Diffuse skin findings secondary to lymph node tularemia in a patient with chronic rheumatoid arthritis on methotrexate.

Tularemia has many atypical presentations which can represent a diagnostic challenge. The history is essential in the investigation of this disease. Bite-induced primary skin lesions should be distinguished from the infrequent immune-mediated secondary skin lesions. Herein, we present an atypical pseudovesicular rash secondary to Francisella tularensis.

The residual effect of coronovirus disease 2019 on olfactory acuity and mucociliary clearance time: a cross-sectional, controlled study.

OBJECTIVE: This study evaluated the olfactory, sinonasal and mucociliary functions of patients with post-coronavirus disease 2019 long-term persistent olfactory dysfunction. METHOD: Three groups of 30 patients each were formed: patients with a history of coronavirus disease 2019 infection with self-reported, persistent, sudden-onset olfactory dysfunction (group 1), patients with a history of coronavirus disease 2019 infection without any self-reported olfactory dysfunction (group 2) and healthy controls with no history of coronavirus disease 2019 infection (group 3). Saccharin time, Sniffin' Sticks, Turkish Nasal Obstruction Symptom Evaluation and Sino-Nasal Outcome Test 22 scores were compared. RESULTS: Turkish Nasal Obstruction Symptom Evaluation scores were similar between groups (p = 0.252). Sino-Nasal Outcome Test-22 scores were higher in group 1 than groups 2 and 3 (p < 0.01 and p < 0.001, respectively). Saccharin time was significantly longer in group 1 than groups 2 and 3 (p < 0.05 and p < 0.01, respectively). Group 1 had lower olfactory scores than groups 2 and 3 (p < 0.001 and p < 0.001, respectively). CONCLUSION: Mucociliary clearance time was significantly prolonged in patients with post-coronavirus disease 2019 persistent olfactory dysfunction. Coronavirus disease 2019 infection was likely to cause asymptomatic olfactory dysfunction.

LPS-induced Src family kinases activity mediates IL-10 production through activation of STAT3 in peripheral blood mononuclear cells of patients with Behçet's Disease.

Behçet's disease (BD) is achronic inflammatory disorder characterized by recurrent oral and genital ulcers, uveitis and skin lesions. Although,the pathogenesis of BD remains poorly understood, excessive or dysregulatedcytokine production including IL-10 is associated with BD. Revealing the key molecular mechanism by which IL-10 expression is regulated is crucial to understanding the pathogenesis of BD. The aim of this study was to investigate whether Src family kinases (SFKs) are upstream mediators of STAT3/IL-10 pathway in peripheral blood mono nuclear cells(PBMCs) of active BD patients.Twenty active BD patients and twenty healthy subjects used as control were included in the study. PBMCs were isolated from total blood by density gradient centrifugation.Western blot and ELISA methods were applied to analyzelipopolysaccharide (LPS)-induced SFKs/STAT3/IL10 signaling pathway in BD.Inhibition of SFKs activity suppressed LPS-induced IL-10 production in PBMCs fromboth controls and active BD patients. Similarly, blockage of STAT3 activation abrogated LPS-induced IL-10 production. However, LPS-induced STAT3 activation required for IL-10 production was found to be dependent on SFKs activity as LPS-induced STAT3 phosphorylation was reduced by the inhibition of SFKs activity in PBMCs of active BD patients.SFKs activity is essential for LPS-induced STAT3/IL-10 pathway in PBMCs of active BD patients. Manipulation of the SFKs activity may offer a novel therapeutic approach for BD.

Smell functions in patients with multiple sclerosis: a prospective case-control study.

Smell functions in patients with multiple sclerosis: a prospective case-control study. OBJECTIVES: The aim of this study is to evaluate the smell function in patients with multiple sclerosis (MS). METHODS: Twenty subjects (six males, 14 females) who were diagnosed as having MS, based on the 2010 Revised McDonald criteria, and 20 healthy individuals (six males, 14 females) were included in this study. In order to measure smell identification abilities, each subject completed the 12-item Brief Smell Identification Test (BSIT). Central and peripheral regions of smell were measured using cranial magnetic resonance (MR) images. The central regions of smell (the temporal lobe insular gyrus and the corpus amygdala) and the peripheral regions of smell (the olfactory bulb, tract and sulcus) were examined in the cranial MR images. Regions of smell were also evaluated for the presence of MS lesions (plaques). RESULTS: The total BSIT scores of the subjects in the MS group were found to be significantly lower than those of the control group (p<0.05). In the MS group, measurement values of the central regions of smell (right corpus amygdala diameter, right and left corpus amygdala) were significantly higher than those of the control group (p<0.05). There were no MS 'lesions in the peripheral regions of smell, but MS lesions were observed in the central regions: the right temporal lobe insular gyrus (four patients, 20.0%); the left temporal lobe insular gyrus (two patients, 10.0%); and the right corpus amygdala (one patient, 5.0%). While these results are not sufficient for statistical analysis, the total smell scores of these patients were found to be low. CONCLUSION: There is a deterioration in the smell functions of patients with MS. Therefore, we highly recommend that ENT specialists use the easily accessible and reliable BSIT for the diagnosis of smell disorders.

Giant serpentine aneurysm with acute spontaneous complete thrombosis.

We report a case of a giant serpentine aneurysm (GSA) of the middle cerebral artery (MCA) that underwent complete spontaneous thrombosis after angiography. The patient was a 24-year-old man who had an acute headache. CT and MR examinations revealed a large partially thrombosed aneurysm of the MCA with residual flow in the artery. Angiography demonstrated a GSA arising from the left MCA. Thirteen days later, a second angiography showed complete thrombosis of the aneurysm.

Fetal biometry: size and configuration of the third ventricle.

PURPOSE: To evaluate the normal configuration and size of the third ventricle in second and third trimester fetuses in a normal population, and to compare our values with those of previously published studies. MATERIAL AND METHODS: Evaluation of fetal third ventricular width and configuration was obtained by antenatal ultrasonography in 474 fetuses with gestational age between 12 weeks and term (mean 28 weeks). Percentiles for third ventricle width were estimated by combining separate fractional polynominal regression models fitted to the mean and standard deviation, assuming that the measurements had a normal distribution at each gestational age. Appearance of the third ventricle was correlated with each gestational age. RESULTS: The third ventricle could be visualized in 471 (99%) of 474 fetuses. The 97th percentile of the third ventricle in preterm fetuses was measured as 3.6 mm in size. The third ventricle was seen as a single echogenic line in 153 (32.4%) of 474 fetuses. Two-hundred-and-ninety-nine (61.5%) of all fetuses had parallel echogenic lines outlining a fluid-filled lumen. V-shaped third ventricular configuration was seen in only 28 (5.9%) of the fetuses. From 24 weeks to term, parallel echogenic lines were the most commonly (83.7% to 79.6%) encountered configuration for the third ventricle. CONCLUSION: The 97th percentile of the third ventricle in preterm fetuses was measured as 3.6 mm in size. In the early second trimester, 77% of the fetuses had a single echogenic line appearance on ultrasonography. As the brain and ventricular structures mature, a parallel echogenic line becomes the prominent ultrasonography appearance (>80% of fetuses) in third trimester healthy fetuses.

Grievances in cases using antibiotics due to orodental problems and assessment of the need for antibiotics.

OBJECTIVE: To assess the complaints of patients who were prescribed antibiotics following orodental problems and the need for antibiotics prescribed for this purpose. SETTING: Examinations were carried out in the Department of Oral Diagnosis and Radiology, Ege University, Turkey. PARTICIPANTS: A total of 203 patients (129 females and 74 males) between 8-70 years of age (mean age 37.7 +/- 13.9). INTERVENTION: Examination and report. MAIN OUTCOME MEASURES: Frequency of unnecessary antibiotic use. RESULTS: Antibiotic therapy was not necessary for 151 (74.4 per cent) cases. Antibiotics were unnecessarily prescribed in 45 cases of acute irreversible pulpitis, 10 chronic apical abscess, 6 acute apical paradontitis, 7 gingivitis, 10 periodontitis, 4 epulis, 2 TMJ (temporomandibular junction) dysfunction, 2 sharp ridge of alveolar bone, 1 burning mouth syndrome and 1 recurrent aphthous stomatitis. In 108 (53.2 per cent) of the cases, the prescribed antibiotics were found to be penicillins, 102 of which were broad-spectrum. It was also determined that only 6 (7.7 per cent) of the 78 cases diagnosed as acute apical abscess were given drainage as local therapy. CONCLUSIONS: Principles for treating dental infections suggest that an antibiotic should only be used to supplement and not substitute for conventional surgical methods. Therefore, in cases with acute apical abscess, mechanical treatment (drainage) should be the first step. Inappropriate antibiotic use is quite widespread in dentistry. Dentists should avoid inappropriate use of antibiotics. To prevent inappropriate administration, necessary precautions need to be taken against dispensing antibiotics without prescription.

[Cowden syndrome (multiple hamartoma syndrome). Role of the dentist in early detection]. / Cowden-Syndrom (Multiple-Hamartome-Syndrom). Rolle des Zahnarzts bei seiner Früherkennung.

First lesions of Cowden syndrome appear in the oral cavity and on the skin. Malignant transformation is a late, common event in thyroid and breast. The early diagnosis of Cowden disease prior to the development of internal malignancy, particularly of the breast and the thyroid gland, is very important. We emphasize that the dentist may be the first health care professional who recognizes the syndrome, and this is a crucial step in the prevention and cure of the predictable malignancy. This article presents a typical case of Cowden disease.

Complete replacement resorption after replantation of maxillary incisors: report of case.

This article describes the treatment of a 17-year-old patient with complete root resorption of the maxillary permanent central and lateral incisors following avulsion and replantation seven years ago. The most important factor influencing the prognosis of replanted teeth is the status of the periodontal ligament (PDL). As a result of replantation, the PDL cells necrosed and tooth replacement resorption occurred. The main factors, which affected the resorption after replantation and survival of PDL cells, could be summarize as; dry extraoral time greater than 30 minutes, the kept tooth in a dry environment, touching the cementum surface, and splint treatment for a prolonged time. Since complete root resorption was found in our case, these factors probably also occurred.

Periodontal lesions in lipoid proteinosis.

Lipoid proteinosis is a rare autosomal recessive heritable disease. Clinical features are hoarseness starting in infancy and the formation of yellowish papules and plaques on the skin and mucous membranes of the nose, oral cavity, pharynx and larynx. Light and electron microscopy demonstrates a subepithelial accumulation of PAS-positive (hyaline) material around blood vessels and in the dermis. This case is unusual in that the gingiva is also involved in the lipoid proteinosis.

[Cowden syndrome (multiple hamartoma syndrome): the role of the dentist in early recognition]. / Cowden-Syndrom (Multiple-Hamartome-Syndrom) : Rolle des Zahnarzts bei seiner Früherkennung.

First lesions of Cowden syndrome appear in the oral cavity and on the skin. Malignant transformation is a late, common event in thyroid and breast. The early diagnosis of Cowden disease prior to the development of internal malignancy, particularly of the breast and the thyroid gland, is very important. We emphasize that the dentist may be the first health care professional who recognizes the syndrome, and this is a crucial step in the prevention and cure of the predictable malignancy. This article presents a typical case of Cowden disease.

The radiographic determinability of the distance between the pulp horns in the permanent first and second molar teeth.

The purpose of this study was to investigate the determinability of the distance between the pulp horns (PHD) radiographically under routine clinical conditions. This study was carried out on 36 maxillary and 28 mandibular first and second molars which were extracted because of periodontal diseases. Prior to extraction two radiographs were taken from each tooth, one using the bisecting-angle technique and the other by using the bitewing technique. After the extractions, each tooth was burred on the distal and mesial approximal surfaces and pulp horns were found. The distance between the pulp horns was measured (anatomical measurement). Using bisecting-angle and bitewing radiographs, 11 clinicians measured the PHD values of each tooth (radiographic measurement). In our study the residual error in mandibular molar teeth was statistically lower when compared to maxillary molar teeth (p < 0.01). Statistically significant differences were found between anatomic and radiographic measurements (p < 0.01) in maxillary molars. No statistically significant difference was found between anatomical and bisecting-angle measurements in mandibular first and second molars. As a result, it is concluded that bisecting-angle techniques are useful in correctly determining the PHD values in mandibular molars.

The radiographic investigation of the visibility of secondary caries adjacent to the gingiva in Class II amalgam restorations.

The aim of this study was to investigate the visibility of secondary caries in the gingivobuccal and gingivolingual corners of teeth restored with amalgam restorations. Standard Class II cavities were created in 15 orthodontically extracted mandibular premolar teeth, and the teeth were randomly divided into five groups of three teeth each. In four of the groups, a 1.0- or 1.5-mm cavity was prepared in the gingivolingual or gingivobuccal corner of the restoration. No lesions were created in group 5, the control group. The teeth were restored with amalgam. The teeth were adapted in the actual tooth space of 15 volunteers with one mandibular premolar missing. Radiographs of each patient were taken with the bisecting-angle technique and the bite wing technique. The radiographs were sorted at random and given to 15 members of the professoriate who were often involved in detecting caries and to 17 members who were not normally involved in detecting caries. The bitewing technique was found to be more reliable than the bisecting-angle technique in detecting secondary caries in gingivobuccal approximal corners (P < .05). It was also found that, in group 1, the bisecting-angle technique was more reliable than the bitewing technique in detecting caries in gingivolingual corners (P < .05). No significant differences were found in the correct evaluation of radiographs between the faculty who were normally involved in the detection of caries and those who were not.

Salivary cortisol levels in children during dental treatment.

Cortisol which is also called as stress hormone, is used as an indicator in the stress evaluation studies. 60 children who never visited a dentist before, participated in the present study. Saliva samples were collected from 30 children without any dental treatment (control group). Experimental group comprised 30 children with caries. Saliva samples were obtained at various stages during dental treatment. Totally 180 samples were collected and the cortisol levels were measured. Paired-t test has shown that the salivary cortisol levels at various stages of dental treatment in the experiment group were significantly higher in comparison with the control group. It is concluded that dental treatment may cause extreme stress in children who never had dental treatment experience before.

Evaluation of surface smoothness detected by a periodontal probe.

An investigation was designed to determine whether or not the required smoothness has been reached. This is still a controversial subject among clinicians. Ten cylindrical metal samples of equal sizes with various degrees of smoothness were prepared, and their degrees of smoothness were assessed in a blind manner by 14 periodontists, who were asked to group them as smooth or rough using a periodontal probe. Along with the metal samples, the roughness of root surfaces smoothed in clinics was also evaluated using a Profilometer. The average value defined as a smooth surface on a max.-min. scale was 1.86 +/- 0.42, and values above 3.57 were considered to be rough. Consequently, decisions taken using the sense of touch about the smoothness of a surface were confirmed to be reliable for clinical use.

Age-related changes in catalase, glutathione reductase activities, the amount of glutathione in total body of oregon and vestigial Drosophila melanogaster.

Natural antioxidants, free radical scavengers as catalase, glutathione reductase and glutathione are considered for aging mechanism. The objective of our study was to investigate the differences in the life span of male Oregon (w.t.) and vestigial Drosophila melanogaster, the possible role of free radical scavengers such as catalase, glutathione reductase and reduced-oxidized glutathione levels in the aging process by studying the pattern of age-related changes. The life span of male Oregon D. melanogaster is longer than that of the vestigial D. melanogaster. The beginning of the dying phase of Oregon was around 40 days, while the vestigial's around 20 days. The maximum life span was 85 days in Oregon population and 56 days in vestigial population. Age-related changes of catalase activities were similar in male Oregon and vestigial and showed a decreasing curve during aging. Glutathione reductase activity of Oregon increased slightly between 10 and 40 days, decreased sharply therafter. Glutathione reductase activity of vestigial followed a pot-shaped trend with 60% decrease during the first 40 days and followed by a sharp increase during the late part of life. The amounts of reduced glutathione (GSH) and oxidized glutathione (GSSG) increased slightly up to 40 days of age and followed a sharp decline thereafter in male Oregon D. melanogaster. In male vestigial D. melanogaster, the concentrations of GSH and GSSG remained quite stable for the nogaster, the concentrations of GSH and GSSG remained quite stable for the first 10 days, followed by a sharp decline around 20th day and increased thereafter.

Herpetic whitlow.

This paper describes a case of transmission of herpetic whitlow to the index finger of a dental student from a patient with herpes simplex virus. The recognition of intraoral viral infections in patients is important because these viruses have serious implications for health care providers. Rubber gloves must be worn when patients with primary or secondary herpetic lesions are treated. Asymptomatic permanent herpes virus carriers must also be treated with appropriate precautions.