Dentists bear the burden of responsibility for antimicrobial resistance since antibiotics are the drugs most prescribed by dentists. Often, "inappropriate" antibiotic use is considered as a "gray ...area" by dentists mainly due to ethical challenges associated with the clinical judgement depending on patients and/or prescribers.
The study aimed to assess whether and in what way dental ethical principles underpin rational antibiotic use by investigating perceptions of postgraduate and undergraduate dental students without formal knowledge of dental ethics.
A cross-sectional anonymous survey comprised nine close-ended questions and was conducted among dental students (n = 125). The investigated practice of appropriate antibiotic prescribing in the survey relied on the respect of three basic principles of ethics: autonomy, non-maleficence, and beneficence.
Results show that dental students exhibit a lack of dental ethics knowledge that results in an inappropriate antibiotic-prescribing practice: prescribing an antibiotic when it is not necessary, without examination, or for indications that are not within the competence of the dentist. Multivariate regression analysis revealed that there was a significant difference between under- and postgraduates.
Within the pharmacology course, a review of the clinical scenarios which cover both ethical and clinical complexities regarding the appropriate use of antibiotics should be introduced as an educational approach.
Cilj: Prikazati slučaj pedijatrijske pacijentice sa sindromom gornjeg medijastinuma (SGM) kod koje je citološkom analizom pleuralnog i perikardijalnog izljeva postavljena preliminarna dijagnoza ...T-staničnog ne-Hodgkinovog limfoma (T-NHL) i zbog životne ugroženosti započeta kemoterapija s izvrsnim odgovorom. Prikaz slučaja: Pacijentica u dobi od 15 godina pregledana je u hitnoj pedijatrijskoj ambulanti zbog nespecificiranog gubitka svijesti. Pet dana pred prijam žalila se na šum u ušima, vrtoglavicu, noćno znojenje, difuzne bolove u trbuhu i povraćanje, uz suh kašalj na dan prijama. Zbog brzog pogoršanja kliničkog stanja s cijanozom i hipoksijom zaprimljena je u Jedinicu intenzivnog liječenja. Slikovne pretrage pokazale su uvećanu sjenu medijastinuma te obilan perikardijalni i pleuralni izljev. Uz intenzivne potporne mjere liječenja, učinjena je hitna perikardiocenteza i pleuralna drenaža. Citološkom analizom izljeva postavljena je dijagnoza T-NHL-a te je bez histološke potvrde uvedena kemoterapija prema EURO-LB 02 protokolu, s izvrsnim odgovorom. Pet godina nakon završetka liječenja pacijentica je u kontinuiranoj kompletnoj remisiji. Zaključak: SGM je hitno stanje u pedijatrijskoj onkologiji. Brz razvoj tipičnih simptoma i znakova SGM-a kod djeteta treba pobuditi kliničku sumnju na medijastinalni tumor. U ovakvim slučajevima životne ugroženosti, uz intenzivne mjere liječenja, potrebno je započeti antitumorsku terapiju na osnovi preliminarne dijagnoze bez histološke potvrde. Rano prepoznavanje i adekvatno zbrinjavanje SGM-a od presudne je važnosti za povoljan ishod.
Aim: To present the case of a pediatric patient with superior mediastinal syndrome (SMS) in whom a preliminary diagnosis of T-cell non-Hodgkin lymphoma (T-NHL) was established by cytological analysis of pleural and pericardial effusion and due to the life-threatening condition, chemotherapy was initiated with an excellent response. Case report: A 15-year-old girl was examined in the emergency pediatric department due to unspecified loss of consciousness. Five days before the admission, she was complaining of tinnitus, dizziness, night sweats, diffuse abdominal pain and vomiting, and dry cough on the day of the admission. Her clinical condition worsened rapidly with cyanosis and hypoxia, and she was admitted to the Intensive Care Unit. Imaging studies demonstrated a mediastinal mass, and large pericardial and pleural effusion. Along with intensive supportive measures, pericardiocentesis and pleural drainage were performed. Cytological examination of fluids established a preliminary diagnosis of T-NHL, and chemotherapy according to EURO-LB 02 protocol was started without histological confirmation, with excellent response. Five years after the end of the treatment, the patient is in complete remission. Conclusion: SMS is an emergency in pediatric oncology. The rapid development of typical SMS signs and symptoms in a child should arouse clinical suspicion of a mediastinal tumor. In life-threatening cases, along with intensive care treatment, it is necessary to start anticancer therapy based on a preliminary diagnosis without histological confirmation. Early identification and adequate treatment of SMS are crucial for a favorable outcome.
High elution and diffusion of 2-hydroxylethyl methacrylate (HEMA) and camphorquinone (CQ) through dentinal tubules may induce pulp injury and postoperative sensitivity. We aimed to investigate the ...melatonin protective effect in HEMA- and CQ-treated human dental pulp cells (hDPCs) as well as its relevance in a mechanism for postoperative sensitivity in diabetic patients. hDPCs were exposed to HEMA (5 mM) and/or CQ (1 mM) in the absence and presence of melatonin (MEL) (0.1 mM and 1 mM). Heme oxygenase-1 (HMOX1), NADPH oxidase-4 (NOX4), BCL-2-associated X-protein (BAX), B-cell lymphoma-2 (BCL-2) and caspase-3 (CASP3) gene expression levels, and superoxide dismutase (SOD) activity were measured in hDPCs while inducible nitric oxide synthase (iNOS) and melatonin protein expression were measured in human dental pulp as well, by RT-PCR, by ELISA, and spectrophotometrically. Bioinformatic analyses were performed by using the ShinyGO (v.0.75) application. Type 2 diabetic patients showed a higher incidence of postoperative sensitivity and lower melatonin and higher iNOS content in dental pulp tissue compared with non-diabetic patients. Melatonin, when co-added in hDPC culture, reverses HEMA and CQ cytotoxic effects via anti-apoptotic and anti-inflammatory/antioxidant iNOS-related effects. Enrichment analyses showed that genes/proteins, altered by HEMA and CQ and normalized by melatonin, are the most prominently overrepresented in type 2 diabetes mellitus pathways and that they share subcellular localization in different oligomeric protein complexes consisting of anti- and pro-apoptotic regulators. This is the first evidence of the ability of melatonin to counteract iNOS-mediated inflammatory and stress effects in HEMA- and CQ-treated hDPCs, which could be of significance for the modulation of presently observed immediate postoperative sensitivity after composite restoration in type 2 diabetic patients.
Cilj: Istaknuti važnost uključivanja prolazne eritroblastopenije djetinjstva u diferencijalnu dijagnozu anemije u prethodno zdravog malog djeteta kako bi se izbjegle nepotrebne dijagnostičke i ...terapijske intervencije te opisati utjecaj infekcije virusom SARS-CoV-2 na tijek i ishod bolesti. Prikaz slučaja: Djevojčica u dobi od dvije i pol godine bila je upućena na hitnu bolničku obradu zbog teške anemije. Kod prijama je bila dobrog općeg stanja, bez subjektivnih tegoba, s bljedoćom kože i sluznica, urednog ostalog somatskog statusa. Premorbidna i obiteljska anamneza bile su negativne. Ponovljeni nalazi potvrdili su izoliranu tešku normocitnu normokromnu anemiju. Praćen je spontani oporavak crvene loze. Interkurentna infekcija COVID-19 s udruženom neutropenijom i trombocitopenijom utjecala je na tijek, ali ne i na povoljan ishod bolesti. Postavljena je dijagnoza tranzitorne eritroblastopenije djetinjstva s komplikacijama uslijed infekcije COVID-19. Liječenje je bilo potporno. U daljnjem tijeku bila je praćena ambulantno, do potpunog oporavka anemije dva mjeseca nakon hospitalizacije. Zaključak: Prolazna eritroblastopenija djetinjstva stečeni je samoograničavajući poremećaj, karakteriziran anemijom i retikulocitopenijom uslijed zastoja eritropoeze u prethodno zdravog djeteta. Evaluaciju treba usmjeriti na isključenje drugih uzroka anemije. Infekcija COVID-19 ne utječe na povoljan ishod bolesti.
Aim: Emphasize the importance of including transient erythroblastopenia of childhood in the differential diagnosis of anemia in a previously healthy young child, aiming to avoid unnecessary diagnostic and therapeutic interventions, and describe the influence of SARS-CoV-2 virus infection on the course and outcome of the disease. Case report: A two-and-a-half-year-old girl was referred to the emergency hospital department due to severe anemia. On admission, she was in good general condition, asymptomatic, with pale skin and mucous membranes, and no other abnormalities. Previous and family history were negative. Repeated findings confirmed isolated severe normocytic normochromic anemia. Spontaneous recovery was observed. Intercurrent COVID-19 infection with associated neutropenia and thrombocytopenia the course but not the favorable outcome of the disease. Transient erythroblastopenia of childhood was diagnosed, with complications due to COVID-19 infection. The treatment was supportive. She was followed up on an outpatient basis, until complete recovery of anemia two months after hospitalization. Conclusion: Transient erythroblastopenia of childhood is an acquired self-limiting disorder, characterized by anemia and reticulocytopenia due to temporary suppression of erythropoiesis in a previously healthy child. The evaluation should be focused on excluding other causes of anemia. COVID-19 infection does not affect a favorable outcome of the disease.
Objective. Nasopharyngeal carcinoma is an extremely rare pediatric malignancy predominantly occurring in adolescent males. Its multifactorial pathogenesis is most strongly associated with the ...exposure to
Epstein-Barr virus in genetically susceptible hosts. In younger patients, more aggressive biological behavior has been observed, although the overall survival is better compared to adults. Due to its rarity and nonspecific clinical presentation, the diagnosis in children is often delayed and misinterpreted. Case report. We report a case of a 16-year-old boy with stage IVB nasopharyngeal carcinoma. He presented with a painless palpable neck mass, nasal congestion and a history of occasional epistaxis and headaches. Four years after the completion of a multimodal treatment, the patient is in complete remission. Conclusion. Although exceedingly rare, pediatricians should consider nasopharyngeal carcinoma in the differential diagnosis of palpable neck masses, especially in male adolescents. A multidisciplinary approach in the diagnosis, treatment, supportive care and follow-up is of utmost importance.
Objectives
To evaluate local effect of gaseous ozone on bacteria in deep carious lesions after incomplete caries removal, using chlorhexidine as control, and to investigate its effect on pulp ...vascular endothelial growth factor (VEGF), neuronal nitric oxide synthase (nNOS), and superoxide dismutase (SOD).
Materials and methods
Antibacterial effect was evaluated in 48 teeth with diagnosed deep carious lesion. After incomplete caries removal, teeth were randomly allocated into two groups regarding the cavity disinfectant used: ozone (open system) or 2% chlorhexidine. Dentin samples were analyzed for the presence of total bacteria and
Lactobacillus
spp. by real-time quantitative polymerase chain reaction. For evaluation of ozone effect on dental pulp, 38 intact permanent teeth indicated for pulp removal/tooth extraction were included. After cavity preparation, teeth were randomly allocated into two groups: ozone group and control group. VEGF/nNOS level and SOD activity in dental pulp were determined by enzyme-linked immunosorbent assay and spectrophotometric method, respectively.
Results
Ozone application decreased number of total bacteria (
p
= 0.001) and
Lactobacillus
spp. (
p
< 0.001), similarly to chlorhexidine. The VEGF (
p
< 0.001) and nNOS (
p
= 0.012) levels in dental pulp after ozone application were higher, while SOD activity was lower (
p
= 0.001) comparing to those in control pulp.
Conclusions
Antibacterial effect of ozone on residual bacteria after incomplete caries removal was similar to that of 2% chlorhexidine. Effect of ozone on pulp VEGF, nNOS, and SOD indicated its biocompatibility.
Clinical relevance
Ozone appears as effective and biocompatible cavity disinfectant in treatment of deep carious lesions by incomplete caries removal technique.
Background/Objectives: Although the role of PET/CT imaging is well established in oncology, its diagnostic value in routine monitoring for recurrent colorectal cancer (CRC) is still controversial. ...The aim was to evaluate the diagnostic value of F-18 FDG PET/CT in detecting recurrent CRC in correlation with CEA, CA 19-9 levels, and conventional imaging modalities (CIM). Methods: Between 2009 and 2023, a retrospective study was performed including 134 CRC patients referred for PET/CT imaging on the suspicion of recurrence, based on elevated CEA and/or CA 19-9 and/or equivocal CIM findings. According to our institution’s Tumor Board CRC protocol, after the initial treatment, which was dependent on the TNM stage (neoadjuvant therapy, primary resection, or adjuvant treatment), patients underwent a standard 5-year surveillance including CEA and CA 19-9 measurements, CIM, and colonoscopy, every six months. The statistics, including univariate and multivariate analyses were conducted using the IBM SPSS 20.0 statistical software. p-values < 0.05 were considered statistically significant. Results: Recurrent CRC was confirmed in 54/134 (40.3%) patients with elevated tumor markers. PET/CT showed high diagnostic performance in detecting recurrent CRC with sensitivity, specificity, PPV, NPV, and accuracy of 94.4%, 82.5%, 78.5%, 95.7%, and 87.3%, respectively. The CEA showed a high sensitivity of 98.1% but both low specificity and accuracy of 15% and 48.5%, respectively. The sensitivity, specificity, and accuracy for CA 19-9 and CIM for diagnosis of CRC recurrence were 44.4%, 67.5%, 58.2%, and 51.9%, 98.8%, 79.9%, respectively. The AUC for PET/CT, elevated CEA levels, CIM, and elevated CA 19-9 levels was 0.885 (95% CI: 0.824–0.946; p < 0.001), 0.844 (95% CI: 0.772–0.916; p < 0.001), 0.753 (95% CI: 0.612–0.844; p < 0.001), and 0.547 (95% CI: 0.442–0.652; p = 0.358), respectively. Univariate analysis showed that both PET/CT and CIM positive results were highly associated with CRC recurrence (p < 0.001 and p < 0.001, respectively). At the same time, gender, mucinous tumor type, presence of initial lymph node metastasis (N+), and presence of initial distant metastasis (M+) had no significance (p = 0.211, p = 0.158, p = 0.583, and p = 0.201, respectively). Our multivariate analysis showed that independent predictors for CRC recurrence are positive PET/CT scans (p < 0.001), positive CIM results (p = 0.001), and elevated CA 19-9 levels (p = 0.023). Although CA 19-9 was not detected as a statistically significant predictor in the univariate analysis (p = 0.358), in a multivariate analysis it was recognized as a significant predicting factor in detecting the CRC recurrence (p = 0.023). Conclusions: F-18 FDG PET/CT showed high diagnostic efficacy in CRC recurrence detection, in correlation with CEA levels, CA 19-9 levels, and CIM. This imaging modality should be routinely integrated into the post-operative follow-op in patients with elevated tumor markers.
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