9% (n=19) had diabetes mellitus, 78.6% (n=22) had hypertension, and 71.4% (n=20) had coronary artery disease. The mortality rate was 42% (n=11). There was no statistically significant difference between the patients who died and those who survived in terms of the SOFA score, comorbidities, and albumin, glucose, and procalcitonin values (p > 0.05), but age, APACHE II and FGSI scores, and the C-reactive protein (CRP) value were significantly higher in the non-survivor group. There was a positive correlation between the FGSI, APACHE II, and SOFA scores. CONCLUSIONS: Older age, high CRP levels at the time of admission, and the presence of comorbidity are still determining factors in the prediction of mortality in patients with FG. We also determined that in predicting mortality in patients monitored in the ICU with the diagnosis of FG, in addition to the routinely used FGSI, the APACHE II score was also useful, but the SOFA score did not have significant predictive value.

Clinical Evaluation of Low-shrinkage Bioactive Material Giomer Versus Nanohybrid Resin Composite Restorations: A Two-year Prospective Controlled Clinical Trial.

This study evaluated the clinical performance of low-shrinkage bioactive resin composite compared with a conventional nanohybrid resin composite. A total of 35 patients (18 males, 17 females; mean age: 29±9 years old) received, randomly, 35 pairs of fillings restored with either low-shrinkage bioactive material employing Giomer filler technology (Beautifil II LS, Shofu Inc, Kyoto, Japan) or conventional nanohybrid resin composite (Clearfil Majesty Posterior, Kuraray, Japan) in Class I and Class II cavities. Two operators made all the restorations using the corresponding adhesive resins: FL-Bond II (Shofu Inc) and Clearfil SE Bond (Kuraray), according to each manufacturer's instructions. Two calibrated operators evaluated the restorations two weeks after placement (baseline), at six months, and at one and two years using FDI criteria (Scores 1-5). Data were analyzed using the McNemar test (α=0.05). Mean observation time was 27.4 ± 4.1 months (min=20.8; max=33.7). In both groups, according to FDI criteria, the restorations were mostly rated with best scores (Score 1 or 2) for biological, functional, and optical parameters. For one filling in the group restored with nanohybrid resin composite, a small and localized secondary caries lesion was observed and monitored at the one- and two-year follow-ups. One restoration in the low-shrinkage Giomer restorative group was accepted as a failure due to retention loss. Over the two-year follow-up, both the Giomer and the nanohybrid resin composite restorations' performance was clinically acceptable.

The value of maspin and PD-L1 expression and peritumoral lymphocytic infiltration in breast tumors.

OBJECTIVE: Breast cancer is the most common type of cancer in women worldwide. Our aim is to evaluate the importance of immunotherapy in breast cancer cases by using PD-L1 expression and to determine the effect of Maspin expression and lymphocytic density on predicting the prognosis. METHODS: A total of 200 breast cancer cases with different histological types were included in the study. The expression of PD-L1 and Maspin in these tumors were evaluated, and the lymphocytic infiltration density was examined. RESULTS: Expression of PD-L1 in tumor cells was significantly higher in "medullary carcinoma" and grade 3 tumors. Expression of PD-L1 in inflammatory cells was increased in the group of "other types" and grade 3 tumors. Maspin expression was observed in 93 cases and was higher in "lobular carcinoma" and high grade tumors. In our study, a significant correlation was found between lymphocytic density score and histological grade and PD-L1 expression. CONCLUSION: In our study, PD-L1 expression was detected in breast cancer, and was associated with triple negativity and high grade. Our results show that the Maspin expression and lymphocyte density are associated with the prognosis (Tab. 5, Fig. 4, Ref. 44).

Clinical Performance of Nanofilled and Microhybrid Direct Composite Restorations on Endodontically Treated Teeth.

This study evaluated the clinical performance of direct restorations made of nanofilled and microhybrid resin composites in endodontically treated teeth. Twenty patients (11 males, 9 females; mean age: 34.2±10) that met the inclusion criteria received a total of 48 restorations. After employing etch-and-rinse adhesive system, one dentist placed all restorations using either a nanofilled (Filtek Ultimate) or microhybrid (Filtek Z250) resin composite. The restorations were clinically reviewed at baseline, 6 months, and up to 2 years using the modified United States Public Health Service (USPHS) criteria. The changes were analyzed using the McNemar test and marginal homogeneity tests (p⟨0.05). The mean observation period was 17.4 months. With respect to color match, marginal adaptation, secondary caries, and surface texture, no significant differences were found between the two restorative materials (p⟩0.05). Most restorations yielded alpha or bravo scores with respect to the evaluation criteria. Five restorations failed due to chipping up to 2 years (1 microhybrid at 6 m, and 3 at 2 years; 1 nanofilled at 2 y) and were repaired. One complete replacement and one extraction due to endodontic complications were needed for 2 microhybrid resin group at 2 years.

Isolation and identification of Treponema pedis and Treponema phagedenis-like organisms from bovine digital dermatitis lesions found in dairy cattle in Turkey.

The isolation and identification of microorganisms associated with digital dermatitis (DD) in Turkish dairy cattle was investigated using punch skin biopsy samples from typical clinical lesions; they were collected from dairy farms and abattoirs in 5 different geographical locations in Turkey. Morphological characteristics and flagellation types were examined using a transmission electron microscope, and their enzyme profiles by enzyme activation kits; their catalase reaction characteristics were evaluated by the addition of 3% H2O2. Their phylogenies were identified using 16S rRNA and the results compared with known gene bank data. Bacterial cells were 5.0 to 18.2 µm long, 0.2 to 0.5 µm wide, and their minimum number of periplasmic flagellum was 4 (4:8:4) with a maximum of 8 (8:16:8). All isolates were catalase negative. Of the spirochetes isolated and identified, group I organisms showed close similarity with Treponema pedis (99% genetic homology), whereas those in group II were similar to Treponema phagedenis (98% homology). This is the first report of specific sub-groups of Treponema spp., isolated from Turkish dairy cattle presenting with DD lesions, being associated with this disease; these morphotypes were similar to those found globally in housed dairy cattle units and are probably significant microorganisms associated with the aetiopathogensis of this infectious disease causing acute bovine lameness. These results suggest that the distribution of DD-associated treponemes is not specific to particular geographic regions of Turkey.

Clinical Evaluation of Sonic-Activated High Viscosity Bulk-Fill Nanohybrid Resin Composite Restorations in Class II Cavities: A Prospective Clinical Study up to 2 Years.

This study evaluated the clinical performance of a bulk-fill resin composite in class II cavities for up to 2 years. Class II restorations (N=111) were made using a nanohybrid bulk-fill resin composite (SonicFill, Kerr Corp.) and evaluated following 1 week after placement, at 6 months, and thereafter annually up to 2 years using the United States Public Health Service (USPHS) criteria. The changes were analyzed using the McNemar test and the Kaplan-Meier method. No secondary caries was observed until the final recall. One restoration underwent endodontic treatment after 2 months following the restorative procedure and was deemed a failure. The overall success rate was 99.1%. Colour match deteriorated from a score of 0 to 1 in eight restorations from baseline to 6 months and six restorations showed marginal staining at final recall. Bulk-fill resin composite (SonicFill) showed acceptable clinical performance through 2 years of service but colour match to the tooth started to show some deterioration within the first 6 months.

Clinical Evaluation of Silorane and Nano-hybrid Resin Composite Restorations in Class II Cavities up to 3 Years.

In this study, the clinical performance of a silorane-based resin composite (SC) vs a nano-hybrid resin composite (NHC) was evaluated in Class II cavities. From January 2012 to February 2013, a total of 29 patients (eight men, 21 women; mean age, 24 ± 5 years) received 29 pairs of restorations using both SC (Filtek Silorane, 3M ESPE) and NHC (Filtek Z550, 3M ESPE) materials. Patients were followed until February 2015. One operator performed all restorations using the corresponding adhesive resins according to the manufacturers' instructions. Two calibrated independent examiners evaluated the restorations at one week, six months, and then annually using the modified United States Public Health Service (USPHS) criteria for anatomic form, marginal adaptation, color match, surface roughness, marginal discoloration, secondary caries, and postoperative sensitivity. Changes in the USPHS parameters were analyzed with the McNemar test (α=0.05). The mean observation period was 31.2 months. Marginal adaptation was the only parameter that showed a significant difference and was worse for SC than NHC (p=0.012). At the final recall, 17 restorations from the SC group and five from the NHC group received a score of 1 (explorer catches). These scores were significantly different between baseline and final recall for SC (p<0.001) but not for NHC (p>0.05). Both NHC and SC performed similarly in Class II restorations up to three years except for marginal adaptation, for which the latter demonstrated significant deterioration at the final recall compared with baseline.

Reattachment of dehydrated tooth fragments: two case reports.

Anterior crown fractures are the most common type of injury in dental trauma. The ideal treatment is to reattach the fragments as quickly as possible following intraoral and radiographic examination, but sometimes delayed treatment appointments are necessary because of uninformed patients/parents or multidisciplinary cases included endodontically and periodontically. Delayed reattachment may lead to unesthetic results because of the dehydration of fragments. The purpose of this study was to present 1-year follow-ups of reattachment of dehydrated fragments using dentin bondings and flowable composites in two different cases. The color of the dehydrated fragments was natural in the control appointments and 1-year follow-ups show harmonious integration of color, form and texture after the reattachment of the original piece of tooth. Restoration of the tooth by reattaching the original fragment is the best way of treatment in esthetic, conservative and economic point of view.

Genitourinary brucellosis: results of a multicentric study.

This study reviewed the clinical, laboratory, therapeutic and prognostic data on genitourinary involvement of brucellosis in this largest case series reported. This multicentre study pooled adult patients with genitourinary brucellar involvement from 34 centres treated between 2000 and 2013. Diagnosis of the disease was established by conventional methods. Overall 390 patients with genitourinary brucellosis (352 male, 90.2%) were pooled. In male patients, the most frequent involved site was the scrotal area (n=327, 83.8%), as epididymo-orchitis (n=204, 58%), orchitis (n=112, 31.8%) and epididymitis (n=11, 3.1%). In female patients, pyelonephritis (n=33/38, 86.8%) was significantly higher than in male patients (n=11/352, 3.1%; p<0.0001). The mean blood leukocyte count was 7530±3115/mm3. Routine laboratory analysis revealed mild to moderate increases for erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The mean treatment duration and length of hospital stay were significantly higher when there were additional brucellar foci (p<0.05). Surgical operations including orchiectomy and abscess drainage were performed in nine (2.3%) patients. Therapeutic failure was detected in six (1.5%), relapse occurred in four (1%), and persistent infertility related to brucellosis occurred in one patient. A localized scrotal infection in men or pyelonephritis in women in the absence of leucocytosis and with mild to moderate increases in inflammatory markers should signal the possibility of brucellar genitourinary disease.

Liver involvement in patients with brucellosis: results of the Marmara study.

Brucellosis is a zoonotic disease that primarily affects the reticuloendothelial system. But, the extent of liver damage in due course of the disease is unclear. This study included 325 brucellosis patients with significant hepatobiliary involvement identified with microbiological analyses from 30 centers between 2000 and 2013. The patients with ≥5 times of the upper limit of normal for aminotransferases, total bilirubin level ≥2 mg/dl or local liver lesions were enrolled. Clinical hepatitis was detected in 284 patients (87.3 %) and cholestasis was detected in 215 (66.1 %) patients. Fatigue (91 %), fever (86 %), sweating (83 %), arthralgia (79 %), and lack of appetite (79 %) were the major symptoms. Laboratory tests showed anemia in 169 (52 %), thrombocytopenia in 117 (36 %), leukopenia in 81 (25 %), pancytopenia in 42 (13 %), and leukocytosis in 20 (6 %) patients. The most commonly used antibiotic combinations were doxycycline plus an aminoglycoside (n = 73), doxycycline plus rifampicin (n = 71), doxycycline plus rifampicin and an aminoglycoside (n = 27). The duration of ALT normalization differed significantly in three treatment groups (p < 0.001). The use of doxycycline and an aminoglycoside in clinical hepatitis showed better results compared to doxycycline and rifampicin or rifampicin, aminoglycoside, doxycycline regimens (p < 0.05). However, the length of hospital stay did not differ significantly between these three combinations (p > 0.05). During the follow-up, treatment failure occurred in four patients (1 %) and relapse was seen in three patients (0.9 %). Mortality was not observed. Hepatobiliary involvement in brucellosis has a benign course with suitable antibiotics and the use of doxycycline and an aminoglycoside regimen seems a better strategy in select patients.

Evaluation of adults with acute viral hepatitis a and review of the literature.

AIM: In developing countries HAV infection is very common in the first years of life and it is often asymptomatic. However especially in regions of intermediate endemicity, exposure to the virus may delay and outbreaks of hepatitis A may be encountered in adults. The aim of this study is to evaluate the clinical and laboratory findings and risk factors of adults with acute viral hepatitis A. MATERIALS AND METHODS: In present study we evaluated 203 patient with acute viral hepatitis A, who were admitted to four different hospitals of three cities of Turkey between January 2000-December 2011, retrospectively. The diagnosis of acute viral hepatitis A was performed by laboratory findings and clinically. RESULTS: In a total of 203 patients, 120 (59.1%) patients were male and 83 (40.9%) were female. Mean age of cases with acute viral hepatitis A was 24.7 +11.8 years (ranged 15 to 82 years old). Acute viral hepatitis A were seen in patient who were 15-20 years and 21-30 years old, commonly. Jaundice (74%), fatigue (68%), nausea- vomiting (56%) and dark urine (48%) were the most common symptoms in cases. Prolonged cholestasis (6.8%) was the most common atypical manifestation. Prolonged jaundice was more frequent in the cases with positive HBsAg (P < 0.001). CONCLUSIONS: Acute viral hepatitis A can cause atypical presentations such as prolonged cholestasis, acute kidney injury and fulminant hepatitis. Some precautions such as routine vaccination program, improvement of hygiene conditions and informing people about it, should be taken for reducing of acute viral hepatitis A infection incidence.

Thin film MoS2 nanocrystal based ultraviolet photodetector.

We report on the development of UV range photodetector based on molybdenum disulfide nanocrystals (MoS2-NCs). The inorganic MoS2-NCs are produced by pulsed laser ablation technique in deionized water and the colloidal MoS2-NCs are characterized by transmission electron microscopy, Raman spectroscopy, X-ray diffraction and UV/VIS absorption measurements. The photoresponse studies indicate that the fabricated MoS2-NCs photodetector (MoS2-NCs PD) operates well within 300-400 nm UV range, with diminishing response at visible wavelengths, due to the MoS2-NCs absorption characteristics. The structural and the optical properties of laser generated MoS2-NCs suggest promising applications in the field of photonics and optoelectronics.

Stability analysis of a mathematical model in a microcosm with piecewise constant arguments.

In this paper, we have modeled a population density of a bacteria species in a microcosm by using a differential equation, [Formula in text] where t ≥ 0, the parameters r, α, ß(0) and ß(1) denote positive numbers ann [t] denotes the integer part of [Formula in text]. First, to obtain the local and global behaviors, the boundedness character and the periodic nature of the population density for bacteria, discrete solutions of differential Eq. (A) is investigated. Examinations of the stability characterization of (A) show that increasing of the population growth rate decreases the local stability of the positive equilibrium point. Due to this result we need to consider a second approximation to obtain stability of population density. This can be performed at low density by incorporating an Allee function to (A) at time t. For the theoretical results obtained here we give an example by taking some parameter values from experimental data of bacteria populations [8] and show that the experimental and theoretical results for both models with and without Allee effect are in good agreement.

Dosing strategies for conversion of haemodialysis patients from short-acting erythropoiesis stimulating agents to once-monthly C.E.R.A.: experience from the MIRACEL study.

AIMS: To analyse the impact of dosing decisions for continuous erythropoietin receptor activator (C.E.R.A.), a continuous erythropoietin receptor activator. METHODS: This was a prospective, multicentre, single-arm study in haemodialysis patients receiving epoetin alfa/beta or darbepoetin alfa. After a 2-month screening phase, patients were converted to monthly C.E.R.A. using pre-filled syringes during a 5-month titration phase and a 2-month evaluation phase. RESULTS: Four hundred and twenty-four eligible patients were converted to C.E.R.A. Mean Hb were 11.7 ± 0.7, 11.7 ± 0.8 and 11.5 ± 0.8 g/dl during screening, titration and evaluation, respectively. C.E.R.A. starting dose was 125 µg (n = 311) or 200 µg (n = 106), with corresponding final doses of 129 ± 61 µg and 203 ± 58 µg. The mean number of C.E.R.A. dose decreases and increases were 0.9 ± 1.0 and 1.1 ± 1.0 per patient, respectively. Hb rarely exceeded 12.5 g/dl after a C.E.R.A. dose increase (< 8%) and remained ≥ 11 g/dl after a dose reduction on approximately three-quarters of occasions. Among the 53 occasions where Hb decreased ≥ 2 g/dl between two consecutive visits, the previous dose had been withheld (n = 9), concomitant blood loss, coagulopathy or infection was present (n = 13), or iron parameters were low (n = 17). There were 104 adverse events/month during screening, and 45/month during the titration/evaluation phases. Serious adverse events occurred in 18.0 and 21.0 patients/month during the screening and titration/evaluation phases, respectively. CONCLUSION: Switching haemodialysis patients from shorter-acting ESA to once-monthly C.E.R.A. using pre-filled syringes is straightforward, and Hb levels remain stable. Starting dose recommendations and dose changes correlated well with the clinical setting. Collateral factors such as infection or aggravating concomitant medical conditions should be taken into account.

Periodontal status in subjects with hyperlipidemia.

BACKGROUND: Hyperlipidemia is a major risk factor for cardiovascular disease. Recent reports showed a possible association between periodontal disease and an increased risk for cardiovascular disease. The aim of this study was to evaluate whether hyperlipidemia has any influence on periodontal status. METHODS: Fifty-one subjects with hyperlipidemia and 47 normolipidemic subjects participated in this study. Biochemical parameters, including plasma triglyceride, total cholesterol, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) levels, and periodontal parameters, including plaque index (PI), probing depth (PD), clinical attachment level (CAL), and percentage of sites with bleeding on probing (BOP [%]), were evaluated. RESULTS: The mean values of PI, PD, CAL, and BOP (%) for the hyperlipidemic group were significantly higher than those for the control group. Plasma triglyceride, total cholesterol, and LDL-C levels were significantly and positively associated with PI, PD, BOP (%), and CAL. HDL-C was significantly, but negatively, associated with CAL. Plasma triglyceride level was significantly associated with PD and BOP (%) after further analyses. CONCLUSIONS: The results of our study showed that patients with mild or moderate hyperlipidemia manifested higher values of periodontal parameters compared to normolipidemic individuals. Further studies are needed to determine the effect of hyperlipidemia on periodontal disease.

The impact of the IL-11:IL-17 ratio on the chronic periodontitis pathogenesis: a preliminary report.

OBJECTIVE: An imbalance in the pro- and anti-inflammatory cytokines may be responsible for periodontal breakdown through immune responses. This study aimed to determine the total amount, concentration and ratio of interleukin (IL)-11 and IL-17 in gingival crevicular fluid (GCF) of chronic periodontitis (CP) patients. MATERIALS AND METHODS: Forty CP patients and 20 healthy controls (C) were included. The CP group was divided into two subgroups in line with the probing depth (PD) in GCF-sampling sites (CPa: PD >or= 5 mm, CPb: PD

The additional diagnostic value of a single-session combined scintigraphic and ultrasonographic examination in patients with thyroid and parathyroid diseases.

AIM: The aim of this study was to investigate the diagnostic efficacy and the clinical impact of scintigraphy combined with ultrasonography (USG) in the management of thyroid and parathyroid disorders in a large series of patients. METHODS: A total of 387 consecutive patients referred to the Nuclear Medicine Department of Hacettepe University in the period from January to September 2007 for investigating a thyroid (N. 339 patients: 232 females and 107 males, mean age+/-SD=48.9+/-13.6 years) or a parathyroid disease (N. 48 patients: 34 females and 14 males, mean age+/-SD=47.4+/-9.6 years) were prospectively evaluated, systematically performing both scintigraphy and USG in a single-day session. All the examinations were independently reviewed by two nuclear medicine physicians; in cases of discrepancy (3%) a final diagnosis was reached by consensus. For thyroid pathologies, USG results were considered to provide additional diagnostic information over scintigraphy: 1) if more nodules were identified; 2) if an irregular hyperactive area at scintigraphy suspicious for the presence of a nodule was clearly characterized at USG; 3) if a nodule missed at scintigraphy because of small size (<1 cm) was well depicted at USG, thus allowing an USG-guided fine needle aspiration cytology (FNAC) to reach a final diagnosis. For parathyroid pathologies, USG was considered to provide additional diagnostic information over scintigraphy if a low intensity radiotracer retention from the parathyroid suspected of being a parathyroid enlargement was clearly depicted at USG. In thyroid diseases, scintigraphy was considered to provide additional diagnostic information over USG, if the functional status of a diffuse or uni- or multi-nodular goiter were clearly defined at scintigraphy. In parathyroid diseases, scintigraphy was considered to provide additional diagnostic information over USG, if the differential diagnosis between a lymph node or a muscle or a vessel depicted at USG was clearly defined as a parathyroid enlargement at scintigraphy. Lastly, the clinical impact of the single-day combined scintigraphic/USG protocol was evaluated. RESULTS: USG. In the thyroid diseases group, USG was particularly useful: 1) to detect additional nodules in glands with suppressed thyroid tissue; 2) to disclose small thyroid nodules (<1 cm) in which it was possible to perform a USG-FNAC. In the parathyroid diseases group, USG was particularly useful for the detection of parathyroid enlargements not visualized at scintigraphy because characterized by a rapid wash-out of the radiotracer and thus by a low radioactivity intensity in the delayed scintigraphic images. Scintigraphy. In the thyroid diseases group, scintigraphy was particularly useful: 1) to diagnose a diffuse hyperfunctioning thyroid gland, and to differentiate in multinodular goiters the hyper- from the hypo-functioning nodules. In the hyperparathyroid diseases group, scintigraphy was particular useful in making a differential diagnosis between a true parathyroid enlargement vs. a lymph node or a muscle or a vessel as depicted at USG, and in cases with deeply or ectopically-positioned parathyroid glands. Combined imaging approach. Combined interpretation provided additional benefit in 225 of 339 patients (64.4%). Overall, using the combined scintigraphic/USG single-day protocol, in the thyroid diseases group the therapeutic strategy (drug therapy vs radioiodine therapy vs surgery) was changed in 176/225 patients (78.2%, P<0.001 by chi(2) of Pearson), and in the parathyroid disease group the therapeutic strategy (medical therapy vs surgery) was changed in 18/48 patients (37.5%, P<0.01 by chi2 test of Pearson). CONCLUSION: In agreement with some previous published experiences, the combined single-day scintigraphic/USG protocol systematically adopted in a large series of consecutive patients with thyroid and parathyroid diseases, enrolled in a limited period of time, proved to significantly increase the global diagnostic accuracy and to change the therapeutic strategy in more than two third of patients with a thyroid disease and in more than one third of patients with a parathyroid disease.

The Bi-Directional Relationship between Periodontal Disease and Hyperlipidemia.

It has been proposed for several decades that infections may be responsible for the accelerated development of atherosclerosis. The initiation of the atherosclerotic plaque is ascribed to focal accumulation of lipids. This explains the importance of plasma lipids in the development of atherosclerosis. Recent reports point towards a possible association between periodontal disease and increased risk for cardiovascular disease. Thus, periodontitis and cardiovascular disease may share common risk factors, and association between periodontitis and coronary heart disease may be due to the elevated levels of plasma lipids. Epidemiological and clinical studies have also suggested that there is a relationship between periodontal disease and impaired lipid metabolism. In this review, we summarized the potential link mechanisms in the association between periodontal infection and serum lipids.

Appropriate oral hygiene motivation method for patients with fixed appliances.

OBJECTIVE: To determine the most appropriate oral hygiene motivation method (OHMM) for orthodontic patients with fixed appliances. MATERIALS AND METHODS: A total of 150 orthodontic patients, scheduled for their regular controls, were included in this study. The patients were divided into five groups (n = 30) according to the verbal OHMM and instructed as follows: only verbal information (V), verbal information with demonstration on model (M), verbal information with demonstration on model and self application by the patient (M+A), verbal information using the illustration catalog (I), and verbal information using the illustration catalog and self application by the patient (I+A). All of the applications of the patients were made under the supervision of the clinicians. The periodontal parameters (plaque index [PI], gingival index [GI], and bleeding on probing [BOP]) were recorded at the baseline (before the instructions of the OHMM), 1 week later, and 4 weeks after the OHMM. RESULTS: All periodontal parameters showed significant decreases after 4 weeks in all OHMM groups (P < .05). I+A group has significantly lower PI scores and BOP percentages than the other groups (P < .05) after 4 weeks. The difference between the V group and M+A, I, and I+A groups in the GI scores were significant (P < .05), and the I+A group has presented the lowest GI score. CONCLUSIONS: The OHMM applied by the patients under the supervision of the clinician seemed to be more successful in the elimination of plaque and inflammatory symptoms in patients with fixed appliances.

The periodontal status of indirectly lead-exposed apprentices working in autorepair workshops.

The aim of this study was to evaluate the periodontal health status of lead-exposed apprentices and to search the correlation between clinical periodontal parameters and either blood lead or oxidative stress/damage indices in erythrocytes. Sixty male subjects were recruited for this study (30 apprentices and 30 controls). The periodontal health status was determined with gingival index, plaque index, gingival bleeding time index, probing depth, and clinical attachment level records. Additionally, blood lead level and indices of oxidative stress (glutathione peroxidase, superoxide dismutase), catalase activities and damage (malondialdehyde concentration) in erythrocytes were determined. The results showed that lead level was significantly higher in apprentices than in controls (P < 0.05). None of the clinical periodontal parameters and oxidative stress/damage indices were significantly different between the groups (P > 0.05). Significant correlation between plaque index and catalase, probing depth and superoxide dismutase, clinical attachment level and superoxide dismutase, and clinical attachment level and malondialdehyde in apprentices group (P < 0.05), and gingival bleeding time index and glutathione peroxidase in control group were found (P < 0.05). In multiple regression analysis, there were statistically significant associations between gingival index and working status, family income and either probing depth or clinical attachment level (P < 0.05). The results of this study showed significant association between the clinical periodontal parameters and oxidative stress/damage indices in apprentices indirectly exposed to low levels of lead.