Evaluation of therapeutic and toxic levels of serum digoxin concentration: a cross-sectional study from a tertiary hospital.

OBJECTIVE: Digoxin is a cardiac glycoside for treating heart failure and atrial fibrillation. Despite its limited therapeutic range and complex pharmacokinetic properties, this medication continues to be frequently prescribed. This study aimed to evaluate the serum digoxin concentration (SDC) at therapeutic, subtherapeutic, and toxic levels and explore the factors affecting these levels in patients receiving digoxin therapy for heart failure. PATIENTS AND METHODS: In this descriptive and cross-sectional study, the data were obtained from the electronic system of patients who presented to Afyonkarahisar Health Sciences University. For the SDC, the reference range was accepted as 0.5-0.9 ng/mL, and the upper limit was 2.0 ng/mL. The patient's demographic characteristics, comorbidities, and laboratory findings were evaluated. The Mann-Whitney U test, Chi-square test, and logistic regression analysis were used. p<0.05 was considered statistically significant. RESULTS: The data of 419 patients (mean age: 65.9±16.1 years, 68.5% women) were evaluated. The mean SDC was 1.11±1.01 ng/mL, and it was below 0.5 ng/mL in 24.3% of the patients, 0.5-0.9 ng/mL in 23.4%, 0.9-2 ng/mL in 41.3%, and over 2 ng/mL in 11.1%. Age, male gender, the presence of diabetes mellitus, and high HbA1c values were found to be associated with greater SDC levels, but this was not statistically significant. The presence of renal failure, elevated creatinine and magnesium levels, and potassium, sodium, and calcium levels outside the normal limits significantly increased the SDC. High creatinine and low/high potassium values significantly affected the detection of SDC at the toxic level. CONCLUSIONS: The measurement of SDC levels holds significance not only in the monitoring of toxicity but also in ensuring adherence to the recommended therapeutic range during therapy. It is recommended to exercise caution in terms of risk factors such as age, kidney function test results, and blood electrolyte levels.

An unusual case of 177 pieces of mandibular compound odontoma: 10-year follow-up.

Odontomas are benign and the most common odontogenic tumors. They are classified as compound or complex odontomas according to their radiological and histological features. They have slow growth potential and compound odontoma is more common. Since they are generally asymptomatic they may reach in excessive sizes. In our case we would like to present a case with a large (177 denticles) compound odontoma in mandible.

Effects of Lactobacillus Plantarum and Lactobacillus Helveticus on Renal Insulin Signaling, Inflammatory Markers, and Glucose Transporters in High-Fructose-Fed Rats.

Background and Objectives: The excess consumption of fructose in the diet may cause metabolic syndrome, which is associated with an increased risk of kidney disease. There is limited data on probiotic treatment in high-fructose-induced metabolic syndrome. The present study aims to investigate whether the supplementation of Lactobacillus plantarum (L. plantarum) and Lactobacillus helveticus (L. helveticus) could provide an improving effect on the renal insulin signaling effectors, inflammatory parameters, and glucose transporters in fructose-fed rats. Materials and Methods: The model of metabolic syndrome in male Wistar rats was produced by fructose, which was given as 20% solution in drinking water for 15 weeks. L. plantarum and L. helveticus supplementations were given by gastric gavage from 10 to 15 weeks of age. Results: High-fructose consumption in rats reduced renal protein expressions of insulin receptor substrate (IRS)-1, protein kinase B (AKT), and endothelial nitric oxide synthase (eNOS), which were improved by L. plantarum and partially by L. helveticus supplementations. Dietary fructose-induced elevations in renal tissue levels of tumor necrosis factor α (TNF-α), interleukin (IL)-1ß, IL-6, and IL-10, as well as expression of IL-6 mRNA, were attenuated, especially in L. plantarum treated rats. The increased renal expression of sodium-glucose cotransporter-2 (SGLT2), but not that of glucose transporter type-5 (GLUT5), was suppressed by the treatment with L. plantarum. Conclusion: Suppression in insulin signaling pathway together with the induction of inflammatory markers and upregulation of SGLT2 in fructose-fed rats were improved by L. plantarum supplementation. These findings may offer a new approach to the management of renal dysregulation induced by dietary high-fructose.

Urinary uric acid excretion as an indicator of severe hypoxia and mortality in patients with obstructive sleep apnea and chronic obstructive pulmonary disease.

OBJECTIVE: Uric acid (UA) is the end product of adenosine triphosphate degradation, and could increase due to hypoxia. We investigated the association of UA metabolites with nocturnal hypoxemia, apnea-hypopnea index (AHI), noninvasive mechanical ventilation (NIMV) usage and five-year mortality. MATERIALS/SUBJECTS AND METHODS: We obtained urinary specimen before and after the night polysomnography in order to measure UA excretion and overnight change in urinary UA/creatinine ratio (ΔUA/Cr) in 75 subjects (14 controls, 15 chronic obstructive pulmonary disease (COPD) without nocturnal hypoxemia (NH), 15 COPD with NH, 16 obstructive sleep apnea syndrome (OSAS) without NH, 15 OSAS with NH). Percentage of time spent below SaO2 of 90% (T90%) for >10% of sleep time was considered as nocturnal hypoxemia. Patients were contacted after 5 years with a questionnaire including information on the use of NIMV treatment (n: 58) and urinary specimen analysis (n: 35). RESULTS: T90% was found to be significantly correlated with UA excretion (coefficient: 0.005, 95%CI: 0.003-0.007) and ΔUA/Cr (coefficient: 0.8, 95%CI: 0.3-1.2) after adjustments for age, gender, body mass index and apnea-hypopnea index. Median and IQR (interquartile range) of baseline UA excretion were 0.79 (0.51-0.89) and 0.41 (0.31-0.55) in 10 deceased and 58 surviving patients, respectively (p=0.001). UA excretion median and IQR of baseline and 5 years of NIMV treatment were 0.41 (0.36-0.57) and 0.29 (0.23-0.37), respectively (p=0.01). CONCLUSION: UA excretion, as a marker of tissue hypoxia, may be useful in the management of OSA and COPD patients.

Marginal bone loss of two implant systems with three different superstructure materials: a randomised clinical trial.

Marginal bone level is a criterion for implant success. The aetiological factors of bone loss have not been clarified. The aim of this study was to evaluate the influence of implant systems and prosthetic materials on the marginal bone loss. Twenty-three patients participated; two implant systems and three superstructure materials were used in this study. Twenty-two of the implants were restored with porcelain fused to base metal alloy (BMA), 25 with porcelain fused to noble metal alloy (NMA) and 20 with zirconium oxide-based ceramics. Radiographs were taken at baseline and 3, 6 and 12 months after loading. Crestal bone-level changes were assessed with digital subtraction radiographs. The effects of superstructure materials and implants were evaluated with one-way anova and independent samples t-test, respectively (α = 0·05). The mean crestal bone loss was found 0·483 mm in 3 months, 0·622 mm in 6 months and 0·816 mm in 12 months. Prosthetic materials were found to have greater effect (ß = 0·575, P = 0·015) on crestal bone loss than implant systems (P > 0·05). The porcelain fused to BMA restorations showed higher crestal bone loss than NMA-based restorations (P = 0·003) at 3 months, (P = 0·038), at 6 months and (P = 0·00) at 12 months; however, crestal bone loss differences between NMA and zirconia were not significant (P = 0·629) at 3 months, (P = 0·974) at 6 months and (P = 1) at 12 months. Within the limitations of this study, our results revealed that rather than the implant systems, prosthetic materials seemed to have an effective role on crestal bone.

Comparison of oral Midazolam and Midazolam-Ketamine as sedative agents in paediatric dentistry.

AIM: We compared the efficacy of sedation with oral Midazolam and a combination of oral Midazolam and Ketamine, used as alternatives to general anaesthesia during tooth extraction. STUDY DESIGN: Retrospective study. MATERIALS AND METHODS: A total of 30 patients aged between 3 and 9 years, who had elective tooth extraction were included in the study. Subjects in Group A (n. 15) were given 0.75 mg/kg Midazolam orally while those in Group B (n. 15) were given 0.75 mg/kg Midazolam orally+5 mg/kg ketamine. Acceptance of orally administered drugs, sedation and anxiety scores and reactions to local anaesthetic injection and tooth extraction were assessed. RESULTS: Sedation and anxiety scores in Group B were better than in Group A (p<0.05). Reactions to local anaesthetic injection and tooth extraction were very significantly less common in Group B (p<0.0001). Requirement for an additional medication was more common in Group A (p<0.05). Side effects were not observed in either group. STATISTICS: Patient demographics and time to discharge were analysed by Mann-Whitney U test, whereas Chi-square test was used to analyse compliance to sedation, anxiety and sedation scores, reaction to tooth extraction, side effects and additional drug requirement. CONCLUSION: Compared to oral Midazolam only, a combination of oral Midazolam+Ketamine resulted in better sedation and surgical comfort in children during a painful procedure such as tooth extraction.