The role of ASA score and Charlson comorbidity index in predicting in-hospital mortality in geriatric hip fracture patients.

OBJECTIVE: We aimed to determine the role of American Society of Anesthesiologists (ASA) score and Charlson Comorbidity Index (CCI) in determining in-hospital mortality and other factors associated with mortality in patients over 65 years of age who underwent surgery for hip fracture during our study, including the COVID-19 process. PATIENTS AND METHODS: Between January 1st, 2020, and December 31st, 2021, 200 patients over 65 years of age who underwent hemiarthroplasty or internal fixation for hip fracture after low-energy trauma were retrospectively evaluated. RESULTS: Of the 200 patients included in the study, 130 were female and 70 were male. The median ASA score was 3 (IQR: 2-3), and the median CCI was 3 (IQR: 5-7). Forty-two of 137 (68.5%) patients with intertrochanteric fractures and 22 of 63 (31.5%) patients with femoral neck fractures (34.4%) died. The median time to surgery was 4 days (IQR: 3-6). Among chronic diseases, cardiac pathologies were the most common (57%, n=114). There were statistically significant differences in ASA scores (p=0.0001 [z=-5.472]), CCI scores (0.0001 [z=-6.156]), presence of cardiac disease [p=0.0001 (χ²=32.155)] and presence of neurological disease [p=0.045 (χ²=4.007)] compared to mortality. ASA and CCI scores were significantly higher in people with mortality. As a result of the multivariate model established with these factors, which were found to be significant in univariate analyses, only the presence of cardiac disease (p=0.0001) and the increase in CCI scores (p=0.0001) were found to have a statistically significant increasing effect on mortality. CONCLUSIONS: CCI and cardiac pathology were associated with mortality. The type of hip fracture, surgical method, and anesthesia method were not associated with mortality.

The impact of infant feeding and oral hygiene habits on early childhood caries: A cross-sectional study.

Background and Aim: The aim of this study is to evaluate the relationship between the Early Childhood Caries (ECC)/severe-ECC (S-ECC) and prolonged breast-feeding (BF), bottle-feeding, and oral hygiene habits in 0-year-old to 5-year-old Turkish children. Patients and Methods: Dental examinations were performed on 255 patients to determine the prevalence of the ECC and the S-ECC as per the definition of the American Academy of Pediatric Dentistry. To predict the progress rate of caries, noncavitated and cavitated lesion scores were assessed by using the International caries detection and assessment system II criteria. Information on infant feeding practices, oral hygiene habits, maternal characteristics, and demographic features were gathered by means of a questionnaire. The results were statistically evaluated. Results: There were no associations between BF duration, night-time BF, bottle-feeding, and the ECC. And there were also no associations between BF duration, night-time BF, bottle-feeding, and the S-ECC. Cavitated lesions were more common in children breastfed at night for 18-23 months compared to 12-17 months (P = 0.031). Sweetened bottle was an impact factor on caries experience (P = 0.042). A significant correlation was found for dmft, S-ECC, and the cavitated lesions regarding sugar consumption (P = .001, P = .002, and P = .001, respectively). Early introduction to tooth-brushing and regular dental visits were significantly effective in reducing the ECC (P < .001 and P < .001, respectively). Conclusion: BF and bottle-feeding practices were not associated with the ECC/S-ECC. Sweetened bottles and sugary foods are strong risk factors for the ECC/S-ECC.

Clinical and morphological evaluation of permanent first molars in Turkey.

Aim: The aim of this study was to investigate the pit and fissure morphology of the permanent first molars (PFMs) in the dentition of 7- to 12-year-old patients in Turkish children. Patients and Methods: The study was conducted on 706 patients who attended the Dokuz Eylul University Child Clinic. Examinations of the patients were carried out with dental unit light, mouth mirror, and probe by two dentists. Age, gender, plaque scores, pit and fissure morphology, caries, restorations, and missing teeth were recorded. Results: Of the 706 patients included in this study, 441 (62.5%) of them have affected PFMs. Intermediate type fissure morphology (57.5%) was seen as the most common type. A positive correlation was observed between the age and the caries experience (p = 0.000). Patients with deep pits and fissure morphology have more caries affected teeth than patients with shallow pit and fissure morphology, and the difference was statistically significant (p = 0.000). Patients with deep pits and fissure morphology have significantly more plaque accumulation on PFMs compared to the patients with shallow and intermediate fissure morphology (p = 0.000). Conclusions: Despite the limitations of the study, we can conclude that the patients with deep pit-fissure morphology are more susceptible to caries development and plaque accumulation than the patients with shallow and intermediate type pit and fissure morphology.

Impact of positive end-expiratory pressure with alveolar recruitment maneuver on respiratory and oxygenation parameters of patients during laparoscopic bariatric surgery.

OBJECTIVE: Laparoscopic bariatric surgery is frequently associated with disturbances in respiratory mechanics. An alveolar recruitment maneuver (ARM) with positive end-expiratory pressure (PEEP) is a strategy to overcome such respiratory conditions. This study aimed to evaluate the effect of ARM+PEEP on intraoperative and postoperative respiratory and hemodynamic parameters of patients with laparoscopic bariatric surgery. PATIENTS AND METHODS: Patients who underwent laparoscopic bariatric surgery between 2009 and 2016 were retrospectively evaluated. The study sample was divided into four groups based on PEEP values and the presence of ARM: Group PEEP 5 (5 cm H2O PEEP only), Group PEEP 5/RM (5 cm H2O PEEP plus ARM), Group PEEP 10 (10 cm H2O PEEP only), Group PEEP 10/RM (10 cm H2O PEEP plus ARM). Patients' demographic characteristics, ventilatory, respiratory, and oxygenation parameters were recorded. Oxygenation index (PaO2/FiO2) was the study's primary outcome. RESULTS: There were 156, 158, 299, and 210 patients in Groups PEEP 5, PEEF 5/RM, PEEP 10, and PEEP 10/RM, respectively. Tidal volume, driving tidal volume/compliance, PaO2, PaO2/FiO2, and PaCO2 were significantly lower in Groups PEEP 5 and PEEP 5/RM, whereas SpO2 and FiO2 were significantly higher in Groups PEEP 5 and PEEP 5/RM (p<0.05). Patients in Group PEEP 5 had significantly higher end-tidal carbon dioxide (EtCO2) values than those of other groups (p<0.001). Patients in Group PEEP 5/RM had significantly higher SpO2 values than those in Group PEEP 5 (p<0.001). Rate of postoperative atelectasis was significantly higher in Group PEEP 5/RM compared to the other groups (p=0.011). CONCLUSIONS: A PEEP level of at least 10 cm H2O with ARM improved intraoperative respiratory parameters and caused a significant reduction in postoperative atelectasis.

The association between preoperative 25-OH vitamin D levels and postoperative complications in patients undergoing colorectal cancer surgery.

BACKGROUND: Determining the modifiable risk factors for postoperative complications is particularly significant in patients undergoing colorectal surgery since those are associated with worse long-term outcomes. METHODS: Consecutive newly diagnosed 104 colorectal cancer patients were prospectively included in this single-center observational study. Preoperative serum 25-OH vitamin D levels were measured and analyzed for infectious and postoperative complications. RESULTS: Serum 25-OH vitamin D levels were found to be < 20 ng/ml in 74 patients (71.2%) and ≥ 20 ng/ml in 30 patients (28.8%); and the mean serum 25-OH vitamin D level was 15.95 (± 9.08) ng/ml. In patients with surgical site infection and infectious complications, 25-OH vitamin D levels were significantly lower than patients without complications (p = 0.036 and p = 0.026). However, no significant difference was demonstrated in 25-OH vitamin D levels according to overall postoperative complications. CONCLUSIONS: Our results suggest that vitamin D levels might be a potential risk factor for infectious complications in patients undergoing colorectal cancer surgery.

Predictive value of prognostic factors at multiple trauma patients in intensive care admission.

PURPOSE: We aimed to evaluate the relationship between trauma patients' mortality and neutrophil/lymphocyte ratio (NLR) at intensive care units admission. METHODS: We examined 107 ICU trauma patients. Patients were divided into two groups as those who survived (Grup I) and deceased (Grup II). Patients' age, NLR, mean platelet volume (MPV), lactate value, length of stay in the intensive care unit, acute physiology and chronic health evaluation 2 (APACHE II) scores were examined. The effects of these factors on mortality were examined. RESULTS: 83 (77.58 %) patients were male, 24 (22.42 %) patients were female. The patients' mean age was 46.89 ± 19.06 years. The mean value of the lactate level was 3.25 ± 2.92, the mean value of MPV was 10.34 ± 1.02, the average value of NLR was 8.23 ± 8.11, the average score of APACHE II was 22.8 ± 8.75, and the average length of stay in the ICU was 11.33 ± 22.98 days. The relationship with mortality was evaluated between the groups, there was a statistically significant difference in APACHE II scores. There was no statistically significant difference between other variables. CONCLUSIONS: NRL, MPV, lactate levels were not suitable for the evaluation of trauma patients as an early prognostic factor like APACHE II during admission to ICU (Tab. 2, Fig. 1, Ref. 23).

Leakage testing for different adhesive systems and composites to permanent teeth.

AIM: To explore the microleakage of different adhesive systems and flowable composites to permanent teeth. SUBJECTS AND METHODS: In this study, a total of 84 human premolar teeth were used. Class V cavities were prepared on the buccal surfaces. The teeth were randomly assigned to six groups of 14 teeth each as follows: The first group - etch-rinse adhesive applied and cavities filled with flowable composite, the second group - etch-rinse adhesive applied and cavities filled with bulk-fill resin composite, the third group - one-stage self-etch (SE) adhesive applied and cavities filled with flowable composite, the fourth group - one-stage SE adhesive applied and cavities filled with bulk-fill resin composite, the fifth group - two-stage SE adhesive applied and cavities filled with flowable composite, and the sixth group - two-stage SE adhesive applied and cavities filled with bulk-fill resin composite. All specimens were then stored for 24 h at 37°C in distilled water. Teeth were then thermocycled for 500 cycles between 5°C and 55°C prior to immersion in 0.5% basic fuchsin for 24 h. Two mesiodistal cuts of each tooth were photographed for leakage with a digital camera. The dye infiltrated surface for each specimen was measured and data were collected with a software program. Statistical evaluations were done by nonparametric Kruskal-Wallis test and Mann-Whitney U-test. RESULTS: There were statistically significant differences in mean microleakage ratio among the groups (P < 0.05). The first group had shown significantly increased microleakage areas than the other four groups (third, fourth, fifth, and sixth groups) (P < 0.05), except for the second group (P > 0.05). It was also no significant different between the mean microleakage areas of group fourth and group fifth (P > 0.05). The sixth group had exhibited the lowest microleakage areas, and it was statistically significant (P < 0.05) compared to the other groups. CONCLUSION: In this study, it has been found that the use of total etch adhesive systems resulted in high leakage values.

Using lung sounds in classification of pulmonary diseases according to respiratory subphases.

Auscultation-based diagnosis of pulmonary disorders relies heavily on the presence of adventitious sounds and on the altered transmission characteristics of the chest wall. The phase information of the respiratory cycle within which adventitious sounds occur is very helpful in diagnosing different diseases. In this study, respiratory sound data belonging to four pulmonary diseases, both restrictive and obstructive, along with healthy respiratory data are used in various classification experiments. The sound data are separated into six subphases, namely, early, mid, late inspiration and expiration and classification experiments using a neural classifier are carried out for each subphase. The AR parameters acquired from segmented sound signals, prediction error and the ratio of expiration to inspiration durations are used to construct the feature set to the neural classifier. Classification experiments are carried out between healthy and pathological sound segments, between restrictive and obstructive sound segments and between two different disease sound segments. The results indicate that the classifier performance demonstrates subphase dependence for different diseases. These results may shed light in eliminating redundant feature spaces in building an expert system using lung sounds for pulmonary diagnosis.

Papillon Lefevre syndrome: treatment of two cases with a clinical microbiological and histopathological investigation.

Papillon Lefevre syndrome is presented in the cases of two female patients of the ages of 7 and 9, who exhibited all typical symptoms of the disease. Microbiological and histopathological studies were done and treatment provided. Actinobacillus actinomycetemcomitans, which is suspected as a pathogenic factor in the disease was identified as well as some other gram negative microorganisms and an antibiogram was performed in which amoxycillin plus clavulanic acid was most effective. Histopathological investigation also confirmed the presence of gram negative bacteria. Granular cell infiltration was predominant in the surface epithelium. Prosthetic appliances were provided for the patients after mechanical and chemical plaque control. In addition to this, antibiotics (amoxycillin plus clavulanic acid) were prescribed every six months. No tooth loss was observed in both patients after more than two years follow-up period. At the moment only one patient is under review and because she is uncooperative, mild periodontal inflammation is still present around the teeth which erupted before the antibiotic regime, but not in the other teeth.