Bone mineral density of the incus body and long process in patients with chronic otitis media and its relationship with functional outcome in type II tympanoplasty.

BACKGROUND: Inflammatory conditions such as chronic otitis media (COM) can cause irreversible impairments in the microarchitecture and functions of the incus, which subsequently leads to conductive hearing loss. OBJECTIVES: To investigate bone mineral density (BMD) of the incus body (IB) and long process (ILP) on preoperative temporal CT in COM patients with and without incudo-stapedial joint discontinuity (ISJD), and also to determine the association between BMD values and the postoperative air-bone gap (ABG) in the ISJD group. MATERIAL AND METHODS: The mean IB density (IBD)/occipital bone density (OBD) and ILP density (ILPD)/OBD values were compared between the patients with and without ISJD. The correlation between ABG gain and preoperative incus density values was assessed in the ISJD group. RESULTS: The mean IBD/OBD and ILPD/OBD values were significantly higher in patients with intact ISJ. There was a moderate positive correlation between postoperative ABG gain and ILPD/OBD values in the ISJD group. CONCLUSION AND SIGNIFICANCE: The decrease in BMD of the incus may involve ILP as well as IB in patients with ISJD caused by ILP lysis in COM. A higher preoperative ILPD/OBD was correlated with a higher postoperative ABG gain in COM patients with ISJD.

Rhino-Orbital Cerebral Mucormycosis in a Healthy Female Child: Case Report.

Mucormycosis is a potentially fatal condition with a high mortality rate, particularly when there is extra nasal involvement, and it is rare for patients with fungal brain disease to survive. It mostly affects patients who are metabolically or immunologically compromised, which constitutes one of the three classical stages of the progression of Rhino-Orbito-Cerebral Mucormycosis (ROCM). Stage I: infection of the nasal mucosa and paranasal sinuses; Stage II: orbital involvement; Stage III: cerebral involvement.Here, we report a case of rhino-orbital cerebral mucormycosis in a 14-year-old girl with no known risk factor who presented with periorbital edema, right eye proptosis, fever, and extreme facial pain, which progressively worsened to confusion and left leg weakness in 3 days after admission. The final diagnosis was rhino-orbital-cerebral mucormycosis. The infection was successfully treated using liposomal amphotericin and surgical debridement to remove infected orbital tissue. Mucormycosis is a potentially fatal disease that necessitates prompt diagnosis and treatment. Children are rarely infected with mucormycosis. The majority of studies show that people are typically between 40 and 50 years old. ROCM is typically diagnosed using clinical symptoms and histopathologic evaluation; however, imaging is critical in determining the presence of intracranial lesions. The standard treatment for ROCM is amphotericin B at a recommended dose of 1.0-1.5 mg/kg/day for weeks or months, depending on the clinical response and severity of adverse drug reactions, particularly nephrotoxicity.Rhino-orbital cerebral mucormycosis in a healthy female child is uncommon; early diagnosis and prompt treatment with Amphotericin B should be necessary. Devastating consequences will result from a delayed diagnosis.

Rare case in Somalia: Fahr's syndrome.

Introduction and importance: Fahr's syndrome is primarily familial, autosomal dominant, and genetically diverse. Basal ganglia calcification that is bilaterally symmetrical is a hallmark of this illness. Although the specific origins of this illness are unknown, it may be brought on by problems with calcium metabolism, infections, toxins, hereditary factors, hypoparathyroidism, and pseudohypoparathyroidism. The prevalence of this syndrome is less than 0.5%. Case presentation: An 11-year-old female comes to the Emergency Department with her parents complaining of high-grade fever and convulsions for 1 week. Convulsion, which is a generalized tonic-clonic seizure, duration was ~5 min and associated with urinary incontinence and biting tongue. On examination, the patient was confused and irritable. Vital signs were normal; there is weakness in the right arm and right leg, associated with irregular movement. There was alternation in her level of consciousness, slurring of speech, and psychiatric symptoms. Another aspect of the neurological examination and systems was normal, and there was no meningeal irritation. Clinical discussion: The pathogenesis of Fahr's syndrome is not completely known. The calcification is caused by flaws in the transport of radioactive particles and tissue damage caused by free radicals. Bilateral calcification found on a computed tomography (CT) scan of the brain, autosomal dominant inheritance, the absence of any infection, drugs, or toxins, the absence of mitochondrial dysfunction, and the presence of progressive neurological dysfunction is the clinical criteria for diagnosing Fahr's syndrome. Conclusion: Basal ganglia calcification that is bilaterally symmetrical is a hallmark of Fahr's syndrome. CT scans are the gold standard for conclusively diagnosing Fahr's syndrome.

Effects of Anatolian Propolis and Hypertonic Saline Combination Nasal Spray on Allergic Rhinitis Symptoms: A Prospective, Multicenter Study.

Objectives: This study aimed to evaluate how Rhinapi nasal spray affects symptoms of allergic rhinitis. Methods: In this prospective, multicenter, observational study, 10,000 patients (comprising 5028 males and 4972 females) exhibiting symptoms of allergic rhinitis (namely, nasal discharge, sneezing, nasal itching, and nasal obstruction) from different centers in different regions of Turkey were enrolled in the study between March 2022 and March 2023. All the patients wanted to participate in the study and were administered Rhinapi one puff to each nostril three times a day, for a period of 3 weeks. Total symptom scores, quality of life (QoL) scores, and otolaryngological examination scores were evaluated before and 3 weeks after treatment. Results: The scores for discharge from the nose, sneezing, nasal pruritus, and blockage of the nose all indicated improvement when compared to pre-medication and post-medication. This difference achieved statistical significance (P < .001). The mean total symptom score fell following treatment (P < .001): whilst the score was 11.09 ± 3.41 before administering Rhinapi; after administration, the average score was 6.23 ± 2.41. The mean QoL scores also altered after medication (P < .001), improving from a mean value of 6.44 ± 1.55 to a mean of 7.31 ± 1.24. Significant improvement was also noted in the scores for conchal color and degree of edema after the treatment had been administered (P < .001). Conclusion: The study demonstrates that Rhinapi nasal spray decreases total symptom scores, and results in improved QoL and otolaryngological examination scores. Propolis spray may be recommended for patients with allergic rhinitis alongside other treatments.

Comparison of the Locking Intramedullary Nailing, Single Plate and Double Plate Osteosynthesis in Treatment of Humerus Shaft Fractures.

OBJECTIVE: To compare the clinical and radiographic outcomes between patients treated with single plate osteosynthesis, double plate osteosynthesis, and antegrade locked intramedullary nailing (IMN) in treatment of humerus diaphyseal fractures. STUDY DESIGN: Descriptive study. Place and Duration of the Study: Department of Orthopaedics and Traumatology, Adiyaman University Training and Research Hospital, Adiyaman, Turkey, between 2014 and 2020. METHODOLOGY: A total of 99 patients with humerus diaphyseal fractures were retrospectively evaluated. Forty-six had been treated with single plating, 24 were treated with double plating, and 29 with IMN. The outcomes were evaluated in terms of the union time, union rate, complications, and Disabilities of the Arm, Shoulder, and Hand (DASH) functional scores. RESULTS: The average union time was 17 weeks and nonunion rate was 6% of patients. There was no significant difference between the groups in terms of DASH functional score and nonunion (p >0.05). The surgical time and bleeding amount were significantly shorter in the IMN group compared to the other groups (p <0.05). A statistically significantly short union time was observed in both plating groups compared to IMN (p <0.05), but it was not different between single and dual plating (p >0.05). CONCLUSION: Regardless of the implant used, good reduction and stable fixation, respect for the soft tissue and use of the implant in accordance with the surgical technique are sufficient to achieve union in the surgical treatment of humeral shaft fractures. KEY WORDS: Humeral shaft fracture, Surgical treatment options, Comparison, Outcomes.

Association of skin autofluorescence and carotid intima-media thickness in acromegaly patients.

BACKGROUND: The Pituitary Tumors Centers of Excellence (PTCOE) concept was established to provide a multimodal approach with careful management of comorbidities. Acromegaly, one of the main concerns of PTCOE per se, leads to increased mortality rates of which cardiovascular disease is an important cause. Increased skin autofluorescence (SAF) was shown to be associated with carotid intima-media thickness (CIMT), a well-established marker of atherosclerosis, and consequently cardiovascular complications. This study aimed to evaluate SAF and CIMT in association with anthropometric, clinical, and biochemical parameters in acromegaly patients and healthy controls. METHODS: The study group included 138 acromegaly patients and 127 healthy controls from the Department of Endocrinology and Metabolism Disease, Marmara University Medical School. Growth hormone, insulin-like growth factor I, lipids, glucose, insulin levels were assessed. Advanced glycation end products (AGEs) were measured by the auto-fluorescence reader. CIMT was measured from the common carotid artery wall on B-mode ultrasound. RESULTS: CIMT and SAF levels were significantly higher in the acromegaly group than the control group. There was a positive correlation between SAF and CIMT both in the total cohort and acromegaly patients. The presence of acromegaly, age, and SAF were the determining factors of CIMT in the whole study cohort. CONCLUSIONS: Our study is the first to examine the relationship between SAF and CIMT in acromegaly patients. We found higher CIMT and enhanced SAF in the acromegaly group compared to the control group with a significant positive correlation in between. The presence of acromegaly was related to increased SAF levels and CIMT. SAF was associated with CIMT in acromegaly patients. Implementation of CIMT and SAF evaluation in this clinical setting may improve cardiovascular complications, particularly in the PTCOE.

Challenges in the Head and Neck Department in the Diagnosis and Surgical Treatment of Patients Presenting to a Single Tertiary Hospital of Somalia With Extreme War Injuries.

In this study, the authors aimed to share their experience with 46 patients who were wounded due to terrorism and war in Somalia. The authors also evaluated the etiological diversity of terror-related and war-related injuries. The study included 46 patients treated at the 150-bed Turkey-Somalia Tertiary Hospital between 2019 and 2021. The authors reviewed medical records including data regarding age, sex, trauma etiology, and type of fracture and trauma. For all patients, surgical technique and plate and screw applications were recorded. The authors also assessed complications and outcomes for the patients. The study included 5 women (10.9%) and 41 men (89.1%). The mean age was 30.36 years. It was found that 2 patients (4.35%) presented to the emergency department with stab injuries, 33 patients with blast injuries from improvised explosive devices (71.73%), and 11 patients with firearm injuries. There were 31 patients with maxillary and mandibular fractures, 17 of which had both maxillary and mandibular fractures. There were 14 patients with maxillary fracture alone, including 3 patients with tripod fracture and 7 patients with inferior and lateral rim fracture. There was a mandibular fracture in 17 patients, including 5 patients with parasymphysis fracture, 7 patients with ramus fracture, and 5 patients with multifocal comminuted fracture. It is a challenging process to treat terror-related injuries in our tertiary hospital in Somalia, where all resources are imported from foreign countries. In such settings, authorities should make protective equipment obligatory to prevent civil and military casualties. Trauma hospitals and experienced trauma surgeons should be available.

The effect of subclinic thyroid pathologies on erythropoietine dose in hemodialysis patients.

PURPOSE: The effect of subclinical thyroid pathologies on erythropoietin (EPO) treatment has not been well defined. The aim of the study is to compare the frequency and dose of EPO administration in patients with subclinical thyroid pathology and euthyroid hemodialysis patients. METHODS: A cross-sectional and retrospective study was conducted with 210 patients. Special conditions were excluded, a total of 191 patients were included. Patients were divided into three groups. RESULTS: The incidences of subclinical hypothyroidism, subclinical hyperthyroidism and euthyroidism were 10.5%, 3.1%, and 86.4%, respectively. Statistically significant difference was found between subclinical hypothyroid and euthyroid patients in terms of the number of patients using EPO (p = 0.0207), monthly total EPO doses (p = 0.003), and total monthly EPO doses per weight (p = 0.001). CONCLUSION: The EPO dose required to achieve similar hemoglobin levels in hemodialysis patients was significantly higher in subclinical hypothyroid patients than in euthyroid patients.

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.

Successful surgical management of a giant neck teratoma in a newborn Baby: A case report.

Neck tumors in newborns are very rare. Teratomas usually include all three germ cell layers, as well as tissues that are not native to the anatomic site of genesis. Teratomas of the head and neck make up a smaller percentage of congenital teratomas. Because of the external compression that oropharyngeal or neck masses produce, they can cause serious airway obstruction. In addition, the larynx or trachea may have an underlying lesion. We presented a mature, 1-day-old newborn with an isolated giant neck tumor and difficulty breathing. The intubation was successfully done and the entire mass was completely removed. Early neonatal life is explored to emphasize this challenge briefly with several interesting instances, including prenatal diagnosis, therapeutic alternatives, and ex-utero intrapartum therapy (EXIT) techniques.

Mermaid syndrome: A case report in Somalia.

Introduction: and Importance: Sirenomelia, which called sirenomelia sequences, is a very rare congenital malformation. It is characterized by complete or incomplete fused lower extremities, renal agenesis, oligohydramnios, absent urinary tract and external genitalia, single umbilical arteries, imperforate anus, etc.We are reporting a case of mermaid syndrome, a twin pregnancy in which one was healthy and the other was identified to have characteristic features of sirenomelia at the time of examination. Case presentation: We present a case of a preterm baby who was born at 34 weeks of gestational age by cesarean section for twin pregnancy due to oligohydramnios with fetal distress. He had abdominal distension, an imperforated anus, no pelvic bone, and a fused leg with two femur bones and two tibial bones that shared one skin and two separate feet. There was none of the two kidneys, ureter, or bladder. He had been diagnosed with an atrial septal defect. Clinical discusion: Sirenomelia is virtually always a fatal congenital abnormality that affects the fetal body's caudal region. Although fusion of the lower limbs is its most obvious feature.The reported percentage of elective termination of pregnancy for the fetal anomaly is about 49.5%.The anomaly is postulated to be due to a combination of genetic predisposition and an environmental trigger factor, while the precise etiology is undetermined and believed to be multifactorial.In surviving sirenomelia cases, treatment can be provided with amultidisciplinary approach. Conclusion: Mermaid Syndrome is a lethal congenital anomaly with a poor prognosis.Ultrasonography can be used to diagnose sirenomelia. Oligo-hydramnios and fused lower limbs are crucial features that aid in the diagnosis during the first trimester of pregnancy, with possible termination of the pregnancy being suggested as an option if detected early.

Does concomitant prolactin measurement increase the accuracy of inferior petrosal sinus sampling?

INTRODUCTION: Prolactin (PRL) measurement during inferior petrosal sinus sampling (IPSS) can be helpful to improve the accuracy. We aimed to evaluate the effect of measuring PRL levels as a predictor for the accuracy of IPSS and evaluate its impact on the lateralization of adenomas. METHODS: In this retrospective cohort study, we reviewed 51 patients who had undergone IPSS for the investigation of ACTH-dependent hypercortisolism. RESULTS: Forty-nine patients had proven Cushing's disease (CD), one had EAS, and the remaining one patient had adrenal adenoma. Forty-seven patients had an above 2 ACTH IPS/P ratio at baseline, and all the post-corticotropin-releasing hormone (CRH) ACTH IPS/P ratios of patients with proven CD were above 3. In these two patients whose ACTH IPS/P ratio at baseline was below 2, PRL IPS/P ratios were above 1.8 in only the dominant side, which was considered secondary to a prolactin intersinus gradient due to the biological effects of the tumor. PRL-adjusted ACTH IPS/P ratios were > 1.3 in all patients with proven CD; it was 0.7 in the patient with EAS. Surgically confirmed positive lateralization was observed in 55.1% of patients with the ACTH gradient, but when PRL-adjusted ACTH IPS/IPS ratios were used in addition to the ACTH gradient, the ratio increased to 67.3%. CONCLUSION: Although PRL-adjusted ACTH IPS/P ratios can be helpful to improve the accuracy of results during IPSS procedures, a prolactin intersinus gradient towards the ACTH-dominant side in patients with CD may invalidate PRL as an indicator of pituitary venous outflow.

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.

The Effect of Allantoin on Chronic Perforation of Rat Tympanic Membrane.

OBJECTIVES: This study aimed to investigate the effectiveness of topical allantoin application on wound healing in a rat chronic tympanic membrane perforation (TMP) model. METHODS: A chronic TMP model was established with 25 healthy, female, 6-month-old, Sprague Dawley rats with chemical damage (trichloroacetic acid 50%). The rats were randomly assigned into 3 groups as follows: Group 1 (10 rats, 20 ears) was administered intratympanic (IT) 20 µL/day 0.57% allantoin solution 7 times, every other day; Group 2 (5 rats, 10 ears) received no substance; Group 3 (10 rats, 20 ears) received IT 20 µl/day distilled water 7 times, every other day. After tympanic membrane (TM) examination with an otoendoscope, histopathological examination of the TM was performed to evaluate neutrophil activity, chronicity, histiocytes, keratin accumulation, subepithelial edema, congestion, fibroblast proliferation, neovascularization, and tympanic membrane thickness. RESULTS: Two TM perforations, 1 in Group 1 and 1 in Group 3, were not healed whereas TM perforations in 48 ears demonstrated closure at the end of the study. According to the histopathological examination, neutrophil activity and fibroblast proliferation were significantly higher in Group 1. There was no significant difference between the groups in terms of other histopathological parameters. CONCLUSION: To the best of our knowledge, this is the first study investigating the effect of allantoin in an experimental chronic TMP model. According to the histopathological findings, allantoin may have positive effects on the wound healing process of chronic TMP.

Is there an increased cardiovascular risk in patients with prolactinoma? A challenging question.

PURPOSE: Epicardial adipose tissue thickness (EATT) is considered to be a surrogate for visceral fat and a novel cardiovascular risk indicator. Hyperprolactinemia has been shown to be associated with increased cardiovascular risk. The aim was to evaluate the association between EATT, carotid intima media thickness (CIMT), and cardiac functions in patients with prolactinoma. METHODS: Patients with the diagnosis of prolactinoma were included. The control group consisted of healthy age matched individuals with normal prolactin levels. Prolactin, fasting blood glucose (FBG), insulin, hemoglobin A1c (HbA1c), alanine aminotransferase (ALT), total cholesterol, triglycerides, and high (HDL) and low density lipoprotein (LDL) cholesterol were measured. EATT, CIMT, cardiac systolic, and diastolic functions were determined using echocardiography. RESULTS: We evaluated 67 patients with prolactinoma (aged 40.7 ± 11.9 years, F/M: 51/16) and 57 controls (aged 42.5 ± 7.4 years, F/M: 36/21). Of the 67 patients, 24 had normal prolactin levels. FBG level was higher in prolactinoma patients than in controls. Patients and controls had similar HbA1c, HOMA-IR, ALT, total, HDL, LDL cholesterol, and triglycerides levels, and similar cardiac systolic and diastolic functions. Prolactinoma patients had greater EATT (3.0 ± 0.5 mm vs. 2.6 ± 0.4 mm, p < 0.001) and CIMT (0.57 ± 0.08 mm vs. 0.52 ± 0.04 mm, p = 0.03) than controls. EATT was correlated with body mass index, FBG, HbA1c, and triglyceride levels. CONCLUSIONS: EATT and CIMT were greater in patients with prolactinoma, although they had normal cardiac systolic and diastolic functions.

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.

Effectiveness of Iloprost in the Treatment of Bone Marrow Edema.

Background and objective Bone marrow edema (BME) is a rare condition caused by insufficient osseous blood supply and may result in severe pain that has adverse effects on patients' life. To date, various conservative treatments have been recommended for the treatment of BME, including analgesics, immobilization of the affected extremity, and iloprost infusion. The aim of this retrospective study was to investigate the effectiveness of parenteral iloprost therapy in the treatment of BME detected in different skeletal locations. Materials and methods This retrospective study included 23 patients (17 men and six women) with BME who were classified as stage I-III according to the Association Research Circulation Osseous (ARCO) classification. BME was localized to the proximal femur in 13 (56.5%), the distal femur in four (17.4%), tarsal bone in four (17.4%), and tibial plateau in two (8.7%) patients. The mean age of the patients was 46.7 years and all the patients were evaluated with the Visual Analog scale (VAS), Functional Mobility Scale (FMS), and MRI. Results A significant improvement was observed in the post-treatment VAS and FMS scores of all patients compared to their pre-treatment scores. Moreover, the edema regressed completely in 60.9% of the patients at three months of MRI control. No serious side effects were observed during the treatment in any of the patients. However, transient side effects including headache, arrhythmia, and flushing were observed in five patients. Conclusion The present study indicated that iloprost therapy is an effective and safe option in the treatment of BME patients, particularly in the reduction of severe pain that has adverse effects on patients' social life, regardless of ARCO staging. Moreover, this therapy could be particularly useful in reducing pain, improving functional recovery, and achieving complete regression of the edema on MRI in ARCO stage I-II patients.

The prognostic and predictive value of platelet parameters in diabetic and nondiabetic patients with sudden sensorineural hearing loss.

BACKGROUND: We aimed to evaluate the association between mean platelet volume, platelet distribution width (PDW), platelet count (PC) and plateletcrit (PCT), and the presence of sudden sensorineural hearing loss (SSNHL) and treatment response. In the literature, there is no study that investigates the platelet functions in diabetic patients with SSNHL. METHODS: The patients were retrospectively assigned into Group 1 (68 diabetic patients with SSNHL), Group 2 (63 nondiabetic patients with SSNHL) and Group 3 (64 healthy controls). RESULTS: PC was not significantly different between the groups (p > 0.05). MPV, PDW and PCT values were significantly higher in Group 1 as compared to Groups 2 and 3 (p < 0.05). Platelet parameters were not significantly different between the patients who were responsive and nonresponsive to the treatment. Therefore, the platelet parameters did not affect prognosis significantly in this study samples (p > 0.05). CONCLUSIONS: This study showed that platelet parameters did not have a significant effect as a prognostic and predictive value in diabetic and nondiabetic patients with SSNHL. Further studies with more homogenous and larger study groups investigating the platelet parameters are needed to demonstrate microvascular damage and vascular alterations induced by diabetes mellitus.

The Effect of Tourniquet Usage and Anesthesia Method on Prognosis in the Treatment of Dorsal Wrist Ganglion Cysts by Open Surgery.

Introduction Ganglion cysts are the most common soft tissue masses seen on the wrist, which often cause pain or cosmetic complaints. The treatment of these masses includes intra-cystic injections or surgery. Recurrence rates are very high in surgical or non-surgical treatment. Inadequate excision for recurrence after surgery is blamed; however, the reasons for the recurrence still remain mysterious. Objectives In this study, the effect of anesthesia selection and tourniquet use on the dorsal wrist ganglion cysts in open surgery was investigated. Materials and methods Patients with dorsal wrist ganglion cysts, who were operated with open surgery between 2015 and 2018 and who had at least six months after the surgery, were examined. The patients were divided into two groups: patients who underwent surgery without tourniquet with local anesthesia and patients operated with tourniquet with general or regional anesthesia. Age, sex, cause of operation, visual analog scale (VAS) scores before and after surgery, limitation of movement, postoperative complications, and recurrence were compared. Results There was no significant difference between the groups in terms of causes of surgery, recurrence rates, preoperative and postoperative limitations of movement, and complications. In terms of age, the group operated with local anesthesia and without tourniquet was significantly larger. There was also no significant difference between the groups in terms of preoperative pain. Postoperative pain was significantly less in the group operated by tourniquet with general-regional anesthesia. Conclusion There is no significant difference in the recurrence and complications between patients operated under local anesthesia without tourniquets and patients operated with tourniquets under general or regional anesthesia during the open excision of the dorsal wrist ganglion cysts. However, it should be kept in mind that postoperative pain does not diminish in later ages, especially in cases of ganglion cysts, and other pathologies may also potentially cause pain in the wrist.

Genotype-Phenotype Correlations in Charcot-Marie-Tooth Disease Due to MTMR2 Mutations and Implications in Membrane Trafficking.

Charcot-Marie-Tooth type 4 (CMT4) is an autosomal recessive severe form of neuropathy with genetic heterogeneity. CMT4B1 is caused by mutations in the myotubularin-related 2 (MTMR2) gene and as a member of the myotubularin family, the MTMR2 protein is crucial for the modulation of membrane trafficking. To enable future clinical trials, we performed a detailed review of the published cases with MTMR2 mutations and describe four novel cases identified through whole-exome sequencing (WES). The four unrelated families harbor novel homozygous mutations in MTMR2 (NM_016156, Family 1: c.1490dupC; p.Phe498IlefsTer2; Family 2: c.1479+1G>A; Family 3: c.1090C>T; p.Arg364Ter; Family 4: c.883C>T; p.Arg295Ter) and present with CMT4B1-related severe early-onset motor and sensory neuropathy, generalized muscle atrophy, facial and bulbar weakness, and pes cavus deformity. The clinical description of the new mutations reported here overlap with previously reported CMT4B1 phenotypes caused by mutations in the phosphatase domain of MTMR2, suggesting that nonsense MTMR2 mutations, which are predicted to result in loss or disruption of the phosphatase domain, are associated with a severe phenotype and loss of independent ambulation by the early twenties. Whereas the few reported missense mutations and also those truncating mutations occurring at the C-terminus after the phosphatase domain cause a rather mild phenotype and patients were still ambulatory above the age 30 years. Charcot-Marie-Tooth neuropathy and Centronuclear Myopathy causing mutations have been shown to occur in proteins involved in membrane remodeling and trafficking pathway mediated by phosphoinositides. Earlier studies have showing the rescue of MTM1 myopathy by MTMR2 overexpression, emphasize the importance of maintaining the phosphoinositides equilibrium and highlight a potential compensatory mechanism amongst members of this pathway. This proved that the regulation of expression of these proteins involved in the membrane remodeling pathway may compensate each other's loss- or gain-of-function mutations by restoring the phosphoinositides equilibrium. This provides a potential therapeutic strategy for neuromuscular diseases resulting from mutations in the membrane remodeling pathway.