Could cellular proliferation be a predictive index for the relapse of nasal polyposis and down-regulated by nasal steroid treatment?

The aim of this article is to identify the cellular mitotic activity using Ki-67 monoclonal antibody for predicting relapses of nasal polyposis after surgery. A prospective study was conducted at Kartal Training and Research Hospital Otolaryngology Department between January 2006 and September 2008. Nasal polyps were obtained from all patients and pathological materials were analyzed for the Ki-67 staining using immunohistochemistry. Patients were followed after surgery for 12 months for relapse. There was no statistically significant difference between recurrent and nonrecurrent polyps. Polyp recurrence has a multifactorial origin. Ki-67 index alone does not provide sufficient information about polyp recurrence before the operation. © 2012 Association of Otolaryngologists of India

Comparison of metoprolol and tramadol with remifentanil in endoscopic sinus surgery: a randomised controlled trial

Objective: Controlled hypotension is commonly induced during functional endoscopic sinus surgery to limit mucosal bleeding. This may be detrimental to elderly patients and patients with arterial stenosis. The aim of this pilot study was to determine if a normotensive anaesthetic technique with sufficient analgesia and without profound vasodilation may reduce intraoperative bleeding and incidence of adverse haemodynamic effects associated with vasodilation and variable rate continuous infusions. Methods: In this double-blind randomised controlled trial in a tertiary care centre, a total of 88 patients were randomised to receive intravenously either 0.1 mg kg?1 metoprolol and 1 mg kg?1 tramadol following anaesthesia induction (MT group) or a bolus dose of 0.5 ?g kg?1 remifentanil following anaesthesia induction, followed by 0.25-0.5 ?g kg?1 min?1 remifentanil infusion (R group). The primary outcome was quality of surgical field and incidence of adverse haemodynamic effects. The secondary outcomes were time to achieve intraoperative bleeding score <3, bleeding rate and changes in cerebral regional oximetry. Results: A total of 105 patients were recruited, in which 88 were randomised. The median intraoperative bleeding score was similar (1, interquartile range: 1-1, p=0.69). The mean bleeding rate was lower in the MT group, although the difference was not significant (p=0.052, 95% CI 0 to 8.8). Hypotension, bradycardia and cerebral desaturation in the MT group were not observed compared to hypotension in 3 (7%), bradycardia in 18 (41%) and cerebral desaturation in 2 (5%) patients in the R group (p=0.241, p<0.001, p=0.474, respectively). Conclusion: Providing sufficient analgesia and eliminating stress response can provide stable heart rate and good surgical field with no need for additional hypotension. This normotensive technique may be useful in patients with stenotic arteries or ischaemic organ diseases

Frontal sinüs boyutlarının yaş ve cinsiyet ile ilişkisinin değerlendirilmesi

Amaç: Adli araştırmaların önemli bir parçası bireyin kimliklendirilmesidir. Frontal sinüs, kişisel tanımlama, yaş tahmini ve cinsiyet tayini için değerli özelliklere sahiptir. Bu çalışmada amaç konik ışınlı bilgisayarlı tomografi (KIBT) görüntülerinde frontal sinüs boyutlarını değerlendirerek, bu boyutların yaş ile ilişkisini ve cinsiyet tayinindeki önemini belirlemektir.Gereç ve Yöntemler: Yaşları 20 ile 85 arasında değişen toplam 178 birey (105 Kadın, 73 Erkek) retrospektif olarak incelendi. KIBT görüntülerinde her sinüs için sağ ve sol taraf olmak üzere genişlik, yükseklik ve anteroposterior derinlik ve maksimum toplam genişlik ölçümleri yapıldı. Çalışmaya dahil olan bireyler yaşa göre 5 alt gruba ayrıldı ve her ölçüm parametresi de alt gruplar arasında karşılaştırıldı. Toplanan verilerin istatistiksel analizi Statistical Package for the Social Sciences (SPSS) 23.0 programı kullanılarak yapıldı.Bulgular: Sağ ve sol frontal sinüs genişliği, anteroposterior derinlik ve maksimum toplam genişlik özellikleri açısından erkekler kadınlardan istatistiksel olarak önemli derecede yüksek ortalamalara sahipken (p&lt;0.01), sinüs yüksekliği açısından istatistiksel olarak önemli bir fark belirlenmedi. Değerlendirilen tüm parametreler için yaş grupları arasında istatistiksel olarak önemli bir fark gözlenmedi. Yapılan diskriminant analizi sonucu cinsiyet tahmininde doğruluk oranı % 71.3 olarak hesaplandı.Sonuç: Bu çalışmada KIBT görüntülerinde ölçülen frontal sinüs boyutlarının yaş grupları arasında önemli farklılık göstermediği belirlendi. Bununla birlikte frontal sinüsün cinsiyet tayininde dimorfik özellikte olduğu fakat tek başına cinsiyet belirlemede yeterli olmadığı ve ilave parametrelerle doğruluğunun artırılacağı düşünüldü.ANAHTAR KELİMELER Adli bilimler, Cinsiyet tespiti analizi, Frontal sinus, Konik ışınlı bilgisayarlı tomograf

Obstrüktif uyku apnesi tan›s›nda periferik arteriyel tonometrinin de¤erlendirilmesi

Objective:Peripheral arterial tonometry (PAT) as a portable method of monitoring sleep quality is a relatively recent innovation. The aim was to compare the results of PAT and polysomnography (PSG) and to evaluate the role of PAT in diagnosing obstructive sleep apnea syndrome (OSAS). Methods: This study included adult patients who admitted to ENT clinic with OSAS complaints (excessive daytime sleepiness, snoring, and witnessed apnea), undergone sleep monitorization using PAT system (WatchPAT 200TM; Itamar Medical Ltd., Caesarea, Israel) and had single-blind, level 1 polysomnography at sleep laboratory of Chest Diseases Department. Results: For the two sleep monitoring sessions as conducted at different times: the apnea-hypopnea index (AHI) and respiratory disturbance index (RDI) values were strongly correlated between sessions (r=0.749, r=0.753; p<0.001). The oxygen desaturation index (ODI) values were very strongly correlated (r=0.861; p<0.001). When the AHI scores calculated using PAT for the patients enrolled in the trial were taken into consideration; 89.7% of the patients were correctly diagnosed with OSAS (AHI?5); for RDI calculated (RDI?5) using PAT, 100% of OSAS diagnoses were correct; for AHI values calculated with the PAT method, taking 15 as cut-off point, the sensitivity was found to be at an extremely high level of 96.1%. Conclusion: PAT and PSG values were highly correlated. This finding demonstrated that the reproducibility of the results obtained with PAT was also high. This study shows that PAT can be used as a screening test for OSAS and in a group of patients who are highly suspected for OSAS.Amaç: Periferik arteriyel tonometrinin (PAT), uyku monitörizasyonunda ta?›nabilir bir yöntem olarak kullan›m› k›smen yeni bir yöntemdir. Bu çal›?mada, PAT sonuçlar› ile polisomnografi (PSG) sonuçlar›n›n kar?›la?t›r›lmas› ve obstrüktif uyku apnesi sendromu tan›s›nda PAT’›n rolününün de¤erlendirilmesi amaçland›. Yöntem: Bu çal›?maya KBB klini¤ine OSAS ?ikayetleri (gündüz uykululuk hali, horlama ve tan›kl› apne) ile ba?vurmu? ve uyku monitörizasyonu PAT sistemi (WatchPAT 200TM; Itamar Medical Ltd., Caesarea, ‹srail) ile yap›lm›?, daha sonra Gö¤üs Hastal›klar› Uyku Laboratuvar›nda kör olarak level 1 polisomnografi uygulanm›? eri?kin hastalar dahil edildi. Bulgular: ‹ki farkl› zamanda yap›lm›? uyku monitörizasyonunda apne hipopne indeksi (AHI) ve solunum bozuklu¤u indeksi (RDI) de¤erleri yüksek oranda korele idi (r=0.749, r=0.753; p<0.001). Oksijen desatürasyon indeksi (ODI) de¤eri ise çok yüksek oranda korele saptand› (r=0.861; p<0.001). Çal›?maya dahil edilen hastalar›n AHI skorlar› PAT yöntemiyle ölçüldü¤ünde; hastalar›n %89.7’si OSAS için (AHI?5) do¤ru tan› ald›; PAT testinde, RDI’ye göre yap›lan de¤erlendirmede (RDI?5) OSAS tan›lar›n›n %100’ü do¤ru idi; PAT yöntemiyle yap›lan ölçümde AHI de¤eri için e?ik de¤eri 15 olarak kabul edildi¤inde, duyarl›l›k %96.1 olarak oldukça yüksek bulundu. Sonuç: PAT ve PSG de¤erleri yüksek oranda korele idi. Bu durum PAT ile elde edilen sonuçlar›n tekrarlanabilirli¤inin de yüksek oldu¤unu göstermi?tir. Çal›?mam›z PAT’›n OSAS’da tarama testi olarak ve yüksek oranda OSAS ?üphesi olan hasta grubunda kullan›labilece¤ini göstermektedir

The Impact of Septal Deviation on Intranasal Schirmer Test Values

Objective:Intranasal Schirmer test serves as an objective measurement for evaluation of nasal secretion and humidity. This study aimed to evaluate the effect of septal deviation on nasal secretion and humidity by measuring the intranasal Schirmer test values in patients who had septal deviation and compare it to the values of our healthy volunteers.Methods:The study included 52 patients with nasal septum deviation and 52 volunteers without any rhinologic complaints or deviated nasal septum. Intranasal Schirmer test was performed to all patients and volunteers for both nasal cavities.Results:The intranasal Schirmer test values of the convex (deviated) side were lower than that of the concave (non-deviated) side (20.71 and 23.35 respectively); although this difference was not statistically significant (p=0.054,). After excluding the four patients with equal Schirmer test results on both sides, 70% (34/48) of our patients had lower intranasal Schirmer test values on the deviated side. There was no statistically significant difference between the Schirmer test values of the patients with septal deviation and the volunteers without septal deviation (p>0.05).Conclusion:The Schirmer test values of the deviated sides were less than the values of the contralateral side in majority of our patients. This finding supports the negative effect of nasal septum deviation on nasal humidification, although the difference did not reach statistical significance

Dynamic thiol/disulphide balance in patients undergoing hypotensive anesthesia in elective septoplasties

Objective We aimed to investigate the effects of hypotensive anaesthesia on oxidative stress with serum thiol/disulphide balance in patients undergoing elective septoplasty procedures under general anaesthesia. Methods Seventy-two patients between the ages of 18-60, with a physical condition I -II, according to the American Society of Anesthesiologists, were included in this prospective observational study. Septoplasty was chosen for standard surgical stress. According to the maintenance of anaesthesia, patients were divided into the groups as Hypotensive Anaesthesia (n = 40) and Normotensive Anaesthesia (n = 32). Serum thiol/disulphide levels were measured by the method developed by Erel & Neselioglu. Results The native thiol and total thiol values of both groups measured at the 60th min intraoperatively were significantly lower than the preoperative values (both P 40 years and female gender were found to have a significant effect on dynamic oxidative stress (P = .002 and .001, respectively). Conclusion This pilot study has found that hypotensive anaesthesia had no adverse effect on dynamic thiol/disulphide balance in elective surgeries

Zonguldak Bölgesinde kömür madeni işçilerinde leptospiroz seroprevalansı

Amaç: Leptospiroz, dünya çapında en yaygın görülen zoonotik hastalıklardan birisidir. İnsanlara çoğunlukla fare dışkısı ve idrarıyla kontamine olan su ve toprakla temas sonucu mikroorganizmanın bütünlüğü bozulmuş deriden veya mukozadan vücuda girmesiyle bulaşır. Çiftçiler, çeltik işinde çalışanlar, kanalizasyon işçileri, maden işçileri, avcılar, askeri personel, gemiciler, çobanlar, süt sağıcıları, mezbaha işçileri, kasaplar, veteriner hekimler ve laboratuvar çalışanları leptospiroz açısından riskli meslek gruplarıdır. Bu çalışmada Zonguldak bölgesinde kömür madeni işçilerinde leptospiroz seroprevalansının belirlenmesi amaçlanmıştır. Yöntemler: Zonguldak ve Bartın illerindeki Türkiye Taşkömürü Kurumu’na bağlı 5 farklı kömür madeninde çalışan toplam 185 gönüllü maden işçisinden, 2013 Haziran-Temmuz aylarında kan örnekleri alınmıştır. Serum örnekleri -80°C’de saklanmıştır. Ayrıca maden işçilerinin yaş, yerleşim bölgesi, madende çalışma süresi, başka mesleklerle uğraşma, madende fare ve/veya fare pisliği görme, madende farelerin eşya ve/veya yiyecek içecekle temasını tespit etme ve madende el hijyeni gibi demografik ve epidemiyolojik verileri için anket yapılmıştır. Leptospiroz seroepidemiyolojik çalışmalarında referans test yöntemi olarak kullanılan mikroskopik aglütinasyon testi (MAT) Ankara Etlik Veteriner Kontrol Merkez Araştırma Enstitüsü Spiroket Hastalıkları Teşhis Laboratuvarı’nda Haziran 2014’te yapılmıştır. MAT ile 8 ayrı serotip için (Leptospira grippotyphosa Moskva V, L. australis Bratislava Jez Bratislava, L. canicola Hund Utrech IV, L. hardjo Hardjoprajitno, L. pomona Pomona, L. icterohaemorrÖzgün hagiae Ictero 1, L. hebdomadis Hebdomadis ve L. patoc Patoc 1) anti-Leptospira antikor düzeyleri araştırılmıştır. Bulgular: Tamamı erkek olan işçilerin yaş ortalamaları 36±6 yıl idi. Madende yeraltında çalışma süresi ortalama 11±6 yıl, yeraltında haftalık çalışma süresi ortalama 44±6 saat olarak saptandı. İşçilerin %18.9’u köyde, %50.3’ü ilçede, %30.8’i il merkezinde ikamet etmekteydi. İşçilerin %7.0’si çiftçilik, %2.7’si avcılık, %0.5’i gemicilik ve %0.5’i besicilik de yapmaktaydı. İşçilerin %82.7’si maden içerisinde her gün fare gördüklerini, %35.7’si madende fare pisliği gördüklerini ifade ettiler. İşçilerin %68.1’i madende kullandıkları giyeceklerde ve yiyecek-içecek kaplarında fare yeniği gördüklerini belirtiler. İşçilerin %91.9’u madene götürdükleri yiyecekleri yemek vaktine kadar poşet/kese kâğıdı içerisinde sakladıklarını bildirdiler. Madende işçilerin %76.2’sinin el temizliği yaptığı, bunların da %94.3’ünün sadece suyla el temizliği yaptığı saptandı. Leptospiroz açısından riskli bir ortam tanımlanmasına rağmen maden işçilerinin hiçbirinin serum örneğinde MAT ile seropozitiflik saptanmadı. Sonuçlar: Madenciler tarafından leptospiroz bulaşması açısından riskli bir ortam ve davranış modelleri tanımlanmakla birlikte, Zonguldak bölgesinde kömür madencilerinden toplanan 185 serum örneklerinde leptospiroz seropozitifliği saptanmadı

Inappropriate antimicrobial use in Turkish pediatric hospitals: A multicenter point prevalence survey

Objectives: Although well-defined principles of rational antimicrobial use are available, inappropriate prescribing patterns are reported worldwide. Accurate information on the usage of antimicrobials, including factors associated with and influencing their use, is valuable for improving the quality of prescription practices. Methods: In this cross-sectional point prevalence survey, data on patients hospitalized in 12 different children's hospitals were collected on a single day. Appropriateness of prescription was compared between the types of antimicrobials prescribed, indications, wards, and presence of/consultation with an infectious disease physician (IDP). Results: A total 711 of 1302 (54.6%) patients evaluated were receiving one or more antimicrobial drugs. The antimicrobial prescription rate was highest in pediatric intensive care (75.7%) and lowest in the surgery wards (37.0%). Of the 711 patients receiving antimicrobials, 332 patients (46.7%) were found to be receiving at least one inappropriately prescribed drug. Inappropriate use was most frequent in surgery wards (80.2%), while it was less common in oncology wards (31.8%; p < 0.001). Respiratory tract infection was the most common indication for antimicrobial use (29.4%). Inappropriate use was more common in deep-seated infections (54.7%) and respiratory infections (56.5%). Fluoroquinolones were used inappropriately more than any other drugs (81.8%, p = 0.021). Consultation with an IDP appears to increase appropriate antimicrobial use (p = 0.008). Conclusions: Inappropriate antimicrobial use remains a common problem in Turkish pediatric hospitals. Consultation with an IDP and prescribing antimicrobial drugs according to microbiological test results could decrease the inappropriate use of antimicrobials

Diagnosis of comorbid migraine without aura in patients with idiopathic/genetic epilepsy based on the gray zone approach to the International Classification of Headache Disorders 3 criteria

BackgroundMigraine without aura (MwoA) is a very frequent and remarkable comorbidity in patients with idiopathic/genetic epilepsy (I/GE). Frequently in clinical practice, diagnosis of MwoA may be challenging despite the guidance of current diagnostic criteria of the International Classification of Headache Disorders 3 (ICHD-3). In this study, we aimed to disclose the diagnostic gaps in the diagnosis of comorbid MwoA, using a zone concept, in patients with I/GEs with headaches who were diagnosed by an experienced headache expert.MethodsIn this multicenter study including 809 consecutive patients with a diagnosis of I/GE with or without headache, 163 patients who were diagnosed by an experienced headache expert as having a comorbid MwoA were reevaluated. Eligible patients were divided into three subgroups, namely, full diagnosis, zone I, and zone II according to their status of fulfilling the ICHD-3 criteria. A Classification and Regression Tree (CART) analysis was performed to bring out the meaningful predictors when evaluating patients with I/GEs for MwoA comorbidity, using the variables that were significant in the univariate analysis.ResultsLonger headache duration (&lt;4 h) followed by throbbing pain, higher visual analog scale (VAS) scores, increase of pain by physical activity, nausea/vomiting, and photophobia and/or phonophobia are the main distinguishing clinical characteristics of comorbid MwoA in patients with I/GE, for being classified in the full diagnosis group. Despite being not a part of the main ICHD-3 criteria, the presence of associated symptoms mainly osmophobia and also vertigo/dizziness had the distinguishing capability of being classified into zone subgroups. The most common epilepsy syndromes fulfilling full diagnosis criteria (n = 62) in the CART analysis were 48.39% Juvenile myoclonic epilepsy followed by 25.81% epilepsy with generalized tonic-clonic seizures alone.ConclusionLonger headache duration, throbbing pain, increase of pain by physical activity, photophobia and/or phonophobia, presence of vertigo/dizziness, osmophobia, and higher VAS scores are the main supportive associated factors when applying the ICHD-3 criteria for the comorbid MwoA diagnosis in patients with I/GEs. Evaluating these characteristics could be helpful to close the diagnostic gaps in everyday clinical practice and fasten the diagnostic process of comorbid MwoA in patients with I/GEs

An extremely rare coronary artery anomaly: Monster left anterior descending coronary artery

[No abstract available