Investigation of the serum vitamin D level in infants followed up with the diagnosis of laryngomalacia: a case-control study.

OBJECTIVE: The possible etiological relationship of the vitamin D with laryngomalacia is unclear. The aim of the study was to demonstrate the relationship between laryngomalacia and vitamin D levels. METHODS: Twenty-three non-syndromic babies under the age of 1 year who were diagnosed with laryngomalacia were included in the study group. Forty healthy babies were included in the control group. The detailed anamnesis was obtained and a complete systemic physical examination, a flexible endoscopic laryngeal examination, and laboratory tests [calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), parathormone (PTH), alanine transaminase (ALT), aspartate transaminase (AST), blood urea nitrogen (BUN), creatinine (Cre), and 25-hydroxy vitamin D (25-OH D)] were performed in all patients. All laboratory tests of the groups were compared. RESULTS: It was observed that there was no significant difference in the parameters that could affect vitamin D levels, namely type of feeding, vitamin D supplement intake, and the season when the serum sample was taken (p > 0.05). The vitamin D level was significantly lower (p = 0.003, p < 0.05) and the P and ALP levels were significantly higher (p = 0.016 and p = 0.001, respectively; p < 0.05) in the laryngomalacia group. Although the correlation between vitamin D and PTH was not statistically significant according to the Pearson correlation analysis, it was lower in the laryngomalacia group compared to the control group (p = 0.381, p > 0.05). CONCLUSION: In this study, it was observed that the vitamin D levels were lower in infants with laryngomalacia compared to the control group. We consider that vitamin D deficiency may be a factor in the etiology of laryngomalacia with a yet-to-be-clarified etiology.

Nesfatin-1 Levels Predict Angiographic No-Reflow in Patients with ST-Segment Elevation Myocardial Infarction.

BACKGROUND: Nesfatin-1 is a novel peptide possessing pleiotropic metabolic effects. No-reflow phenomenon (NR) is a poor prognostic indicator occurring in around 30% of all patients undergoing primary percutaneous coronary interventions (pPCI). Inflammation and complexity of coronary artery disease (CAD) play pivotal roles in the pathogenesis of NR. In this study, we investigated the relationship between admission serum nesfatin-1 level, NR and complexity of CAD assessed by SYNTAX-1 (SS-1) and SYNTAX-2 (SS-2) scores in patients with ST-segment elevation myocardial infarction (STEMI) undergoing pPCI. METHODS: A total of 174 STEMI patients who underwent pPCI were included in the study and divided into NR (n = 36) and normal flow (n = 138) groups. Serum nesfatin-1 was measured by enzyme-linked immunosorbent assay. Seventy-eight consecutive age-, gender- and co-morbidity-matched patients undergoing coronary angiography with < 50% stenosis comprised the control group. RESULTS: Nesfatin-1 levels were significantly lower in the NR group compared to the normal flow and control groups (10.8 ± 6.6 ng/mL vs. 34.9 ± 24 ng/mL vs. 43.6 ± 23.2 ng/mL, respectively, p < 0.001). Nesfatin-1 was significantly and inversely correlated with SS-1 and SS-2 scores (r = -0.709 and r = -0.655, respectively, both p < 0.001). Multivariate logistic regression analysis showed that nesfatin-1 [odds ratio (OR) = 0.81, 95% confidence interval (CI) = 0.708-0.936, p = 0.004] and glomerular filtration rate (OR = 0.94, 95% CI = 0.892-0.989, p = 0.018) were independently associated with NR. In the receiver operating characteristic analysis, nesfatin-1 < 15.21 ng/mL predicted NR with 78.4% sensitivity and 72.2% specificity (area under the curve = 0.809, 95% CI = 0.701-0.918, p < 0.001). CONCLUSIONS: Admission nesfatin-1 level is a potent predictor of NR in STEMI patients undergoing pPCI. Additionally, nesfatin-1 has a robust and negative correlation with the complexity of CAD.

Evaluation of index of cardiac-electrophysiological balance before and after hemodialysis in patients with end-stage renal disease.

BACKGROUND: Ventricular arrhythmias and sudden cardiac deaths are the most common cause of mortality in patients with end-stage renal disease (ESRD). Index of cardiac-electrophysiological balance (iCEB) (QT/QRS) may predict malignant ventricular arrhythmias. In this study, we investigated whether iCEB value is increased in ESRD patients and whether it changes before and after hemodialysis. METHODS: The study included 52 ESRD patients and 53 control subjects matched for age and comorbidities. Biochemical, electrocardiographic and echocardiographic values of all participants were recorded. QRS, QT, Tp-e were measured manually. QTC was calculated using Bazett's formula. Then, Tp-e/QT, Tp-e/QTc, QT/QRS, and QTc/QRS ratios were calculated. The changes in ECG parameters of the ESRD patients before and after HD were compared using paired t-test. RESULTS: Mean age and male sex ratio was comparable in both groups (p = 0.448 and p = 0.777, respectively). Comorbidity incidences, and biochemical parameters except eGFR (p < 0.001), albumin (p < 0.001), HDL cholesterol (p = 0.03) and platelet counts (p < 0.001) were comparable in both groups. Compared to the control group, QT, QTc, Tp-e, Tp-e/QT, Tp-e/QTc, QT/QRS, and QTc/QRS ratios were higher in the ESRD group (p < 0.05 for each). While QT and QTc intervals did not change after HD in ESRD patients, Tp-e, Tp-e/QT, Tp-e/QTc, QT/QRS, and QTc/QRS parameters increased significantly. CONCLUSION: In addition to ventricular repolarization dispersion indices in ESRD patients, iCEB elevation and increasing values after HD session indicate the increased risk of TdP-mediated ventricular arrhythmia after HD. Larger studies are needed to confirm our results.

Piezoelectric Drilling Hole Technique in Septal Fixation.

OBJECTIVES: The act of securing the septum to the midline is very important for the success of the operation during septoplasty and septorhinoplasty operations. The authors' aim in this study is to open a hole in the anterior nasal spine with the Piezoelectric drilling hole technique so as to fix the septum to the midline with a suture passing through that hole. METHODS: Patients with anterior segmental deviation on whom we performed septoplasty or closed technique septorhinoplasty were included in the study. The patients were divided into 2 groups, as the Classic and Piezo Groups. A total of 63 patients were included in the study; in the Classic Group, we performed septum fixation with suture of the nasal spine to the mucoperiosteum in 27 patients; whereas in the Piezo Group, fixation was performed on 36 patients using the piezo-surgical suture through a nasal spinal opening. Patients were assessed preoperatively and postoperatively by VAS and NOSE scores, and also by postoperative examinations. RESULTS: Preoperative and postoperative VAS-NOSE scores were found to be statistically significantly different in both groups (P < 0.0001, P < 0.0001). Redeviation with no need for revision surgery was reported to develop in 1 patient of the classical group (3.7%). CONCLUSION: Piezoelectric drilling hole technique provides stronger fixation in the midline and prevents postoperative redeviation. Its most important superiority over the other methods used in fixing the septum to the nasal spine is its ability to provide adequate stabilization without damaging soft tissue.

Significance of Medial Osteotomy on the Olfactory Function in Patients Who Underwent Septorhinoplasty.

OBJECTIVE: This study was designed to explore the impact of medial osteotomy on olfactory function. METHODS: This nonrandomized, prospective study included 60 adult patients who underwent open technique septoplasty (group 1), rhinoplasty with only lateral osteotomy (group 2), and septorhinoplasty with medial and lateral osteotomies (group 3). Olfactory functions were evaluated by using the Connecticut Chemosensory Clinical Research Center (CCCRC) olfactory test. The CCCRC test includes the butanol threshold test and smell identification test using common smells. The butanol threshold test and smell identification test scores of each group were recorded preoperatively and at 1st and 4th months and compared. RESULTS: Each group is consisted of 20 patients. The preoperative smell identification test and butanol threshold test scores were similar in each group. The smell identification test, butanol threshold test, and CCCRC olfactory test scores of the 1st month were statistically significantly low in group 3. There was no statistically significant difference between the groups at 4th month postoperatively. CONCLUSION: The present study is the first analysis of the effect of medial osteotomy on olfactory function. Medial osteotomy may decrease the olfactory function in early time, but afterwards olfaction could recover at preoperative levels.

Association between Growth Differentiation Factor 15 and Non-Dipping Circadian Pattern in Patients with Newly Diagnosed Essential Hypertension.

OBJECTIVE: Non-dipper hypertension (HT) confers greater risk compared with dipper HT. Growth differentiation factor 15 (GDF-15) recently emerged as a novel and independent marker of cardiovascular disease, both in diagnostic and prognostic scopes. Our aim was to evaluate the relationship of circadian blood pressure (BP) pattern with serum GDF-15 level in newly diagnosed HT patients without left ventricular hypertrophy. SUBJECTS AND METHODS: Newly diagnosed non-dipper (n = 66) and dipper (n = 60) HT patients were selected according to 24-h ambulatory BP monitoring (ABPM). The controls comprised healthy normotensive subjects (n = 31). Data was collected through physical examination, laboratory analysis, ABPM, and echocardiography. GDF-15 was measured using ELISA. RESULTS: Greater GDF-15 level was found in the non-dippers compared with the dippers and the controls (557.53 ± 91.7, 513.79 ± 62.86, and 494.44 ± 79.30 ng/L, respectively, p < 0.001). In bivariate linear correlation analysis, GDF-15 correlated positively with glomerular filtration rate (r = 0.180, p =0.030), total cholesterol (r = 0.170, p = 0.038), septal E/E' ratio (r = 0.344, p = 0.001), lateral E/E' ratio (r = 0.366, p < 0.001), nighttime systolic BP (r = 0.166, p = 0.046), and nighttime diastolic BP (r = 0.188, p = 0.024); however, it correlated negatively with septal and lateral E' velocities (r = 0.268, p = 0.005 and r = 0.236, p = 0.013, respectively). Furthermore, GDF-15 level and nighttime diastolic BP remained independently associated with non-dipper HT. In ROC analysis, optimal cutoff value for GDF-15 was 524.6 ng/L with 56.7% sensitivity and 72.4% specificity (AUC: 0.676, 95% CI: 0.580-0.772, p < 0.05). CONCLUSION: Our results showed GDF-15 upregulation in the non-dipper HT group. GDF-15 and nighttime diastolic BP were independently associated with the non-dipping pattern. This study may suggest possible utilization of GDF-15 in the prediction of non-dipper HT.

Usefulness of white blood cell count to mean platelet volume ratio in the prediction of SYNTAX score in patients with non-ST elevation myocardial infarction.

OBJECTIVE: White blood cell (WBC) count to mean platelet volume (MPV) ratio (WMR) is associated with major adverse cardiovascular events in patients with non-ST elevation acute coronary syndrome (NSTEMI). We aimed to compare WMR between NSTEMI patients and matched-controls and to evaluate its predictive value on SYNTAX score. METHODS: Total 175 patients with NSTEMI and 160 age and co-morbidity matched subjects were recruited in our study. WMR was compared between the patient and control groups. The patient group was further subdivided into 3 tertiles according to SYNTAX scores as follows: low SYNTAX score tertile (score ≤22, 141 patients); intermediate SYNTAX score tertile (score between 23 and 32, 20 patients); and, high SYNTAX score tertile (score ≥33, 14 patients). WMR was further assessed among the tertiles. RESULTS: WMR was significantly greater in the patient group compared to the control group (p<0,001). WMR among low, intermediate and high score tertiles were calculated to be 890±26, 1090±042 and 1500±65, respectively (p <0,001). In receiver operating characteristics (ROC) analysis, WMR >960 predicted a SYNTAX score ≥23 with 80.6% sensitivity and 67.6% specificity (AUC: 0.756; 95% CI: 0.685 - 0.818; p <0.0001) and a WMR >1360 predicted a SYNTAX score ≥33 with 71.4% sensitivity and 93% specificity (AUC: 0.840; 95%CI: 0.777 - 0.892; p <0.0001). CONCLUSIONS: WMR value was significantly elevated in NSTEMI patients, compared to controls. Higher WMR was associated with greater SYNTAX score in patients with NSTEMI. WMR may be used to predict severity of the CAD and to implement risk stratification in patients with NSTEMI.

Changes in the parameters of ventricular repolarization during preapnea, apnea, and postapnea periods in patients with obstructive sleep apnea.

BACKGROUND: Ventricular arrhythmias are reported to be more common in patients with obstructive sleep apnea (OSA). Preliminary evidence showed such parameters regarding ventricular repolarization as Tp-e, Tp-e/QT, and Tp-e/QTc may be related with increased cardiac arrhythmias and even sudden cardiac death. The purpose of the present study was to evaluate ventricular repolarization during immediately preapnea period, apnea period, and postapnea hyperventilation period in patients with OSA. METHODS: A total of 59 patients who underwent polysomnography and were diagnosed with OSA between the years 2016-2017 in our hospital were included in our study. Of 59 patients (mean age: 52.51 ± 9.66), 28 were male and 31 were female. In all patients, Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio, together with some other parameters, were calculated. Categorical variables were expressed as proportion and continuous variables were expressed as mean ± standard deviation. Electrocardiogram calculations of interest were compared through preapnea, apnea, and postapnea periods using Friedman's test. RESULTS: Tp-e interval (85.6 ms [78.3-95.6], 98 ms [88.5-107.7], 91.2 ms [81-98.8], respectively; P < 0.001), Tp-e/QT ratio (0.219 [0.202-0.237], 0.242 [0.224-0.269], 0.233 [0.212-0.246], respectively; P < 0.001), and Tp-e/QTc ratio (0.210 [0.190-0.222], 0.233 [0.209-0.247], 0.212 [0.193-0.229], respectively; P < 0.001) were significantly increased during apnea period compared to the preapnea period and significantly decreased during postapnea hyperventilation period compared to the apnea period. CONCLUSION: Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio were shown to be increased during apnea period and decreased during postapnea hyperventilation period. Our findings may help explain cardiac arrhythmias and sudden death in OSA patients.

Does the Degree of the Mastoid Pneumatization Affect the Side of Bell Palsy?

OBJECTIVE: The aim is to investigate the impact of degree of mastoid pneumatization on the affected side of Bell palsy (BP). STUDY DESIGN: Retrospective study in tertiary academic hospital. METHODS: In total, 52 patients who were diagnosed with as BP were included in the study. Each patient was staged using House-Brackmann (HB) staging system. All patients underwent temporal bone computed tomography imaging. House-Brackmann scores, side of the BP, and mastoid pneumatization of all of patients were evaluated in the present study. RESULTS: Regarding the degree of the mastoid pneumatization, there were no significant differences between the affected side and the unaffected side (P = 0.439). The degree of the mastoid pneumatization of the affected side and the unaffected side did not differ between males and females (P = 0.918 for the affected side, P = 0.765 for the unaffected side, respectively). A negative correlation between the age and mastoid pneumatization of each side was found (P = 0.001, P = 0.025, respectively). There was no significant correlation between HB score and the degree of the mastoid pneumatization of each side (P = 0.789, P = 0.703). CONCLUSION: As a conclusion, the degree of the mastoid pneumatization is not one of the risk factors for BP. Further randomized studies with larger numbers of patients are needed to confirm these findings.

Interobserver Consistency of Drug-Induced Sleep Endoscopy in Diagnosing Obstructive Sleep Apnea Using a VOTE Classification System.

OBJECTIVES: To explore the interobserver consistency of drug-induced sleep endoscopy (DISE) for patients with obstructive sleep apnea syndrome (OSAS) and review the current literature. METHODS: In total, 55 patients with an apnea-hypopnea index >5, as determined by on overnight sleep study, were included in this study, 45 males and 10 females, with an average age of 46.87 ±â€Š10.06 years old (range, 19-71). For all OSAS patients, DISE was performed by the same surgeon, which was recorded digitally. The video recordings of DISE were evaluated independently by 3 experienced surgeons who were asked to note his or her decisions as the pattern, site, and degree of upper airway collapse using a VOTE (velum, oropharynx lateral wall, tongue base, and the epiglottis) classification system. RESULTS: Interobserver consistency in the diagnosis of velum-related obstruction in anteroposterior, lateral, and concentric configurations ranged from poor to good. Only significant interobserver consistency among observers A and B was obtained in the diagnosis of oropharynx-related obstruction in the lateral configuration (concordance 60.0%, kappa: 0.365, P < 0.05). Interobserver consistency in the diagnosis of the tongue-related collapse in an anteroposterior configuration, the epiglottis-related collapse in an anteroposterior and lateral configuration ranged from fair to moderate (all kappa values >0.20, all P values < 0.05). CONCLUSION: Our data suggested that the interobserver consistency of DISE ranged from poor to good. Therefore, further studies with larger numbers of patients are needed to standardize DISE procedures, training, and interpretation.

Outcomes of cochlear implantation in children with and without inner ear malformations.

OBJECTIVE: To evaluate the auditory functions and progress of speech development in children with and without cochlear anomalies who underwent cochlear implantation due to prelingual profound sensorineural hearing loss (SNHL). METHODS: This study was conducted at Gaziantep University Faculty of Medicine Ear-Nose-Throat Department, between October 2006 and December 2007. A total of 69 children (aged 6 to 24 months) diagnosed with profound SNHL were included. Patients were divided into two groups with respect to the presence of inner ear anomalies: Group-1 consisted of 41 children without inner ear anomaly, whereas Group-2 was composed of 28 patients with inner ear anomalies. The auditory performance was assessed using Listening Progress Profile Test (LPPT) and Monosyllabic Trochee Polysyllabic Test (MTP), the subsections of Evaluation of Auditory Responses to Speech (EARS) test battery. RESULTS: Preoperative LPPT scores were 5 (12%) in both groups. Mean LPPT values after fitting in Group-1 and Group-2 on 1st, 3rd and 6th months were 18.5 (44.1%) and 19 (45.6%); 27 (64.2%) and 28 (67.3%); 31 (75%) and 34 (83%), respectively. Postoperatively, MTP scores in Group-1 and Group-2 were 7.5 (62%) and 7.7 (64%) for 3-words set; 10.4 (58%) and 10.6 (59%) for 6-words set; 14.3 (60%) and 14 (59%) for 12-words set, respectively. The rate of stimulation for electrodes was 1345 q/u (quick/unit) in Group-1 and 1310 q/u in Group-2. No statistically significant difference was detected between groups for variables under investigation. CONCLUSION: Cochlear implantation is an effective treatment in children with prelingual profound SNHL. Auditory performance and advancement of speech are similar for children with and without inner ear anomalies.

Determination of the knowledge level, attitudes, and behaviors of islamic religious officials toward blood donation.

The aim of the present study was to determine knowledge level, attitudes, and behaviors of Islamic religious officials toward blood donation. This study included 334 religious officials rendering service in the province of Kahramanmaras, located in the Mediterranean region of Turkey. A questionnaire was administered to gather sociodemographic data of the participants and their knowledge levels, attitudes, and behaviors toward blood donation. The questionnaire consisted of 11 questions that yielded a total of 11 points. The religious officials in the study included 206 imams (61.7%, males) and 128 Quran course instructors (38.3%, females). Of study participants, 134 (40.1%) reported a previous experience of blood donation and 200 (59.9%) denied previous experience of blood donation. The mean knowledge score was 7.09±2.54 points for males and 6.89±2.18 points for females. Male and female participants achieved comparable scores (p=0.476). Of the participants, 291 (87.1%) agreed and nine (2.7%) disagreed with the expression, "Blood donation is permissible in Islam;" 34 (10.2%) participants had no idea. The present study revealed considerable deficiencies in knowledge about blood donation among religious officials. In addition, the rate of blood donation and willingness to donate blood were low among religious officials. Although the level of knowledge about blood donation was similar in males and females, it was an interesting finding that the blood donation rate was significantly higher in males than in females.

Do the Angle and Length of the Eustachian Tube Affect the Success Rate of Pediatric Cartilage Type 1 Tympanoplasty?

OBJECTIVES: To investigate the relationships between the angle and length of the Eustachian tube (ET) (the ETa and the ETl) and the success rates of pediatric type 1 tympanoplasty. STUDY DESIGN: A retrospective clinical chart review. METHODS: In total, 51 children (31 females and 20 males; average age, 11.92 ±â€Š3.46 years; age range: 7-18 years) who underwent cartilage type 1 tympanoplasty were included. Demographics and anatomical outcomes were recorded. The patients were divided into 2 groups in terms of anatomical success. In group A, all patients had intact grafts without perforation, retraction, or lateralization, and a dry ear, at 6 months postoperatively. In group B, reperforation of the tympanic membrane was evident 6 months postoperatively. The average ETa and ETl values of each group were measured on computed tomography images using a multiplanar reconstruction technique, and compared. RESULTS: The ETa values of diseased ears of males and females were, respectively, 26.60 ±â€Š6.42° and 23.29 ±â€Š6.51°, compared to 27.25 ±â€Š5.23° and 23.32 ±â€Š4.61° for normal male and female ears, respectively. In group A, the ETa was 26.46 ±â€Š6.82° in males and 22.95 ±â€Š7.50° in females. In group B, the ETa was 26.85 ±â€Š6.12° in males and 23.90 ±â€Š4.45° in females. In group A, the mean ETl was 41.0 mm (29.6-45.3 mm) in males and 37.9 mm (32.0-44.5 mm) in females. In group B, the mean ETl was 40.5 mm (30.5-47.1 mm) in males and 38.0 mm (32.8-45.0 mm) in females. In group A, the ETa value of diseased ears did not differ between females and males, but in normal ears, the ETa was higher in males than females (P = 0.020 and P < 0.05, respectively). In group B, no difference was evident between the ETa values of normal and diseased ears (P > 0.05). No difference in the ETl values of diseased and normal ears, in either group, was apparent between females and males (both P > 0.05). CONCLUSIONS: Neither the ETa nor the ETl affected the success rate of pediatric cartilage type 1 tympanoplasty. Further studies with larger numbers of patients are needed to compare anatomical outcomes after placement of various graft types and the effects of anatomical features of the ET on the success rate of pediatric tympanoplasty.

Impact of Laryngopharyngeal Reflux on the Levels of Depression and Anxiety in Patients With Obstructive Sleep Apnea Syndrome.

OBJECTIVES: The aim of the study was to assess the impact of the presence of laryngopharyngeal reflux (LPR) on the level of depression and anxiety in patients with obstructive sleep apnea syndrome (OSAS). STUDY DESIGN: A nonrandomized, prospective clinical study. METHODS: In total, 62 patients with an apnea-hypopnea index >5 were included in this study. Each patients completed the 21-item Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Epworth Sleepiness Scale (ESS), and Reflux Symptom Index (RSI). Patients were diagnosed with LPR based on laryngeal examination and symptom presentation, with RSI score >13. The patients were divided into 2 groups based on the presence of LPR. In group A, all patients were diagnosed with LPR. In group B, the patients had no diagnosis of reflux disease. RESULTS: The mean RSI was 3.86 ±â€Š2.46 in group B and 17.2 ±â€Š6.34 in group A. The mean ESS scores did not differ between the groups (P = 0.107). Mean BAI and BDI scores were both higher in group A than in group B (P = 0.016 and P = 0.011, respectively). There was no correlation between RSI and BAI scores (r = -0.237; P = 0.063), BDI scores (r = 0.191; P = 0.138), or ESS scores (r = 0.210; P = 0.102). A positive correlation was found between RSI and apnea-hypopnea index scores (r = 0.338; P = 0.007). CONCLUSION: The authors observed significantly higher levels of depression and anxiety in patients with LPR and OSAS. The authors suggest that the presence of LPR induces depression and anxiety in patients with OSAS and vice versa. Further studies involving larger numbers of patients are needed to confirm these initial findings.

The Effect of the Angle and Length of the Eustachian Tube on the Success Rate of Cartilage Type 1 Tympanoplasty.

OBJECTIVES: To explore the relationships between the angle and length of the eustachian tube (ET) (the ETa and the ETl) and the success rates of type 1 tympanoplasty. STUDY DESIGN: A retrospective clinical chart review. METHODS: In total, 160 patients (81 females and 79 males; average age, 37.12 ±â€Š12.46 years; age range: 18-65 years) who underwent cartilage type 1 tympanoplasty were included. Demographics and anatomical outcomes were recorded. The patients were divided into 2 groups in terms of anatomical success. The average ETa and ETl values of each group were measured on computed tomography images using a multiplanar reconstruction technique, and compared. A P value <0.05 was considered to reflect statistical significance. RESULTS: In group A, the ETa of diseased ears was 27.74 ±â€Š12.06° in males and 21.87 ±â€Š7.58° in females. In group A, the ETa of normal ears was 27.53 ±â€Š4.15° in males and 22.25 ±â€Š4.67° in females. In group B, the ETa of diseased ears was 28.85 ±â€Š6.19° in males and 22.91 ±â€Š5.65° in females. In group B, the ETa of normal ears was 27.71 ±â€Š5.23° in males and 23.72 ±â€Š6.20° in females. In group A, the mean ETl of diseased ears was 42.1 mm (28.9-45.1) in males and 38.2 mm (31.0-44.7) in females. In group A, the mean ETl of normal ears was 41.9 mm (29.2-45.8) in males and 37.4 mm (30.5-44.1) in females. In group B, the mean ETl of diseased ears was 40.8 mm (30.2-47.4) in males and 37.9 mm (31.8-45.2) in females. In group B, the mean ETl of normal ears was 41.6 mm (30.0-45.0) in males and 39.1 mm (30.0-43.7) in females. In group A, the ETa value of diseased ears did not differ between females and males, but in normal ears the ETa was higher in males than females (P =0.002 and P <0.05, respectively). In group B, no difference was evident between the ETa values of normal and diseased ears (P >0.05). No difference in the ETl values of diseased and normal ears, in either group, was apparent between females and males (both P >0.05). CONCLUSION: Neither the ETa nor the ETl affected the success rate of cartilage type 1 tympanoplasty. Further studies with larger numbers of patients are needed to compare anatomical outcomes after placement of various graft types and the effects of anatomical features of the ET on the success rate of type 1 tympanoplasty.

Carotid Artery Aneurysm: A Rare Cause of Hemotympanum.

Temporal bone fractures can occur as a result of various head trauma. The most common cause of the hemotympanum is traumatic temporal bone fracture. Facial paralysis and hearing loss can be seen associated with temporal bone fracture. The development of the internal carotid artery aneurysm after temporal bone fracture is extremely rare. In this article, the authors evaluated carotid artery aneurysm that developed after temporal fracture and aneurism compressed by coagulated blood mass which showed itself as a hemotympanum. The internal carotid artery aneurysm that induced by temporal bone fracture and presented as hemotympanum has not been reported yet. This patient is the first case in the literature. Diagnosis, treatment, and follow-up options will be discussed in the light of current literature.

Evaluation of the Level of Knowledge of Oral Cancer Among High School Students.

The present study aims to determine the knowledge level of high school students regarding oral cancer. The present study included students from 20 high schools located in the city center of Kahramanmaras between 1 and 28 April 2015. The students were informed prior to the study and 2759 students who gave written consent were included in the study. The participants were administered a questionnaire that was prepared by the investigators. The questionnaire included 25 questions that were prepared using literature in order to establish the knowledge level of the students about oral cancer, and it was evaluated scoring one point to each question. There were 1711 (62.0 %) female students and 1048 (38.0 %) male students; the mean age was 16.01 ± 1.09 years. The knowledge score of the male students was 7.48 ± 5.15 and the knowledge score of the female students was 7.58 ± 4.96. The knowledge score of the female and male participants was similar (p = 0.605). Of the students, 2107 (76.4 %) stated that they heard the expression of oral cancer before compared to 652 (23.6 %) students stating they did not. The study found that high school students had insufficient levels of knowledge about oral cancer. There was a general lack of knowledge about oral cancer and the risks among these students.

Efficacy of early endoscopy and colonoscopy in very elderly patients with gastrointestinal bleeding.

OBJECTIVE: We aimed to determine the efficacy and safety of early (within the first 24 hour from application) endoscopy and colonoscopy in very elderly patients with GIS bleeding. METHODS: In this study, 95 patients were included who underwent early endoscopy with the pre-diagnosis of upper GIS bleeding or endoscopy-colonoscopy with the pre-diagnosis of lower GIS bleeding between 2012 and 2016. Endoscopy and colonoscopy procedures were compared in terms of the development of complications, tolerance of procedure, detection of bleeding site, and rate of therapeutic interventions performed for bleeding. In addition, the adequacy of colonoscopy preparation was evaluated. RESULTS: There was no significant difference between endoscopy and colonoscopy on procedural complication (2.1% vs 2.8%) and tolerance rates (81% vs 74.2), (p>0.05). The bleeding site was detected during endoscopy in 34(56.6%) patients, and an endoscopic intervention was required for 15(25%) of these patients. The bleeding site was detected during colonoscopy in 12(34.3%) patients, and an endoscopic intervention was performed for two (5.7%) patients (p<0.05). In addition, the colonoscopy procedure was suboptimal in 26 of 35 patients (74.2%) because of poor preparations. CONCLUSION: Early endoscopy and colonoscopy are safe and well tolerated in very elderly patients with GIS bleeding. Upper GIS endoscopy in this patient population enables the detection of the bleeding site and an endoscopic intervention for the bleeding. However, colonoscopy is insufficient for detecting bleeding sites, and colonoscopic treatment of bleeding sites is difficult because of poor or no preparation in this patient population.

Can the retinal ganglion cell layer (GCL) volume be a new marker to detect neurodegeneration in bipolar disorder?

PURPOSE: The aim of this study was to compare the ganglion cell layer (GCL) volume and retinal nerve fiber layer (RNFL) thickness in bipolar patients and controls using optic coherence tomography to demonstrate neurodegeneration in bipolar disorder. METHODS: This study involved 43 euthymic bipolar I patients who were being followed by the Psychiatry Department of Adiyaman University Medical School and 43 healthy volunteers as controls. Optic coherence tomography (OCT) measurements were performed for both groups. The RNFL thickness and GCL volumes were measured and recorded automatically by a spectral OCT device. FINDINGS: No differences in sociodemographics were detected between groups, except for unemployment status, which was significantly higher in the patient group. The RNFL thickness was lower in patients compared with controls at all measured regions, and this decrease was statistically significant for the global RNFL measurement. The GCL volume was also significantly lower in the patient group. There was a significant negative correlation between the disease parameters, such as the disease duration, YMRS score, CGI score, and number of hospitalizations, and GCL volume. DISCUSSION: These findings suggest that neurodegeneration occurs during the course of bipolar disorder. This degeneration may be demonstrated by decreased GCL at early stages, and as the disease progresses, involvement of other retinal layers, such as the RNFL and IPL, may be observed.

Correlation Between the Degree of the Mastoid Pneumatization and the Angle and the Length of the Eustachian Tube.

OBJECTIVES: The aim of the present study is to explore the correlation between the degree of the mastoid pneumatization and the angle (ETa) and the length of the Eustachian tube (ETl). STUDY DESIGN: The study design consisted of a retrospective clinical chart review. METHODS: In total, 217 patients (110 females and 107 males; average age, 33.14 ±â€Š12.88 years; age range: 18-65 years) were included in the study. The patients were divided into 3 groups in terms of the degree of the mastoid pneumatization. The mastoid pneumatization was measured between 0 and 5 cm for group A, between 5 and 10 cm for group B, and ≥10 cm for group C. The ETa and ETl of each group were compared. RESULTS: The mean mastoid pneumatization of groups A, B, and C was 4.32 ±â€Š1.96, 8.26 ±â€Š2.68, and 11.94 ±â€Š1.28 cm, respectively. The ETl of group A was lower than that of other groups statistically (P = 0.006 and 0.018, respectively). The mean ETl did not differ between the groups B and C (P = 0.698, >0.05, respectively). The ETa of each group did not differ (all P > 0.05). The mastoid pneumatization and the ETl were higher in males than in females (P = 0.004 and 0.001, respectively). The ETa did not differ between males and females (P = 0.0158). There was a positive correlation between the degree of the mastoid pneumatization and the ETl (r = 0.159/P = 0.002, <0.05, respectively). CONCLUSIONS: The present study is thus the first to analyze the relationship between the degree of the mastoid pneumatization and the ETa and the ETl. We found a positive correlation between the degree of the mastoid pneumatization and the ETl.