Corneal topometric indices and proclivity toward corneal ectasia in vernal keratoconjunctivitis.

PURPOSE: To investigate changes in topometric corneal indices and proclivity toward corneal ectasia, as well as keratometric indices and anterior chamber dimensions in palpebral vernal keratoconjunctivitis (VKC). METHODS: This study included 80 patients with clinically established symptoms of grade 0 or grade 1 palpebral VKC (group 1) and 66 healthy participants (group 2). After a comprehensive ophthalmic examination including best-corrected visual acuity, intraocular pressure measurements and slit-lamp biomicroscopy, pachymetric indices and anterior chamber dimensions were measured using the Pentacam HR rotating Scheimpflug device. Topometric indices, which are particularly useful for determining proclivity toward corneal ectasia, were extracted from a topometric map. RESULTS: In groups 1 and 2, the mean ages were 13.11±5.22 and 16.45±5.09 years, respectively. The mean age at disease onset in group 1 was 10.09±5.03 years, and the mean disease duration was 36.23±8.43 months. Group 1 had significantly higher mean topometric indices than group 2, particularly the index of surface variance (P=0.001), index of vertical asymmetry (P=0.007), center keratoconus index (P=0.050), and Belin/Ambrosio enhanced ectasia total deviation value (P=0.032). Mean posterior corneal astigmatism differed significantly between groups 1 and 2 (P=0.003). CONCLUSIONS: Significantly higher mean topometric indices in VKC indicate a proclivity for corneal ectasia, which could be attributed to general changes in the corneal ultrastructure caused by persistent itching-induced eye rubbing.

Negative Quasiprobabilities Enhance Phase Estimation in Quantum-Optics Experiment.

Operator noncommutation, a hallmark of quantum theory, limits measurement precision, according to uncertainty principles. Wielded correctly, though, noncommutation can boost precision. A recent foundational result relates a metrological advantage with negative quasiprobabilities-quantum extensions of probabilities-engendered by noncommuting operators. We crystallize the relationship in an equation that we prove theoretically and observe experimentally. Our proof-of-principle optical experiment features a filtering technique that we term partially postselected amplification (PPA). Using PPA, we measure a wave plate's birefringent phase. PPA amplifies, by over two orders of magnitude, the information obtained about the phase per detected photon. In principle, PPA can boost the information obtained from the average filtered photon by an arbitrarily large factor. The filter's amplification of systematic errors, we find, bounds the theoretically unlimited advantage in practice. PPA can facilitate any phase measurement and mitigates challenges that scale with trial number, such as proportional noise and detector saturation. By quantifying PPA's metrological advantage with quasiprobabilities, we reveal deep connections between quantum foundations and precision measurement.

Higher liver stiffness scores are associated with early kidney dysfunction in patients with histologically proven non-cirrhotic NAFLD.

AIM: The association between Liver fibrosis (LF), as assessed by either histology or Liver stiffness measurement (LSM), and the presence of Early kidney dysfunction (EKD) was investigated in this study, as was also the diagnostic performance of LSM for identifying the presence of EKD in patients with Non-alcoholic fatty liver disease (NAFLD). MATERIALS AND METHODS: A total of 214 adults with non-cirrhotic biopsy-proven NAFLD were recruited from two independent medical centres. Their histological stage of LF was quantified using Brunt's criteria. Vibration-controlled Transient elastography (TE), using M-probe (FibroScan®) ultrasound, was performed in 154 patients and defined as significant when LSM was≥8.0kPa. EKD was defined as the presence of microalbuminuria with an estimated glomerular filtration rate≥60mL/min/1.73 m2. Logistic regression modelling was used to estimate the likelihood of having EKD with NAFLD (LSM-EKD model). RESULTS: The prevalence of EKD was higher in patients with vs without LF on histology (22.14% vs 4.82%, respectively; P<0.001) and, similarly, EKD prevalence was higher in patients with LSM≥8.0kPa vs LSM<8.0kPa (23.81% vs 6.59%, respectively; P<0.05). The area under the ROC curve of the LSM-EKD model for identifying EKD was 0.80 (95% CI: 0.72-0.89). LF detected by either method was associated with EKD independently of established renal risk factors and potential confounders. CONCLUSION: LF was independently associated with EKD in patients with biopsy-proven NAFLD. Thus, TE-measured LSM, a widely used technique for quantifying LF, can accurately identify those patients with NAFLD who are at risk of having EKD.

Fracture resistance force of primary molar crowns milled from polymeric computer-aided design/computer-assisted manufactured resin blocks.

Purpose: To compare fracture resistance force (FRF) and failure types of crowns milled from resin nanoceramic (Lava Ultimate)-, and modified polymethylmethacrylate (PMMA) (Vita computer-aided design (CAD)-Temp)-, and PMMA (Telio CAD)-based CAD/computer-assisted manufactured (CAM) blocks. Materials and Methods: Three experimental groups of 10 milled crowns were arranged: Group-1 (Lava Ultimate), Group-2 (Vita CAD-Temp), and Group-3 (Telio CAD). Crowns were machined in sizes similar to a primary second molar stainless steel crown (SSC) and stored in water at 37°C for 30 days. The crowns were seated on Cr-Co dies. Their FRFs were measured using a universal test machine until fracture. FRFs and failure types were recorded and statistically analyzed (P < 0.05). Results: There were statistically significant differences among the groups for both FRFs and failure types. The sources of significant differences for FRFs and failure types were Group-3 and Group-1, respectively. CONCLUSION: Crowns milled from different chemical structural CAD/CAM blocks may be used for restoration of primary molar teeth.

Evaluation of candida albicans biofilm formation on various dental restorative material surfaces.

AIMS: Candida adhesion to any oral substrata is the first and essential stage in forming a pathogenic fungal biofilm. In general, yeast cells have remarkable potential to adhere to host surfaces, such as teeth or mucosa, and to artificial, nonbiological surfaces, such as restorative dental materials. This study compared the susceptibility of six dental restorative materials to Candida albicans adhesion. MATERIALS AND METHODS: Cylindrical samples of each material were made according to the manufacturersa instructions. The antifungal effect of the samples on C. albicans was determined with the disc-diffusion method. The samples were put in plates with sterile Mueller Hinton and Sabouraud dextrose agar previously seeded with C. albicans. After the incubation period, the inhibition zone around each sample was evaluated. To evaluate the biofilm formation, the XTT technique and scanning electron microscopy (SEM) were used. RESULTS: No inhibition zone was observed around the samples. According to the XTT assays, the amalgam samples revealed the lowest quantity of biofilm formation (P > 0.001). The highest median XTT values, significantly higher than the other materials (P < 0.001), were found for the composite and the compomer samples. Within the SEM examination, the amount of candidal growth was significantly lower on the resin-modified glass ionomer and glass-ionomer cement samples. The compomer and the composite samples showed more candidal adhesion. CONCLUSION: This finding emphasizes the use of glass ionomer restorative cements and amalgam to reduce C. albicans adhesion to dental restorative materials especially in people with weakened immune systems, neutropenia, and cancer.

A retrospective analysis of postoperative patients admitted to the intensive care unit.

BACKGROUND: The aim of this retrospective study was to evaluate postoperative patients admitted to the intensive care unit (ICU) and to describe their characteristics and outcomes. METHODS: We performed a retrospective chart review of 1,756 postoperative patients admitted to the ICU of a tertiary referral hospital from January 2008 to December 2012. For each patient we recorded: demographic data, reason for admission to the ICU, duration of mechanical ventilation, elective versus emergency surgery, type of anaesthesia, American Society of Anesthesiologists (ASA) physical status, Acute Physiology and Chronic Health Evaluation (APACHE) II score, Glasgow Coma Score (GCS), and outcome. RESULTS: During the study period, the rate of postoperative ICU admission increased each year, and the number of ICU beds was increased in order to perform a greater number of elective surgical procedures for patients who required postoperative ICU care. In 2008, 20.80 % of the patients were postoperatively admitted to the ICU; 58.97 % were in 2012. The mean ratio of five years was 46.97 %. Median age was 63 (1-94) years, and 57.4 % of the patients were male. The most common reasons for admission were major surgery (41.90 %) and comorbidities (34.10 %). Mortality rates were higher in patients that underwent emergency surgery, received general anesthesia, were operated on by a general surgeon, or had low GCS scores coupled with high ASA or APACHE II scores. CONCLUSIONS: The postoperative patients who had metabolic or hemodynamic instability, high ASA or APACHE II scores, and low GCS had higher mortality rates despite ICU care. Hippokratia 2016, 20(1): 38-43.

Protective effect of curcumin on priapism and ischemia-reperfusion injury in rats.

OBJECTIVE: We aimed to identify the oxidative stress effects of the ischemic priapism on cavernosal tissues and to assess the biochemical and histopathological effects of curcumin in rats. MATERIALS AND METHODS: 26 adult male Sprague Dawley rats were randomly divided into three groups. Group 1 (Control, n = 8): only penectomy was performed and 3 ml blood samples were obtained from the vena cava inferior (VCI). Group 2 (ischemia-reperfusion group; n= 8): penectomy was performed after 1 hour ischemic priapism + 30 min reperfusion and 3 ml blood samples were obtained from the VCI. Group III (IR + CURC group, n = 10): 200 mg/kg/day curcumin per orally before surgery for 7 days + penectomy after 1 hour ischemic priapism + 30 min reperfusion and 3 ml blood samples from the VCI. Total oxidant status (TAS), total antioxidant status (TAS) and paraoxonase (PON1) levels were measured. Tissue samples were investigated and scored histopathologically in terms of bleeding, edema and necrosis. RESULTS: TOS levels were higher (p = 0.002), and TAS levels were lower (p = 0.001) in the IR group compared to the control group. As a result of curcumin treatment, TAS levels were increased (p = 0.003), and TOS levels were decreased (p = 0.004) in the IR + CURC group compared to the IR group. In the treatment group (IR + CURC) TAS and TOS levels were similar to levels in the control group. PON1 levels were increased with ischemia-reperfusion (p = 0.21) and decreased with curcumin treatment (p = 0.53), however these changes were not statistically significant. There was no significant difference in the effects of curcumin on histopathological changes. CONCLUSIONS: This study showed that curcumin has preventive effects on oxidative stress parameters against ischemia-reperfusion injury.

Analysing Biological Rhythms in Fibromyalgia Syndrome.

AIM: This study evaluated biological rhythm disorders in patients with fibromyalgia syndrome (FMS). METHODS: The study enrolled 82 patients with FMS and 82 controls. Pain intensity was evaluated using a visual analogue scale (VAS). The psychological conditions of the patients were evaluated using the Beck Depression Inventory (BDI). The Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN) was used to assess disturbances in biological rhythms (ie sleep, activity, social and eating patterns). RESULTS: There was no difference between the two groups at baseline (all p > 0.05). The BDI, BRIAN total, sleep, activity, social, and eating scores were higher in patients with FMS than in the controls (all p < 0.001). Further, a significant correlation was found between biological rhythms and BDI scores (p < 0.001) and there were positive correlations between the VAS score and BRIAN total, sleep, and eating and BDI in patients with FMS (all p < 0.001). CONCLUSION: There are marked biological rhythm disturbances in FMS. There is an important relationship between rhythm disorders and FMS. The disturbances in sleep, functional activities, social participation, and disordered rhythms like eating patterns show the need for a multidisciplinary approach to treating patients with FMS.

Are small adrenal incidentalomas solely a radiological finding?

OBJECTIVE: The criterium defining the threshold size of adrenal incidentaloma (AI) is a size greater than 1 cm diameter. However, data concerning AI≤1 cm in diameter is scant. The aim of this study was to evaluate the function of adrenal masses≤1 cm and to compare them with adrenal masses>1 cm. MATERIALS AND METHODS: The study included 130 consecutive patients with AI (38 and 92 AI at ≤ 1 cm and > 1 cm, respectively). The patients were evaluated according to demographic and hormonal characteristics. RESULTS: The prevalence of SCS was 5.3 and 12% in AI≤1 cm and > 1 cm diameter, respectively. Hyperaldosteronism was found only in patients with > 1 cm AI. Pheochromocytoma were not found in either group. Patients with > 1 cm AI had a higher prevalence of SCS and primary hyperaldosteronism than patients with ≤ 1 cm AI, but the difference was not significant. The prevalence of diabetes and hypertension was high both in non-functional AI with ≤ 1 cm and > 1 cm patients and showed no significant difference between the 2 groups. CONCLUSION: Our study is the first to focus on the clinical and hormonal characteristics of patients with ≤ 1 cm AI. Those with AI≤1 cm harboured SCS, as was the case for AI>1 cm. Similar to AI>1 cm, non-functional AI≤1 cm also had a higher prevalence of diabetes and hypertension.

The prevalence of Factor V Leiden, prothrombin G20210A, MTHFR C677T and MTHFR A1298C mutations in healthy Turkish population.

BACKGROUND: Factor V Leiden (FVL), prothrombin gene (PT G20210A) and methylenetetrahydrofolate reductase (MTHFR) C677T polymorphisms are the main biomarkers used in the evaluation of tendency to venous thromboembolism. Our study aimed to investigate the distribution frequencies of these polymorphisms in healthy Turks living in the urban Yozgat region.  MATERIAL AND METHODS: This study included 90 blood donor candidates. All the donors were apparently healthy, and there was no family relationship between them. Mutations including FVL, PT G20210A, and MTHFR (C677T, A1298C) were investigated in all participants. Screening of polymorphisms was carried out using the SNaPshot® multiplex system. RESULTS: There were 42 male and 48 female individuals with age range 17-78 years and mean age 47.5 ± 13.6 years. The heterozygous FVL mutation was noted in 17 (10 male and seven female) donors (19%). FVL mutation was more frequently encountered in males than in females (23.8% vs. 12.5%). The heterozygous PT G20210A mutation was observed in five (5.5%) of the 90 (three male, two female) donors. The prevalence of homozygous polymorphisms of MTHFR C677T was 8.8% and of MTHFR A1298C 13.3%. On the other hand, four of the 90 participants (4.4%) carried none of these polymorphisms. CONCLUSION: This study showed that the prevalence of FVL, PT G20210A, MTHFR C677T and MTHFR A1298C polymorphisms is quite high, and the coexistence of FVL with other genotypes is not rare in a healthy Turkish population living in the Yozgat region. Of course, further detailed studies should be performed to support these findings. Hippokratia 2015; 19 (4): 309-313.

Renal impairment and coronary collaterals in patients with acute coronary syndrome.

OBJECTIVE: We aimed to elucidate the relationship between mild-to-moderate renal impairment and the development of coronary collateral vessels (CCV) in patients with acute coronary syndrome (ACS). METHODS: We enrolled 461 patients with ACS who underwent coronary angiography for the first time. The development of CCV was assessed with the Rentrop score. Kidney function was classified according to the estimated glomerular filtration rate (eGFR). The Gensini score was used to show the extent of atherosclerosis. RESULTS: The mean eGFR value was 89.9 ± 24.3 U/l for patients with no development of collaterals and 82.7 ± 20.5 for patients who had CCV. The mean age was 59 ± 11 years and 349 patients (75.7 %) were male. Rentrop classifications 1-2-3 (presence of CCV) were determined in 222 (48.1 %) patients. The presence of CCV was significantly associated with low levels of eGFR (p = 0.001), increased serum creatinine levels (p = 0.034), high levels of serum albumin (0.036), and the Gensini score (p < 0.001). Multivariate analysis showed that the Gensini score was an independent predictor of the presence of CCV (OR = 1.090, 95 % CI: 1.032-1.151, p = 0.002). CONCLUSION: We suggest that the association between mild-to-moderate renal impairment and the presence of CCV may be explained by increased myocardial ischemia and severe CAD.

Review article: coffee consumption, the metabolic syndrome and non-alcoholic fatty liver disease.

BACKGROUND: Coffee consumption may modulate the risk of the metabolic syndrome (MetS) and non-alcoholic fatty liver disease (NAFLD). AIM: To review the experimental, epidemiological and clinical studies investigating the association between coffee consumption and the risk of MetS and NAFLD. METHODS: A literature search was conducted with the aim of finding original experimental, epidemiological and clinical articles on the association between coffee consumption, MetS and NAFLD. The following databases were used: PubMed, Embase, Scopus and Science Direct. We included articles written in English and published up to July 2013. RESULTS: Three experimental animal studies investigated the effects of coffee in the MetS, whereas five examined whether experimental coffee intake may modulate the risk of fatty liver infiltration. All of the animal studies showed a protective effect of coffee towards the development of MetS and NAFLD. Moreover, we identified eleven epidemiological and clinical studies that met the inclusion criteria. Of them, six were carried out on the risk of the MetS and five on the risk of NAFLD. Four of the six studies reported an inverse association between coffee consumption and the risk of MetS. The two studies showing negative results were from the same study cohort consisting of young persons with a low prevalence of the MetS. All of the epidemiological and clinical studies on NAFLD reported a protective effect of coffee intake. CONCLUSIONS: Coffee intake can reduce the risk of NAFLD. Whether this effect may be mediated by certain components of the MetS deserves further investigation.

A two-year clinical evaluation of glass ionomer and ormocer based fissure sealants.

UNLABELLED: The objective of the present study provides further data comparing retention, marginal integrity and caries preventive effects of two fissure sealants (glass ionomer based; GC Fuji VII Capsule [Fuji VII] and ormocer based; Admira Seal [AS]) in children. This study was designed as a randomized single-blind clinical trial. The permanent first molars (PFMs) of 50 children, 7-13 years of age (mean age: 8.9 +/- 1.3 years), were sealed with a split-mouth design. Fissure sealants applied to the PFMs according to the manufacturer's recommendations by one pediatric dentist. Clinical evaluation of the sealants was carried out to record retention, marginal integrity and presence of caries at 6, 12, 18 and 24 months after placement by the other pediatric dentist. Kaplan-Meier survival analysis and Cox's regression models were used to estimate the probability of two sealants success. RESULTS: Alpha and Bravo retention rates at the end of follow-up were 13% and 80% for Fuji VII and 3% and 83% for AS, respectively. For retention and marginal integrity between fissure sealants was found similar survival rates (p > 0.05). After 24 months, presence of caries was 16% for Fuji VII and 32% for AS (p < 0.05). CONCLUSION: Fuji VII and AS exhibited similar retention and marginal integrity during 24 months. However Fuji VII was showed better results than AS for caries preventive effect. Consequently, Fuji VII sealants may be a better choice for preventing occlusal caries.

Temperature changes in the pulpal chamber and the sealing performance of various methods of direct pulp capping of primary teeth.

AIM: To compare changes in pulpal chamber temperature during the visible-light curing of direct pulp capping compounds and various modes of diode laser irradiation without prior placement of a pulp capping compound and the resultant seals. MATERIALS AND METHODS: Pulp exposure holes were made in 100 extracted human primary first molars, which were randomly assigned to ten equal groups. The holes were sealed by (a= Group 1, 2, 3, 4, 5, 6 and 7) different pulp capping compounds which were cured using various types of visible-light curing units or (b=Group 8, 9 and 10) diode laser irradiation without prior application of a pulp capping compound. Pulpal chamber temperatures were recorded during the procedure, and the resultant seals were examined under a scanning electron microscope. RESULTS: Visible-light curing of the pulp capping compounds and diode laser irradiation at a 0.7 W output power can cause non-injurious temperature rises in the pulpal chamber. At higher output powers of the diode laser, the temperature rises are sufficient to cause thermal injury. The seals were complete when pulp capping compounds were used for direct pulp capping, but were incomplete when laser irradiation without prior placement of a pulp capping compound was used for the identical purpose. CONCLUSION: The visible-light curing of pulp capping compounds is not harmful to vital pulp, and provides an effective seal of the pulp exposure hole. Laser irradiation is not an effective sealant, and can cause thermal injury to vital pulp at high output powers.

Longitudinal occlusal changes during the primary dentition and during the passage from primary dentition to mixed dentition among a group of Turkish children.

AIM: To determine the changes in the molar and canine relationships in transition from the primary to the mixed dentition in 98 subjects selected among Turkish children living in the Erzurum city centre. METHODS: This study is based on a 3-year follow-up of 98 children (46 girls, 52 boys) between the ages of 4 and 6 years at the start of the study. The survey focused on the investigation of the changes that appeared in the occlusal relationships in the primary dentition and in the transition to the mixed dentition according to gender and age. RESULTS: The findings indicated that 73.6 % of the 98 cases evaluated in the primary dentition developed a Class I molar relationship, and 26.4 % developed a Class II molar relationship. As 64.3 % FTP, 22.4 % DS, and 13.3 % MS molar occlusal relationships were evaluated at baseline; 22.4 % FTP, 11.2 % DS, and 66.3 % MS molar occlusal relationships were evaluated at the end of the third year. While 75.5 % Class I, 11.2 % Class II, and 13.3 % Class III primary canine occlusal relationships were evaluated at baseline; 53.1 % Class I, 5.1 % Class II, and 41.8 % Class III primary canine occlusal relationships were evaluated at the end of the third year. With increased age, a statistically significant difference (p < 0.001) was found in flush terminal plane, mesial step, and primary canine occlusal relationships and no statistically significant difference (p > 0.05) was found in distal step relationships. CONCLUSION: Malocclusions observed in the primary dentition are signs of malocclusions in the permanent dentition.

Triggers of asthma and COPD: Are they different?

Background: Asthma symptoms can be triggered by a variety of factors commonly referred to as “triggers”. Some of these factors can also induce severe asthma exacerbations. Thus, it can be assumed that actions taken against such triggers may prevent the progression of the disease. However, limited data exist on the clinical importance of these triggers in patients with chronic obstructive pulmonary disease (COPD). Objective: To compare the effect of triggers on symptoms and actions taken against certain modifiable triggers in patients with asthma and COPD. Methods: The study was conducted in a university hospital between June 2009 and June 2010. Patients with asthma and COPD were asked to complete a questionnaire in which both the factors triggering symptoms and the actions taken against several triggers were assessed. Results: Three hundred consecutive adult patients (150 asthma, 150 COPD) were enrolled to the study. The frequency of triggering factors was similar in both groups. Vaccination rates for influenza and pneumococcus were significantly higher in patients with COPD. However, such anti-allergic approaches as the use of strategies to decrease dust exposure, the use of anti-mite bed sheets, and the removal of pets from the home were more commonly employed by asthmatic patients. Conclusion: This study revealed that certain triggers affected COPD and asthma patients to the same degree. Therefore, triggers and strategies for controlling modifiable triggers should be more concentrated on during education in both groups. However, the preventive effect of these strategies on disease progression, particularly in patients with COPD, needs clarification(AU)

Urgent surgical management of a prenatally diagnosed midgut volvulus with malrotation.

Midgut volvulus is a life-threatening condition that commonly presents during the first year of life rarely antenatally. Here we report successful urgent surgical management of an unusual case with malrotation exhibiting the sonographic findings of volvulus in utero that leads to premature birth. This 34-wk, 2700 g infant was born via spontaneous vaginal delivery. Prenatal ultrasound showed polyhydramnios and 30 x 40 mm cystic lesion showing whirlpool sign in abdomen that made us think midgut volvulus. The patient had distended abdomen with skin discoloration. An emergency surgical management was performed showing malrotation, volvulus and a 15 cm ischemic necrotic region of terminal ileum.