Effect of omega-3 fatty acid use on sepsis and mortality in patients with Covid-19.

Background: This study aimed to investigate the effects of omega-3 fatty acid use on sepsis and mortality in patients treated for COVID-19 disease in the intensive care unit (ICU) based on clinical and laboratory results. Aim: To determine the effect of omega-3 fatty acid use on sepsis and mortality in patients with COVID-19. Patients and Methods: A total of 80 patients with confirmed COVID-19 infection who were hospitalized in the ICU of Ankara City Hospital, received (n = 40) or did not receive (n = 40) omega-3 fatty acid dietary supplementation, were included in this single-center, retrospective study. The clinical and laboratory data of eligible patients were extracted from the hospital records. Results: The mean age was 65.5 (13.6). The mean length of stay in the intensive care unit was 11.5 (6.3) days. Mortality and sepsis development rates were similar in the groups. The frequency of patients who received pulse steroid therapy was higher in the group of patients who did not receive omega-3 (P < 0.05). Hypertension was more common in the patient group receiving omega-3 supplements (P < 0.05). Mean procalcitonin and interleukin-6 (IL-6) levels were significantly lower in patients who received omega-3 supplements compared to those who did not receive supplements (P < 0.001 and P < 0.05). Mean prothrombin time (PT) was shorter in patients receiving omega-3 supplementation (P < 0.05). Conclusions: Study results obtained in this study indicate that providing omega-3 fatty acid supplements may be beneficial to patients with severe COVID-19, however further research with large-scale randomized controlled trials is necessary.

Are preoperative CT parameters predictive for the outcome of septoplasty?

Background: Despite successful septoplasty surgery, some patients still complain of nasal obstruction (NO). Aim: Our aim in the present study is to determine whether preoperative computed tomographic (CT) parameters have prognostic significance for the success of septoplasty. Material and Methods: Retrospective data from 61 patients in a secondary care hospital who had undergone septoplasty met the inclusion and exclusion criteria. The effects of demographic and preoperative CT parameters (internal nasal valve [INV], external nasal valve area, angle of septal deviation, choana area, aperture pyriformis area, high septal deviation [HSD], transverse diameter of midnose, anterior/posterior deviation, concha and meatus diameter [superior, middle, inferior]) were studied in relation to the change in NOSE scores and the success of surgery. Results: Of the 61 patients studied, 31 were male (51%) aged 18-55 years with a mean age ± SD (26.59 ± 9.41). It was found that the changes in NOSE scores were significantly different from each other (P < 0.01). Male gender, trauma history, moderate septal deviation, HSD, mucosal pathology, posterior deviation, bullous turbinate (right and left middle, right superior), and in the absence of allergy, paradoxical turbinate (right and left middle and superior), S-shaped deviation were found to have a significant correlation in the change of NOSE scores (P < 0.05). Age and internal valve differed with respect to outcome (P < 0.05). Variables in multiple linear regresion models of all parameters were found to be insignificant (P < 0.05). Conclusion: Preoperative CT parameters are informative, but do not predict the postoperative success of septoplasty.

Comparison of the protective effects of selective endothelin-a receptor antagonist, ambrisentan, and dual endothelin-A/B receptor antagonist, bosentan, in experimental renal ischemia reperfusion injury.

AIM: This study aims to compare the protective effects of ambrisentan, a selective endothelin typeA receptor antagonist, and bosentan, a dual endothelin typeA/B receptor antagonist, on experimental renal ischemia reperfusion injury. METHOD: The study sample consisted of 21 female rats, which were divided into 3 groups: Control, Ambrisentan and Bosentan. For the ischemia-reperfusion injury model, left­kidney nephrectomy was performed after sacrificing the animals. In the immunohistochemical examination, caspase-3 was examined, and then the apoptotic index was determined. In the biochemical examination, the activities of malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase, and the levels of nitrite (NOx), TNF-α, and IL-1ß were determined. RESULTS: There were statistically significant differences between the groups in terms of total injury score grade in range of 0‒3 (p=0.001).The glomerular and tubular apoptotic indices were higher in the control group as compared to those of the ambrisentan and bosentan groups (p=0.001).There were no statistically significant differences in terms of SOD, CAT, GPx, MDA, IL-1ß and TNF-α measurements among the groups (p>0.05). CONCLUSIONS: In the experimentally created renal ischemia reperfusion model, both ambrisentan and bosentan increased the NOx level, decreased the apoptosis, and protected the kidney from renal ischemia reperfusion injury. However, no significant superiority was found between ambrisentan and bosentan in terms of their protective effects (Tab. 3, Fig. 2, Ref. 31).

PLASMA INTERLEUKIN-6 LEVELS MAY BE ASSOCIATED WITH THE LENGTH OF STAY TIME OF ADULT HYPERGLYCEMIC PATIENTS IN AN INTENSIVE CARE UNIT.

CONTEXT: Estimation of intensive care unit (ICU) length of stay time (LOS) may be challenging, and pro-inflammatory cytokines can be used as a marker for this purpose. OBJECTIVE: The current study aimed to investigate the association between pro-inflammatory cytokine levels and LOS in hyperglycemic patients admitted to adult ICU. DESIGN: This is a prospective observational study. SUBJECTS AND METHODS: All adult ICU patients with a blood glucose level higher than 250 mg/dL, during the study period were included. Hospitalization day demographics were recorded, and plasma IL-6, IL1-ß, and TNF-α concentrations were measured. RESULTS: A total of 74 patients were enrolled in the study. Diabetic ketoacidosis (DKA) was positive in 31 patients, and the remaining 43 were in the non-DKA (NDKA) group. There was no difference between the two groups in terms of age, gender, LOS, hemoglobin, hematocrit, lactate levels, and platelets count. IL-6, IL-1ß, and TNF-α levels did not show any difference between DKA and NDKA groups (p=0.784, 0.413, and 0.288, respectively). There was a positive correlation between IL-6 levels and LOS (n=74, Pearson correlation=0.330; p=0.004). CONCLUSIONS: Among pro-inflammatory cytokines, IL-6 showed a better performance for the prediction of LOS than IL-1ß, TNF-α, and CRP.

Evaluation of the relationship between neutrophil lymphocyte ratio and the most common bacterial urinary tract infections after transplantation.

OBJECTIVE: We aimed to evaluate the relationship between neutrophil lymphocyte ratio and the most common bacterial urinary tract infections after transplantation. We also assessed the frequency of bacterial infections, e.g. Escherichia coli, Klebsiella, and Enterococcus in the urinary tract, and determined the important factors affecting neutrophil/lymphocyte ratio (N/L). METHODS: We compared the percentage of neutrophils (NE%), percentage of lymphocytes (Lym%), and N/L, along with blood urea nitrogen (BUN), creatinine, and white blood cells (WBC) in all patients before and after renal transplantation. RESULTS: The Lym% and WBC significantly increased after surgery while N/L%, BUN, and creatinine levels were significantly decreased. Postoperative infections were evaluated by measuring WBC, NE%, Lym%, N/L%, serum urea and creatinine levels, and no significant differences were seen compared to the preoperative values. Univariate analysis also did not show any significant differences between pre- and post-operative parameters. However, a significant difference in N/L% ratio was seen between the E. coli infected and uninfected recipients. CONCLUSIONS: Any significant difference in NE%, Lym%, and N/L%, BUN, creatinine, and WBC parameters among infected and non-infected renal transplant patients were not found. The steps should be taken to prevent pre-transplantation infection and patients should be continuously monitored for infections post-transplantation (Tab. 6, Fig. 1, Ref. 24).

Microleakage of glass ionomer based restorative materials in primary teeth: An In vitro study.

AIM: Using AutoCAD, we examined the microleakage of dye at the edges of primary-teeth restorations using three glass ionomer-based restorative materials. MATERIALS AND METHODS: A total of 30 extracted noncarious primary molars were used. Class V cavities were adjusted on the buccal surfaces. The teeth were randomly divided into three groups of 10 teeth each as follows: Group A (Ketac Molar), Group B (Photac Fil), and Group C (Dyract XP). All specimens were stored for 24 h at 37°C in distilled water. The teeth were thermocycled 1000 times between 5°C ± 2°C and 55°C ± 2°C before immersion in 0.5% basic fuchsin for 24 h. Two mesiodistal cuts of each tooth were photographed under a stereomicroscope equipped with a digital camera. The dye-infiltrated surface area was measured. Statistical evaluations were performed by the Kolmogorov-Smirnov test, Levene test, one-way analysis of variance, and Tukey's honestly significant difference test. RESULTS: The mean microleakage ratio differed significantly among the groups (P < 0.05). Group C exhibited a significantly smaller area (P < 0.001) than the other groups. Group A had a nonsignificantly higher mean microleakage value than Group B (P > 0.05). CONCLUSIONS: Polyacid-modified composite resin may be a useful restorative material in primary teeth in terms of minimizing microleakage.

Prevalence of traumatic dental injuries and associated factors among 8 to 12-years-old schoolchildren in Diyarbakir, Turkey.

BACKGROUND AND OBJECTIVES: This study aimed to assess the prevalence of traumatic injuries of the permanent incisors in public primary schoolchildren from 8 to 12 years old in South-Eastern Anatolia, Turkey. Additionally, the relationship between traumatic dental injuries, parents' education level, family income, size of incisal overjet and the presence of anterior open bite were examined. MATERIALS AND METHODS: Data were collected through oral examinations and structured interviews, and included socio-economic indicators. A total of 2907 children of both genders (1498 boys, 1409 girls) were included in the study. The response rate was 97%. RESULTS: The prevalence of dental injuries was 4.6% (n = 135). The highest frequency of trauma in permanent teeth was observed at the age of 12 (8%). Boys experienced more dental injuries than girls, 5.9% and 3.3% (p = 0.001), respectively. The most commonly reported cause of injuries to the permanent incisors was falls (71.8%), followed by collision with objects or people (17.8%). Maxillary central incisors were the most affected by dental injuries (154, 84.6%). The most common crown fracture was in enamel only (67.58%) followed by crown fracture of enamel and dentin (22.52%). CONCLUSION: Socio-economic indicators and parents' level of education were not statistically significantly associated with the occurrence of traumatic dental injuries. Factors associated with increased risk of dental injuries in permanent teeth were age, gender, having an incisal overjet greater than 5mm and anterior open bite.

Uterine extra gastrointestinal stromal tumor presenting as intramural leiomyoma.

Extra gastrointestinal stromal tumors (EGIST) are reported in different sites and organs. This tumors are rare in gynecologic apparatus. Here the authors report an uterine unique tumor represented as intramural leiomyoma. Because of different treatment options, clinicians should be aware of this rare tumor which may be located in uterus and confused with a smooth muscle tumor.

Vitamin D status in children with Crimean-Congo hemorrhagic fever.

BACKGROUND & OBJECTIVES: Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne viral disease, causing severe viral hemorrhagic fever outbreaks. This study aimed at determining the serum vitamin D levels and investigated the association between Crimean-Congo hemorrhagic fever (CCHF) and serum vitamin D levels in children with CCHF. METHODS: A total of 45 children aged between 5 and 15 yr, viz. 15 healthy control (HC) and 30 pediatric patients diagnosed with CCHF with real-time polymerase chain reaction (PCR) (patient group) were selected for the study. RESULTS: Analysis of the blood serum samples taken from the said individuals revealed that vitamin D, parathyroid hormone and calcium levels of the patients and the control groups were statistically different. INTERPRETATION & CONCLUSION: It was found that the serum vitamin D levels of the pediatric patients with CCHF were lower when compared to those of the controls, and that a low vitamin D level could negatively affect the reaction of the body to infections in children having CCHF.

Evaluation of incidental thyroid cancer in patients with thyroidectomy.

OBJECTIVES: Variations such as communications between median nerve and musculocutaneous nerve or in their abnormal branching pattern constitute a major concern in clinical and surgical field. Knowledge of these variations not only provides the clinician with a proper interpretation of the case, but also minimizes the complication in surgical approaches in this region. METHOD: We examined 50 isolated upper limbs to investigate the possible incidences of various types of communications between these two neighbouring peripheral nerves. RESULT: Twenty-eight per cent of limbs were found to have communication between these two nerves. When categorized according to Venieratos and Anagnostopoulou's classification method, 11 out of 14 cases (79%) showed type I communications, two out of 14 (14%) showed type II and the remaining one (7%) showed type III communication pattern. CONCLUSION: Prior knowledge of communications between these two neighbouring nerves, both in terms of their incidences and pattern of communications, may be of considerable significance to neurologists and orthopaedicians in dealing with nerve entrapment syndromes in the upper limb of patients.

The necessity and timing of exercise after lumbar disc herniation surgery.

OBJECTIVE: Physical therapy and rehabilitation may improve low back pain and quality of life after lumbar disc herniation. However, there is no agreement on its optimal start time and rehabilitative methods. This study evaluates the effects of early and late rehabilitation on low back pain and quality of life following unilateral microdiscectomy. PATIENTS AND METHODS: A total of 204 patients who underwent surgery for lumbar disc herniation were included and subsequently randomized into five groups: 1. No exercise, 2. The 2nd-week walking group, 3. 1st-month walking group, 4. 2nd-week waist exercise, 5. 1st-month waist exercise. Visual analog scale (VAS) and Oswestry Disability Index (ODI) were assessed at the 1st week, 1st, 3rd, and 6th, and 12th-month follow-up after surgery. RESULTS: 1st-month VAS scores were analyzed, and a significant difference was found between the VAS scores of the 2nd-week walk (3.60±0.78) and 2nd-week waist exercise (3.38±0.67) groups and the other groups (p<0.001). 3rd-month VAS results were analyzed, and the VAS scores of the 1st-month walk group (2.67±0.48) were significantly higher than those of the 2nd-week walk group (1.73±0.45) (p<0.001). A significant difference was observed between the no-exercise group (2.93±0.91) and the other groups according to the 12-month VAS scores, with the VAS scores of the no-exercise group being significantly higher than the other groups (p<0.001). There was a significant difference between the ODI scores of both the 2nd-week walk (38±8.55) and the 2nd-week waist (33.8±6.61) exercise groups and the other groups according to the 1st-month ODI scores (p<0.001). A significant difference was observed between the no-exercise group (35.2±8.25) and the other groups according to the 12-month ODI scores, and the ODI scores of the no-exercise group were significantly higher than the other groups (p<0.001). CONCLUSIONS: Regular exercise is highly recommended for long-term pain relief, as well as for achieving a speedy recovery after surgery, which is crucial to maintaining a high quality of life and preventing loss of earning potential. We believe that early implementation of exercises is ideal, but even if initiated later, standard back exercises can still expedite rehabilitation.

Is neutrophil-to-lymphocyte ratio a prognostic marker for traumatic brain injury in the pediatric population?

OBJECTIVE: The neutrophil-to-lymphocyte ratio (NLR) is used for the prognosis of diseases characterized by inflammatory processes. This study aims to discuss the long-term outcomes and NLR in pediatric traumatic brain injury cases. PATIENTS AND METHODS: This study investigated traumatic brain injury patients younger than 18 years. Patients were grouped into 5 groups according to their Glasgow outcome scores (GOS). Initial admission Glasgow coma scale (GCS) values, neurological examinations, pupil conditions, cardiopulmonary resuscitation (CPR) administration, and seizure occurrence were recorded. Neutrophil counts and lymphocyte counts, derived from complete blood count (CBC) values taken during the patient's first 8 hours of admission, were used to calculate the NLR value. RESULTS: A total of 150 patients, 54 (36%) females and 96 (64%) males, were assessed in the study. The most frequent accident type was falling from a height [84 patients (56%)]. The GCS, CPR, pupillary reflex, anisocoria, surgical procedure, and neutrophil counts were significantly different between the GOS scores. There was no statistically significant difference between the GOS and the NLR (p=0.400). There was a significant difference in NLR value according to CPR, seizures, and brain injury type (p<0.05). CONCLUSIONS: NLR values are not correlated with 1-year outcome scores in pediatric traumatic brain injury patients, unlike proven parameters such as initial GCS scores and neurological status.

Making stereotactic radiosurgery decisions by calculating the probability of perilesional edema in cavernomas.

OBJECTIVE: Stereotactic radiosurgery is a therapeutic modality for cavernomas that is associated with certain adverse effects, such as perilesional edema. In this study, we aimed to estimate the presentation of perilesional edema using imaging techniques, considering its location, proximity to major venous and arterial structures, size, depth, and eloquent location. PATIENTS AND METHODS: The radiographic evaluation included their sizes, localization of the lobes, whether they were in the deep or superficial regions, eloquent areas, and their proximity to the major arteries and venous sinuses. RESULTS: As the size increased, the time to edema increased at the same rate (r=0.972, p=0.001). We determined that the duration of edema increases as it attaches to the great venous structures, and edema occurs over a longer time (r=-0.761, p=0.001). Cavernomas >13 mm had a high probability of causing edema (p=0.0014). Edema occurred with a high probability in patients with an arterial distance <5.69 mm and a venous/arterial distance ratio >8.93 (specificity 100%, selectivity 98.2%). CONCLUSIONS: When recommending stereostatic radiosurgery treatment, the possibility of edema formation should be calculated based on the location, size, and proximity of the cavernoma to the vascular structures, and the choice of treatment should be made accordingly.

Under what conditions is the intra-articular steroid injection superior to nonsteroidal anti-inflammatory drugs for treating sacroiliac joint pain?

OBJECTIVE: The purpose of this prospective study was to determine the conditions under which intra-articular injection therapy may be superior to nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with sacroiliac joint pain in the outpatient setting at our hospital. PATIENTS AND METHODS: Patients with sacroiliac pain were divided into two groups: NSAID and the sacroiliac injection group. The NSAID group received 25 mg of indometacin orally once a day and 750 mg of naproxen orally once a day. In the sacroiliac injection group, 5 mg of betamethasone were injected into the sacroiliac joint. The patients' history of lumbar surgery, whether they had sacroiliitis, and the duration of pain were recorded. The patients' VAS (Visual analogue scale) scores at week 1 and month 1 were evaluated. RESULTS: VAS scores were decreased after the first week and first month in the sacroiliac injection group compared to the NSAID group (p<0.001). Sacroiliac steroid injection was found to be superior to NSAIDs in reducing VAS scores in patients with sacroiliitis, a history of lumbar surgery, and pain lasting more than 30 days (p<0.001). In patients without sacroiliitis, without a history of lumbar surgery, and with less than 30 days of pain, no difference was observed between the groups in reducing VAS scores at the end of the first month. CONCLUSIONS: In patients with sacroiliac joint pain, sacroiliac joint injection is superior to NSAIDs in pain relief in patients with pain for more than 30 days, those with MRI-diagnosed sacroiliitis, and those who have undergone lumbar surgery.

Incisor trauma in a Turkish preschool population: prevalence and socio-economic risk factors.

OBJECTIVE: This study aimed to assess the prevalence of traumatic injuries of the primary incisors in preschool children from 2 to 5 years old in South-Eastern Anatolia, Turkey. Additionally, the relationship between traumatic dental injuries, parents' education level, family income, size of incisal overjet and the presence of anterior open bite were examined. BASIC RESEARCH DESIGN: A cross-sectional survey CLINICAL SETTINGS: Data were collected through oral examinations and structured interviews, and included socio-economic indicators. PARTICIPANTS: A total of 727 children of both genders were included in the study. 122 of these children were aged 2; 183 aged 3; 178 aged 4 and 186 aged 5. RESULTS: The prevalence of dental injuries was 8.0% (n = 58). The highest frequency of trauma in the primary teeth was observed at the age of 4. Boys experienced more dental injuries than girls, 12.2% and 4.0%, respectively. The most common crown fracture was in enamel only (57%) followed by crown fracture of enamel and dentin (19%). CONCLUSION: The prevalence of dental injuries in Turkish preschool children was very low. The children with incisal overjet greater than 5mm and anterior open bite experienced more dental injuries in primary teeth than their counterparts with normal occlusion. Socio-economic indicators were not statistically significantly associated with the occurrence of traumatic dental injuries.

Olfactory dysfunction and coronavirus disease 2019 severity: a prospective cohort study.

OBJECTIVE: The primary goal of this study was to evaluate the association between olfactory dysfunction or taste impairment and disease severity and radiological findings in coronavirus disease-2019. The secondary goal was to assess the prevalence, severity and course of olfactory dysfunction or taste impairment in patients with coronavirus disease 2019. METHOD: This prospective observational cohort study evaluated patients hospitalised with coronavirus disease 2019 between April 1 and 1 May 2020. Olfactory dysfunction and taste impairment were evaluated by two questionnaires. Chest computed tomography findings and coronavirus disease-2019 severity were assessed. RESULTS: Among 133 patients, 23.3 per cent and 30.8 per cent experienced olfactory dysfunction and taste impairment, respectively, and 17.2 per cent experienced both. The mean age was 56.03 years, and 64.7 per cent were male and 35.3 per cent were female. No statistically significant association was found between olfactory dysfunction (p = 0.706) and taste impairment (p = 0.35) with either disease severity or chest computed tomography grading. CONCLUSION: Olfactory dysfunction or taste impairment does not have prognostic importance in patients with coronavirus disease 2019.

Intracranial hemorrhage in Kimura's disease: coincidence or consequence?

OBJECTIVE: To report an unusual case of Kimura's disease associated with intracranial hemorrhage, the first such report in the literature. CASE REPORT: A 38-year-old man presented with chronic neurological disorders and a 10-year history of left cervical soft tissue swellings. Magnetic resonance imaging (MRI) of the cranium showed a subacute/chronic hematoma in the left occipitotemporal lobe and a chronic infarct in the right parietal lobe. Cervical computed tomography (CT) and MRI showed multiple masses on the left side of the neck and parotid gland. Histopathologic examination revealed lymphocyte and eosinophil infiltration, proliferation of hyalinated blood vessels, and interstitial fibrosis. Steroid therapy (2 mg/kg per day) was started and the lesions regressed partially. The masses and some enlarged regional lymph nodes were resected. CONCLUSIONS: Intracranial hemorrhage can either be a coincidental finding or complication of Kimura's disease. MRI and CT are effective modalities in radiologic diagnosis of this condition.

Calvarial bone defects in ovariectomised rats treated with mesenchymal stem cells and demineralised freeze-dried bone allografts.

BACKGROUND: The aim of the study was to investigate the ability of a combination of bone marrow mesenchymal stem cells (BM-MSCs) with and without demineralised freeze-dried bone allografts (DFDBAs) to induce bone regeneration in calvarial defects in ovariectomised rats. MATERIALS AND METHODS: Critical size defects were filled with a combination of DFDBAs and BM-MSCs or BM-MSCs alone. Eight weeks after calvarial surgery, the rats were sacrificed. The samples were analysed histologically and immunohistochemically. RESULTS: No difference was observed in vascularisation between groups C1 (animals with cranial defect only, control group) and O1 (animals with cranial defect only, ovariectomy group). Intramembranous ossification was observed at a limited level in groups C2 (animals with cranial defect with MSCs, control group) and O2 (animals with cranial defect with MSCs, ovariectomy group) compared to C1 and O1. In group C3 (animals with DFDBAs with MSCs, control group), the fibrous structures of the matrix became compact as a result of a bone graft having been placed in the cavity, but in group O3 (animals with DFDBAs with MSCs, ovariectomy group), the fibrous tissue was poorly distributed between the bone grafts for the most parts. CONCLUSIONS: We conclude that the insertion of BM-MSCs enhances bone healing; however, the DFDBA/BM-MSC combination has little effect on overcoming impaired bone formation in ovariectomised rats.

Three-year clinical evaluation of endodontically treated anterior teeth restored with a polyethylene fibre-reinforced composite.

BACKGROUND: Polyethylene fibre-reinforced composites (FRCs) have been under development for some time. However, there is a lack of data on the clinical performance of these restorations. The purpose of this descriptive study was to evaluate the clinical performance of endodontically treated anterior teeth restored using polyethylene FRCs. METHODS: Eighty-seven endodontically treated anterior teeth in 65 patients were restored with polyethylene FRCs. The restorations were placed by three operators. The patients were recalled for examinations every year for up to three years. The restorations were evaluated using modified Ryge and USPHS criteria. RESULTS: A statistical analysis showed no significant difference in marginal irregularity, marginal discolouration, surface texture, wear/anatomic form, fracture and retention, radiographic appearance, or debonding between the baseline and three-year results. CONCLUSIONS: Based on our three-year examination results, polyethylene FRC restorations appear to be clinically successful.