Assessment of oral manifestations in pediatric patients with celiac disease in relation to marsh types.

BACKGROUND: To investigate the presence of molar-incisor hypoplasia and recurrent aphthous ulcers, the level of caries experience, and oral hygiene status, and to measure salivary flow rate, salivary buffer capacity, and salivary cariogenic microflora with Marsh types. MATERIAL AND METHODS: A single-blind, prospective clinical study with 62 pediatric patients diagnosed with celiac disease with 64 controls. Clinical identification of molar-incisor hypomineralization (MIH) was followed according to the European Academy of Pediatric Dentistry criteria. DMFS and dfs index were used for the caries experience of each child. The clinical diagnosis of RAU was present or not. Oral hygiene was surveyed by recording the OHI-S and the CRT® Bacteria and Buffer Test was used to examine the cariogenic microflora of each child. RESULTS: The prevalence of MIH was 61% and the number of recurrent aphthous ulcers were significantly higher in children with celiac disease. There was no statistically significant difference in the CD group, when DMFS, dfs, and MIH parameters were investigated according to dietary compliance. Higher dietary compliance resulted in better oral hygiene status. There was an inverse relationship between the duration of celiac diagnosis and the presence of MIH. A positive relation was found between the duration of the disease and the severity of MIH. In addition to the higher S. mutans counts, the salivary flow rate was very low in children with celiac disease, indicating a positive correlation between poor dietary compliance and poorer oral hygiene. CONCLUSIONS: In children, enamel defects and recurrent mucosal lesions may be a sign of celiac disease. Higher numbers of dental caries in permanent teeth of children with celiac disease may be related to Marsh 2 type. The pediatricians and/or pediatric gastroenterologists should refer the chin with celiac disease to the pediatric dentist for the accurate treatment of intraoral manifestations of the disease itself.

Peer-Assisted skills learning in structured undergraduate medical curriculum: An experiential perspective of tutors and tutees.

Background and Aims: : This study aims to evaluate the implication of peer-assisted learning model adopted in students' clinical skills training from the perspective of tutees and tutors at the end of a peer-tutored clinical skills program and peer tutors themselves. Subjects and Methods: This cross-sectional study was conducted in the Faculty of Medicine, Bursa Uludag in between January and March 2018. Following the clinical skills training, a questionnaire designed to assess the views of tutees and peer tutors was filled out on a voluntary basis by 159 tutees and 43 tutors. The statistical analysis of the collected and processed data was analyzed by using IBM SPSS 23.0 statistical program. The statistical significance level was maintained as α = 0.05. Results: According to the Likert scale, satisfaction with the tutors and the educational environment was high in general. The 2nd term tutees provided more negative feedback compared to other terms. Among all the terms, the most positive answers were provided by the 3rd term students. Although the tutors found themselves fully skilled in communication with colleagues, there were striking differences between the tutors in the 5th and 6th terms of providing a good role model for pre-clinical terms students. Conclusion: Considering peer assisted learning (PAL)'s positive responses from this study, the adoption of PAL has been started to be used as a supplementary teaching method for the clinical skills training at the Faculty of Medicine, Bursa Uludag University. PAL is considered a successful education model since it is cost-efficient for undergraduate medical training and improves the professional skills of both teacher and learner students. It can be availed of as an alternative method in medical faculties where especially the number of academic members is insufficient.

Development of Valid and Reliable Tools for Pediatricians' Knowledge and Self-Perceived Competency Towards Oral Health of Children in Turkey.

BACKGROUND: This study aimed to develop a valid and reliable questionnaire of knowledge about oral health in childhood and a scale of self-perceived competency for pediatricians. In this way, the contributions of Turkish pediatricians on oral health in childhood and their effects on children's oral health and caregivers will be evaluated. SUBJECTS AND METHODS: Items were generated from published scientific literature, other questionnaires, and interviewing notes with the pedodontists. The study group examined publications on the preventive oral health of children, and they included items related to children in the item pool. The initial knowledge questionnaire consisted of 23 items and 10 items for the self-perceived competency scale. The content validity of the questionnaire and scale were determined by the assessments of the expert team. The internal consistency of the knowledge questionnaire and test-retest reliability of the self-perceived competency scale was examined. RESULTS: Thirty pediatricians took part in the study. The pediatricians were: 63.3% (n = 19) female and 36.7% (n = 11) male; their mean age was 37.97 ± 3.86 years. Most of the pediatricians were specialists with 83.4% (n = 25). The medical specialization of all pediatricians was university and the working year mean was 10.93 ± 4.28. The knowledge questionnaire had 10 items after content validity and internal consistency reliability investigations. The initial number of items for the self-perception level scale was 10. We excluded five items due to the content validity index. ICC value for 5-item self-perception level scale was calculated as 0.816 (95% CI: 0.606-0.914). Therefore, the scale has a good reliability level. CONCLUSION: Our knowledge questionnaire and self-perceived competency scale provide a validated and reliable tool in the assessment of pediatricians' knowledge and competency regarding oral health. Pediatricians can test themselves using this knowledge questionnaire and self-perceived competency scale.

Self-awareness of X, Y, and Z generations for dental health: A comparative clinical study.

BACKGROUND AND AIM: Generation defines as a group of people who were born in a same interval of year and shares similar life events at critical developmental stages, values, behaviors, and significant reactions. The aim of this clinical study was to assess self-awareness of dental health of X, Y, and Z generations in Turkey. MATERIALS AND METHODS: Total of 239 individuals were divided into three homogenous groups X Generation (X Gen; n = 80), Y Generation (Y Gen; n = 80), and Z Generation (Z Gen; n = 79) by their date of birth 1965-1980; 1981-2000; 2001-2013, respectively. Self-rated caries status, frequency of tooth brushing, frequency of dental visits, and actual caries status were recorded. Self-awareness was calculated as the extraction of the numbers of actual caries and self-rated caries and coded as △ Caries. RESULTS: Mean Dental caries status was recorded using the number of decayed, missing or filled teeth (dft/DMFT) was 4.92 for X Gen; 4.68 for Y Gen; 3.66/3.51 for Z Gen individuals, respectively. Actual caries and self-rated caries were significantly incompatible with each other in all study groups (<0.001). △Caries were insignificant in X, Y, and Z Generations (>0.05); nevertheless, self-awareness (self-rated caries = actual caries) of Z Gen were found numerically more (23%) compared to other groups. Tooth-brushing habits of all individuals were mostly once-a-day (>0.05). Mean frequency of dental visits were once in a 3.5; 2.9; 1.5 years for X, Y, and Z Gens, respectively. CONCLUSION: There is no significant correlation between frequency of dental visits and self-awareness measures. Oral health education should urgently point out for all generations by dental professionals, media, and governmental authorities including preventive methods, oral hygiene instructions all aimed at preventing caries and raising self-awareness.

Dental caries severity and related factors of 1307 Turkish boarding school children.

BACKGROUND: In Turkey, dental caries is a disease which still has been considering as a real public health problem. School children of lower socioeconomic status had greater caries experience and higher caries severity in both primary and permanent dentitions. AIMS: To determine the frequency of dental caries and its related factors among boarding school children. PATIENTS AND METHODS: Cross-sectional study. We examined 1307 boarding school children aged 7-14 for caries status and its related factors. Data on dental health and its related factors were obtained from the archive of Ege Oral Health and Dentistry Association. Comparisons of caries severity (as decayed/missing/filled primary teeth, dmft/decayed/missing/filled permanent teeth, DMFT and significant caries index,) and examination years were made. Caries trend were also identified. Correlations between caries severity and its related factors were also performed. SPSS 20.0 was used for statistical analysis. RESULTS: DMFT and SiC for DMFT of all children were 2.35 and 5.04, respectively. 70-year-old had the highest dmft, whereas 14-year-olds had the highest DMFT. No correlation was found between decreased dmft and tooth brushing frequency, regular dental check-ups, and oral hygiene status. There was a weak correlation between decreased DMFT and increased number of dental visits in 2008 and 2009. In children received more than one examination and/or treatment (n = 269), the SiC index for dmft was 10.52 in 2002. In 2004, the index decreased to 3.57. The SiC for DMFT was 4.09 in 2002 and 2004. No correlation was identified between decreased dmft and DMFT and tooth brushing frequency, regular dental check-ups, and oral hygiene status both for the years of 2002 and 2004. The mean dmft of 32 children had prophylaxis for dental caries in 2002 was significantly decreased in 2004. CONCLUSION: Caries prevalence and severity of boarding school children were high even they were followed-up regularly.

Clinical outcomes of posterior segment intraocular foreign bodies: The volume effect.

PURPOSE: To assess the effect of foreign body volume on visual and anatomic outcomes in patients with a posterior segment intraocular foreign body (IOFB). METHODS: Patients were divided into three groups according to the volume of the IOFB; group 1 (n=18 eyes) with IOFBs<2mm3, group 2 (n=15 eyes) with 2mm3≤IOFBs<6mm3, group 3 (n=18 eyes) with IOFBs≥6mm3. All eyes underwent pars plana vitrectomy (PPV) for removal of the IOFB. Demographic characteristics, features of the injury and IOFB, findings of the initial and final ophthalmological examinations, and timing of IOFB removal were studied. RESULTS: The mean age was 38.8±12.0years, and the median follow-up period was 12.0 (range: 6-98) months. Initial visual acuity (VA) was significantly lower in group 3 (P=0.005), while final VA was similar between the three subgroups. Frequencies of primary globe repair, initial vitreous hemorrhage (VH), corneoscleral entry, and IOFB removal through the cornea were significantly higher in eyes with large volume IOFBs (P<0.05). Siderosis was only seen in 4 patients in group 1 (22.2%). No patients developed postoperative endophthalmitis. CONCLUSION: Large volume posterior segment IOFBs are associated with poor initial VA, initial VH and corneoscleral injury. Nevertheless, PPV and IOFB extraction under favorable conditions may provide significant visual improvement in eyes with large volume IOFBs.

Differentiation of hepatocellular carcinoma from non-hepatocellular malignant tumours of liver by chemical-shift MRI at 3 T.

AIM: To evaluate the diagnostic performance of chemical shift magnetic resonance imaging (MRI) in distinguishing hepatocellular carcinomas (HCCs) from non-hepatocellular malignant tumours (non-HCCs) of the liver. MATERIALS AND METHODS: Patients with a diagnosis of malignant liver tumours examined at 3 T MRI were included in this retrospective study. Forty-seven HCCs and 75 non-HCCs that were studied with chemical-shift MRI between January 2012 and October 2016 were retrieved from the radiology database. Two blinded observers measured the signal intensities of the tumours, adjacent normal-looking liver parenchyma, and spleen on chemical-shift MRI. The fat quantification for HCCs, non-HCCs, and adjacent normal-looking liver parenchyma were calculated by using the spleen as a reference standard. The subtraction scores were calculated by subtracting fat percentages in liver parenchyma from those in tumours. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the fat percentage subtraction scores in distinguishing HCCs from non-HCCs were calculated. RESULTS: According to the optimal cut-off value acquired from both readers, a subtraction score >-0.26 was considered to be a HCC. Fat signal percentage subtraction scores were ≥-0.26 in 45 of 47 HCCs and were <-0.26 in 69 of 75 non-HCCs. The sensitivity, specificity, PPV, and NPV of fat signal percentage subtraction score to differentiate HCCs from non-HCCs were found to be 95.7%, 89.3%, 84.9%, and 97.1%, respectively. CONCLUSION: Intracytoplasmic lipid in HCCs demonstrated by quantitative chemical-shift MRI may be a potentially powerful imaging biomarker to distinguish HCCs from the other malignant liver tumours.

Lornoxicam injection is inferior to betamethasone in the treatment of subacromial impingement syndrome : A prospective randomized study of functional outcomes.

BACKGROUND: Subacromial impingement syndrome (SIS) is one of the most frequent shoulder pathologies. Initial treatment is conservative. Subacromial injection of drugs achieves a high concentration at the pathologic site with less drug use and fewer systemic side effects. Glucocorticoids are most frequently injected. One concern with steroid use is the wide array of potential systemic and local complications. Nonsteroidal anti-inflammatory drugs (NSAIDs) are also peripherally acting and can be used locally. Although intraarticular (IA) use of NSAIDs is common in orthopedic practice, it is mostly restricted to the knee joint. Reports of local NSAID for joint pathologies are relatively rare. This study compared the efficacy of single-dose subacromial injections of betamethasone and lornoxicam for treatment of SIS. METHODS: Subacromial injections of either 7.0 mg betamethasone or 8 mg lornoxicam were received by 70 patients with mean age 53 (46-68) years. Treatment outcome was assessed with Constant-Murley and UCLA questionnaires before injection and at 2­, 4­, and 6­week follow-ups. RESULTS: The change in outcome scores compared to pretreatment was higher in the steroid group at all follow-ups (p < 0.001). Patients in the steroid group showed a significant improvement at all follow-ups compared to pretreatment (p <0.001) and previous follow-ups (p <0.05) at all times. Patients in the lornoxicam group showed a significant functional improvement in week 2 (p <0.001), which was not evident in the following weeks (p >0.05). Although functional recovery halted after week 2, outcome scores remained significantly higher than the pretreatment values at all weeks (p <0.001). CONCLUSION: Although a single subacromial lornoxicam injection provides rapid functional recovery, which partially extends into the intermediate term, its results are inferior to betamethasone and it may be an alternative only in patients where corticosteroids are contraindicated.

Effectiveness of percutaneous vertebroplasty in cases of vertebral metastases.

PURPOSE AND OBJECTIVES: To assess the effectiveness of percutaneous vertebroplasty (PV) in patients with vertebral collapse due to metastases. MATERIALS AND METHODS: PV procedures performed on 95 vertebras in 52 patients with primary malignancy were retrospectively evaluated. Vertebral metastases, primary malignancies of the patients, pain before and after PV on a visual analogue scale (VAS), amount of polymethylmethacrylate (PMMA) cement applied to the vertebral body during PV, PMMA cement leakage and vertebral approaches were evaluated. RESULTS: VAS scores of 43 patients (in total 79 vertebras) were evaluated. Median VAS scores of patients declined from 8 (4-10) before PV to 3 (0-7) within one day after the procedure, to 2 (0-9) one week after the procedure and eventually to 2 (0-9) 3months after the procedure (p<0.001). PMMA amount applied to the vertebral body during PV varied between 1.5-9mL (average±SD 4.91±1.61). There was no significant statistical correlation between PMMA amounts and VAS scores within one day after, 1week after and 3months after the PV procedure (p>0.05). CONCLUSION: PV is a simple, effective, reliable, easy to perform and minimally invasive procedure in patients with painful vertebral metastases.

A comparison of Ki 67 proliferative index in primary tumor and axillary metastatic lymph nodes with length of survival in patients with breast cancer.

OBJECTIVE: The aim of the present study was to investigate the possibility to predict the histopathological features of breast and metastatic lymph nodes and survey and prognosis of patients and likelihood of being a predictive factor for treatment by using Ki67 immunohistochemical stain. MATERIALS AND METHODS: 95 patients who were admitted to Uludag University Medical Faculty, Department of General Surgery with a diagnosis of stage II-III breast cancer between dates May 1997 and December 2002 were retrospectively evaluated with respect to breast cancer related prognostic factors treatments and last-control related data. Ki67 immunohistochemical staining was performed to appropriate specimens using Streptavidin-biotin technique. Ki67 was reported as the proliferation index, and the number of stained nuclei were stated to be / 1000. RESULTS: In the evaluation of the lymph node by univariate analysis, we ascertained that duration of survival is shorter above the 227 cut-off value for Ki67 proliferative index. Length of survival of patients with tumor Ki67 proliferative index below 141 and with no distant metastasis was established to be better. Ki67 proliferative index in the lymph node was detected to increase more with increasing histological and nuclear grade, estrogen and progesterone receptor negativity and at stage III. CONCLUSION: Since numerous factors are effective on breast cancer, each patient and tumor behaves differently. A lot of prognostic factors are taken into account while treatment choice is determined. We may have information on the biological behavior of the tumor in patients who underwent sentinel lymph node biopsy or axillary dissection in staining with Ki67 pattern (Tab. 5, Fig. 3, Ref. 13).

The effect of a chitosan coating on the adhesive potential and tensile strength of polypropylene meshes.

PURPOSE: The polypropylene mesh used for the repair of abdominal wall hernia can cause intraabdominal adhesions. In this study, the effect of chitosan coating of the polypropylene meshes on the adhesion and tensile strength of the meshes was investigated. METHOD: After coating polypropylene meshes with 2 % chitosan, 5 × 3 cm patches were prepared. Under general anesthesia, sterile laparotomy was performed in 96 Wistar albino female rats that were equally allocated to 6 groups. In the first group, only laparotomy was performed. In the second group, chitosan was applied to the peritoneal cavity, and the laparotomy was closed. In the third group, polypropylene (prolene) patches were used to close the abdomen; in the fourth group, polypropylene polyglecaprone 25 (ultrapro) mesh patches were used to close the abdomen. In the fifth and sixth groups, chitosan-coated versions of the meshes used in the third and fourth groups, respectively, were applied. All skin incisions were closed in all groups. On the 7th and 21st days, eight randomly selected rats from each group were killed. The abdomen was opened, and the adhesions were evaluated using the diamond score. The tensile strength of the meshes was measured by an Instron 4301 device. The histopathological evaluation of the inflammatory response was performed according to the Ehrlich and Hunt classification. RESULTS: The adhesion score was comparable among mesh groups but higher when mesh groups were compared with the control and chitosan groups (p<0.001). The tensile strength of meshes did not differ among mesh groups. Histopathologically, meshes with or without chitosan were similar in terms of inflammatory findings. CONCLUSIONS: The chitosan coating did not affect the adhesion potential, the tensile strength, or the inflammatory response of the polypropylene meshes.

Prevalence of femoroacetabular impingement in asymptomatic contralateral hips in patients with unilateral idiopathic osteoarthritis.

Radiographic findings of femoroace tabular impingement in the contralateral asymptomatic hip of patients who had undergone total hip arthroplasty because of primary osteoarthritis (n = 44) were compared with controls (n = 40). The centre-edge angle and caput-collum-diaphyseal angle were measured and the presence of crossover sign and a prominent ischial spine noted on anteroposterior radiographs of the pelvis. The α-angle and offset ratio were measured on cross-table lateral radiographs of the hip. The centre-edge angle and offset ratio were significantly lower and the α-angle significantly higher in the study group compared with controls. While the number of cases with an abnormal centre-edge angle was similar in both groups, the numbers with an α-angle > 50° and the number with an offset ratio ≤ 15 were significantly higher in the study group. It was concluded that morphological anomalies associated with femoroacetabular impingement are seen more frequently in the asymptomatic contralateral hip of patients who have undergone hip replacement for primary osteoarthritis than in controls.

The effect of vitamin D replacement therapy on insulin resistance and androgen levels in women with polycystic ovary syndrome.

Insulin resistance (IR) is one of the common features of the polycystic ovary syndrome (PCOS), and recent studies indicate the possible role of vitamin D in the pathogenesis of IR and glucose metabolism. Aim of this study was aimed to determine the effect of vitamin D replacement therapy on glucose metabolism, insulin, and androgen levels in obese, insulin-resistant women with PCOS. Eleven women with PCOS were included in the study. Mean age of the patients was 23.6+/-5.7 yr, body mass index 33.9+/-5.1 kg/m(2). Six patients (54.5%) had acantosis nigricans and 10 (90.9%) oligoamenorrhea. The mean Ferriman Gallwey score was 14.1+/-4.6. Only 2 women were within the normal limits of vitamin D levels as >20 ng/ml. Three weeks after the administration of the single dose of 300,000 units of vitamin D3 orally, 25-hydroxyvitamin D3 significantly increased from 16.9+/-16 ng/ml to 37.1+/-14.6 ng/ml (p: 0.027) and only 2 women were detected to have vitamin D3 levels <20 ng/ml. Although glucose and insulin levels were decreased non-significantly, homeostasis model assessment (HOMA)-IR significantly decreased from 4.41+/-1.38 to 3.67+/-1.48 (p: 0.043). No significant alterations were witnessed at the levels of DHEAS, total and free testosterone, androstenedione. No correlation was found between vitamin D with HOMA and other hormonal parameters. In conclusion, women with PCOS have mostly insufficient vitamin D levels, and vitamin D replacement therapy may have a beneficial effect on IR in obese women with PCOS.

Acute respiratory distress syndrome due to Cryptococcus albidus pneumonia: case report and review of the literature.

Although cryptococcal infections due to Cryptococcus neoformans are frequently reported in the immunosuppressed patients, infections related to other Cryptococcus spp. are rarely reported. We are reporting a case of pulmonary infection and ARDS due to C. albidus in a patient receiving immunosuppressive therapy because of Still's disease. The diagnosis was made by tissue biopsy and culture. The patient responded to treatment with amphotericin B lipid complex 400 mg/day. The case is significant in that it reminds of yeasts as a cause of community acquired infection in the immunosuppressed patients.

The effects of environmental light--dark changes on experimental mild traumatic brain injury.

OBJECTIVES: The aim of this study was to investigate the effects of environmental light-dark changes on the outcome of mild traumatic brain injury (MTBI) using an experimental rodent model. The functions of endogenous and exogenous melatonin on the outcome of injury were also investigated METHODS: Mild traumatic brain injury was experimentally induced in 56 male Sprague-Dawley rats using a weight-drop device. Animals were divided into four groups of 14 each as follows: (i) sham-operated (trauma only, normal day-night cycle), (ii) treated with melatonin (trauma+melatonin, normal day-night cycle), (iii) darkness-induced (trauma+48 h constant dark), and (iv) treated with melatonin and darkness-induced (trauma+48 h constant dark+melatonin). Melatonin (50 mg/kg) was administered, intraperitoneally, immediately after trauma. EEG recordings were taken at three time periods (pretrauma, immediately after trauma, and 48 h after trauma). Motor functions were tested pretrauma, 24 and 48 h post-trauma. Serum melatonin levels were determined pretrauma and 48 h post-trauma. Tissue samples from right frontal area were taken 48 h after trauma for light and electron microscopic examinations. CONCLUSION: Following MTBI light deprivation alone and light deprivation in combination with exogenously administered melatonin indicated significant neuroprotective effects. Although there may be other important pathways, darkness-induced elevation in endogenous melatonin secretion appears to play an important role in this neuroprotective outcome.