Coexistence of neurological diseases with Covid-19 pneumonia during the pandemic period.

Although clinical findings are related to respiration in the Covid-19 pandemic, the number of patients with neurological symptoms and signs is increasing. The purpose of this study was to assess the prevalence of Covid-19 pneumonia using thoracic CT in patients who presented to the emergency room with neurological complaints during the pandemic. We retrospectively examined the files of 1093 patients who admitted to the emergency room and had a Neurology consultation. The research involved patients who had a neurological diagnosis and had typical findings of COVID-19 pneumonia on thorax computed tomography (CT). The thoracic CT scans of 68 (6.2%) of 1093 patients with neurological disorders at the time of admission revealed results consistent with Covid-19 pneumonia. The "real-time reverse transcription polymerase chain reaction" (RT-PCR) was positive in 42 of the 68 patients (62%), and the patients were diagnosed with Covid-19. Ground glass opacity was the most common finding in thoracic CT in patients diagnosed with Covid-19 pneumonia, with a rate of 92.9% (n = 39). Ischemic stroke (n = 26, 59.5%), cerebral haemorrhage (n = 11, 28.6%), epilepsy (n = 3, 7.1%), transient ischaemic attack (TIA; n = 1, 2.4%), and acute inflammatory demyelinating polyneuropathy (n = 1, 2.4%) were the most common neurological diagnoses among the patients. Even though Covid-19 affects the central and peripheral nervous systems, eliminating the possibility of Covid-19 pneumonia with thorax CT is critical for early treatment and patient prognosis.

Validation of a New Diabetic Retinopathy Knowledge and Attitudes Questionnaire in People with Diabetic Retinopathy and Diabetic Macular Edema.

Purpose: A validated questionnaire assessing diabetic retinopathy (DR)- and diabetic macular edema (DME)-related knowledge (K) and attitudes (A) is lacking. We developed and validated the Diabetic Retinopathy Knowledge and Attitudes (DRKA) questionnaire and explored the association between K and A and the self-reported difficulty accessing DR-related information (hereafter referred to as Access). Methods: In this mixed-methods study, eight focus groups with 36 people with DR or DME (mean age, 60.1 ± 8.0 years; 53% male) were conducted to develop content (phase 1). In phase 2, we conducted 10 cognitive interviews to refine item phrasing. In phase 3, we administered 28-item K and nine-item A pilot questionnaires to 200 purposively recruited DR/DME patients (mean age, 59.0 ± 10.6 years; 59% male). The psychometric properties of DRKA were assessed using Rasch and classical methods. The association between K and A and DR-related Access was assessed using univariable linear regression of mean K/A scores against Access. Results: Following Rasch-guided amendments, the final 22-item K and nine-item A scales demonstrated adequate psychometric properties, although precision remained borderline. The scales displayed excellent discriminant validity, with K/A scores increasing as education level increased. Compared to those with low scores, those with high K/A scores were more likely to report better access to DR-related information, with K scores of 0.99 ± 0.86 for no difficulty; 0.79 ± 1.05 for a little difficulty; and 0.24 ± 0.85 for moderate or worse difficulty (P < 0.001). Conclusions: The psychometrically robust 31-item DRKA questionnaire can measure DR- and DME-related knowledge and attitudes. Translational Relevance: The DRKA questionnaire may be useful for interventions to improve DR-related knowledge and attitudes and, in turn, optimize health behaviors and health literacy.

Partial neuromuscular blockage levels with mivacurium during mastoidectomy allows intraoperative facial nerve monitoring.

BACKGROUND: Facial nerve monitoring during otologic surgery is helpful for facial nerve preservation, but its usage is closely related to anesthetic procedures. OBJECTIVES: The aim of this study was to investigate the effectiveness of mivacurium-based partial neuromuscular blockade on facial nerve monitoring during otologic surgery. METHODS: Forty-three patients scheduled for elective otologic surgery (mastoidectomy with and without tympanoplasty) participated in the study. After induction with propofol 2-3 mg x kg(-1), remifentanil 1 microg x kg(-1) and mivacurium 0.2 mg x kg(-1), anesthesia was maintained with isoflurane 0.6-1.6 minimum alveolar concentration and remifentanil 0.25 microg x kg(-1) x min(-1). Following complete recovery of neuromuscular blockade during induction, mivacurium infusion was initiated at 6 microg x kg(-1) x min(-1) in an adjusted dose to reflect adductor pollicis activity of 50, 75 or 100% of normal. The minimum stimulation thresholds obtained from each case were recorded. RESULTS: Pre- and postoperatively, all 43 patients demonstrated clinically normal facial nerve function. In all cases, intraoperative facial nerve monitoring was performed successfully. There were no differences in threshold levels of the facial nerve stimulation between group I (1.84 +/- 0.4 mA ) and group II (1.97 +/- 0.2 mA). However, the stimulation thresholds of group III (1.53 +/- 0.4 mA ) were found to be lower than those of groups I and II (p < 0.05). CONCLUSION: We conclude that partial neuromuscular blockade with mivacurium permits intraoperative facial nerve monitoring.

Long-term follow-up outcomes of nonlaser intranasal endoscopic dacryocystorhinostomy: how suitable and useful are conventional surgical instruments?

PURPOSE: To investigate the long-term follow-up outcomes of nonlaser intranasal endoscopic dacryocystorhinostomy (IEDCR) using a nasal endoscope and conventional surgical instruments available in all operating rooms, the advantages of this technique, and the usability and suitability of conventional instruments. METHODS: Twenty-seven IEDCRs were performed in combination with bicanalicular silicone intubation on 24 patients with primary nasolacrimal sac or duct obstruction who had undergone no previous procedures. Ablation of the nasal mucosa was performed with a sickle blade (12 operations) or insulated sickle blade allowing simultaneous intranasal monopolar cauterization (15 operations); a bony window was opened with a drill; and ablation of the medial wall of the lacrimal sac was performed with a sickle blade, Blakesley forceps, and Bellucci ear microscissors. Revision intranasal endoscopic surgery was performed in unsuccessful cases. RESULTS: Patients were followed up for 35 to 71 months (average 49.3 months). In 7 (25.9%) of the 27 IEDCRs, nasolacrimal obstruction recurred within 3 months. Success rates were as follows: 66.7% (8 operations) for the first 12 operations; 80% (12 operations) for the second 15 operations; and 74.1% overall. There were seven cases of surgical failure; revision surgery was successful in four, increasing the overall success rate to 88.9%. CONCLUSIONS: IEDCR can be performed with acceptable facility with standard conventional surgical instruments (sickle blade, endoscopic forceps, and scissors) and surgical tools (drill, monopolar cautery) found in all operating rooms, and the nonlaser intranasal endoscopic approach may be a reasonable alternative to the laser assisted surgery approach.

Paranasal sinus computed tomographic findings of children with chronic cough.

OBJECTIVE: Chronic cough is a frequent problem in the practice of clinical pediatrics, and sinusitis is a common etiologic factor. In this study, our aim was to determine the prevalence of sinus abnormalities in pediatric patients presenting with chronic cough. METHODS: Forty-two patients, ranging from 3 to 16 years of age from both sexes completed the study. Paranasal sinuses were examined by coronal paranasal sinus limited computed tomographic scan. The CT scan findings were categorized as no disease, minimal, moderate and severe sinusitis. RESULTS: The most frequent symptoms after cough were rhinorrhea, sniffling, and halitosis. We found sinus abnormalities in 66.6% and no abnormality in 33.3% of the children. Age and sex were not important factors in sinus disease. There was no correlation between sinus findings and any of symptoms. The most common anatomical abnormalities were concha bullosa, paradoxical middle turbinate, Haller's cells, and deviated nasal septum. These abnormalities were not correlated with sinus disease. CONCLUSION: Paranasal sinus abnormalities are common among pediatric patients with chronic cough and imaging studies of the sinuses should be considered in these children.

Impact of various leachate recirculation regimes on municipal solid waste degradation.

Landfilled municipal solid waste can be treated by introducing leachate into the waste matrix. Increasing attention is being given to landfill leachate recirculation as a means for in situ leachate treatment and landfill stabilization. Landfills with leachate recirculation may be operated as municipal solid waste bioreactor treatment system rather than as a conventional waste dumping sites. In order to study the impact of various leachate recirculation regimes on municipal solid waste degradation, two landfill-simulating reactors, one with leachate recycle and one without, were constructed and placed at a constant room temperature (34 degrees C). Both reactors were filled with a municipal solid waste mixture representing the typical solid waste composition determined for the city of Istanbul. For the purpose of this experiment, leachate recirculation volume and frequency were changed periodically. This research showed that increased frequency of leachate recirculation accelerates the stabilization rate of waste matrix. About 2l of recirculated leachate and four times per week recirculation strategy were found to provide the highest degree of waste stabilization. Additionally, this research confirmed that leachate recirculation is a very feasible way for in situ leachate treatment.

Evaluation of total oxidative stress parameters in patients with nasal polyps.

Oxidative stress, an imbalance between reactive oxygen species production and antioxidative defense activity, is believed to have a role in the development and pathogenesis of nasal polyps (NPs). Based on this assumption, several known oxidants and antioxidants have been studied in patients with NPs. The purpose of this study was to evaluate the association between oxidative stress parameters with a more valid and reliable method in patients with NPs. Seventy-three patients with NPs, septal deviations and middle concha hypertrophies were recruited. Patients were divided into two groups; group 1 (n = 38) consisted of patients with NPs, and group 2 (n = 35) included patients with septal deviations and middle concha hypertrophies. Polyp specimens were taken from all patients who underwent endoscopic surgery for NPs. Control specimens were obtained from patients who underwent an operation for septoplasty or middle concha hypertrophy. Blood and tissue samples were obtained to assess total oxidant status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI). Compared to group 2, group 1 had significantly higher TOS and OSI and lower TAS levels both in serum and tissue samples (p < 0.001 for all). In group 1, tissue TOS and OSI levels were significantly higher, and TAS levels were significantly lower than in serum (p < 0.001 for all), whereas no significant difference was found in TOS, OSI and TAS levels either in serum or tissue samples in group 2 (p = 1.0; p = 1; p = 0.208, respectively). In group 1, serum OSI levels were significantly correlated with age (r = 0.442, p = 0.005). Our study demonstrated that oxidative stress, both in serum and tissues in patients with NPs, was higher than in patients without NPs. Our study differs from previous studies in that we used a more reliable method that measures both TOS and TAS.

Prolidase activity and oxidative stress parameters in patients with nasal polyps.

BACKGROUND AND AIM: Oxidative stress is believed to have a role in the development of nasal polyps (NPs). It is also known that prolidase activity increases secondary to chronic inflammation. The purpose of this study was to evaluate the association between prolidase activity and oxidative stress parameters in patients with NPs. MATERIALS AND METHODS: Sixty patients with NPs, septal deviations and the concha hypertrophies were recruited to the study. Patients were divided into two groups; group 1 (n=30) consisted of patients with NPs, and group 2 (n=30) included patients with septal deviations and concha hypertrophies. Polyp specimens were taken from all patients who underwent endoscopic surgery for NPs. Control specimens were acquired from patients who underwent an operation for septoplasty or concha hypertrophy. Blood and tissue samples were obtained to assess lipid hydroperoxide (LOOH), catalase (CAT) and prolidase activity. RESULTS: Compared to group 2, group 1 had significantly higher LOOH and prolidase levels, and lower CAT levels both in serum and tissue samples (p<0.05 for all). Prolidase activity was correlated with increased LOOH and decreased CAT levels (r = 0.507 p = 0.004; r = - 0.579, p = 0.001, respectively). CONCLUSIONS: Our study demonstrated that oxidative stress and prolidase activity, both in serum and the tissue in patients with NPs, were higher than in patients without NPs.

An unusual dark pigmentation on the tympanic membrane.

OBJECTIVE: To report an extremely rare case of dark pigmentation on the tympanic membrane due to alkaptonuria, and to discuss the probable association between this condition and hearing loss. CASE REPORT: A 58-year-old man with alkaptonuria was admitted with tinnitus and hearing loss in both ears. Physical examination showed bluish-black pigmentation on the helixes of both ears and both sclerae. Otoscopic examination revealed dark discolouration of both tympanic membranes. Audiological evaluation revealed mixed high frequency hearing loss in both ears. Tympanometric examination revealed type A tympanograms bilaterally, and absence of acoustic reflexes both ipsilaterally and contralaterally. Computed tomography of the temporal bones revealed no abnormality. CONCLUSION: Clinicians should consider alkaptonuria in the differential diagnosis of patients with abnormal tympanic membrane pigmentation and hearing loss.

Long-term follow-up outcomes of nonlaser intranasal endoscopic dacryocystorhinostomy:How suitable and useful are conventional surgical instruments?

PURPOSE: To investigate the long-term follow-up outcomes of nonlaser intranasal endoscopic dacryocystorhinostomy (IEDCR) using a nasal endoscope and conventional surgical instruments available in all operating rooms, the advantages of this technique, and the usability and suitability of conventional instruments. METHODS: Twenty-seven IEDCRs were performed in combination with bicanalicular silicone intubation on 24 patients with primary nasolacrimal sac or duct obstruction who had undergone no previous procedures. Ablation of the nasal mucosa was performed with a sickle blade (12 operations) or insulated sickle blade allowing simultaneous intranasal monopolar cauterization (15 operations); a bony window was opened with a drill; and ablation of the medial wall of the lacrimal sac was performed with a sickle blade, Blakesley forceps, and Bellucci ear microscissors. Revision intranasal endoscopic surgery was performed in unsuccessful cases. RESULTS: Patients were followed up for 35 to 71 months (average 49.3 months). In 7 (25.9%) of the 27 IEDCRs, nasolacrimal obstruction recurred within 3 months. Success rates were as follows: 66.7% (8 operations) for the first 12 operations; 80% (12 operations) for the second 15 operations; and 74.1% overall. There were seven cases of surgical failure; revision surgery was successful in four, increasing the overall success rate to 88.9%. CONCLUSIONS: IEDCR can be performed with acceptable facility with standard conventional surgical instruments (sickle blade, endoscopic forceps, and scissors) and surgical tools (drill, monopolar cautery) found in all operating rooms, and the nonlaser intranasal endoscopic approach may be a reasonable alternative to the laser assisted surgery approach. (Eur J Ophthalmol 2004; 14: #-60).