A Comparison of the Autologous Platelet-Rich Plasma Gel Fat Graft Myringoplasty and the Fat Graft Myringoplasty for the Closure of Different Sizes of Tympanic Membrane Perforations

Objective: We aimed to evaluate the effect of autologous platelet-rich plasma gel (PRPG) on fat graft myringoplasty (FGM) in tympanic membrane perforations caused by chronic otitis media. Methods: This retrospective study involved 63 patients who underwent operations between 2015 and 2018. Fat graft myringoplasty was performed with the transcanal approach with and without the use of PRPG in the surgical field. The patients were classified into 2 groups: group A, which included 32 patients who underwent FGM with the use of autologous PRPG, and group B, which included 31 patients who underwent FGM alone. Tympanic membrane perforations were divided into 2 groups: small perforations (1-2 mm) in a single quadrant and large perforations (2-4 mm) in at least 2 quadrants. Results: Both groups were statistically matched regarding age and sex. The mean postoperative follow-up was 11.6 and 12.1 months for groups A and B, respectively. Four months postoperatively, the success rate of the graft in group A (100%) was significantly higher than that in group B (83.8%; P = .03). The preoperative and postoperative median air-bone gaps of the groups were similar (P = .653 and P = .198, respectively). No worsening of the air-bone gap was noted postoperatively in either group. Conclusions: This study demonstrated that autologous PRPG application during FGM allows for a higher success rate than FGM alone. Furthermore, the use of PRPG with FGM for large perforations increases the success rate. Further studies are needed to investigate the PRPG healing effect on other tympanic membrane perforation closure techniques

Rhinolith in the concha bullosa as a rare location: a case report

The presence of a rhinolith is a rare condition, which can cause long-standing symptoms, such as rhinorrhea, foul-smelling discharge, nasal obstruction, and headache. A rhinolith is usually easily diagnosed by a clinical examination and a paranasal computed tomographic scan. Rhinoliths are usually found in nasal cavities, but rare locations are also possible. We report a patient who was evaluated in our clinic for nasal obstruction, headache, and snoring symptoms. A clinical examination showed no major findings, but a paranasal computed tomographic scan of coronal sections showed a hyperdense mass within the right concha bullosa. A rhinolith in the concha bullosa is a rare condition. Our case is the third case of a rhinolith in the concha bullosa to be reported in the literature

COVİD-19 Pandemisi Sırasında Trakeostomi ve Trakeostomi Bakımı

Covid-19 pandemic is a global health problem that affects the whole world and can progress with asymptomatic or viral symptoms of pneumonia or cause severe acute respiratory failure. SARS-CoV-2 has spread much more widely and quickly than other viruses and has caused a significant number of life losses globally. Tracheostomy is a surgical procedure that is frequently performed by ENT and head & neck surgeons with various indications, and its implementation can facilitate weaning patients from mechanical ventilation, thereby potentially increasing the availability of beds in the intensive care unit (ICU). Since tracheostomy causes a large amount of aerosol formation, it is a serious risk process for the spread of covid-19 infection even if personal protective equipment (PPE) is used both during surgery and postoperative care. There is not enough experience on how to perform tracheotomy in Covid-19 patients. Therefore, thesurgical procedure and indications for tracheostomy should be revised during the covid-19 pandemic process. We aim to provide authoritative guidance for healthcare providers and healthcare systems by synthesizing our experience with tracheostomy, available evidence, and information in the literature data during the current COVID-19 pandemic.Covid-19 pandemisi tüm dünyayı etkisi altına alan, asemptomatik veya viral pnömoni semptomlarıyla seyredebileceği gibi ciddi akut solunum yetmezliğine de neden olabilen global bir sağlık problemidir. SARS-CoV-2, diğer virüslerden çok daha geniş ve hızlı bir şekilde yayılmıştır ve küresel olarak ciddi sayıda hayat kaybına yol açmıştır. Trakeostomi, KBB ve baş-boyun cerrahları tarafından çeşitli endikasyonlarla sıkça gerçekleştirilen cerrahi bir prosedürdür ve bu prosedürün uygulanması hastaları mekanik ventilasyondan ayırmayı kolaylaştırabilir ve böylece yoğun bakım ünitesindeki (YBÜ) yatakların kullanabilirliğini potansiyel olarak artırabilir. Trakeostomi yüksek miktarda aerosol oluşumuna neden olduğu için hem cerrahi sırasında hem de cerrahi sonrası bakım sırasında kişisel koruyucu ekipman (KKE) kullanılsa bile covid-19 enfeksiyonu yayılımı için ciddi risk oluşturan bir işlemdir. Covid-19 hastalarında trakeotominin nasıl yapılması gerektiği konusunda yeterli deneyim mevcut değildir. Bu yüzden covid-19 pandemisi sürecinde trakeostomi cerrahi prosedürü ve endikasyonları yeniden gözden geçirilmelidir. Mevcut COVID-19 pandemisi sırasında trakeostomi ile ilgili deneyimlerimizi, mevcut kanıtları ve literatürdeki bilgileri sentezleyerek sağlık hizmeti sağlayıcıları ve sağlık sistemleri için yetkili rehberlik sağlamayı amaçlıyoruz

Lifelong Learning As a Necessity, Progress, Durableness and Incentive Tool: Metaphoric Perceptions

DergiPark: 460003tredThis study examined the metaphorical perception of master students about lifelonglearning term. In this context, phenomenology pattern which is a qualitativeresearch model was used as the research model. The study group was determinedwith sampling criteria which is one of the purposeful sampling methods.Therefore, 31 postgraduate students who have distance education at SakaryaUniversity Institute of Education Sciences occupied in the study group. Asemi-structured interview form was developed by the researchers for collectingdata. Some measures were taken in order to ensure trustworthiness, and somemethods were applied in order to consider confirmability, credibility,dependability and transferability criteria. The data were analyzed with contentanalysis method. After this analysis, totally 31 different metaphors aboutlifelong learning were developed. The metaphors were categorized according totheir rationales. Based on these rationales, four categories were made in whichrequirement, development, continuity and encouragement categories existed. Inthe light of these findings, the results were produced, and the discussionswere made. After then, some suggestions were presented for future authors andstudies.Bu çalışma katılımcıların yaşamboyu öğrenme kavramına ilişkin metaforikalgılarını ortaya koymayı amaçlamaktadır. Bu kapsamda, araştırma modeli nitelaraştırma modellerinden fenomenoloji deseni ile tasarlanmıştır. Çalışmagrubunun belirlenmesinde, amaçlı örneklem yöntemlerinden biri olan kriterörneklem tercih edilmiştir. Bu kapsamda, çalışma grubu Sakarya ÜniversitesiEğitim Bilimleri Enstitüsünde uzaktan eğitim alan 31 yüksek lisansöğrencisinden oluşmaktadır. Verilerin toplanma için araştırmacılar tarafındanbir yarı yapılandırılmış görüşme formu geliştirilmiştir. Çalışma kapsamında,geçerlik ve güvenirliği sağlamak adına inanırlık, aktarılabilirlik,güvenilebilirlik ve onaylanabilirlik ölçütleri göz önünde bulundurularak bazıtedbirler alınmıştır. Çalışma grubundan elde edilen verilerin analizinde içerikanalizi yöntemi kullanılmıştır. Katılımcıların yaşamboyu öğrenme ile ilgilitoplam 31 farklı metafor geliştirdiği görülmüştür. Bu metaforlar gerekçelerinegöre incelenmiş ve sonrasında bu gerekçeler üzerinden gereklilik, gelişim,süreklilik ve teşvik şeklinde dört kategori oluşturulmuştur. Bu bağlamda, eldeedilen bulgulara dayalı olarak sonuç ve tartışma belirtilmiş; ayrıca yaşamboyuöğrenmenin bu dört yönü vurgulanarak öneriler sunulmuştur

A new horizon in the treatment of biofilm-associated tonsillitis

Objective: To demonstrate the efficacy of tonsil brushing in patients with chronic tonsillitis to remove the microbial biofilm on the tonsil surface using an in vitro model. Design: Specimens from patients undergoing tonsillectomy were evaluated prior to and following surface cleaning methods, including rinsing and brushing, using scanning electron microscopy (SEM). Patients: The study population consisted of 25 randomly selected patients with chronic tonsillitis. Interventions: Specimens were collected and divided into four portions. Each portion received distinct surface cleaning methods and was immediately fixed for SEM examination. Outcome measures: The biofilm layer on the surface of the tonsils was examined using SEM. The density of the biofilm layer and the degree of persistence of the biofilm after rinsing and brushing were measured. Results: The surface biofilm of the tonsils in the first group, which were neither brushed nor rinsed, revealed a thick layer of biofilm on the mucosal surface. The second group of tonsils, which were only rinsed, also showed a thick layer of biofilm. The third group of tonsils, which were rinsed following gentle brushing using a soft toothbrush, showed a reduction in the thickness of the biofilm layer. The fourth group of tonsils, which were brushed with a hard brush, was almost devoid of a biofilm layer. Conclusion: Our results demonstrate that rinsing does not effectively remove the biofilm layer on the tonsil surface. The use of a harder brush was identified as a more powerful means of removing biofilm compared with a soft brush

Comparison of two hematocrite measurement methods in diarrheic neonatal calves

Bu çalışmada veteriner hekimlikte sıklıkla kullanılan hücre sayımı temel prensipli ve amperometrik yöntem ile ölçüm yapan iki farklı hematokrit ölçüm tekniğinin karşılaştırılması amaçlandı. Farklı etiyolojileri bulunan her iki cinsiyetten toplam 84 neonatal ishalli buzağı çalışmaya dahil edildi. Hematokrit ölçümleri için buzağılardan lityum heparin içeren kan gazı enjektörlerine ve tüplere kan örnekleri, toplamda 4 ml olacak şekilde alındı. Hematokrit ölçümleri için Abacus Junior Vet 5 kan sayım cihazı ve Irma Truepoint kan gazı analiz cihazından yararlanıldı. Linear regresyon analizi ve pearson korelasyonu sonuçlarına göre hematokrit ölçümlerinden elde edilen verilerin her iki ölçüm tekniği arasında r=0.90 (p<0.000) düzeyinde pozitif yönde korelasyona sahip olduğu, ancak iki test tekniğinin ortalama değerleri arasında istatistiksel yönden farklılıkların bulunduğu belirlendi. Passing-bablok regresyon analizinde ise y= 0.88x+1.81 denklemi elde edildi. Çalışma sonuçlarına göre, klinikte yoğun şekilde yapılan hematokrit ölçümlerinin değerlendirilmesinde her iki ölçüm tekniğinden yararlanılabileceği ancak iki ölçüm metodu arasında farklılıkların bulunmasına bağlı olarak hasta hayvanlarda şüpheye düşüldüğü durumlarda klasik santrifüj yöntemine dayalı mikrohematokrit ölçümlerinin yapılması gerektiği sonucuna varıldı.In this study, it was aimed to compare two different hematocrit measurement techniques which are commonly used in veterinary medicine by cell count, and amperometric method. A total of 84 neonatal diarrheic calves from both sexes with different etiologies were included in the study. For hematocrit measurements, blood samples (4 ml) were taken to blood gas injectors and tubes containing lithium heparin from calves. The Abacus Junior Vet 5 whole blood cell counter and Irma True Point blood gas analyzer were used for hematocrit measurements. According to the results of linear regression analysis and Pearson correlation, it was determined that the data obtained from the hematocrit measurements had positive correlations between r = 0.90 (p <0.000) between the two measurement techniques, but statistically significant differences were found between the mean values of the two test techniques. In Passing-bablok analysis y= 0.88x+1.81 equation was found. According to the results, both measurements can be utilized in assessing hematocrit measurement, but in case of the difference between the two measuring methods, it was concluded that suspected cases should be made based on the conventional measurement microhematocrit centrifugation

Success rates, complications and causes for replacement of primary provox voice prothesis

Amaç: Provox ses protezinin konuşmadaki başarı oranını, insitu ömrünü, oluşan komplikasyonları ve protezin değiştirilme nedenlerini araştırmaktır. Ek olarak başarı oranıyla cerrahi uygulama ve radyoterapi arasındaki ilişkiyi saptamaktır. Yöntem: 32 hastaya total larenjektomi ile eş seanslı trakeoesofageal fistül işlemi ile Provox ses protezi uygulandı. Bu hastaların 9’una yalnızca total larenjektomi, 23’üne total larenjektomi ile beraber boyun diseksiyonu ve bu 23 hastadan 17’sine de boyun diseksiyonu sonrasında bir ay süre ile radyoterapi uygulandı. Hiçbir hastaya krikofarengeal myotomi uygulanmadı. Bulgular: Protez uygulanan 32 hastanın 19’u (% 59) başarılı konuşmakta, 8’i (%25) konuşamıyor ve 5’i (% 16) kalitesiz konuşmaktaydı. Konuşma protezinin ömrü en kısa 20 gün ve en uzun 20 ay olup ortalama 8.5 ay olarak bulundu. Protez değişiminin en sık iki nedeni, protez içinden sıvı gelmesi ve/veya protez çevresinden saliva gelmesi idi. Majör komplikasyon gözlenmedi. En sık gözlenen minör komplikasyon protezde mantar kolonizasyonu idi. Uygulanan cerrahi protokolün (total larenjektomi, total larenjektomi ile beraber boyun diseksiyonu ve radyoterapi) ses protezi ile konuşabilme başarısını etkilemediği saptandı. Radyoterapinin uzun dönemde konuşmanın üzerine olumsuz etkisi görülmemekle beraber trakeoesofageal fistülde genişleme (%18.8) ve migrasyon (%4) komplikasyonunu arttırdığı gözlendi. Boyun diseksiyonu uygulanan hastalarda konuşma becerisi olumsuz etkilenmemekle beraber konuşma egzersizlerine başlama 20. güne uzamakta idi. Sonuç: Trakeoesofageal fistül ile primer provox ses protezi tatbiki başarı oranı yüksek ve komplikasyon oranı düşük, basit ve kısa sürede uygulanabilen yararlı bir ses rehabilitasyonu yöntemidir. Radyoterapinin ve boyun diseksiyonunun uzun dönemde provox ses protezi ile konuşma üzerine olumsuz etkisi bulunmamaktadır.Objective: To analyze the speech success, in situ lifetime, causes for replacement and the complications encountered in Provox Voice Prosthesis rehabilitation. In addition, to determine the relationship between the rate of speech success and surgical procedure and radiation therapy. Methods: A total of 32 male patients managed with Provox Voice Prosthesis voice rehabilitation were included. Nine patients underwent total laryngectomy and 23 patients underwent total laryngectomy combined with neck dissection. The indwelling Voice Prosthesis were inserted immediately at the time of primary tracheoesophageal puncture. Pharyngoesophageal myotomy was not performed. Seventeen patients were managed with postoperative radiotherapy. Results: Nineteen of 32 patients (59%) demonstrated successful speech, eight patients (25%) were found to be aphonic and five patients (16%) demonstrated less successful speech. The mean in situ lifetime of the Voice Prosthesis was 8.5 months (range; 20 days - 20 months). The most common causes for Voice Prosthesis replacement were; leakage of saliva around the prosthesis and leakage through the prosthesis. There was no major complication and the most common minor complication was fungus colonization on the prosthesis. Surgical procedure (total laryngectomy alone, total laryngectomy in combination with neck dissection and postoperative radiotherapy) was found to have no effect on speech success. Enlargement of the tracheoesophageal fistula (18.8%) and migration (4%) were more common in the patients who received postoperative radiotherapy. Phonation exercises were delayed until 20th day postoperatively in the patients who underwent neck dissection. Conclusion: Primary Provox voice prosthesis insertion via trachea-esophageal fistula is an easy and useful rehabilitation method with high success and low complication rates. Radiotherapy and neck dissection have no long term negative effect on speech success of Provox voice prosthesis

Update of Laryngeal Transplantatıon in 2014

The idea of substituting the non-functioning human larynx with another one insipired many researchers and numerous studies associated with this topic have been performed so far. Following operations performed due to malignancies, the survival rates of the patients increased and hence quality of life became gradually more important. This is especially important for laryngectomees who had increased life spans due to of progresses in medical and surgical treatment of laryngeal cancer. As a consequence, the idea of performing a laryngeal transplantation to improve the quality of life is becoming more substantial. In this review, we aimed to recall the history of the laryngeal transplat procedure, overview the indications and ethico-medico-legal issues and discuss the opinions related with the future of the procedure in details

The genetic history of the Southern Arc: a bridge between West Asia and Europe

By sequencing 727 ancient individuals from the Southern Arc (Anatolia and its neighbors in Southeastern Europe and West Asia) over 10,000 years, we contextualize its Chalcolithic period and Bronze Age (about 5000 to 1000 BCE), when extensive gene flow entangled it with the Eurasian steppe. Two streams of migration transmitted Caucasus and Anatolian/Levantine ancestry northward, and the Yamnaya pastoralists, formed on the steppe, then spread southward into the Balkans and across the Caucasus into Armenia, where they left numerous patrilineal descendants. Anatolia was transformed by intra–West Asian gene flow, with negligible impact of the later Yamnaya migrations. This contrasts with all other regions where Indo-European languages were spoken, suggesting that the homeland of the Indo-Anatolian language family was in West Asia, with only secondary dispersals of non-Anatolian Indo-Europeans from the steppe