Tetramethylpyrazine Attenuates Radiation-Induced Ototoxicity in a Rat Model.

INTRODUCTION: Tetramethylpyrazine (TMP) is a chemical compound, which has been shown to possess numerous biological features such as anticoagulation, inhibition of platelet aggregation, anti-inflammation, capillary dilatation, improvement in microcirculation, and protection against reactive oxygen radicals. The aim of the present study was to investigate the protective effect of TMP against radiation-induced ototoxicity. MATERIALS AND METHODS: 40 rats were divided into four groups. The first group was irradiated for 5 days. The second group received a single dose of 140 mg/kg/day intraperitoneal TMP given to the rats 30 min before radiotherapy (RT) for 5 days. The third group received a single dose of 140 mg/kg/day i.p. TMP for 5 days, whereas the fourth group was administered saline. All rats underwent distortion product otoacoustic emission (DPOAE) and auditory brainstem response measurements before and after the application. The temporal bulla of animals was removed for immunohistopathological examination. RESULTS: Signal-noise ratio values were significantly decreased in the RT group for the frequencies of 2-32 kHz after RT (p < 0.05), whereas the difference was not significant in terms of pre- and posttreatment values for the other groups. Also in the RT group, the ABR thresholds were significantly increased after treatment. In H&E staining, the mean scores for outer hair cells (OHCs), stria vascularis (SV), and spiral ganglion (SG) injuries were significantly higher in RT and RT + TMP groups than in the other groups. The mean OHCs and SV injury scores were also significantly higher in the RT group than in the RT + TMP group (p < 0.05). The number of cochleas that showed cytoplasmic caspase-3 immunoreactivity in the OHC, SV, and SG was significantly higher in RT and RT + TMP groups than in the other groups. CONCLUSION: The findings of the present study suggest that TMP may have a therapeutic potential for preventing sensorineural hearing loss (SNHL) related to RT.

Novel Thioether-Bridged 2,6-Disubstituted and 2,5,6-Trisubstituted Imidazothiadiazole Analogues: Synthesis, Antiproliferative Activity, ADME, and Molecular Docking Studies.

In this study, starting from 2-amino-1,3,4-thiadiazole derivatives (3-5), a new series of 2,6-disubstituted (compounds 7-15) and 2,5,6-trisubstituted (compounds 16-33) imidazo[2,1-b][1,3,4]-thiadiazole derivatives were synthesized using cyclization and Mannich reaction mechanisms, respectively. All synthesized compounds were characterized by 1 H-NMR, 13 C-NMR, FT-IR, elemental analysis, and mass spectroscopy techniques. Also, X-ray diffraction analysis were used for compounds 4, 7, 11, 17, and 19. The cytotoxic effects of the new compounds on the viability of colon cancer cells (DLD-1), lung cancer cells (A549), and liver cancer cells (HepG2) were investigated using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) method in vitro. Compound 15 was found to be the most potent anticancer drug candidate in this series with an IC50 value of 3.63 µM against HepG2 for 48 h. Moreover, the absorption, distribution, metabolism, and excretion (ADME) parameters of the synthesized compounds were calculated and thus, their potential to be safe drugs was evaluated. Finally, to support the biological activity experiments, molecular docking studies of these compounds were carried out on three different target cancer protein structures (PDB IDs: 5ETY, 1M17, and 3GCW), and the amino acids that play key roles in the binding of the compounds to these proteins were determined.

Secukinumab may be remedy for systemic amyloidosis findings secondary to hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is a chronic relapsing inflammatory disease of follicular epithelium; many comorbidities occur that disrupt the quality of life of patients. Amyloidosis is one of them. We present a case with systemic amyloidosis secondary to HS and responding positively to secukinumab therapy. Secukinumab may also be an important option for amyloidosis findings in HS patients.

An Unusual Bullet Trajectory: Entered Through the Face and Ended Up in the Neck.

The authors describe a case of gunshot injury in a 26-year-old male patient with an unusual bullet trajectory. The bullet had an entry hole just near the right lateral alar cartilage of the nose, and the trajectory descended through the left side of the neck by route of the hard palate, soft palate, and posterior pharyngeal wall, respectively. Surgical removal of the bullet was achieved with neck exploration. Gunshot injuries of the head and neck necessitate a thorough clinical and radiological evaluation due to the possibility of an unusual bullet trajectory.

Effects of propolis in an experimental rat model of allergic rhinitis.

PURPOSE: The aim of this study was to determine the anti-allergic activity of propolis in an ovalbumin-induced rat model of allergic rhinitis. MATERIALS AND METHODS: This prospective experimental study was conducted at Hakan Çetinsaya Clinical and Experimental Animal Research Center with 30 rats. After sensitization of all rats with 0.3mg intraperitoneal ovalbumin plus 30mg aluminum hydroxide for 14days (first phase), rats were divided to five groups. In the second phase of the study 10µL of ovalbumin was applied to each nostril for 21days. Together with second phase, ketotifen (n:6), oral propolis (n:6), intranasal propolis (n:6) and intranasal mometasone furoate (n:6) were given to rats. A control group (n:4)(salin) and sham group (n:2) were planned. Symptoms were assessed on days 19, 22, 25, 30 and 35, resulting in 5 symptom scores: symptom scores 1-5. On day 35, nasal tissue was removed and histological examination was performed. RESULTS: When rats that received systemic and intranasal propolis were compared to controls, ciliary loss, inflammation, increase in goblet cells, vascular proliferation, eosinophil count, chondrocytes and allergic rhinitis symptom score were found to be decreased (p<0.05). CONCLUSIONS: It was found that propolis had anti-allergic effects on allergic symptom scores and nasal histology.

Protective role of misoprostol against cisplatin-induced ototoxicity.

Cis-diammineedichloroplatinum (cisplatin) is a chemotherapeutic agent that is widely used in the treatment of many cancers. Nephrotoxicity, ototoxicity and neurotoxicity are dose-limiting adverse effects for cisplatin. The cellular and molecular mechanisms underlying cisplatin-induced ototoxicity aren't fully understood. It has been proposed that cisplatin primarily cause damage at the cochlea, outer hair cells in particular, leading to excessive production of free oxygen radicals in the organ of Corti, stria vascularis, spiral ligament, and spiral ganglionic cells. The cytotoxicity is associated with the generation of reactive oxygen species (ROS); thus, there is an increasing interest on antioxidants with an effort to discover the established protection against cisplatin-induced ototoxicity over time. Misoprostol (MP) has gained considerable interest as a reactive oxygen species scavenger in recent years. To best of our knowledge, there is no study about protective effect of MP, a prostaglandin E1 (PGE1) analogue, on cisplatin-induced ototoxicity. In our study, we show that protective effects of misoprostol on cisplatin-induced ototoxcity on rats.

Cervical and ocular vestibular evoked myogenic potentials in Behcet's disease.

OBJECTIVE: To investigate vestibular evoked myogenic potentials combined with audiologic status in Behcet's disease (BD) and to compare the results with normal healthy subjects. METHODS: Cervical vestibular evoked myogenic potential (cVEMP) test, ocular vestibular evoked myogenic potential (oVEMP) test, Dix-Hallpike test, conventional pure tone audiometry (cPTA) and high frequency audiometry (HFA), and 226 and 1000Hz tympanometry were performed to each subject of the study. Cranial magnetic resonance imaging (MRI) with contrast enhancement was also performed to evaluate the central nervous system (CNS) in patients with BD. RESULTS: VEMP parameters including the mean peak latencies of p13-n23 and n10-p15, AR values and thresholds were not statistically different both in cVEMP and oVEMP between the BD and control groups. Except for 250Hz, mean audiological thresholds were significantly higher in the BD group. Five of the 20 patients had pathological cranial MRI findings that may be compatible with central nervous system involvement. CONCLUSION: To our knowledge, the present study is the first report investigating oVEMP and cVEMP responses combined with MRI findings in patients with BD. The presence of high frequency hearing loss is a common finding in BD and HFA may help early detection of hearing loss in patients with BD when combined with cPTA.

The Efficacy of Levobupivacaine Hydrochloride-Dexamethasone Infiltration for Post-Tonsillectomy Pain in Adults.

OBJECTIVE: The aim of the study is to evaluate the efficacy of peritonsillar infiltration of a levobupivacaine hydrochloride and dexamethasone combination for post-tonsillectomy pain in adult patients. METHODS: A total of 40 patients were included in this double-blind, randomized, and placebo-controlled study. The patients were equally randomized into 2 groups by means of sealed envelopes. The study group (SG) received peritonsillar levobupivacaine hydrochloride and dexamethasone infiltration and the control group (CG) received peritonsillar saline infiltration. Pain scores at the second, fourth, eighth, 12th, 16th, and 24th hours and the second to seventh days after operation were recorded by the patients in each group using a visual analog scale. Duration of surgery and the total amount of blood loss during the surgery were also recorded for each patient. RESULTS: All pain scores in the SG were lower than those in the CG; however, the difference was significant at the second, 12th, and 16th hours, and the second and third day (P < 0.05). Postoperative morbidity parameters, including otalgia, nausea, vomiting, fever, halitosis, and bleeding were similar between the 2 groups. Total amount of analgesic consumption in the SG was significantly lower than in the CG on each day of the week after tonsillectomy. CONCLUSIONS: Peritonsillar infiltration of a levobupivacaine hydrochloride and dexamethasone combination may provide pain reduction and decrease analgesic consumption in the postoperative period after adult tonsillectomy.

The protective role of thymoquinone in the prevention of gentamicin ototoxicity.

OBJECTIVE: To investigate the potential protective effect of thymoquinone in gentamicin-induced ototoxicity through auditory brain stem responses (ABR) testing and histomorphological evaluation of the cochlea. METHODS: This study was conducted on 48 adult female Sprague-Dawley rats that were randomized into 4 groups. Group 1 received intraperitoneal gentamicin; group 2 received intraperitoneal gentamicin plus corn oil solution; group 3 received intraperitoneal thymoquinone; and group 4 received intraperitoneal gentamicin plus thymoquinone. All groups received the drugs (once daily) in the above-mentioned protocols over 15 days. After conducting repeated ABR measurements, the rats were sacrificed, and their cochleae were isolated. RESULTS: ABR thresholds were preserved in the gentamicin plus thymoquinone group when compared with the group receiving gentamicin alone. There were fewer TUNEL-positive cells and caspase-3 and caspase-9 expressions were weaker in the inner and outer hairy cells of the organ of Corti in the gentamicin plus thymoquinone group compared with the group receiving gentamicin alone. CONCLUSION: The ABR values and number of apoptotic cells did not significantly increase in the group receiving gentamicin plus thymoquinone when compared to the group receiving gentamicin alone. Again, the cochlear histomorphological findings were supportive of the auditory findings. In light of these findings, we conclude that gentamicin-induced ototoxicity may be prevented by thymoquinone use in rats.

Incidence of hypothyroidism and its correlation with polysomnography findings in obstructive sleep apnea.

The aim of this study is to investigate the thyroid functions and its correlation with polysomnography findings in obstructive sleep apnea patients. This study was conducted on 203 patients evaluated with the complaints of snoring, witnessed apnea and daytime sleepiness and established polysomnography (PSG) indication between May 2008 and August 2011. All patients' nocturnal PSG recordings were carried out. The thyroid function was classified as euthyroid, subclinical hypothyroidism and clinical hypothyroidism after analyzing serum TSH and free T4 values. The correlation between the data obtained from PSG records and thyroid function values was statistically compared. Apnea hypopnea index obtained from PSG was in the range of 5.4-132.9/h, and mean value was 32.7/h. The lowest oxygen saturation level was in the range of 20-92 %, and the mean value was 76.4 %. According to PSG results, 55 patients (27.09 %) had mild obstructive sleep apnea syndrome (OSAS), 48 patients (23.65 %) had moderate OSAS and 100 patients (49.26 %) had severe OSAS. On evaluation of the thyroid function test results, 10.8 % (n = 22) of the patients were defined to have subclinical hypothyroidism and 1.97 % (n = 4) clinical hypothyroidism. We found a total of 12.77 % subclinical and clinical hypothyroidism in patients with OSAS. Though the incidence of hypothyroidism was pretty high in patients with OSA, there was no statistically significant correlation between thyroid functions and polysomnography findings. We suggest that evaluation of the thyroid functions is important and necessary in patients with OSAS. Polysomnography findings do not correlate statistically with thyroid function tests, addressing the need for thyroid screening for all OSAS patients.

Imidazole-Derived Alkyl and Aryl Ethers: Synthesis, Characterization, In Vitro Anticancer and Antioxidant Activities, Carbonic Anhydrase I-II Inhibition Properties, and In Silico Studies.

Imidazole derivatives display extensive applications in pharmaceutical chemistry and have been investigated as bioactive compounds for medicinal chemistry. In this study, besides the starting materials (3a-c and 4a-c), synthesis, characterization, and biological activity studies were conducted on a total of 18 compounds, nine of which are known and the other nine are original. The compounds investigated in the study are a series of alkyl (7-15) and aryl (16-24) ether derivatives bearing substituted phenyl and imidazole rings, which were characterized using various methods including 1H NMR, 13C NMR, FT-IR analysis, elemental analysis, and mass spectroscopy. Computer-aided drug design studies have been carried out to predict the biological activities of compounds. Besides DFT calculations, the binding affinities of the compounds to EGFR, VEGFR2, FGFR1, HSP90, hCA I, and hCA II were investigated. Additionally, drug-likeness and ADME analyses were performed on the compounds. Anticancer, antioxidant, and enzyme inhibition activity tests were performed in biological activity studies on the synthesized compounds. Among the synthesized compounds, compounds 17 and 19-24 generally exhibited inhibition profiles against the widespread cytosolic hCA I isozyme with IC50 values ranging from 4.13 to 15.67 nM and cytosolic hCA II isozyme with IC50 values ranging from 5.65 to 14.84 nM. L929 (mouse fibroblast cell line) was used as the control healthy cell line, and MCF7 (breast cancer), C6 (rat glioblastoma), and HT-29 (colon cancer) cells were used in cell culture studies as cancer cell lines. Before the study on cancer cells, all compounds were examined on healthy cells, and their cytotoxicity was determined. As a result of these data, studies continued with six compounds determined to be nontoxic. On cancerous cells, it was determined that compounds 3a, 3b, 4a, 4b, 4c, and 7 had cytotoxic effects on both colon cancer and brain tumors. It was found that compound 3b had a more toxic effect than cisplatin on the glioma cell line with an IC50 value of 10.721 ± 0.38 µM, and compound 3a had a more toxic effect on the colon cancer cell line with an IC50 value of 20.88 ± 1.02 µM. However, it was determined that the same compounds did not have a statistically significant effect on breast cancer. Flow cytometry studies also showed that when the IC50 dose of compound 3b was applied to the C6 cell line, the cells tended to early and late apoptosis. Additionally, it has been shown by flow cytometry that the cell cycle stops in the G0/G1 phase. A similar effect was observed in the colon cancer cell line with compound 3a. Compound 3b caused early and late apoptosis of the colon cancer cell line with the applied IC50 dose and stopped the cell cycle in the G0/G1 phase. Finally, the FRAP method studied all synthesized compounds' antioxidant effects. According to the measured antioxidant power results, it was determined that no compound had a more effective reducing power than vitamin E.

Investigation of lateral pharyngeal walls in OSAS.

The aim of this study is to investigate the relationship between the site of obstruction detected on Müller's maneuver and the polysomnography findings in patients with obstructive sleep apnea syndrome. This study is a prospective cohort study in a setting of Tertiary referral center. The study was performed on 87 patients (59 males and 28 females) with a mean age of 50 ± 10.34 years (range 20-83 years) who presented with the complaints of snoring, apnea, witnessed apnea and daytime sleepiness. The height and body weight of the enrolled patients were measured and the body mass indexes were calculated. The obstruction degrees of the soft palate and lateral pharyngeal walls at the level of the soft palate and the obstruction degrees of the tongue base and lateral pharyngeal walls at the level of the tongue base were determined using the Müller's maneuver. All patients underwent whole-night polysomnography at our hospital's Sleep Center. The apnea-hypopnea index values of the patients increased as their ages and body mass index values increased. There was a highly statistically significant correlation between apnea-hypopnea index and the obstruction degree of the lateral pharyngeal walls at the level of the tongue base on Müller's maneuver (p < 0.01). We found that the apnea-hypopnea index increased as the obstruction degree of the lateral pharyngeal walls increased on Müller's maneuver. In patients with obstructive sleep apnea syndrome, a high apnea-hypopnea index can be predicted if the obstruction degree of the lateral pharyngeal walls is high at the level of the tongue base on Müller's maneuver.

Evaluation of treatment efficacy in patients with minimal nasal septum deviation and concha bullosa using the nasal obstruction symptom evaluation scale.

OBJECTIVES: This study aims to compare the treatment efficacy of middle turbinate lateral lamella resection alone with septoplasty plus middle turbinate lateral lamella resection for nasal stuffiness in two patient groups using the nasal obstruction symptom evaluation (NOSE) scale in patients with concomitant minimal nasal septum deviation and concha bullosa. PATIENTS AND METHODS: A total of 80 patients who had minimal nasal septum deviation and concha bullosa at the middle turbinate were included in this study. Of these patients, 40 patients underwent middle turbinate lateral lamella resection, while 40 patients underwent middle turbinate lateral lamella resection plus septoplasty under general anesthesia. Complaints of nasal stuffiness in patients included were evaluated with the NOSE scale before the operation and three months after the operation. RESULTS: When preoperative and postoperative NOSE scale parameters were compared, all parameters statistically significantly improved postoperatively in both groups (p<0.05). The total NOSE scores were decreased significantly after surgery. CONCLUSION: Middle turbinate lateral lamella resection alone is as efficient as septoplasty plus middle turbinate lateral lamella resection for the treatment of symptomatic nasal stuffiness in selected patients.

[Inconsistency of the Epworth sleepiness scale results with the polysomnography findings in patients with sleep-disordered breathing]. / Uykuda solunum bozuklugu olan hastalarda Epworth uykululuk skalasi sonuçlarinin polisomnografi bulgulari ile uyumsuzlugu.

OBJECTIVES: This study aims to investigate the consistency of Epworth sleepiness scale (ESS) results and polysomnography (PSG) findings in the patients with sleep-disordered breathing (SDB). PATIENTS AND METHODS: A total of 109 patients (68 males, 41 females; mean age 48.6 years; range 20 to 77 years) who were admitted with the complaints of apnea, witnessed apnea and daytime sleepiness were included. The correlation among age, body mass index (BMI), and ESS and PSG findings were assessed. RESULTS: There was a positive and statistically significant correlation between the age and apnea-hypopnea index (AHI) (p<0.01). We observed that AHI figures increased with increasing age. There was also a positive and statistically significant correlation between the BMI and AHI (p<0.05). We found that AHI increased in parallel with BMI increase. There was, no statistically significant correlation among the AHI results based on the ESS assessment, the percentage of sleep under 90% of saturation, and the Arousal index (AI). CONCLUSION: The responses to the questions in the ESS may vary from individual to individual, depending on the socio-cultural and economic status. We believe, therefore, that a new Turkey-based questionnaire considering the lifestyle of our population would offer more useful information about sleep disordered breathing.

Objective Evaluation of Smell and Taste Senses in COVID-19 Patients.

Objective: The severe acute respiratory syndrome-coronavirus-2 pandemic is one of the largest of the recent times and can cause many symptoms including smell and taste disorders. In the literature, smell disorders caused by coronavirus disease-2019 (COVID-19) have been reported within a wide range from 3.2% to 98.3%. A small number of these studies demonstrated smell and taste disorders through objective tests. Our aim in this study was to determine the prevalence of smell and taste disorders in hospitalized patients due to COVID-19 infection. Methods: The study was carried out with 100 patients who were positive for real-time polymerase chain reaction and treated at the Kayseri City Hospital, and 100 healthcare worker relatives. We used the Connecticut Chemosensory Clinical Research Center test to evaluate the sense of smell. Sense of taste was evaluated using four different standardized bottles of preparations, and the results were scored according to the patients' statements. Results: Patient (Group 1) and control (Group 2) groups were compared for age, gender, smell and taste disorders. There were 39 women and 61 men in the patient group, and 40 women and 60 men in the control group. Mean age was 50.2±1.37 (range 21-70) years in Group 1 and 47.6±1.25 (range 18-70) years in Group 2, and there was no significant difference between the two groups. While the rate of smell disorder was 80% in Group 1, we found this rate as 35% in Group 2. Taste disturbance was identified in 38 patients, of whom 16 had mild hypogeusia, 17 had moderate hypogeusia, four had severe hypogeusia, and one patient had ageusia. We found that taste disorder was 38% in Group 1 and 3% in Group 2. Conclusion: Smell and taste dysfunctions are very common symptoms in COVID-19 patients. The results obtained using objective test methods are higher than the rates obtained from patient statements.

Comparison of glass ionomer cement and incus interposition in reconstruction of incus long process defects.

The ossicles may be affected through the mass effect of the pathological tissue in chronic otitis media. Ossicular reconstruction may be accomplished using the patients' own ossicles or with alloplastic materials. Glass ionomer ossiculoplasty is a fast, efficient, safe and cost-effective method and it has been used more frequently in recent years. Forty-six patients who had surgery for chronic otitis media were included in this study. All patients had an incus long process defect and a normal stapes superstructure. Ossicular reconstruction was performed using glass ionomer cement (GIC) (Ketac-Cem, Espe Dental AG, Seefeld, Germany) in 23 patients (group 1), while incus interposition was performed in other 23 patients (group 2). Preoperative and postoperative air pure tone averages of the group 1 patients were 42.8 and 35.2 dB, respectively (p < 0.01). These values were 42.9 and 34.5 dB in group 2 (p < 0.01). Two groups were similar with respect to postoperative hearing gain (p > 0.05). The air bone gap of group 1 was 27 dB preoperatively and 20.7 dB postoperatively. These values were 28.7 and 20.2 dB, respectively, in group 2. The closure of air bone gap was statistically significant in both the groups (p < 0.01, p < 0.01). The comparison of the mean gains of the air bone gap revealed no difference between the groups (p > 0.05). In conclusion, the use of both GIC ossiculoplasty and incus interposition are efficient methods for reconstruction of incus long process and one is not superior to the other. A larger study population may be useful for comparison of these methods.

Protective role of lycopene in experimental allergic rhinitis in rats.

OBJECTIVE: We investigate whether lycopene has a protective effect in an experimental rat model of allergic rhinitis. METHODS: Experimental animals (65 rats) were randomized to 7 groups (Sham-Control, Lycopene 10 mg/kg/day, Lycopene 20 mg/kg/day, Intranasal lycopene drops, Intranasal steroid, Corn oil, Allergic Rhinitis). Rats were sensitized by administering of ovalbumin intraperitoneally and intranasally. In addition to ovalbumin; lycopene, corn oil and steroids were given to the relevant groups. Nasal symptom scores of the rats were recorded throughout the study. At end of the study, after intracardiac blood sample collection, all rats were sacrificed, and nasal tissues were examined histopathologically. Serum total immunoglobulin E (IgE) and ovalbumin (OVA) specific IgE were studied from all rats before and after the study. RESULTS: There was a statistically significant increase (p < 0.05) in OVA specific IgE values measured before and after the study in all groups except the sham group. In serum total IgE values; there was a statistically significant increase after treatment in allergic rhinitis, corn oil, lycopene 10 mg and intranasal lycopene drops group, but other groups did not show any significant change. Histopathological study with hematoxylin-eosin staining and cyclooxygenase-2 (COX-2), matrix metalloproteinase-9 (MMP-9), vasoactive intestinal peptide (VIP) expression found that lycopene suppresses inflammation with both nasal administration and increased dose. Nasal symptom scores were observed to decrease significantly in all lycopene and steroid groups compared to allergic rihinits and corn groups. CONCLUSION: It was determined that lycopene were effective in the treatment of allergic rhinitis, and this effect was found to be stronger with increasing doses of lycopene.

Prognostic Value of Fibrinogen/HDL Ratio in Idiopathic Sudden Sensorineural Hearing Loss.

OBJECTIVES: Vascular causes are most frequently implicated in idiopathic sudden sensorineural hearing loss (ISSHL), and the process has been reported to be associated with fibrinogens and plasma lipoproteins. The purpose of this study was to determine the relationship between serum fibrinogen and high-density lipoprotein (HDL) levels, and the ratios of fibrinogen/HDL and monocyte/HDL, and ISSHL. MATERIALS AND METHODS: The present retrospective study included 116 patients with ISSHL. Treatment outcomes was categorised four groups according to Siegel's criteria as follows: complete recovery (Group1), partial recovery (Group 2), slight recovery (Group 3), or no improvement (Group 4). Fibrinogen, HDL and monocyte levels of patients were assessed through routine blood analyses, and fibrinogen/HDL and monocyte/HDL ratios were calculated for each patient. RESULTS: Fibrinogen values were significantly lower in Group 1 than in Groups 3 and 4, whereas the values were also significantly lower in Group 2 than in Group 3. HDL values in Group 1 were significantly higher than in the other groups. Fibrinogen/HDL values were significantly lower in Group 1 than in Groups 3 and 4. However, there was no significant difference among the groups with regard to monocyte/HDL ratios. CONCLUSION: To our knowledge, this is the first study investigating the fibrinogen/HDL ratio in ISSHL in the literature. Although fibrinogen/HDL ratio might be a useful prognostic indicator for hearing recovery in patients with ISSHL, further studies with a larger patient population is required to confirm its clinical practicability and reliability.

Susceptibility of severe COVID-19 patients to rhino-orbital mucormycosis fungal infection in different clinical manifestations.

PURPOSE: To present the different clinical manifestations of rhino-orbital mucormycosis (ROM) co-infection in severe COVID-19 patients. STUDY DESIGN: Prospective observational clinical study METHODS: Among 32,814 patients hospitalized with the diagnosis of COVID-19 between March 2020 and December 2020 in our center, eleven microbiologically confirmed ROM co-infection cases in severe COVID-19 patients were evaluated. RESULTS: There were nine men and two women with a mean age of 73.1 ± 7.7 years. Eight patients had uncontrolled type 2 diabetes with a mean diagnosis duration of 12.1 ± 4.4 years. All patients had COVID-19-associated acute respiratory distress syndrome and received corticosteroids. The mean time interval between COVID-19 diagnosis and ROM diagnosis was 14.4 ± 4.3 days. Seven patients (63.6%) had orbital apex syndrome, and four patients (36.4%) presented with orbital cellulitis. Endophthalmitis was detected in 54.5% of patients, and two of these patients developed retinoschisis. CT scan/MRI revealed sino-orbital involvement in all patients, and three of these had cerebral involvement at initial presentation. All patients received intravenous and retrobulbar liposomal amphotericin B and had undergone radical debridement of involved sinuses. Intravitreal liposomal amphotericin B injected in patients with endophthalmitis. Despite all measures, 63.6% of patients expired. CONCLUSIONS: Severe COVID-19 is associated with a significant incidence of ROM with higher mortality rates due to immune dysregulation and the widespread use of steroids. Physicians should be aware of the possibility of this infection in patients with COVID-19. An aggressive multidisciplinary approach can help to reduce mortality.

[Revision surgery for chronic otitis media: evaluation of indications and results]. / Kronik otitis media düzeltme ameliyatlari: Endikasyon ve sonuçlarinin degerlendirilmesi.

OBJECTIVES: In patients who underwent primary and revision surgery for chronic otitis media, the types of revision surgery, most frequently observed regions of cholesteatoma, hearing results and the status of graft membrane were evaluated. PATIENTS AND METHODS: Forty-three of 495 patients (21 males, 22 females; mean age 38.4+/-15.2 years; range 15 to 76 years) with chronic otitis media who underwent revision surgery in our clinic between May 2003 and March 2009 were evaluated retrospectively. Indications for revision surgery were recurrence of the disease in 32 patients (74.4%) and reconstruction of hearing in 11 patients (25.6%). Forty patients (93.0%) underwent revision surgery once and three patients (7.0%) underwent revision twice. Over an average of 3.2 (range 1 to 6) years follow-up after primary and revision surgery, the types of revision surgery, the most frequently observed regions of cholesteatoma, hearing results and the status of graft membrane were assessed. RESULTS: Recurrence of cholesteatoma in revision surgery was seen in 28 patients (65.1%). Out of 27 patients, 23 patients (85.1%) showed intact graft membranes and four patients (14.8%) showed perforated graft membranes. CONCLUSION: In revision surgery, the first goal is to eliminate the disease. The management of chronic otitis media with cholesteatoma is surgery. Because of high postoperative recurrence rates, long-term follow-up is necessary.