Impact of positive end-expiratory pressure with alveolar recruitment maneuver on respiratory and oxygenation parameters of patients during laparoscopic bariatric surgery

OBJECTIVE

Laparoscopic bariatric surgery is frequently associated with disturbances in respiratory mechanics. An alveolar recruitment maneuver (ARM) with positive end-expiratory pressure (PEEP) is a strategy to overcome such respiratory conditions. This study aimed to evaluate the effect of ARM+PEEP on intraoperative and postoperative respiratory and hemodynamic parameters of patients with laparoscopic bariatric surgery.

PATIENTS AND METHODS

Patients who underwent laparoscopic bariatric surgery between 2009 and 2016 were retrospectively evaluated. The study sample was divided into four groups based on PEEP values and the presence of ARM: Group PEEP 5 (5 cm H2O PEEP only), Group PEEP 5/RM (5 cm H2O PEEP plus ARM), Group PEEP 10 (10 cm H2O PEEP only), Group PEEP 10/RM (10 cm H2O PEEP plus ARM). Patients' demographic characteristics, ventilatory, respiratory, and oxygenation parameters were recorded. Oxygenation index (PaO2/FiO2) was the study's primary outcome.

RESULTS

There were 156, 158, 299, and 210 patients in Groups PEEP 5, PEEF 5/RM, PEEP 10, and PEEP 10/RM, respectively. Tidal volume, driving tidal volume/compliance, PaO2, PaO2/FiO2, and PaCO2 were significantly lower in Groups PEEP 5 and PEEP 5/RM, whereas SpO2 and FiO2 were significantly higher in Groups PEEP 5 and PEEP 5/RM (p<0.05). Patients in Group PEEP 5 had significantly higher end-tidal carbon dioxide (EtCO2) values than those of other groups (p<0.001). Patients in Group PEEP 5/RM had significantly higher SpO2 values than those in Group PEEP 5 (p<0.001). Rate of postoperative atelectasis was significantly higher in Group PEEP 5/RM compared to the other groups (p=0.011).

CONCLUSIONS

A PEEP level of at least 10 cm H2O with ARM improved intraoperative respiratory parameters and caused a significant reduction in postoperative atelectasis.

Knowledge, attitude, and behavior of Turkish dentists about radiation protection and radiation safety

OBJECTIVES

Dentists use dental imaging methods frequently in the diagnosis and treatment of dental diseases. This study aimed to determine dentists' knowledge, attitudes, and behaviors about radiation protection during dental imaging procedures.

METHODS

Dentists from two major dental health centres in İzmir province were asked to participate in this study. The participants replied to a questionnaire that consisted of questions on the use of radiographic devices, knowledge on the radiation protection of patients and staff, and attitudes and behaviors regarding radiation protection. The questionnaire also included questions about the socio-demographic characteristics of the participants. Descriptive statistics of data were performed using the SPSS software program.

RESULTS

Sixty-six dentists participated in the survey. The mean knowledge score of dentists on dental imaging, radiation, and radiation protection was 8.3 ± 2.6 out of 17, while the mean attitude and behavior score was 8.3 ± 2.1 out of 27.97% of the participants stated that medical imaging technicians should carry out imaging procedures. The use of rectangular collimators was 9.1%, and using E/F film was 56.3% among dentists. 23.3% of participants stated that they applied the bisecting angle technique during dental imaging, 23.8% stated that they wear a lead apron during imaging, and 37.8% stated that they always used thyroid shields on the patients. In addition, 37.2% of the dentists stated that the patient holds the film during preapical radiography, and 81.5% used the same imaging parameters for adult and pediatric patients. 62% of dentists stated that they question the pregnancy of female patients before imaging.

CONCLUSION

Findings of the study suggest that the knowledge of dentists about dental imaging procedures and radiation protection needs to be improved. The implementation and the follow-up of quality training programs in accordance with the standards set by the national authority will be of great importance.

Effects of Oral pH Changes on Smoking Desire

BACKGROUND

Nicotine addiction is associated with nicotine absorption from the buccal mucosa, and it is stated that the main factor that determines nicotine absorption is saliva pH. In the literature, the effects of changes in saliva pH values after eating and drinking on smoking desire in smokers were not questioned.

AIM

To show the effect of saliva pH changes on smoking desire. The secondary aim was to show the impact of coffee and water drinking on saliva pH and smoking on oral-dental health (oral hygiene and gingival bleeding).

STUDY DESIGN

Case-control study.

METHODS

A questionnaire was administered that included "Sociodemographic Data Form" and smoking history and Fagerström Test for Nicotine Dependence (FTND). Oral and dental examinations were performed with mirror sonds and using oral hygiene standard Silness and Leöe plaque index and DMFT Index (Index of Decayed Missing or Filled Teeth). Untreated saliva samples were taken, and baseline saliva flow rate and pH values were measured. To assess pH changes, saliva pH was remeasured after sugar-free instant coffee and water consumption. Smoking desire was evaluated with the Visual Analog Scale (VAS).

RESULTS

In this study, 24 (55.8%) females and 19 (44.2%) males were among the 43 smoking and 39 nonsmoking cases. Smoking was significantly associated with poor oral hygiene (in smokers 4.71 (±1.40), in non-smokers 2.30 (±1.59); P < .01). DMFT index was higher in smokers than in non-smokers (in smokers 6.45 (±3.69), in non-smokers 3.87 (±2.67); P < .01). Gingival bleeding was more prevalent in smokers (0.68 (±0.76)) than non-smokers (1.20 (±0.90); P = .009). Salivary flow rates were lower in smokers (in smokers 2.56 (±1.34), in non-smokers 3.00 (±1.22), P = .06). In both groups, pH values increased after coffee consumption and decreased after water; in smokers basal: 6.67 (±0.41), pH coffee: 6.93 (±0.36), pH water: 6.85 (±0.33); in non-smokers pH basal: 6.84 (±0.37), pH coffee: 7.02 (±0.37), pH water: 6.97 (±0.31), P < .01. The VAS values of smokers at basal 4.73 (±3.21); P < 0.01, after coffee consumption 4.91 (±3.08); P < .01, and after water 3.15 (±2.72); P < .01.

CONCLUSION

The saliva pH increased after coffee consumption and decreased after drinking water. Besides, VAS values decreased significantly after drinking water. The results suggest that a simple behavior such as drinking water may be used in conjunction with behavioral and cognitive therapies to pursue smoking cessation.

Effects of Oral pH Changes on Smoking Desire

Background

Nicotine addiction is associated with nicotine absorption from buccal mucosa and it is stated that the main factor that determines the nicotine absorption is saliva pH. In the literature, the effects of changes in saliva pH values after eating and drinking on smoking desire in the smokers were not questioned.

Aim

The main purpose of this study was to show the effect of saliva pH changes on smoking desire. The secondary aims were to show the effects of coffee and water drinking on saliva pH and the effects of smoking on oral-dental health (oral hygiene, gingival bleeding).

Study Design

Case-control.

Methods

A questionnaire was administered that included "Sociodemographic Data Form" and smoking history and Fagerström Test for Nicotine Dependence (FTND). Oral and dental examinations were performed with mirror sonds and using oral hygiene standard Silness and Leöe plaque index and DMFT Index (Index of Decayed Missing or Filled Teeth). Untreated saliva samples were taken and baseline saliva flow rate and pH values were measured. To assess pH changes, saliva pH was remeasured after sugar-free instant coffee and water consumption. Smoking desire was evaluated with Visual Analog Scale (VAS).

Results

There were 24 (55.8%) female and 19 (44.2%) male among the 43 smoking and 39 nonsmoking cases. Smoking was significantly associated with poor oral hygiene (in smokers 4.71 (←1.40), in nonsmokers 2.30 (←1.59); p<0.01). DMFT Index was higher in smokers than in nonsmokers (in smokers 6.45 (←3.69), in nonsmokers 3.87 (←2.67); p<0.01). Gingival bleeding was more prevalent in smokers (0.68 (←0.76)), than nonsmokers (1.20 (←0.90); p=0.009). Salivary flow rates were lower in smokers (in smokers 2.56 (←1.34), in nonsmokers 3.00 (←1.22), p=0.06). In both groups, pH values increased after coffee consumption and decreased after water; in smokers basal:6.67 (±0.41), pHcoffee: 6.93 (±0.36), pHwater: 6.85 (±0.33); in nonsmokers pHbasal: 6.84 (±0.37), pHcoffee: 7.02 (±0.37), pHwater: 6.97 (±0.31), p<0.01. The VAS values of smokers at basal 4.73 (±3.21); p<0.01, after coffee consumption 4.91 (±3.08); p<0.01 and after water 3.15 (±2.72); p<0.01.

Conclusion

The saliva pH increased after coffee consumption and decreased after drinking water. Besides VAS values decreased significantly after drinking water. The results suggest that a simple behavior such as drinking water may be used in conjunction with behavioral and cognitive therapies in the pursuit of smoking cessation.

An evaluation of the effectiveness of dental health training administered at a health services school

ISSUE ADDRESSED

The aim of this study was to determine the knowledge and behaviour of health technician students to determine their oral health (OH) status, and to evaluate the effectiveness of a structured education administered for increasing OH awareness.

METHODS

Interventional research was performed between December 2018 and March 2019 on 445 Vocational School of Health Services students in … University. Questionnaires were conducted under observation. The first questionnaire (Q1) included socio-demographic characteristics, OH knowledge level, attitudes and behaviours. One month after the OH training was given to the students, the same questions in Q1 were asked again in the second questionnaire (Q2). Dental caries and Simplified Oral Hygiene Index (OHI-S) status were determined by a dentist via a clinical oral examination.

RESULTS

Of the 445 students, 416 (93.5%) participated in the study and completed the Q1 and Q2 questionnaires. A total of 277 (66.6%) students were female and 139 (33.4%) were male, with the age range being 17-33 years (average: 19.2 ± 1.86 years). Of the 416 students who answered the Q1 and Q2 questionnaires, 385 received oral examinations. While the Q1 knowledge score was 7.06 ± 2.08, the Q2 was found to be 12.36 ± 2.90 (P < .001). It was seen that 119 (30.9%) students who had poor OHI-S and 120 (31.2%), had a mean number of decayed, missing and filled teeth (DMFT) value of 6 and above. It was found that the females had better OH values ​​than males (P < .001) and smokers had worse OH values overall (P < .016).

CONCLUSION

It was observed that the health technician students had a low level of knowledge about OH before the training but after receiving the training, their knowledge, attitude and behaviour changed positively. SO WHAT?: It was concluded that the OH education given to students caused a positive change in their behaviour, attitude and knowledge.

Prevalence, aetiology, and treatment of molar incisor hypomineralization in children living in Izmir City (Turkey)

BACKGROUND

Molar incisor hypomineralization (MIH) is frequent in children and etiology is different.

AIM

The aim of this study was to determine the prevalence, severity, and risk factors of MIH and to investigate the relationship between the severity of the defect in the teeth affected by MIH and the risk factors.

DESIGN

The study included patients at the age range of 9 and 10 years, who were admitted to the clinic of paediatric dentistry in Dokuz Eylul University and had four-first molar teeth (FMT) and eight incisor teeth eruptions in the jaws. The presence of only demarcated opacities in one or several FMT and incisor teeth was defined as MIH1, and the presence of post-eruptive breakdown (PEB), atypical restorations, and extracted teeth was defined as MIH2.

RESULTS

MIH was detected in 142 (11.5%) of 1237 children. Although there was no statistically significant difference between upper and lower FPM and the occurrence of MIH (P < 0.902), there was a difference between upper and lower central and lateral teeth (P < 0.001; P < 0.009). A significant difference was detected between birth week, birthweight, high fever, and asthma/bronchitis and MIH1 and MIH2 (P < 0.001).

CONCLUSION

The prevalence of MIH was found to be 11.5%. It was observed that the patients undergoing low birthweight, preterm delivery, high fever, and asthma/bronchitis were more severely affected by MIH.

Long-term Dental Anomalies after Pediatric Cancer Treatment in Children

Objective:

The aim of this study is to determine the frequency of dental anomalies (DAs) (microdontia, hypodontia, hyperdontia, enamel defect, root malformation) in pediatric cancer patients at the ages <5 years and between 5 and 7 years, and understand their relationship with the received therapy.

Materials and Methods:

Pediatric patients who were diagnosed with cancer and treated before the age of 7 years were investigated in a case- control design. The study included 93 pediatric patients whose ages at diagnosis were between 9 months and 7 years and whose treatments were completed before 5-8 years. Group A consisted of patients in the age range of 9 months to 4 years and Group B consisted of patients in the age range of 5-7 years. Seventy-two siblings with compatible dental age ranges were included in the control group. For both groups, intraoral examinations were performed and panoramic radiographs were taken.

Results:

Among the 93 pediatric patients, the mean age was 9.54±1.25 (range: 8-13 years) and 48 (51.6%) patients were male. The most common diagnosis was hematologic malignancy with a rate of 65.5%. At least one DA was detected in 7 (9.7%) individuals of the control group and in 78 (83.9%) of the patient group. While the patients in the study group had all kinds of DAs, those in the control group had only enamel defects. The rates of microdontia (p=0.077) and hypodontia (p=0.058) were detected to be significantly higher in Group A than in Group B. Root malformation was more common in patients receiving chemotherapy and radiotherapy than in those receiving only chemotherapy (p=0.006).

Conclusion:

In this study it was found that the pediatric patients who received cancer treatment before the age of 7 years constituted a high-risk group for DAs. The frequencies of microdontia and hypodontia were increased even more when the patient was treated for cancer before 5 years of age.

The Prevelance of Tobacco Use and the Factors Influencing in Students Studying at Two Dentistry Faculties in Turkey

OBJECTIVES

The objective of this study was to determine the pattern and effects of tobacco and tobacco products use among students of dentistry.

MATERIAL AND METHODS

A cross sectional study was performed in the Dentistry Faculty of Ege and Dicle Universities between April and May 2013. All freshmen and senior year students receiving education in both universities were included into the study (n= 321). A questionnaire consisting of 26 questions was used to determine the smoking habits of the students and the influencing factors regarding this habit. Students replied the questions under supervision.

RESULTS

A survey was conducted among 298 students out of 321 who were attending both universities. 46.6% of the participants were female and 53.4% were male. Smoking prevelance of the students was 29.9%. It was 19.9% in freshmen students and 45.8% in senior students. According to the first class of students in the fifth grade students in the prevalence of smoking in was found to be highly statistically significant (p< 0.001). Among other tobacco products the following was identified as mostly used: waterpipe, also known as narghile (27.4%), cigarwraps (9.7%), cigar (9.4%) and smoking pipe (2.0%). While 22.5% of the students stated that they started smoking after the age of 15, 36.0% started between the ages of 15 and 18 and 41.5% after the age of 19. The rate of smoking in the house was significantly higher (p< 0.001) among smokers than non-smokers. While 78.7% of the students stated that they would like to quit, 64.3% tried once or more to quit.

CONCLUSION

Smoking habit was found to be higher among medical students than the social average. Smoking is more frequent in higher classes. From early years onwards, students of dentistry should be intensively educated regarding the harmful effects of tobacco on health, and efforts should be made to prevent and control of tobacco epidemic.