Heparin-Induced Thrombocytopenia (HIT)

Heparin-induced thrombocytopenia (HIT I) is a severe, life-threatening, and immunological drug reaction. According to the clinical-laboratory characteristics, there are two types of HIT: type I (HIT I) and type II (HIT II). HIT I is the result of non-immunologic, direct interaction of heparin with the platelet surface. Contrary, HIT II is immunologically induced (antibody-mediated) and life-threatening side effect of heparin therapy, often associated with thromboembolic complications. All patients receiving heparin are exposed to the development of anti-heparin antibodies, irrespective of the heparin dosage, type, and method of administration. HIT most commonly develops in intensive care patients, dialyzed patients, and cardiosurgical and orthopedic patients. It commonly develops after 5–10 days of heparin therapy. Platelet count decreases by more than 50% from the baseline and ranges from 20 × 109/L to 100 × 109/L. In HIT II, thromboembolic complications usually include deep-vein thrombosis and pulmonary embolism, but they also include arterial occlusion of the extremities, myocardial infarction, stroke, and necrosis and organ damage. Clinical assessment of the HIT probability using 4T´s score system, systematic monitoring of platelet number in heparin-receiving patients, and specific laboratory diagnosis of anti-heparin antibodies substantially contribute to the final confirmation of the diagnosis, enable timely administration of direct non-heparin thrombin antagonists, and reduce mortality from thromboembolic complications

The Disinfecting Efficacy of Root Canals with Laser Photodynamic Therapy

Introduction: Infecting microorganisms of the root canals are difficult to eliminate during endodontic treatment. In this study the effect of root canal disinfection with photodynamic therapy (PDT) at different time intervals in comparison to 2.5% sodium hypochlorite (NaOCl) irrigation and passive ultrasonic irrigation (PUI) in extracted teeth colonized with Enterococcus faecalis and Candida albicans was tested to assess which treatment reaches the best disinfection rate.Methods: One hundred and fifty-six extracted single-rooted teeth were collected, sterilized, and incubated with Enterococcus faecalis (ATCC 29212) and Candida albicans (ATCC 60193). The two groups were further divided into 6 groups depending on the treatment mode; HELBO®Endo Blue photosensitizer dye application followed by HELBO laser irradiation, with the output power 100 mW and emission of 660 nm, for a 1, 3 and 5 minutes, irrigation with 2.5% NaOCl, 10 second PUI with 2.5% NaOCl and control group. Flow cytometry and scanning electron microscopic (SEM) analysis were used to determine the effectiveness of the different disinfecting methods.Results: The different disinfecting methods had a significantly different effect on the percent of dead cells (p<0.001). A statistical significance of dead cells between organisms (p<0.001) was observed. Interaction between the disinfecting method and both of organisms had shown the statistical significance (p=0.045). Percent of dead cells in treatment groups were significantly higher compared to control group for both organisms (p<0.001).Conclusions: PUI still remains the most effective method for disinfection of infected root canalsin endodontics compared to hand instrumentation for both microorganisms. SEM analysis only confirmed the results. Other results ex vivo suggested that prolonging the time from 1 to 5 minutes of PDT increased the number of killed microorganisms significantly, therefore longer times of photodynamic therapy were recommended. Irrigation with 2.5% NaOCl showed similar results to 5 min irradiation

Evaluation of ENA-6 Profile by ELISA Immunoassay in Patients with Systemic Lupus Erythematodes

Autoimmune diseases occur in 3−5% of the population. Study included 30 patients with clinically diagnosed SLE and 30 healthy controls (American college of Rheumatology, 1997). SLE was diagnosed according to criteria issued in 1997 by the American College of Rheumatology (ACR). The aim of this study was to evaluate concentration values of each antigen of ENA-6 profile in SLE, to investigate possible correlation between the concentration of Sm antibodies and CIC, and to test their use as possible immunobiological markers in SLE. Furthermore, the aim of our study was to determine whether there is a correlation between Sm antibodies and CIC and SLE activity. The results revealed that all of these ENA-6 and Sm antibodies as biomarkers complement diagnoses of active SLE but their use as solo markers does not allow classifying patients with SLE. Our study has shown that based on calculations from ROC curves, Sm/RNP was clearly a very important marker for diagnosis of SLE (cut off ≥ 9.56 EU, AUC 0,942). The high incidence of Scl-70 (10%) reactivity suggests that ELISA monitoring of this antibody produces more false positive results than other multiplex assay. An important conclusion that can be drawn from the results of our study is that laboratory tests are no more effective than clinical examination for detecting disease relapse, but are helpful in the confirmation of SLE activity

How far are we from vaccination against Helicobacter pylori infection?

Introduction: Helicobacter pylori infection results in chronic gastritis, peptic ulcer, or gastric cancer; therefore, eradication of this bacterium is essential. The strategy for developing effective vaccines against H. pylori entails immunization of mice with a combination of classical and recombinant H. pylori antigens, but this has proven to be onerous in all cases. Areas covered: We have reviewed literature databases in PubMed and Scopus using the key words H. pylori, vaccine, and vaccination and have conducted a systematic review of published clinical trials and animal model studies on vaccines against H. pylori and have tried to summarize why the vaccines are not effective or only partially effective. Expert commentary: This is the perfect time to review vaccine development against H. pylori as, after several failed attempts, promising results were reported by Zeng et al. in 2015. Successful vaccine development requires knowledge of both the immune mechanisms active during natural infection by H. pylori, owing to the complicated host response against the pathogen, and the factors that allow the persistence of bacteria, such as genetic diversity of H. pylori. Moreover, various clinical trials are needed to prove vaccine efficacy

Persistent hypoglossal artery

It is well known that the internal carotid artery has no branches in the neck during postfetal life (von Lanz & Wachsmuth, 1955), but during embryonic development there are anastomotic connections between the internal carotid and basilar artery that rarely persist after intrauterine life (Hassen-Khodja et al. 1992; Widmann & Sumpio, 1992; De Caro et al. 1995). The most common anomaly found incidentally on angiography is a persisting trigeminal artery, but persistent hypoglossal, otic and proatlantal arteries can also be found (Reynolds et al. 1980; Ouriel et al. 1988; Salas et al. 1998). We report a rare example of a persistent hypoglossal artery in a 64 y old female cadaver, cause of death unknown, embalmed by standard mortuary procedures for dissection during the routine anatomy course. The persistent hypoglossal artery originated from the anteromedial wall of the left internal carotid artery 2.5 cm above the bifurcation (Fig.). It extended towards the hypoglossal canal. The diameter of its lumen was 1.5 mm. During its course in the neck, it was positioned anterior to the internal carotid artery and medial to the facial and lingual arteries, the posterior belly of the digastric muscle and the convexity of the hypoglossal nerve in the neck. At 1 cm above the convexity of the hypoglossal nerve in the neck, the artery gave rise to a branch that entered the skull through the carotid canal anteromedial to the internal carotid artery (Fig. 1) and joined the basilar artery. The medial branch of the hypoglossal artery crossed the internal carotid artery on its medial side and entered the skull together with the hypoglossal nerve and joined the basilar artery. We found no other anomalies in the cerebral arterial system

Detection of Occult Metastases in Patients with T1 and T2 Stage Lower Lip Squamous Cell Carcinomas after Positive Lymphoscintigraphy

The aim of this study was to detect lower lip squamous cell carcinomas (SCC) that had metastasized to the lymph nodes and to evaluate if neck dissection was necessary for patients with T1 or T2-stage lip cancer after a sentinel lymph node biopsy (SLNB). The study was conducted as a prospective clinical study to detect occult neck metastases in patients with T1 or T2 stage SCC of the lower lip. Thirty-one patients were eligible and underwent echo-ultrasound, computer tomography, magnetic resonance and lymphoscintigraphy (LSG) as diagnostic procedures. LSG was performed on the same day as the surgical procedure, after intradermal injection of 37 Mbq Tc99m-Sn-colloid/mL at four peritumoral sites. In patients with positive LSG results, the sentinel lymph nodes were extracted surgically. The risk factors for cancer development were sun exposure and smoking. The highest accuracy for detecting lymph node enlargements was achieved with magnetic resonance imaging (MRI; 80.7%). LSG showed excellent sensitivity (100%) and negative predictive value (NPV; 100%). Overall, occult metastases were diagnosed with an SLNB in eight (25.8%) patients. According to the results, with great caution, we suggest that an SLNB is reasonable to initiate only for patients with positive sentinel nodes by positive LSG, to be used as a lower morbidity approach for selected patients with T1 and T2 stage cancers

Ortodontski materijali s fluoridom imaju antimikrobnu sposobnost za prevenciju karijesnih lezija

Aim: Orthodontic brackets during their wear cause demineralization of enamel, which is the initial step in caries development. The prevention of such spots is crucial to ensure healthy teeth, but patients’ compliance is not the most optimal way. The aim of this study was to compare the antimicrobial properties of fluoride-containing orthodontic materials to the materials without additional fluoride. Materials and Methods: Antibacterial effectiveness of orthodontic materials with fluoride – Transbond Plus SEP Bonding agent, Transpond Plus Adhesive agent, Fuji I Band cement, Fuji Ortho LC Adhesive agent, Ortho Solo Bonding agent, and without antimicrobial substances – Transpond XT Bonding agent, Transbond XT Primer were tested with the inhibition on most common causes L. achidophilus (ATCC 4356) and S. mutans (ATCC 10449) and compared to negative control. Antimicrobial effectiveness of each material was measured with the agar diffusion method and expressed with the diameters of inhibition zones around the disk. Results: Materials containing fluoride showed more antimicrobial effectiveness compared to materials without fluoride or negative control (p0.05). Conclusion: Materials containing fluoride showed more significant antimicrobial effectiveness when compared to the materials without antimicrobial substance and thus might have the potential of antimicrobial properties in vivo.Cilj: Ortodontski breketi tijekom nošenja uzrokuju demineralizaciju cakline, što je početni korak u razvoju karijesa. Prevencija takvih mrlja presudna je za osiguravanje zdravih zuba, ali suradljivost pacijenata nije uvijek optimalna. Cilj ovog istraživanja bio je usporediti antimikrobna svojstva ortodontskih materijala koji sadrže fluorid s materijalima bez dodatnog fluorida. Materijal i metode: Antibakterijsku učinkovitost ortodontskih materijala s fluoridom – Transbond Plus SEP Bonding agent, Transpond Plus ljepilo, Fuji I Band cement, Fuji Ortho LC ljepilo, Orto Solo Bonding agent, i učinkovitost ortodontskih materijala bez antimikrobnih tvari – Transpond XT Bonding agent, Transbond XT Primer, testirali smo s inhibicijom na najčešće uzročne bakterije L. achidophilus (ATCC 4356) i S. mutans (ATCC 10449) i usporedili učinkovitost s negativnom kontrolom. Antimikrobna učinkovitost svakog materijala izmjerena je metodom difuzije agara i izražena promjerom zona inhibicije oko diska. Rezultati: Materijali koji sadrže fluorid pokazali su veću antimikrobnu učinkovitost u usporedbi s materijalima bez fluorida ili u usporedbi s negativnom kontrolom (p 0,05). Zaključak: Materijali koji sadrže fluorid pokazali su značajniju antimikrobnu učinkovitost u usporedbi s materijalima bez antimikrobne tvari i stoga mogu imati potencijal antimikrobnih svojstava u uvjetima in vivo

Minor Physical Anomalies in Children with Hearing Impairment and Normal Controls

The aim of this research was to assess differences in the frequency of individual minor phyisical anomalies (MPA) between healthy controls and children with hearing impairment (HI) and to find out whether some MPAs are more informative in discriminating between two groups than cumulative Waldrop’s scores. The aim was also to investigate the influence of gender on MPA in children with HI and those with normal hearing (NH). The study was carried out on a sample of 424 children (121 children with hearing impairment (82 boys and 39 girls) aged from 5 to 18 and 303 healthy schoolchildren with normal hearing (152 boys and 151 girls) aged from 8 to 16). In HI children, the mean value of MPA was 2.2 times higher than in the controls. Binary Logistic Regression Model is entirely (with all 18 predictors) statistically significant, that is, it recognizes partial deafness The comparisons between the studied groups of boys and girls HI and boys and girls NH showed a higher relative involvement of MPA in boys than in girls. MPA comparison of HI boys versus NH boys and HI girls versus NH girls according to topographic regions revealed that for HI children there were higher mean scores than for the same-sex controls from all regions, but differences are particularly pronounced in the ear and tongue region. However and that the difference is statistically significant for the majority of regions but this difference tended to be more pronounced in girls with relatively better expressed peripheral dysmorphia in the former and craniofacial dysmorphia in the latter. From the obtained results, it can be seen that in HI children, common etiological factors were probably in effect leading to physical anomalies and hearing impairments. Given the present findings of increased MPAs in HI children, further investigations are necessary to determine whether these developmental abnormalities arise from genetic factors or as a consequence of nvironmental influences