The evaluation of endodontic flare-ups and their relationship to various risk factors.

BACKGROUND: To evaluate the incidence of flare-ups and identify the risk factors including age, gender, tooth type, number of root canals, initial diagnosis, the type of irrigation regimen, treatment modality and the number of visits, in patients who received root canal treatment from January 2002 to January 2008. METHODS: Records of 1819 teeth belonging to 1410 patients treated by 1 endodontics specialist during 6-year period were kept. Patient, tooth, and treatment characteristics were evaluated and the relationships between these characteristics and flare-ups were studied. Statistical analysis was carried out by using Pearson Chi-square test, Fisher's Exact test, and Binary Logistic regression analyses. RESULTS: The incidence of flare-ups was 59 (3.2 %) out of 1819 teeth that received endodontic therapy. Pulpal necrosis without periapical pathosis was the most common indication for flare-up (6 %) (p < 0.01). Teeth undergoing multiple visits had a higher risk of developing flare-ups compared to those with single appointments (OR: 3.14, CI: 1.414-7.009, p < 0.01). There were also no statistically significant differences in the incidence of flare-ups regarding to age, gender, tooth type, number of root canals, treatment modality, and the irrigation solutions that used during the treatment. CONCLUSIONS: The incidence of flare-up is minimal when teeth are treated in one visit. Absence of a periapical lesion in necrotic teeth is a significant risk factor for flare-ups.

Comparative evaluation of maxillary protraction with or without skeletal anchorage.

INTRODUCTION: The aim of this prospective clinical study was to evaluate the skeletal, dentoalveolar, and soft-tissue effects of maxillary protraction with miniplates compared with conventional facemask therapy and an untreated Class III control group. METHODS: Forty-five subjects who were in prepubertal or pubertal skeletal growth periods were included in the study and divided into 3 groups of 15 patients each. All subjects had skeletal and dental Class III malocclusions with maxillary deficiency, vertically normal growth pattern, anterior crossbite, Angle Class III molar relationship, normal or increased overbite, and retrusive nasomaxillary complex. Before maxillary protraction, rapid maxillary expansion with a bonded appliance was performed in both treatment groups. In the first group (MP+FM), consisting of 5 girls and 10 boys (mean age, 10.91 years), facemasks were applied from 2 titanium miniplates surgically placed laterally to the apertura piriformis regions of the maxilla. The second group (FM) of 7 girls and 8 boys (mean age, 10.31 years) received maxillary protraction therapy with conventional facemasks applied from hooks of the rapid maxillary expansion appliance. The third group of 8 girls and 7 boys (mean age, 10.05 years) was the untreated control group. Lateral cephalometric films were obtained at the beginning and end of treatment or observation in all groups and analyzed according to a structural superimposition method. Measurements were evaulated statistically with Wilcoxon and Kruskal-Wallis tests. RESULTS: Treatment periods were 6.78 and 9.45 months in the MP+FM and FM groups, respectively, and the observation period in the control group was 7.59 months. The differences were significant between the 3 groups (P <0.05) and the MP+FM and FM groups (P <0.001). The maxilla moved forward for 2.3 mm in the MP+FM group and 1.83 mm in the FM group with maxillary protraction. The difference was significant between 2 groups (P <0.001). The protraction rates were 0.45 mm per month in the MP+FM group and 0.24 mm per month in the FM group (P <0.001). The maxilla showed anterior rotation after facemask therapy in the FM group (P <0.01); there was no significant rotation in the MP+FM group. Posterior rotation of the mandible and increased facial height were more evident in the FM group compared with the MP+FM group (P <0.01). Both the maxilla and the mandible moved forward significantly in the control group. Protrusion and mesialization of the maxillary teeth in the FM group were eliminated in the MP+FM group. The maxillomandibular relationships and the soft-tissue profile were improved remarkably in both treatment groups. CONCLUSIONS: The undesired effects of conventional facemask therapy were reduced or eliminated with miniplate anchorage, and efficient maxillary protraction was achieved in a shorter treatment period.

Clinical and hematologic findings in Noonan syndrome patients with PTPN11 gene mutations.

Reports on Noonan syndrome (NS) have documented multiple types of coagulation defects and bleeding diathesis, and a wide range of clinical presentations. Early studies suggested that a large proportion of NS patients have coagulation defects, whereas more recent reports indicate low rates of coagulopathy. The aim of this study was to evaluate phenotypic characteristics, PTPN11 gene mutations, and hematological and coagulation parameters in 30 clinically diagnosed cases of NS. One of the NS patients had a history of easy bruising; however, his hematological and coagulation tests were normal. None of the other patients had clinical coagulation problems. In the NS group, values for platelet count, activity of factors XI, XII, and protein C were significantly lower than the corresponding means for the control group. However, the results of coagulation tests in the NS group were diagnostically inconclusive and only one patient had clinical signs of coagulopathy. Interestingly, two NS patients had low protein C activity. One of these children had an A1517C mutation and transient myelodysplasia. The other patient had a C1528G mutation in exon 13 that has not been reported previously. Neither of these individuals experienced a thrombotic event or any complication during approximately 3 years of follow-up. For all patients clinically diagnosed with NS, a thorough history of coagulation issues should be taken and first-line coagulation testing should be done to evaluate for bleeding diathesis. However, if these assessments reveal nothing abnormal, complications related to coagulation are unlikely and extensive testing is unnecessary.

The apolipoprotein E gene and Taq1A polymorphisms in childhood obesity.

Obesity is a multifactorial disease that is influenced by genetic and environmental factors. The apolipoprotein E (Apo E) polymorphism has been reported to influence some lipid profile abnormalities associated with obesity in childhood. In this study, the relationship between the Apo E gene and Taq1A polymorphisms with childhood obesity has been studied. Regarding the Apo E genotypes, e3/4 was the most frequent in both the patient and control groups. Further, there was a significance between the Apo E genotypes with low density lipoprotein and total cholesterol levels. However, no relationship was found between the Taq1A polymorphism and obesity. In conclusion, polygenic inheritance should be kept in mind when dealing with childhood obesity.

Dose-related immunohistochemical and ultrastructural changes after oral methylphenidate administration in cerebrum and cerebellum of the rat.

Methylphenidate is a piperidine derivative and is the drug most often used to treat attention deficit/hyperactivity disorder of children and young adults. Our aim is to investigate dose-dependent dopamine-2 receptor and glial fibrillary acidic protein expression and ultrastructural changes of the rat brain, to demonstrate possible toxicity of the long-term and high dose use of the methylphenidate. In this study, 27 female prepubertal Wistar albino rats, divided into three different dose groups (5, 10 and 20 mg/kg) were treated orally with methylphenidate dissolved in saline solution for 5 days per week during 3 months. At the end of the third month, tissues were removed and sections were collected for immunohistochemical and ultrastructural studies. We believe that methylphenidate causes dose-related activation of the dopaminergic system in several brain regions especially in ventral tegmental area and also causing neuronal degeneration and capillary wall structural changes such as basal membrane thickness and augmentation of the pinostatic vesicle in the endothelial cells. Also, increased dose of Ritalin is inducing astrocytes hypertrophy especially astrogliosis in pia-glial membrane and this is the result of the degenerative changes in prefrontal cortex region due to high dose methylphenidate administration. The dose-related accumulation of the astrocytes in capillary wall might well be a consequence of the need for nutrition of the neuronal tissue, due to transport mechanism deficiency related to neuronal and vascular degeneration. Thus, we believe that the therapeutic dose of methylphenidate must be kept in minimum level to prevent ultrastructural changes.

Evaluation of cerebellar asymmetry with vertigo cases: a stereological study.

AIM: We aimed to evaluate the relevant methods of stereology to estimate cerebellar asymmetry according to gender in both adult right-handed vertigo cases and healthy cases. MATERIAL AND METHODS: The study included 14 adult control subjects and 18 patients with vertigo. The volumes of the cerebellar hemispheres were determined on MRI using the point-counting approach of stereological methods. RESULTS: The mean (+/-SD) of the right cerebellar hemispheres in the patients with vertigo were 52.49+/-5.42 cm3 in males, 50.11+/-4.02 cm3 in females. The mean (+/-SD) of the left cerebellar hemispheres in the patients with vertigo were 53.11+/-3.70 cm3 in males and 49.73+/-4.69 cm3 in females. There was no significant quantitative evidence detected in terms of cerebellar asymmetry between sagittal plane estimates in the cases with vertigo in both genders (p > 0.05). There were no statistically significant differences by genders between vertigo and control subjects (p > 0.05). There was statistical significance only between right and left hemispheres in male control subjects (p=0.039) CONCLUSION: There was no cerebellar asymmetry between control and vertigo cases by gender. The stereological evaluation of cerebellar asymmetry or atrophy in humans in correlation with gender is of importance both for clinicians and anatomists. The technique is simple, reliable, inexpensive and unbiased.

Accidents of the elderly living in Kocaeli Region (Turkey).

The accidents seen in the elderly have a remarkable impact on their family life and the society they live in. In this study, we have aimed to assess the prevalence, types and characteristics of the accidents seen among the elderly. We performed a cross-sectional study. The data was collected from 486 old people living in Kocaeli Region, in 2003. Demographic features, numbers and the variety of accidents were recorded after interviews. The data were also obtained from a questionnaire given after a physical examination. The ratio of accidents was found to be 9.5% (46 cases) in the study group; of those 71.7% were indoor and 28.3% outdoor accidents. The causes of the accidents were falls (69.6%), cuts (13.0%) and stings (10.9%). The distribution of the indoor accidents was 72.7% for falls, 12.1% for cuts, 9.1% for stings and 6.1% for other injuries. The distribution of the outdoor accidents was 61.5% for falls, 15.4% for cuts, 15.4% for stings and 7.7% for burns. Fall-induced injuries seem to be a major problem among the elderly. The results of our study indicate that the occurrence of indoor accidents is an important health problem in the geriatric population.

[Activity of tigecycline on planktonic and sessile cells of Acinetobacter baumannii]. / Tigesiklinin Acinetobacter baumannii planktonik ve biyofilm hücrelerine etkisi.

Acinetobacter baumannii is an important pathogen, capable of survival for very long periods on various surfaces in the hospital environment. Tigecycline is a commonly used antimicrobial agent especially for the treatment of resistant infections. The aim of this study was to investigate the activity of tigecycline on both planktonic and sessile biofilm cells of A. baumannii strains isolated from blood cultures and to compare the efficiency in terms of biofilm synthesis. Tigecycline activity on 59 A. baumannii strains was examined by agar dilution technique. The ability of strains to form biofilm was evaluated by adherence on polystyrene surfaces in brain heart infusion broth supplemented with 0.25% glucose. Time-kill technique was used for determination of the time and concentration dependent activity of tigecycline on biofilm positive and negative strains. The planktonic cells in logarithmic growth phase were exposed to tigecycline at 0.5, 1, 2, 4, ve 8 x minimum inhibitory concentration (MIC) concentrations and colony counts were evaluated after 0, 2, 4, 6, 24 and 48 hours. The effect of tigecycline on sessile cells was studied on biofilm matrix composed around plastic beads. Tigecycline susceptibility rate of planktonic cells was 89.8% and MIC50 and MIC90 values were 1 and 2 microg/ml, respectively. Biofilm formation was detected in 52.5% of isolates and no significant correlation was found between MIC values and biofilm production of the strains (p > 0.05). Tigecycline showed a potent antibacterial activity against planktonic cells regardless of biofilm forming capability of strains. Biofilm inhibitory concentrations of sessile cells were elevated significantly. As a result, tigecycline showed a potent activity on planktonic A. baumannii cells however, the effect was decreased significantly on sessile cells in biofilm environment. The results suggest that, the possibility of decreased sensitivity of cells in biofilm environment should be considered as well as antibiotic sensitivity test results during the treatment of infections caused by A. baumannii.

Effect of prenatal exposure to an anti-inflammatory drug on neuron number in cornu ammonis and dentate gyrus of the rat hippocampus: a stereological study.

Prenatal exposed to an anti-inflammatory drug is a major problem for the developing central nervous system. It is not well known the effect of prenatal exposed to a non-steroidal anti-inflammatory drug on the hippocampus. Total neuron number in one side of the cornu ammonis (CA) and gyrus dentatus (GD) of the hippocampal formation in control and drug-treated (diclofenac sodium, DS) groups of male rats was estimated using the optical fractionator technique. Each main group has also two subgroups that are 4 weeks old (4W-old) and 20 weeks old (20W-old). In CA, no significant difference between 4W-old DS-treated and their control was found, but a significant difference was observed between 20W-old DS-treated and their controls. A decreasing of neuron number was 12% for 20W-old DS-treated group. In GD, a decreasing of the granule cell number in 4W-old of DS-treated group was seen but an increasing of granule cell number was found in the 20W-old drug-treated rats in comparison to its control group, 7% and 9%, respectively. Although an increasing of neuron number in CA at the control group was seen with age, from 4th week to 20th week (10%), age-dependent substantial granule cell decline (17%) was observed in GD. No age effect on the total cell numbers of CA and GD of the drug-treated groups was seen in comparison to 4W-old week and 20W-old. A pronounced neuron loss observed in the drug-treated group may be attributed to the neurotoxicity of diclofenac sodium (DS) on the developing hippocampal formation. Age-dependent neuron increase in the CA of 20W-old and neuron decline in GD of 20W-old control groups may be a result of a dual effect of saline injection during the fetal life, since these animals were exposed to a stress of 15-day-period of saline injection, prenatal stress. The reason of no age effect on CA and GD cell number in the drug-treated groups may be attributed to the depletion of the progenitor cells due to neurotoxicity of DS in the fetal life of these animals.