Alternating pattern of rhino-orbital-cerebral mucormycosis with COVID-19 in diabetic patients.

PURPOSE: Our aim was to analyze the patients with diabetic rhino-orbital-cerebral mucormycosis that we have treated in our clinic in the last 5 years, and to reveal the altering conditions with COVID-19. MATERIALS AND METHODS: A retrospective study was conducted on 39 rhino-orbital-cerebral mucormycosis (ROCM) patients with diabetes mellitus between 2017 and 2022. The patients were divided into two groups as those associated with and not associated with COVID-19 and compared. RESULTS: Thirty-nine diabetic patients were included in the study, with 15 (38.5%) of them being COVID-19 associated mucormycosis (CAM) group. CAM patients showed higher orbital involvement and cavernous sinus involvement (p = 0.002 and p = 0.013, respectively). The mortality rate in the non-COVID-19 associated mucormycosis (non-CAM) group was statistically higher in patients with intracranial and cavernous sinus involvement (p = 0.015 and p = 0.033, respectively). The difference between the overall survival of the CAM patients and non-CAM patients was not statistically significant (p = 0.741). CONCLUSIONS: With COVID-19, progressive mucormycosis accompanied by orbital and intracranial involvement is observed more frequently. However, on the contrary, the mortality rate in COVID-19-associated mucormycosis is considerably lower than expected. The fact that temporary immune suppression can be ameliorated with adequate supportive treatment and liposomal amphotericin-B which can be given to patients in high doses may explain this situation. It has been attained hints that the essential factor in the treatment of COVID-19-associated ROCM is the control of the underlying disease and to be cautious in the decision of early aggressive surgery.

Microplastic-induced oxidative stress response in turbot and potential intake by humans.

Microplastic (MP) pollution has become a health concern subject in recent years. Althoughann increasing number of studies about the ingestion of microplastics by fish, research on the oxidative stress response to MPs in natural environments is quite limited. In this study, the identification and characterization of MPs in gill (G), muscle tissues (M), and gastrointestinal tract (GI) of turbot (Scophthalmus maximus) were evaluated. Oxidative damage of MPs on the brain (B), liver (L), gill (G), and muscle (M) tissues as well as their effect on superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), paraoxonase (PON), arylesterase (AR) myeloperoxidase (MPO), and malondialdehyde (MDA) biomarkers were evaluated. The potential transmission of MPs from muscle tissues to humans was examined. Results showed that gills contain the highest amounts of MPs, ethylene propylene is the most dominant polymer type, black and blue are the most common MP color, fiber is the most common shape, and 50-200 µm is the most common MP size. Results showed that MPs cause oxidative stress of tissues with inhibiting effect on enzyme activities and promoting impact on lipid peroxidation. The oxidative damage mostly affected the liver (detoxification organ) followed by gill tissue. The intake of MPS in the European Union was estimated by EFSA as 119 items/year, while in Turkey it is 47.88 items/year. This study shows that more research is needed in terms of ecosystem health and food chain safety. The risk assessment of MPs in living organisms and environmental matrices including food safety and human health should be considered a public health issue.

Predictive value of ALDH1 and CD44 positivity for radiotherapy response and prognosis in early-stage glottic laryngeal squamous cell carcinoma.

To evaluate the predictive value of CD44 and aldehyde dehydrogenase 1 (ALDH1) expression for prognosis and radiotherapy (RT) response in patients with early-stage laryngeal cancer receiving RT. Forty-four patients with early-stage laryngeal cancer diagnosed between 2002 and 2016 were included in the study. The correlation between RT response and pre-treatment immunohistochemical ALDH1 and CD44 staining was evaluated. In addition, survival times were compared between groups. The mean age of the 44 patients was 59.8 ±9.0 (43-81) years and 41 were male. There were 20 patients in the non-recurrent group (all men) and 24 patients in the recurrent group (21 men). Immunohistochemical positivity for ALDH1 was found to be a significant risk factor for RT failure (p = 0.0001), whereas CD44 positivity (p = 0.114) and age group (p = 0.287) were not significant. ALDH1 positivity was identified as a significant predictor of DFS and RT sensitivity, while CD44 positivity did not differ according to RT response.

PD-L1 and EBV LMP1 expressions in classic Hodgkin lymphomas and its correlation with clinicopathological parameters and prognosis.

BACKGROUND: Programmed death pathway leads to T cell anergy. Wide range of malignancies take advantage of this pathway by programmed death-ligand 1 (PD-L1) expression either on neoplastic cells or on the nonneoplastic cells of tumour microenvironment. New therapeutic approaches have been directed against this pathway. We studied PD-L1 expression on both neoplastic Hodgkin and Reed-Sternberg (HRS) cells and cells of tumour microenvironment in classic Hodgkin lymphoma (CHL) patients and compared it with Ebstein-Barr virus (EBV) positivity, clinical data, and survival rates. METHODS: Lymph node excision materials of 56 CHL patients diagnosed between 2007 and 2017 were included in this retrospective study. PD-L1 expression of HRS cells and tumour microenvironment cells were evaluated by immunohistochemical assay. Staining intensity and rate of the PD-L1 expressions were estimated. EBV was examined by immunohistochemistry for latent membrane protein 1 (LMP1) antibody. Clinical data of 39 patients and survival data of 34 patients were compared with PD-L1 expressions on tumour cells. RESULTS: PD-L1 expression was present in HRS cells in 89.2% of the cases. There was more than 20% of PD-L1 expression in cells of tumour microenvironment in all the cases. PD-L1 positivity did not show statistically significant difference according to EBV expression, clinical parameters, and prognosis. DISCUSSION: Previous studies showed inconsistent rates for PD-L1 prevalence (20%-95.7%) in CHL patients due to differences in the study methods. Although high prevalence of PD-L1 positivity was found in majority of them, there was no statistically significant difference between PD-L1 positivity on HRS cells and EBV expression, clinical parameters, and prognosis. This high prevalence in patients with various clinical properties makes PD-L1 a potential target for new emerging immunotherapies for CHL.

Evaluating bacterial contamination of free bone fragments falling to the ground and the effectiveness of antiseptic solutions.

OBJECTIVES: This study aims to determine the contamination incidence rate of bone fragments that have been dropped on the floor of the operating theatre, as well as how effective antimicrobial solutions are at decontaminating them. METHODS: Bone fragments obtained after 30 total knee arthroplasties were used in the study. Inert pieces of bone emerging after the bone cuts during total knee arthroplasty were divided into 1 × 1 cm fragments. The bone fragments were first left in free fall on the floor of the operating theatre and then were kept in a number of antimicrobial solutions for 15 s. Subsequently, they were microbiologically and histopathologically examined. A swab culture was also taken from the floor of the operating theatre. RESULTS: It was determined that 63.3% of osteochondral fragments in the non-intervened group were contaminated. Growth was likewise detected in all swab cultures. Microorganisms growing in the swab culture and the non-intervened group were similar and mostly Staphylococcus epidermidis and Klebsiella pneumoniae. When the growth rates of the 10% povidone-iodine and 4% chlorhexidine gluconate groups were compared with the growth rate of the non-intervened group, a statistical difference was found. No difference was determined between the growth rates of the sodium hypochlorite and the non-intervened groups. The histopathological analysis revealed no statistical difference between the groups in terms of bone marrow, vascular structure, fat tissue, and osteoblastic activity results in the osteochondral fragments CONCLUSION: Bone tissues dropped from a sterile area on the floor of the operating theatre are highly contaminated. An effective decontamination without bone cell toxicity was achieved using povidone-iodine. Although chlorhexidine gluconate solution had an effective decontamination effect compared to the non-intervened group, it was not 100% effective. Sodium hypochlorite solution was not effective in the decontamination of grafts under our working conditions.

Microplastics in Tissues (Brain, Gill, Muscle and Gastrointestinal) of Mullus barbatus and Alosa immaculata.

The researches on MPs in commercial marine fish are very limited although in marine environments microplastic (MPs) pollution is a global problem. In this study, the presence, composition, and characterization of MPs in different tissues (brain, gill, muscle, and gastrointestinal tract) of commercial fish species [red mullet (Mullus barbatus) and pontic shad (Alosa immaculata Bennett 1835)] from the Black Sea were investigated. M. barbatus (demersal) and A. immaculata (pelagic) fish were preferred in the selection of fish species in order to represent demersal and pelagic environments. After dissected the fish, MPs were obtained from the tissues by extraction using the flotation method; then the MPs were counted and categorized according to shape, size, and color. The composition of the MPs was determined via ATR-FTIR spectroscopy. In terms of microplastic abundance in fish tissues, the gastrointestinal tract (40.0%) ranked first in both fish species, while the lowest MPs density was determined in brain tissues (7.0%). After the gastrointestinal tissue, gills were identified as the second tissue with the highest MPs density. Regardless of fish species, MPs characterization was mainly fibrous (51.0%), black colored (49.0%), and 50-200 µm in size (55.0%). Among the nine different polymers determined, polychloroprene (18.8%) and polyamide (15.0%) were found most frequently. This research provides data for tissue-based assessment of MPs in fish. The obtained data showed that MPs (one of the anthropogenic pollutants) are quite high in all tissues regardless of fish species. Moreover, it has emerged that these two fish species are suitable for monitoring microplastics in the study area.

Outcomes of Pneumatic Lithotripsy Versus Holmium Laser-Assisted Lithotripsy With Sialendoscopy in Management of Submandibular Sialolithiasis.

OBJECTIVE: This study aimed to comparatively analyze the indications, treatment outcomes, and reliability levels of the intraductal pneumatic lithotripsy (IPL) and holmium laser-assisted lithotripsy (HLL) methods that are used to sialendoscopically separate stones into smaller pieces in submandibular gland sialolithiasis (SMGS) patients. To the best of the author's knowledge, there is no study that compared these 2 methods in the literature in English. METHODS: The retrospectively designed study included 51 patients with SMGS. The IPL was used to break up 32 stones in 28 patients, while HLL was used to break up 28 stones in 23 patients. RESULTS: The stones could be completely extracted in 95.6% of the patients in the HLL group, 92.8% of those in the IPL group and 94.1% of all patients. The complete and partial recovery rates of the patients were respectively 91.3% and 8.7% in the HLL group and 92.8% and 7.2% in the IPL group. There was no significant difference based on the lithotripsy method that was used in the patients' laterality of stones, location of stones, stone diameter, operation time, need of papillotomy and silicone stent, complete removal status of stones and the symptomatic assessments of the patients in the 6th postoperative month. CONCLUSION: This study showed that both HLL and IPL treatments are effective, minimally invasive, and promising methods in difficult/complex SMGS treatments which may provide success rates of higher than 90% when they are performed by an experienced surgeon and by selection of appropriate patients.

The Utility of Endoscope-Assisted Rigid Bronchoscopy in Pediatric Airway Foreign Body Removals.

INTRODUCTION: Aspiration of foreign bodies is an emergency condition in children and may result in death, especially in children under 3 years of age. Therefore, diagnosis and treatment must be made rapidly. OBJECTIVE: This study sought to summarize our experience with endoscope-assisted rigid bronchoscopy (RB) in the diagnosis and treatment of pediatric tracheobronchial foreign body emergencies to reduce complications and mortality. METHODS: This was a retrospective cross-sectional study. The medical records of 337 children diagnosed with clinically suspected airway foreign body aspiration in the pediatric emergency department were analyzed retrospectively. The patients were divided into 2 groups with endoscopy used during RB in group 1 whereas group 2 was RB only. The surgeons who performed the bronchoscopies completed a survey on the advantages/disadvantages of these 2 procedures. RESULTS: All of the patients had a positive history of suspected foreign body aspiration and foreign bodies were identified in 77.1% of the patients during RB. There were 161 (47.8%) patients in group 1 and 176 (52.2%) patients in group 2. In group 2, 5 patients showed transient hypoxia, and 6 patients had an episode of transient bleeding during the operations. These numbers were 3 and 3, respectively, in group 1. One patient in group 2 suffered cardiac arrest and died during surgery. The authors did not see any long-term complications after these operations and the authors did not find any statistically significant differences between the groups for complication rates. CONCLUSION: The RB is the gold standard procedure for removal of pediatric airway foreign bodies. The survey used in this study and our extensive experience have shown that the distal bronchi and foreign bodies can be visualized more effectively when using a rigid endoscope during RB, especially in children under the age of 3 years. In order to improve the safety of the surgical procedure, the authors propose that endoscope-assisted RB should be used in emergencies concerning foreign bodies in the airways of children.

Recurrent renal giant leiomyosarcoma.

Primary renal leiomyosarcomas are rare, aggressive tumors. They constitute 1-2% of adult malignant renal tumors. Although leiomyosarcomas are the most common histological type (50-60%) of renal sarcomas, information on renal leiomyosarcoma is limited. Local or systemic recurrences are common. The radiological appearance of renal leiomyosarcomas is not specific, therefore renal leiomyosarcoma cannot be distinguished from renal cell carcinoma by imaging methods in all patients. A 74-year-old female patient presented to our clinic complaining of a palpable mass on the right side of her abdomen in November 2012. The abdominal magnetic resonance imaging revealed a mass, 25 × 24 × 23 cm in size. Her past medical history revealed that she has undergone right radical nephrectomy in 2007, due to a 11 × 12 × 13 cm renal mass that was then reported as renal cell carcinoma on abdominal magnetic resonance imaging, but the pathological diagnosis was low-grade renal leiomyosarcoma. The most recent follow-up of the patient was in 2011, with no signs of local recurrence or distant metastases within this four-year period. The patient underwent laparotomy on November 2012, and a 35 cm retroperitoneal mass was excised. The pathological examination of the mass was reported as high-grade leiomyosarcoma. The formation of this giant retroperitoneal mass in 1 year can be explained by the transformation of the lesion's pathology from low-grade to a high-grade tumor.

[Transcanal endoscopic tympanoplasty in the treatment of chronic otitis media]. / Kronik otitis media tedavisinde transkanal endoskopik timpanoplasti.

OBJECTIVES: This study aims to report early postoperative complications and hearing results in patients with chronic otitis media undergoing endoscopic transcanal tympanoplasty. PATIENTS AND METHODS: Twenty-four patients (6 males, 18 females; mean age 25.9 years; range 9 to 46 years) who were operated with endoscopic transcanal tympanoplasty in the Department of Otorhinolaryngology, Faculty of Medicine, Çukurova University between December 2012 and January 2014 were included. Postoperative complication rates, graft success, and hearing outcomes (mean air-bone gap) were evaluated. RESULTS: The mean preoperative air bone gap was found 25.1 dB and the mean postoperative air bone gap was found 20.3 dB. Postoperative duration of hospital was 24 hours. Reperforation was seen in one patient and medialization of the anterior quadrant of the graft was seen in one patient. The mean follow-up time was 7.3 months. CONCLUSION: Endoscopic transcanal tympanoplasty can be easily applied, cheap and safe method and can be given successful results in challenging cases.

The effect of primary thyroid surgery on the morbidity of reoperative thyroid surgery.

OBJECTIVES: This study aims to investigate the effect of primary surgery on the morbidity of reoperative thyroid surgery. PATIENTS AND METHODS: Fifty-seven patients (14 male, 43 female; mean age 41 years; range 21 to 70 years), who underwent reoperative thyroid surgery in our clinic between January 2007 and January 2012 were retrospectively analyzed in terms of vocal cord paralysis, temporary or permanent hypoparathyroidism, and other complications. The patients were classified into two groups. The first group consisted of 42 completion thyroidectomy patients that had undergone the primary operation of unilateral total lobectomy + isthmusectomy in our clinic, whereas the second group consisted of 15 patients that had undergone bilateral subtotal or near total thyroidectomy in another center. Complication rates were compared between the groups. RESULTS: Complication rates were observed as permanent vocal cord paralysis in one patient (1.7%), permanent hypocalcemia in two patients (3.5%) and temporary hypocalcemia in four patients (7%). None of the patients had temporary vocal cord paralysis. The complications in the second group were significantly higher than the first group (p=0.021). CONCLUSION: The minimal operation should be hemithyroidectomy (total lobectomy and isthmusectomy) to minimize the complications. This approach removes the need for the intervention to the previous surgery field during reoperative thyroid surgery.

Protective Effects of Syringic Acid on Ischemia-Reperfusion Injury in Testicular Torsion: An Experimental Study in a Rat Model.

AIM: The purpose of this study was to assess the effectiveness of syringic acid in preventing ischemia-reperfusion injury following detorsion in a rat model of induced testicular torsion. MATERIAL AND METHODS: In our study, a total of 24 rats, eight in each group, were used. Group 1 served as the control group. Group 2 underwent testicular torsion and detorsion. Group 3 underwent the same procedures as Group 2, but also received 100 mg/kg syringic acid immediately following ischemia. Spectrophotometric analysis was performed on blood samples, and the activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px), as well as the values of malondialdehyde (MDA), were evaluated under direct microscopic examination of the testis to determine tissue injury. The architecture of the seminiferous tubules and spermatogenesis processes were graded using the Johnsen and Cosentino scoring systems. RESULTS: The mean value of MDA was higher in Group 2 compared to the other groups (p < 0.001). Group 3 demonstrated a decline in the concentrations of proinflammatory cytokines, such as tumor necrosis factor-alpha, interleukin-6, and interleukin-1 beta, as indicated by biochemical analysis of blood samples, when compared to Group 2 (p-values: 0.045, 0.001, and <0.001, respectively). In addition, the improvement in Johnsen and Cosentino scores was significantly higher in Group 3 compared to Group 2 (p = 0.028 and p = 0.001, respectively). CONCLUSION: These findings suggest that syringic acid has a protective effect against testicular oxidative damage.

An Experimental Rat Model Study: Is There Any Effect of Syringic Acid on Ischemia-Reperfusion Injury in Priapism?

Purpose The purpose of this research is to examine the impact of syringic acid on ischemia-reperfusion injury in cavernosal tissue, utilizing a rat model of induced priapism. Materials and methods A total of 24 rats were allocated into three groups. Group 1 was designated as the control group, while Group 2 underwent ischemia-reperfusion injury assessment using the priapism model. Group 3 underwent the same procedures as Group 2, with the addition of intraperitoneal administration of syringic acid (100 mg/kg) 60 min after priapism initiation. All rats underwent penectomy, and sufficient blood samples were collected. Histopathological assessment of penile cavernosal tissue involved grading tissue damage, inflammation, vasocongestion, desquamation, and edema on a scale of 0-3 (0: normal, 1: mild, 2: moderate, 3: severe). Result Significant differences were observed among the three groups in terms of IL-1 beta and TNF-alpha levels (p=0.001 and p<0.001, respectively). IL-1 beta and TNF-alpha levels in Group 2 were found to be significantly higher than Group 3 (p=0.003 and p=0.004). There was also a significant difference among the three groups in terms of median MDA levels (p<0.001). Furthermore, the median MDA level in Group 2 was found to be significantly higher than that in Group 3 (p<0.001). While significant differences were observed among the three groups in terms of median SOD and GSH-px levels, no significant difference was found among the groups in terms of median PC levels (p=0.004, p= 0.048, and p=0.159, respectively). In direct microscopic examination, a significant improvement in pathological scores was noted in Group 3 compared to Group 2 (p<0.001). Conclusion Syringic acid demonstrated protective properties against ischemia-reperfusion injury caused by priapism in cavernosal tissue.

Analysis of the roles of smoking and allergy in nasal polyposis.

OBJECTIVES: Recent studies on the etiopathogenesis of nasal polyps have shown that smoking and nonallergenic inhalants such as occupational dust exposure cause chronic inflammation of the nasal mucosa. These factors may be associated with nasal polyps. The aim of this study was to use laboratory tests to investigate the effects of smoking and allergens on the development of nasal polyps. METHODS: The study included 60 consecutive patients with a diagnosis of nasal polyposis who were treated with functional endoscopic sinus surgery at our clinic and 25 smoker and 25 nonsmoker participants who constituted a control group. RESULTS: In the patient and control groups, the mean absorbance value for cotinine in smokers was found to be statistically significantly lower than that in nonsmokers. There was a significant difference between the groups with respect to blood cotinine positivity. No significant difference was found between the groups in terms of allergy parameters. In the regression model, smoking was found to be the only significant risk factor for the development of nasal polyps, independent of smoking duration, absorbance value, or cotinine positivity. CONCLUSIONS: Smoking restriction and avoiding exposure to cigarette smoke by patients with nasal polyps may be an important strategy in the prevention and recurrence of nasal polyposis. No direct relationship was determined between allergy and nasal polyposis.

The Results of Cochlear Implantation in the Inner Ear Malformations.

BACKGROUND: Cochlear implants are arguably the most successful neural prosthesis today. Cochlear implantation has several difficulties in patients with internal ear anomalies. This study was performed to analyze intraoperative, postoperative findings, and auditory performance of 55 patients who had inner ear malformations and were treated with cochlear implants at Otorhinolaryngology Department of Çukurova University Hospital. METHODS: Auditory performances were analyzed in 30 of 55 patients. Patients with cochlear anomalies were evaluated as group I, patients with vestibular malformation as group II, and patients with the normal bone labyrinth as group III. Listening progress profiles and meaningful auditory integration scale tests were used to determine performances. RESULTS: Comparison between the listening progress profiles test performance of the groups at 12th and 18th month of group I was significantly lower than other groups (P < .05) and reached at the same level after the 24th month. Comparison between the meaningful auditory integration scale test performance of groups at 24th and 36th month of group I was significantly lower than other groups (P < .05). Perilymph gusher was observed in 3 patients who had incomplete partition I malformation. Oozing was observed in 50% of incomplete partition II patients. Facial nerve traced a variant course in 4 of 55 patients and 6 patients had postoperative meningitis. CONCLUSION: Initially patients with inner ear anomalies showed that the level of language development was worse than patients with normal bone anatomy. However, it was shown that they both reached the same point as a result. Facial nerve anomaly and meningitis risk is higher in patients with inner ear malformations.

The value of copper and zinc levels in hernia formation.

BACKGROUND: A defect in collagen metabolism is suspected to be one of the factors responsible for hernia formation. Lysyl oxidase is a copper-dependent enzyme in the process that provides for the structural integrity of collagen molecules, while zinc is essential for tissue maintenance. MATERIALS AND METHODS: In a prospective fashion, copper and zinc levels were measured in plasma and tissue specimens obtained from indirect (n=23), direct (n=20) and incisional hernia patients (n=19) and from healthy controls (laparoscopic cholecystectomy patients, n=15) by enzymatic colorimetric analysis. RESULTS: Groups were similar in age, comorbid diseases and body mass index. Whereas plasma levels of Cu and Zn in hernia and control patients were similar, and tissue levels were significantly lower in all hernia groups (especially the incisional hernia group) compared to controls (P<0·001). The incisional hernia group had significantly lower tissue copper levels than direct hernia patients and lower zinc levels than indirect hernia patients. CONCLUSIONS: Patients with all types of hernia, especially those with incisional hernias, have significantly lower tissue copper and zinc levels than control patients, despite having similar plasma levels. This finding might reflect excessive consumption or dysfunction of lysyl oxidase as playing a role in the aetiology of hernias.

[Auditory performance analyses of cochlear implanted patients]. / Koklear implant uygulanan hastalarin isitsel performans analizleri.

OBJECTIVES: The aim of this study was to analyze the auditory performance development of cochlear implanted patients. The effects of age at implantation, gender, implanted ear and model of the cochlear implant on the patients' auditory performance were investigated. PATIENTS AND METHODS: Twenty-eight patients (12 boys, 16 girls) with congenital prelingual hearing loss who underwent cochlear implant surgery at our clinic and a follow-up of at least 18 months were selected for the study. Listening Progress Profile (LiP), Monosyllable-Trochee-Polysyllable (MTP) and Meaningful Auditory Integration Scale (MAIS) tests were performed to analyze the auditory performances of the patients. To determine the effect of the age at implantation on the auditory performance, patients were assigned into two groups: group 1 (implantation age = or <60 months, mean 44.8 months) and group 2 (implantation age = or <60 months, mean 100.6 months). RESULTS: Group 2 had higher preoperative test scores than group 1 but after cochlear implant use, the auditory performance levels of the patients in group 1 improved faster and equalized to those of the patients in group 2 after 12-18 months. Our data showed that variables such as sex, implanted ear or model of the cochlear implant did not have any statistically significant effect on the auditory performance of the patients after cochlear implantation. CONCLUSION: We found a negative correlation between the implantation age and the auditory performance improvement in our study. We observed that children implanted at young age had a quicker language development and have had more success in reading, writing and other educational skills in the future.

Mucormycosis in a pediatric population: a review of 20 cases from southern Turkey.

BACKGROUND: Mucormycosis is a fatal invasive fungal infection seen most often in patients with compromised defense mechanisms. The aim of this article was to review the data of pediatric mucor in the South of Turkey. METHODS: Twenty pediatric cases with biopsy proven mucormycosis were reported, between January 2007 through January 2017. Data were extracted from the medical charts of patients retrospectively. RESULTS: Underlying conditions were hematological malignancy (75%), in whom 93% had acute leukemia, aplastic anemia (15%), diabetes mellitus (5%) and other malignancies (5%). The main sites of infection were sinus (85%); alone (29.4%) or with cerebral (17.6%), and orbital involvement (17.6%). Pulmonary involvement was reported in 11 patients (55%), two of them had the alone form and nine cases were associated with nasal sinus involvement. Disseminated mucormycosis was documented in 45%. Fever and pain/swelling of organs were the most commonly encountered signs and symptoms. Treatment compromised of am-photericin B monotherapy in five patients. All patients except one received liposomal formu-lations (LAmB). A combination of surgery and antifungal therapy was performed in 75%. Crude survival was 55%; among 15 cases treated with a combination of surgery and antifun-gal therapy, survival rate was 8/15 (53%). The overall mortality rate was high in patients diagnosed with disseminated infection (100%). CONCLUSIONS: Mucormycosis in pediatric cases requires a high index of suspicion and urgent evaluation of clinical samples. Surgical debridement should be considered when feasible. Initial medical therapy should include an amphotericin preparation with or step-down to posaconazole.

Assessment of HPV 16, HPV 18, p16 expression in advanced stage laryngeal cancer patients and prognostic significance.

INTRODUCTION: Human papilloma virus is an etiological risk factor for a subset of head and neck squamous cell carcinomas. HPV has been proven to be a powerful prognostic biomarker for oropharyngeal cancer, but its role in the larynx has not been explored in depth. The developmental mechanisms of laryngeal carcinomas are quite complex and controlled by various factors. Smoking and alcohol are most important risk factors. Recent studies indicate that HPV infection also plays an important role in larynx carcinomas. HPV related laryngeal carcinomas especially occur at the supraglottic region of larynx. OBJECTIVE: We aimed to determine the frequency of HPV/protein16 positivity in patients with laryngeal carcinoma and association of HPV and/or p16 positivity with variables such as age, sex, smoking habits, tumor localization, lymph node metastasis, recurrence and survival in advanced stage laryngeal carcinoma in our study. METHODS: This retrospective study included 90 patients with advanced laryngeal carcinoma. The Control group was 10 normal larynx mucosa specimens. The presence of HPV was investigated polyclonally by polymerase chain reaction, and protein16 with immunohistochemical method. In HPV positive cases, the presence of HPV types 16, 18 were evaluated by polymerase chain reaction. Demographic features of patients were noted. Patient survival and association with HPV/protein16 was determined. RESULTS: Polyclonal HPV positivity was detected in 11 (12.2%) of 90 cases. Out of these 11 cases, HPV 16 was positive in 6, HPV 18 in 4, and both HPV 16 and 18 were positive in 1. In 18 (20%) of the cases, p16 was positive. Six of the cases (6.6%) had both HPV and protein16 positivity. In cases where protein16 alone or HPV and protein16 were co-positive, alcohol use was less and the tumor was found more likely to be localized in the supraglottic area. These ratios were statistically significant. Supraglottic localization of tumor was determined to be increased in protein16 positive cases. The correlation between protein16 positivity and supraglottic area location was determined to be statistically significant (p =  0.011). 55.6% of protein16 positive cases was located in the supraglottic region, 33.3% was glottic and 11.1% was transglottic. Although life expectancy over 5 years were numerically higher in HPV and protein16 positive cases, this was not found to be statistically significant. There was no statistically significant relationship between HPV positivity and mean age, differentiation, smoking and alcohol use, tumor progression, lymph node metastasis, localization, recurrence, cause of mortality and treatment methods in our study. The mean follow-up period of our patients was 6.7 years. CONCLUSION: The close relationship between HPV and oropharyngeal squamous cell carcinoma could not be shown in larynx malignancy in many studies, including our study. Our findings support a limited role of HPV in laryngeal carcinogenesis. Protein16 is not a reliable surrogate for HPV status in laryngeal cancers and is not a predictor of laryngeal cancer survival. Supraglottic localization of tumor was determined to be increased in protein16 positive cases. The correlation between protein16 positivity and supraglottic area location was determined to be statistically significant. There is a need for more populated clinical trials, where neoplastic proliferation is better demonstrated and the accuracy of the results obtained is supported by different techniques.

Management of Complications in 1452 Pediatric and Adult Cochlear Implantations.

OBJECTIVE: The aim of this study was to determine the short- and long-term complications after cochlear implantation (CI) procedures and to discuss the management and prevention of these complications. METHODS: The study included a total of 1452 pediatric and adult cochlear implantation procedures performed in our clinic from March 2000 through September 2019. Of the 1452 implantations, 1201 were performed in children and 156 in adults. The minimum follow-up period was three months and maximum was 19 years. The mean age of the patients was 6.7±3.9 years (range, 10 months-69 years) at the time of their respective procedures. Complications were classified as major complications requiring reimplantation, major complications not requiring reimplantation and minor complications. All postoperative complications and treatment methods were examined. RESULTS: A total of 148 (10.1%) complications were observed in the 1452 cochlear implants. Of these, 69 (4.75%) were major and 79 (5.44%) were minor complications. While 40 (2.75%) of the major complications required reimplantation, 29 (1.99%) did not. The most common cause of major complications leading to reimplantation was device failure (29 patients, 1.99%). The most common cause of minor complications was hematoma (21 patients). Total complication rates (6.68%) were significantly higher in children than in adults (3.51%) (p=0.00). CONCLUSION: Our 19 years of clinical experience has shown that CI is a successful and safe procedure that can be performed with low major complication rates. It is important to know the possible complications and to manage them correctly.