Evaluation of general anesthesia and sedation during dental treatment in patients with special needs: A retrospective study.

BACKGROUND: Patients with special health care needs are more likely to develop health problems, including dental problems. Dental treatments require a good level of communication with the patient. Therefore, in these patients, sedation and general anesthesia are an extremely humanistic approach for comfortable and successful treatment. In patients with special needs, there is no standard anesthetic approach due to varying clinical conditions. The aim of this study was to provide literature content about the anesthetic approaches used by us in patients with special needs. METHODS: The medical records of 710 patients with special health care needs treated under general anesthesia or sedation were reviewed retrospectively. Demographic data, the American Society of Anesthesiologists classification, Mallampati score, anesthesia duration, anesthesia type, anesthetic and analgesic agents used, dental treatment performed, secondary diseases, and complications in the perioperative period were recorded. Patients were evaluated under five groups: Down syndrome, other syndromes, psychiatric disorders, physical disabilities, and complicated medical story. RESULTS: Among the patients evaluated, 47.5% were females and 52.5% were males (mean age 15.76 ± 11.17 years), and general anesthesia and sedation were administered in 72.9% and 22.1% patients, respectively. The mean duration of anesthesia was 43.20 ± 35.85 min. Simple dental treatments were performed in all groups, and the most common complications were observed in the other syndromes group. CONCLUSION: Complications can be reduced by utilizing the appropriate anesthetic approach and taking serious precautions in patients with special needs.

Corrigendum: The neuroprotective action of dexmedetomidine on apoptosis, calcium entry and oxidative stress in cerebral ischemia-induced rats: Contribution of TRPM2 and TRPV1 channels.

This corrects the article DOI: 10.1038/srep37196.

Different doses of dexmedetomidine reduce plasma cytokine production, brain oxidative injury, PARP and caspase expression levels but increase liver oxidative toxicity in cerebral ischemia-induced rats.

Cerebral ischemia-induced progression of brain, liver, and erythrocyte oxidative injuries might be modulated by dexmedetomidine (DEX) as a potent antioxidant and anti-inflammatory drug. The present study was conducted to explore whether two different doses of DEX protect against plasma cytokine and brain, liver and erythrocyte oxidative toxicity and apoptosis in cerebral ischemia-induced rats. Forty-two rats were equally divided into 7 groups. The first and second groups were used as untreated and sham controls, respectively. The third (DEX4) and fourth (DEX40) groups received 4mg/kg and 40mg/kg DEX treatments. The fifth, sixth and seventh group were operated on to induce cerebral ischemia. The fifth, sixth and seventh groups are used to represent cerebral ischemia, cerebral ischemia+DEX4, and cerebral ischemia+DEX40, respectively. DEX was intraperitoneally given to the DEX groups at the 3rd, 24th and 48th hour. Brain and erythrocyte lipid peroxidation (MDA) levels and plasma IL-1ß and TNF-α levels were high in the cerebral ischemia group although they were low in the DEX4 and DEX40 groups. Decreased glutathione peroxidase (GSH-Px) and reduced glutathione (GSH) values in the brain and erythrocyte of the cerebral ischemia group were increased by the DEX treatments, although PARP, and the caspase 3 and 9 expressions in the brain were further decreased. Conversely, the cerebral ischemia-induced decrease in the liver vitamin A, vitamin E, GSH, and GSH-Px were further decreased by the DEX treatments, although MDA level, PARP, and caspase 3 and 9 expressions were further increased by the DEX treatments. In conclusion, DEX induced protective effects against cerebral ischemia-induced brain and erythrocyte oxidative injuries through regulation of the antioxidant level and cytokine production. However, both doses of DEX induced oxidative toxicity and apoptotic effects in the rats' livers.

The neuroprotective action of dexmedetomidine on apoptosis, calcium entry and oxidative stress in cerebral ischemia-induced rats: Contribution of TRPM2 and TRPV1 channels.

Dexmedetomidine (DEX) may act as an antioxidant through regulation of TRPM2 and TRPV1 channel activations in the neurons by reducing cerebral ischemia-induced oxidative stress and apoptosis. The neuroprotective roles of DEX were tested on cerebral ischemia (ISC) in the cultures of rat primary hippocampal and DRG neurons. Fifty-six rats were divided into five groups. A placebo was given to control, sham control, and ISC groups, respectively. In the third group, ISC was induced. The DEX and ISC+DEX groups received intraperitoneal DEX (40 µg/kg) 3, 24, and 48 hours after ISC induction. DEX effectively reversed capsaicin and cumene hydroperoxide/ADP-ribose-induced TRPV1 and TRPM2 densities and cytosolic calcium ion accumulation in the neurons, respectively. In addition, DEX completely reduced ISC-induced oxidative toxicity and apoptosis through intracellular reactive oxygen species production and depolarization of mitochondrial membrane. The DEX and ISC+DEX treatments also decreased the expression levels of caspase 3, caspase 9, and poly (ADP-ribose) polymerase in the hippocampus and DRG. In conclusion, the current results are the first to demonstrate the molecular level effects of DEX on TRPM2 and TRPV1 activation. Therefore, DEX can have remarkable neuroprotective impairment effects in the hippocampus and DRG of ISC-induced rats.

Association between oxidative stress index and serum lipid levels in healthy young adults.

OBJECTIVES: To investigate the relationship between lipid levels and oxidative stress index in healthy young adults. METHODS: The study was camed out at the Department of Emergency Service, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey, between January 2011 and July 2012. A total of 100 healthy adult volunteers were enrolled in the study. Venous blood samples (10 ml) were collected from all individuals, and serum lipid parameters, total antioxidant capacity and total oxidative levels were studied. SPSS 15 was used for statistical analysis. RESULTS: Overall, there were 84 (84%) males and 16 (16%) females. The mean age fo the male population was 30 +/- 3 years, while that of the females was 31 +/- 3 years. Overall age ranged from 25 to 35 years. A statistically significant correlation was found between the oxidative stress index and serum cholesterol (p < 0.001; r = 0.596), triglyceride (p < 0.001; r = 0.476) and low-density lipoprotein levels (p < 0.001; r = 0.318). However, no significant correlation was found between oxidative stress index and serum high-density lipoprotein levels (p = 0.564; r = 0.058). CONCLUSION: The results showed that even at an early age, there is a direct linear correlation between oxidative stress and serum lipid levels.

A case of subcorneal pustular dermatosis in association with monoclonal IgA gammopathy successfully treated with acitretin.

Subcorneal pustular dermatosis (SPD), or Sneddon-Wilkinson disease, is a rare, chronic, recurrent, pustular eruption. Association with several diseases is well known, mainly IgA and IgG gammopathies or myelomas. Although dapsone is often considered to be the first-line treatment, some patients fail to respond or cannot tolerate the side effects. For cases that do not respond well to this treatment, acitretin, an excellent second-line treatment, may be used. Herein, a 55-year-old woman with SPD associated with monoclonal IgA gammopathy refractory to dapsone is presented, who was successfully treated with acitretin in a short period.

Mean platelet volume in psoriasis and psoriatic arthritis.

Mean platelet volume (MPV), an indicator of platelet activation, is a newly emerging risk factor for atherothrombosis. There is evidence of platelet activation in psoriasis and psoriatic arthritis (PsA). The association between psoriasis, PsA, and atherosclerosis is well documented, yet, the underlying mechanisms remain unclear. The aim of this study was to investigate the differences of MPV values in patients with psoriasis, PsA, and healthy subjects and the correlation between MPV and the clinical disease activity. A total of 106 patients with psoriasis were included in this study. The study population grouped as 48 patients with PsA (group 1) and 58 patients without PsA (group 2) and 95 healthy controls (group 3). MPV was measured in psoriasis and PsA patients. MPV values were collected from standard complete blood count samples. Clinical features and PASI scores in group 1 and 2 were also recorded. MPV in patients with psoriasis 8.7 +/- 0.9 fL was significantly higher than that of control subjects 7.3 +/- 0.8 fL (p < 0.001). There was also statistical difference between MPV levels of patients with (9.5 +/- 0.8) and without (8.0 +/- 0.7) arthritis (p < 0.001). MPV levels were positively correlated with psoriasis area and severity index score (p = 0.000, r = +0.735). MPV levels showed positive correlation with disease duration (p = 0.01, r = 0.518). MPV levels are increased in patients with psoriasis and PsA. MPV may be a marker for the severity of psoriasis. This study may confirm previous observation indicating increased platelet activation in psoriasis. Increased platelet activity could contribute to increasing the atherosclerotic risk in patients with psoriasis and PsA.

Treatment of acrodermatitis continua with topical 8-methoxypsoralen plus local narrowband ultraviolet B phototherapy.

Treatment of acrodermatitis continua of Hallopeau (ACH) is known to be difficult. A 24-year-old man presented with an 11-year history of recurrent flares of painful pustular and scaly lesions on the distal portion of his fingers and toes, with persistent nail dystrophy. Based on the clinical and histopathological findings, ACH was diagnosed. The patient was treated with topical 8-methoxypsoralen (8-MOP) without occlusion, plus local narrowband ultraviolet B (NB-UVB) phototherapy. The patient did not use any other medication between sessions except topical emollients. Ten weeks later, when the patient had received 20 sessions, almost all the lesions had cleared. We report the first case of ACH which successfully responded to treatment with 8-MOP/NB-UVB.

Oral multidose caffeine-paracetamol combination is not effective for the prophylaxis of postdural puncture headache.

STUDY OBJECTIVES: To investigate the effects of different doses of oral caffeine-paracetamol combinations in postdural puncture headache (PDPH) prophylaxis. DESIGN: Prospective, randomized, placebo-controlled, blinded study. SETTING: University hospital. PATIENTS: A total of 210 ASA physical status I and II patients undergoing lower extremity surgery. INTERVENTIONS: Patients were randomly divided into 3 groups. One hour before the spinal anesthesia, the first group (n = 70) received placebo, the second group (n = 70) received 500-mg paracetamol + 75-mg caffeine, and the third group (n = 70) received 500-mg paracetamol + 125-mg caffeine orally. The same doses were repeated every 6 hours for 3 days. Patients were then interviewed on days 1, 2, 3, 4, and 7 to inquire about any PDPH. The interviewer was unaware of the PDPH prophylaxis group members. Patients who were discharged early were interviewed by telephone. MEASUREMENTS AND MAIN RESULTS: Postdural puncture headache occurred in 11 patients (15.7%) in group 1, 10 patients (% 14.28) in group 2, and 10 patients (% 14.28) in group 3. The differences between the groups were insignificant (P > .05). The complications due to spinal anesthesia were similar in the 3 groups. Side effects of caffeine such as lack of sleep, tachycardia, and hypertension were not observed in groups 2 or 3. CONCLUSIONS: Prophylactic administration of paracetamol-caffeine combinations at the stated doses does not prevent PDPH.