Prolonged QT Dispersion in the Infants of Diabetic Mothers

Myocardial hypertrophy and cardiac dysfunction frequently occur in newborns of diabetic mothers. The authors hypothesized that wall hypertrophy or disproportionate left ventricular wall thickness in newborns of diabetic mothers may affect both QT and QTc dispersion. This study aimed to assess whether left ventricular hypertrophy affects the QT variables of infants born to diabetic mothers. This prospective cross-sectional study was conducted with 47 consecutively selected neonates of gestational diabetic mothers and 30 healthy neonates born to healthy mothers. All the subjects were evaluated during the neonatal period. Electrocardiography with echocardiography was performed for the patients and the control subjects. The newborns of the diabetic mothers were classified according to septal thickness as group 1 (16 newborns with septal hypertrophy) or group 2 (31 newborns without septal hypertrophy). The study group consisted of three cohorts: groups 1, 2, and 3 (control group). Both QT and QTc dispersion were computed from a randomly selected beat as well as from an average beat derived from 12 beats included in a 10-s electrocardiography. A total of 16 infants (34 %) had a septal thickness of 6 mm or greater. The left ventricular end-systolic diameter in group 1 was smaller (p = 0.0029) than in groups 2 and 3 (p = 0.003). The interventricular septal thickness at end diastole (IVSTd) and the left ventricular posterior wall thickness at end diastole in group 1 were higher than in of groups 2 and 3. The QT and QTc dispersion intervals were longer in group 1 than in groups 2 and 3 (p < 0.001), and a highly significant positive correlation was detected between IVSTd and QT dispersion (r = 0.514, p = 0.042). Elevated QT and QTc dispersions may be risk factors for the development of arrhythmias in newborns of diabetic mothers. These patients may critically need systematic cardiac screening.     

Evaluation of surface roughness and bond strength of quartz fiber posts after various pre-treatments

Purpose. Debonding at the post-adhesive interface is a major problem for quartz fiber posts. The objective of this study was to evaluate surface roughness and bond strength of quartz fiber posts after various surface treatments. Materials and methods. Sixty-six quartz fiber posts were randomly divided into six experimental groups (n = 11) including group C, untreated (control); group SB, sandblasted; group SC, silica coated; group HF, hydrofluoric acid-etched; group N, Nd:YAG laser irradiated; group E, Er:YAG laser irradiated. Surface roughness of the posts was measured before and after pre-treatment. They were then bonded to resin cement and tensile bond strength was determined in a universal testing machine. Furthermore, two-way ANOVA and post hoc comparison tests (α = 0.05) were performed on all data. Results. The highest mean force value was observed in group SB and followed by group E. Tukey’s HSD test showed that there was no statistical difference between group SB and group E (p = 0.673). The highest mean roughness value was observed in group SB and a significant difference was found between group SB and all other groups (p < 0.001). This study reveals that sandblasting and Er:YAG laser irradiation provided a significant increase in bond strength between quartz fiber posts and resin cement. Conclusions. Sandblasting or Er:YAG laser-irradiation of the surface of the quartz fiber post before cementation is recommended for increasing retention.     

Management of orthopedic oncology patients during coronavirus pandemic

The new measures implemented in hospitals also altered the operation of orthopedics and traumatology departments. The main purpose of this article is to discuss how orthopedic oncology clinics should be organized during the pandemic and to present the process management scheme for patients requiring orthopedic surgery, including trauma surgery, from diagnosis to treatment, together with our experiences. Instead of thinking about the global emergence of the epidemic, it is time to act decisively. At first glance, the coronavirus disease 2019 (COVID-19) pandemic and orthopedics may seem to be unrelated disciplines, but the provision of healthcare services to patients who require them proves that these two fields are parts of the same whole. Our experiences in treating neutropenic, lymphocytopenic, and chemotherapy patients seem to have proven beneficial during this process. We operated on 10 biopsy patients, 15 primary bone sarcomas, 9 soft tissue sarcomas, and 82 trauma patients within this time frame. Only three patients were suspected to have COVID-19 before admission. The early identification, strict isolation, and effective treatment of these patients prevented any nosocomial infections and disease-related comorbidities. This success is the result of the multidisciplinary cooperation of the Ministry of Health, our hospital, and our clinic.     

Does corticosteroid usage in rhinoplasty cause mood changes?

In this study, the psychological effects of single-dose corticosteroids administered to patients who had undergone rhinoplasty were assessed. A total of 30 rhinoplasty patients were included in the study and were randomly assigned to 1 of 2 groups. Preoperatively, patients completed the Bech Rafaelsen Mania Scale and the Beck Depression Inventory. Dexamethasone 10 mg was given intravenously just before surgery to the first group, but no medication was administered to the second group. On the first postoperative day, patients were seen again, and the Bech Rafaelsen Mania Scale and the Beck Depression Inventory were again completed. Periorbital edema and ecchymosis were graded, and psychological well-being was measured on a standard visual analog scale. All patients and physicians were blinded to treatment until the end of the study. Results show that administration of a single-dose of dexamethasone 10 mg caused neither euphoria nor depression. No significant differences were observed between steroid and control groups in terms of patients’ psychological well-being. With single-dose dexamethasone, periorbital edema was significantly reduced on the first 2 postoperative days, and upper eyelid ecchymosis was significantly decreased only on the first postoperative day. However, preoperative steroid administration had no influence on ecchymosis of the lower eyelid. The authors conclude that single-dose dexamethasone 10 mg can be used safely to reduce periorbital edema and ecchymosis in rhinoplasty patients.     

Comparison of Adhesive Properties of Five Different Prosthetic Materials Used in Hernioplasty

This experimental study was designed to assess and to compare intra-abdominal adhesions following the use of five commercially available prosthetic mesh grafts in the repair if abdominal wall defects. Sixty Wistar albino rats were randomly divided into six groups (n = 10). A 2 × 1 cm defect at abdominal wall was created and defects were closed either primarily or with one of the following prosthetic mesh grafts: monofilament polypropylene, polytetrafluoroethylene, sodium hyaluronate/carboxymethylcellulose-coated polypropylene, polypropylene/polyglactin 910 composite, or resorbable hydrophilic collagen-coated multifiber polyester. The severity of adhesions was graded, tensile strengths of adhesions were measured, and histopathological grades of inflammation and fibrosis were evaluated. Polypropylene mesh resulted in more adhesion formation in comparison to primary repair and other grafts used in this study, except polypropylene/polyglactin 910 composite mesh. In addition, the highest tensile strength of omental adhesions was detected in the polypropylene group (χ² = 26.249; p =. 0001). Polyester composite mesh caused the least adhesion formation among the groups. Sodium hyaluronate/carboxymethylcellulose-coated polypropylene and polyester composite meshes revealed the highest fibrosis scores (χ² = 50.776; p =. 0001). The highest inflammatory activity was detected in the polytetrafluoroethylene mesh group (χ² = 16.564; p =. 005). Thus, sodium hyaluronate/carboxymethylcellulose-coated polypropylene and polytetrafluoroethylene meshes following polyester composite mesh were the minimal adhesion-forming grafts in this study. Disadvantages of the polytetrafluoroethylene mesh were lower fibrotic activity and higher inflammatory reaction to the graft.     

A Technique for Retrofitting a Metal Ceramic Crown to an Attachment‐Retained Removable Partial Denture: A Clinical Report

In dental applications, precision attachments have been used to retain removable partial dentures (RPDs) for several decades. Various types of extracoronal attachments are commonly used in combination with fixed partial dentures and RPDs to achieve retention and stability. Fracture of the framework, fracture of the roots or teeth, and irretrievable decrease of retention are common reasons for a failed attachment‐retained RPD. Another complication of metal ceramic crowns with precision attachment is decementation of the crowns. When fixed components of the attachment‐retained RPD fail, the traditional treatment approach requires remaking both the fixed and removable components of the attachment‐retained RPD. This technique describes retrofitting of a metal ceramic crown to a resilient attachment‐retained RPD.     

The evaluation of safety and efficacy of colistin use in pediatric intensive care unit: Results from two reference hospitals and review of literature

Colistin, an old cationic polypeptide antibiotic, have been reused due to rising incidence of infections caused by multi-drug resistant (MDR) Gram-negative microorganisms and the lack of new antibiotics. Therefore, we evaluated safety and efficacy of colistin in treatment of these infections. This study included 104 critically ill children with a median age of 55,9 months between January 2011 and January 2016. Nephrotoxicity occurred in 11 (10.5%) patients. Nephrotoxicity occurred between the third and seventh day of treatment in 63% of colistin induced nephrotoxicity episodes. The subgroup analysis between the patients who developed nephrotoxicity during colistin treatment and those that did not, showed no significant difference in terms of age, underlying disease, cause for PICU admission and type of infection required colistin treatment, P values were 0.615, 0.762, 0.621, 0.803, respectively. All patients were receiving a concomitant nephrotoxic agent (P = 0,355). The majority of the patients (52%) were having primary or secondary immune deficiency in treatment failure group and the most common cause of PICU admission was sepsis in treatment failure group, P values were 0.007 and 0.045, respectively. Mortality attributed to colistin failure and crude mortality were 14.4% and 29.8%, respectively. In conclusion, colistin may have a role in the treatment of infections caused by multidrug-resistant Gram-negative bacteria in critically ill children. However, the patients have to be followed for side effects throughout colistin treatment, not for only early stage. And the clinicians should be aware of increase in the rate of nephrotoxicity in patients those have been receiving a concomitant nephrotoxic agent.     

Impact of Arterial Stiffness on Adverse Cardiovascular Outcomes and Mortality in Peritoneal Dialysis Patients

♦ Background: Cardiovascular (CV) disease is a major cause of morbidity and mortality in patients with end-stage renal disease. In recent years, arterial stiffness has taken on great importance in the pathophysiology of CV diseases. The independent predictive value of arterial stiffness for CV events and for all-cause and CV mortality has been demonstrated in the general population and in hemodialysis patients. Our aim in this study was to determine the relationship of arterial stiffness with mortality and fatal and nonfatal CV events in peritoneal dialysis (PD) patients.♦ Methods: In this prospective observational cohort study with 2 years of follow-up, we studied a cohort of 156 PD patients with a mean follow-up of 19.2 ± 6.4 months. At baseline, echocardiography and standard clinical and biochemical analyses were performed in all patients and in 28 healthy subjects. Aortic stiffness index beta (ASIβ, a surrogate marker of arterial stiffness) was calculated as follows: ♦ Results: During the follow-up period, 25 of the patients (16.0%) died, and 10 of those deaths had CV causes. Nonfatal CV events occurred in 15 patients. The median ASIβ was greater in PD patients than in control subjects (4.2 vs. 3.5; interquartile range: 3.2 – 5.5 vs. 2.5 – 4.8; p = 0.028]. In the fully adjusted multivariate Cox regression analysis (co-variates: age, sex, albumin, hemoglobin, diabetes mellitus, comorbid CV disease, left ventricular mass index, residual glomerular filtration rate, dialysate-to-plasma ratio of creatinine, Kt/V urea, left ventricular ejection fraction, duration of dialysis, smoking), ASIβ independently predicted fatal and nonfatal CV events (hazard ratio: 1.239; 95% confidence interval: 1.103 to 1.392), but not all-cause mortality.♦ Conclusions: Our results provide the first direct evidence that arterial stiffness is an independent risk predictor of adverse CV outcome in PD patients.     

Effects of a single, 24-hour, low-dose intravenous dobutamine infusion on left ventricular myocardial performance index in congestive heart failure: A prospective, nonrandomized study

Background:

Dobutamine, a predominantly beta-adrenergic sympathomimeticagent, is used for improving left ventricular (LV) systolic performance with different dosing regimens in patients with congestive heart failure (CHF). Myocardial performance index (MPI) is an indicator of LV global function that is correlated with LV end-diastolic pressure, and it is increased in CHF.

Objective:

The purpose of this study was to examine the effects of a single, 24-hour, low-dose, IV dobutamine infusion on LV systolic and diastolic function and on MPI in CHF as an indicator of LV global function, as well as the adverse effects (AEs) of the infusion.

Methods:

This prospective, nonrandomized study was conducted at theDepartment of Cardiology, Baskent University Hospital, Ankara, Turkey. Adult patients with LV ejection fraction (EF) <35%, sinus rhythm, and symptomatic CHF were treated using a standard protocol for at least 4 weeks. At the end of this period, patients with symptomatic CHF and EF <35% underwent echocardiography that included measuring isovolumic relaxation and contraction times (IRT and ICT, respectively) and LV ejection time (ET), and calculating LV MPI using the formula MPI = (IRT + ICT)/ET Dobutamine 2.5 μg/kg · min was then infused intravenously for 24 hours. Echocardiography was repeated 24 hours later and values were compared with preinfusion data. Patients were observed and monitored for CHF symptoms and AEs for 24 hours.

Results:

Forty-three patients were enrolled in the study, and 31 (22 men,9 women; mean [SD] age, 67.55 [11.78] years) continued after the 4-week standard-treatment period. Mean (SD) heart rate (74.93 [20.15] vs 80.23 [13.74] bpm, respectively), systolic blood pressure (129.00 [19.23] vs 126.67 [23.79] mm Hg), and diastolic blood pressure (75.80 [11.26] vs 74.96 [8.30] mm Hg) were statistically similar before and after the infusion. The mean (SD) end-diastolic volume was statistically similar to the preinfusion value (215.87 [76.74] vs 211.08 [65.51] mL); however, the mean (SD) end-systolic volume was significantly reduced (163.80 [63.86] vs 146.74 [53.12] mL; P = 0.01). Mean (SD) EF (25.33% [7.77%] vs 30.45% [7.63%]; P = 0.001) and stroke volume (SV) (54.92 [22.30] vs 63.59 [23.91] mL; P = 0.04) increased significantly. The mean (SD) early:late diastolic flow velocity (E/A ratio) (1.58 [1.36] vs 1.65 [1.27]), IRT (107.03 [35.37] vs 100.42 [34.32] ms), ICT (96.61 [34.27] vs 86.35 [44.80] ms), ET (240.65 [33.28] vs 243.48 [33.54] ms), and MPI (0.81% [0.28%] vs 0.78% [0.31%]) did not change significantly after dobutamine infusion. No AEs were observed.

Conclusions:

In this study of adult patients with symptomatic CHF, a single, 24-hour, low-dose, IV dobutamine infusion (2.5 μg/kg · min) was associated with decreased LV end-systolic volume and increased SV and EF However, LV diastolic function parameters, isovolumic time intervals, ET, and MPI were statistically similar to preinfusion values. The infusion was well tolerated.