Can retinal nerve fiber layer (RNFL) thickness be a marker for distinguishing bipolar depression from unipolar depression?

OBJECTIVE: We aimed to compare retinal nerve fiber layer (RNFL) thickness and ganglion cell complex (GCC) thickness in bipolar disorder (BD) and major depressive disorder (MDD). METHOD: The study included thirty MDD, thirty-two BD participants in depressive episode, and thirty-seven controls matched according to age, gender, body mass index (BMI), and smoking status. Optic coherence tomography (OCT) measurements were performed for both participants and controls. The RNFL and GCC thickness were measured and recorded automatically by a spectral OCT device. Participants were also subjected to Hamilton Depression Rating Scale (HAM-D). RESULTS: RNFL superior thickness was significantly lower in BD participants, compared to the MDD participants and controls (p = 0.001). GCC inferior (p = 0.022) and inferonasal (p = 0.005) thickness were detected lower in BD group, compared to the control groups. In the BD group, HAM-D scores were negatively correlated with RNFL-temporal (p = 0.049, r= -0.357), GCC inferotemporal (p = 0.02, r= -0.416) and superotemporal thickness (p = 0.002, r= -0.546). CONCLUSIONS: RNFL thickness were lower in BD participants compared to the MDD and controls and, GCC thickness were lower in BD participants compared to the controls. Our findings support the hypothesis that neurodegeneration is part of the pathogenesis of BD. Future research are needed to confirm the lack of RNFL thickness in MDD, which could have immediate therapeutic consequences as well as implications for distinguishing BD from MDD.

RNFL thickness is lower in BD participants compared to the MDD and controls.GCC thickness were lower in BD participants compared to the controls.HAM-D scores are negatively correlated with RNFL temporal and, GCC inferotemporal and superotemporal thickness.

Neurocognitive impairment in multiple sclerosis and its association with thiol-disulfide homeostasis and ischemia-modified albumin.

This study aimed to assess the possible association between cognitive impairment and two important biochemical biomarkers of oxidative stress, thiol-disulfide homeostasis (TDH), and ischemia-modified albumin (IMA) in patients with multiple sclerosis (MS). This study included 85 patients with MS (38 treatment-naïve relapsing-remitting MS (RRMS), 31 RRMS on fingolimod therapy, and 16 secondary progressive MS (SPMS)) and 33 healthy controls. Cognitive evaluation was carried out by applying the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) test battery and the scores were adjusted for age and years of education. Plasma TDH was assessed using an automated method and plasma IMA levels were determined using the cobalt-albumin binding assay. Plasma native thiol and total thiol levels were significantly decreased in patients with SPMS when compared with the naïve patients and healthy controls. Cognitive impairment was detected in 47.4% of naïve patients, 64.5% of patients on fingolimod therapy, and 80% of patients with SPMS. Naïve patients or patients on fingolimod therapy who were cognitively impaired had significantly decreased levels of native thiol and total thiol compared to the cognitively normal patients. Logistic regression analysis revealed total thiol and native thiol to be significantly associated with cognitive impairment in naïve patients and patients on fingolimod therapy. Significant correlations were determined between BICAMS scores, TDH, IMA, clinical indices of disease severity (EDSS and MSSS), and magnetic resonance imaging parameters. This study has shown for the first time that plasma TDH parameters are associated with cognitive impairment in MS.

Single nucleotide variants around the connective tissue growth factor (CTGF/CCN2) gene and their association with multiple sclerosis risk, disability scores, and rate of disease progression.

BACKGROUND: This study aimed to explore the possible association of single nucleotide polymorphisms (SNPs) in the upstream (rs9402373) and downstream regions (rs9399005 and rs12526196) of the gene encoding connective tissue growth factor (CTGF/CCN2) with relapsing-remitting multiple sclerosis (RRMS) risk and clinical parameters including disability scores and rate of disability progression. MATERIALS AND METHODS: In total, 200 patients with RRMS and 305 controls were genotyped using real-time PCR (rs1252696 C/T and rs9402373 G/C) or PCR-RFLP (rs9399005 C/T) methods. Furthermore, the association between these genotypes and clinical parameters including Expanded Disability Status Scale (EDSS) score, Multiple Sclerosis Severity Score (MSSS), age at onset, duration of disease, duration of treatment, and presence of contrast-enhancing lesions was analyzed. RESULTS: rs9399005 genotypes TT and CT in the dominant model were significant predictors of RRMS vs. control status by logistic regression analysis (OR = 1.45, 95% CI = 1.01-2.08, P = .04). Moreover, these genotypes for rs9399005 were associated with a MSSS ≥ 2.4 (OR = 3.54, 95% CI = 1.56-8.05, P = .003). In addition, MSSS was lower in patients who had at least one rs12526196C allele than in the corresponding patients with the TT genotype (P = .02). CONCLUSION: To our knowledge, this is the first evidence of the involvement of variants around the CTGF gene in MS risk and disability progression.

Synthesis and characterization of antibacterial drug loaded ß-tricalcium phosphate powders for bone engineering applications.

Powders of ß-tricalcium phosphate [ß-TCP, ß-Ca3(PO4)2] and composite powders of ß-TCP and polyvinyl alcohol (PVA) were synthesized by using wet precipitation methods. First, the conditions for the preparation of single phase ß-TCP have been delineated. In the co-precipitation procedure, calcium nitrate and diammonium hydrogen phosphate were used as calcium and phosphorous precursors, respectively. The pH of the system was varied in the range 7-11 by adding designed amounts of ammonia solution. The filtered cakes were desiccated at 80 °C and subsequently calcined at different temperatures in the range between 700-1100 °C. Later on, rifampicin form II was used to produce drug-loaded ß-TCP and PVA/ß-TCP powders. All the synthesized materials have been characterized from morphological (by scanning electron microscopy) and structural-chemical (by X-ray diffraction and Fourier transform infrared spectroscopy) point of view. The drug loading capacity of the selected pure ß-TCP powder has been assessed. The biological performance (cytocompatibility in fibroblast cell culture and antibacterial efficacy against Escherichia coli and Staphylococcus aureus) has been tested with promising results. Application perspectives of the designed drug-bioceramic-polymer blends are advanced and discussed.

Are long-term auditory results following ossiculoplasty with bone cement as successful as early-middle period results?

PURPOSE: Bone-cement (BC) ossiculoplasty is one of the options to solve ossicular chain problems. Many authors reported successful results in the early or mid-follow-up period; however, there is no long-term result in the literature. We aim to evaluate long term results of BC ossiculoplasty. MATERIALS AND METHODS: Forty-eight patients who underwent BC ossiculoplasty as incudostapedial re-bridging by the same surgeon were invited to evaluation. Postoperative otomicroscopic examination was performed. Pre-operative and post-operative audiological results after longer follow up and graft success rate were noted. RESULTS: Fourteen patients came for control examination. The follow-up period was between 87 and 135 months (mean 102 months). None of the patients had graft failure. Ten patients had early postoperative follow-up results (between 10 and 52; mean 24 months). In the comparison of preoperative and early postoperative air-bone gap, there were significant differences in all frequencies while the comparison of preoperative and long-term postoperative results showed a significant difference only in 250 and 500 Hz. Early postoperative results were better than late with significant difference only in the 2000 and 4000 Hz. CONCLUSIONS: As reported by many studies, bone cement application provides a significant auditory improvement in the early postoperative period. The results of the present study showed that this early auditory success may decrease over time with a long-term follow-up. Further studies should be conducted with larger patient groups to clarify the long-term benefits of this treatment and possible causes for its deterioration.

Facial canal dehiscence rate: a retrospective analysis of 372 chronic otitis media cases.

PURPOSE: This study aimed to investigate the rate and location of facial canal dehiscence (FCD) observed during surgery for chronic otitis media (COM) with or without cholesteatoma. MATERIAL AND METHOD: Operative details of 1296 patients who underwent chronic otitis media surgery from January 2000 to January 2017 by the same surgeon were included in this retrospective study focusing on intraoperative observations of FCD. RESULTS: Because of the type of the surgery, the Fallopian canal could not be seen completely, so 924 of the cases which only involved performing a tympanoplasty were not included in the study. A total of 372 patients (196 males and 176 females) who had a canal wall down (CWD) or canal wall up (CWU) mastoidectomy were included in the study. A CWD mastoidectomy was performed on 250 patients, while 122 patients underwent a CWU mastoidectomy. The prevalence of FCD was 11.29% (42/372 patients). The dehiscence was more common in patients with cholesteatoma (n = 37; 88.1%) than those with non-cholesteatoma (n = 5; 11.9%). The tympanic segment (n = 32; 76.19%) was the most common location for FCD. When we compared the ossicular erosion results of the cases that had FCD, erosion in three ossicles together was more statistically significantly frequent than the other possibilities. CONCLUSION: It is possible to see FCD because of COM, especially with cholesteatoma. FCD is most commonly seen around the oval window. If stapes or all three ossicles are eroded, the surgeons must be more careful regarding FCD to be more effective in preventing facial nerve damage.

Thiol/disulphide homeostasis in manic episode and remission phases of bipolar disorder.

PURPOSE: Bipolar disorder (BD) is a chronical psychiatric disorder of which pathophysiology was demonstrated to be related with oxidative stress. Thiol-disulphide homeostasis is an indicator of oxidative balance. This study aims to investigate thiol-disulphide homeostasis in BD. MATERIALS AND METHODS: 27 patients in manic episode (MA), 29 patients in remission (RE) and 60 healthy participants (HC) were included to the study. Serum native thiol and total thiol levels were measured with a novel colorimetric, automated method. The disulphide levels and disulphide/native thiol ratios were also calculated from these measured parameters. RESULTS: Native thiol levels and total thiol levels of both MA and RE groups were lower than HC. No significant difference detected between MA and RE in terms of native thiol levels and total thiol levels. Disulphide levels and disulphide/native thiol ratio was detected statistically similar between three groups. CONCLUSION: Our results support the oxidative imbalance theory in pathophysiology of BD. Further studies with larger sample sizes are needed for being able to understand these pathways in detail and use them as a target of treatment.

Aging as the Impact Factor on Septoplasty Success.

OBJECTIVE: The aim of the study was to discuss the impact of aging on septoplasty success. STUDY DESIGN AND SETTING: This prospective case control study was conducted at the Umraniye Education and Research Hospital. METHODS: Our study group consists of 23 patients older than 60-year-old who have septal deviation and have previously been postponed for this surgery due to various reasons. Twenty-six patients under 40-year-old are randomly chosen as the control group who were running to septoplasty. Postoperative Glasgow Benefit Inventory Index, preoperative and postoperative NOSE score, and nasal mucociliary clearance time (MCCt) were noted for both the groups. All collected data were compared between the groups. RESULTS: In both the groups, postoperative NOSE scores decreased significantly compared to preoperative values (P < 0.01). This decrease was not significantly different between the groups. In both the groups, a significant decrease was noted in nasal MCCt with surgery (P = 0.004). However, this difference between two groups was not statistically significant. In addition, the Glasgow Benefit Inventory (GBI) index of control group was notably higher than the study group and this was statistically significant (P = 0.027). Also, the decrease of NOSE scores was conversely related to high GBI indexes and this is statistically significant (P = 0.005). CONCLUSION: For many surgical procedures, aging is considered as one of the important prognostic factors on success. To date no study in the literature discussed this relationship between aging and the success of septoplasty. At this point, our results showed that septoplasty is a successfully performed procedure in all ages. But, satisfaction of patients is statistically decreasing with aging.

The Effect of Platelet-Rich Fibrin and Hyaluronic Acid on Perforation of Nasal Septum.

BACKGROUND: Conservative approaches and surgical methods have been tried for the treatment of nasal septum perforations (NSPs), but a satisfactory method has not yet been determined. OBJECTIVE: Our study aimed to investigate the effect of platelet-rich fibrin (PRF) and hyaluronic acid (HA) in repairing NSPs, which were experimentally created in rabbit septum. METHODS: A total of 36 white New Zealand rabbits were included in the study. Perforations measuring 0.7 × 0.7 cm were created in their nasal septa. No additional intervention was made to the control group, which was the first group. For the second, third, and fourth groups, respectively, HA, PRF, and HA + PRF were used in the NSP region. Macroscopic and histopathological evaluations were performed after 40 days. RESULTS: In the first group, closure was observed in none of the rabbits' NSPs. In the second group, 6 rabbits (66.7%) had full closure in their NSPs. In the third group, the NSP of 6 rabbits (66.7%) was completely closed. In the fourth group, the NSP of 7 rabbits (77.8%) had full closure. CONCLUSION: Statistically significant closure was achieved with PRF and/or HA in rabbits in which NSP was established. These materials can be used to increase the likelihood of perforations closing.

The Effect of Passive Smoking on Mucociliary Clearance and Inferior Concha Reactivity.

INTRODUCTION: The aim of this study is to investigate the effect of cigarette smoke on turbinate reactivity and mucociliary clearance (MCC) in passive smokers. METHODS: 60 adult patients (30 passive smokers and 30 healthy subjects as the control group) were recruited for this study. Following a questionnaire on passive smoke exposure, MCC measurement using the saccharin test was carried out to all participants. The baseline and after decongestant acoustic rhinometry values (MCA1, MCA2, VOL1, VOL2) were measured and the percentage changes between the two test values (ie; response to nasal decongestants = concha reactivity) were recorded. RESULTS: All 60 patients, including 37 women (61.7%) and 23 men (38.3%) were between 18-57 years of age . MCC's average measurements were 11.13 minutes in the passive smokers group, 7.87 minutes in the control group, which was statistically significantly different (p < 0.05). There was a statistically significant difference between the passive smokers and control group for acoustic rhinometric measurement of the ratio of MCA2 and VOL2 values before and after decongestant application (p < 0.05). DISCUSSION: Passive smoking can damage the nasal mucosa at least as active smoking. The number of studies on this subject is limited. There are no studies in the literature showing the effect of cigarette smoke on the inferior turbinate mucosal response. In our study, the inferior turbinate decongestant capacity was found to be significantly decreased in the passive smokers compared to the control group. CONCLUSION: As a result of cigarette exposure, the erectile function of the lower turbines may be impaired. The task of the ENT physicians is to warn the passive smokers in this regard.

Fabrication of tissue-engineered tympanic membrane patches using 3D-Printing technology.

In recent years, scaffolds produced in 3D printing technology have become more widespread tool due to providing more advantages than traditional methods in tissue engineering applications. In this research, it was aimed to produce patches for the treatment of tympanic membrane perforations which caused significant hearing loss by using 3D printing method. Polylactic acid(PLA) scaffolds with Chitosan(CS) and Sodium Alginate(SA) added in various ratios were prepared for artificial eardrum patches. Different amounts of chitosan and sodium alginate added to PLA increased the biocompatibility of the produced scaffolds. The created patches were designed by mimicking the thickness of the natural tympanic membrane thanks to the precision provided by the 3D printed method. The produced scaffolds were analyzed separately for chemical, morphological, mechanical and biocompatibility properties. Scanning electron microscope (SEM), Fourier-transform infrared (FT-IR) spectroscopy was performed to observe the surface morphology and chemical structure of the scaffolds. Mechanical, thermal and physical properties, swelling and degradation behaviors were examined to fully analyze whole characteristic features of the samples. Cell culture study was also performed to demonstrate the biocompatibility properties of the fabricated scaffolds with human adipose tissue-derived mesenchymal stem cells (hAD-MSCs). 15 wt % PLA was selected as the control group and among all concentrations of CS and SA, groups containing 3 wt% CS and 3 wt% SA showed significantly superior and favorable features in printing quality. The research continued with these two scaffolds (3 wt% CS, and 3 wt% SA), which showed improved print quality when added to PLA. Overall, these results show that PLA/CS and PLA/SA 3D printed artificial patches have the potential to tissue engineering solutions to repair tympanic membrane perforation for people with hearing loss.

Could sudden sensorineural hearing loss be the sole manifestation of COVID-19? An investigation into SARS-COV-2 in the etiology of sudden sensorineural hearing loss.

OBJECTIVE: This study aimed to investigate the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients presenting with only sudden sensorineural hearing loss (SSHNL) during the COVID-19 pandemic. METHODS: The study included five male patients who presented with the sole complaint of unilateral SSNHL to the otolaryngology outpatient clinic between 03-12 April 2020. The patients were referred to the infectious diseases clinic to be evaluated for SARS-CoV-2 by real time polymerase chain reaction (RT-PCR) testing. RESULTS: RT-PCR testing for SARS-CoV-2 was positive in one of the patients and negative in the other four patients. A positive response to COVID-19-specific treatment in the SARS-CoV-2 positive SSNHL patient was noted. CONCLUSION: It should be remembered that non-specific symptoms such as SSNHL could be the only sign with which to recognize a COVID-19 case. Awareness of such a non-specific presentation of COVID-19 patients is crucial during this pandemic period for preventing infectious spread through isolation and early initiation of COVID-19 targeted treatment.

Nasopharyngeal Pleomorphic Adenoma: A Rare Case Report and Review of the Literature.

Salivary gland tumors are rare among all head and neck tumors. Pleomorphic adenoma (PA) is the most commonly seen subtype, and 85% of the cases are located in the parotid gland. PA may very rarely be seen in minor salivary glands. Minor salivary gland PAs are mostly located in the hard and soft palates. Nasopharyngeal PA is very rare, and a total of 8 cases have been published to date. In this case report, a 51-year-old female patient who had nasopharyngeal PA with chondroid metaplasia is presented, and we review the relevant literature.

Novel electrospun polycaprolactone/graphene oxide/Fe3O4 nanocomposites for biomedical applications.

In this study, one of the most promising methods of tailoring a composite scaffold material in nano sized diameters, electrospinning method were used to produce Polycaprolactone (PCL)/Graphene Oxide (GO)/Iron(II, III) Oxide (Fe3O4) nanocomposite fibers as biocompatible scaffolds for biomedical applications. Products were analyzed by scanning electron microscopy (SEM) for morphological analysis of the electrospun nanocomposites and Fourier Transform Infrared Spectroscopy (FTIR) was used to determine functional groups of the PCL, GO, and Fe3O4 materials in the electrospun nanocomposites. For physical properties, viscosity, density, permittivity, dielectric loss and liquid and solid state alternating current conductivity, measurements were done for each nanocomposite fibers. Effects of concentration percentage of GO on permittivity, dielectric loss and AC conductivity have been analyzed by using measured and calculated data. Trend lines have been drawn for permittivity, dielectric loss and conductivity via concentration percentage of GO. The relation between ac conductivity and frequency have been studied for each concentration percentage of GO and interpretations have been done by using the obtained results.

Synthesis, characterization, and biological properties of composites of hydroxyapatite and hexagonal boron nitride.

Hydroxyapatite (HA), obtained from bovine bones, was successfully reinforced with hexagonal boron nitrite (h-BN). h-BN/HA composites, with BN content up to 1.5 wt %, were sintered at various temperatures between 1000 and 1300°C, in air. Well-sintered samples were obtained after sintering at 1200 and 1300°C. The presence of h-BN contributed to dense, fine, and well-crystallized microstructure. The results of X-ray diffraction analysis and FT-IR spectroscopy showed that the produced composites comprised biphasic ß-TCP/HCA (HCA: carbonate partially substituted HA). High values of mechanical properties were achieved, namely compression strength 155 MPa for the sample 0.5% h-BN/HA and Vickers microhardness of 716 HV for the samples 1.5% h-BN/HA, both sintered at 1300°C. U2OS human bone osteosarcoma proliferation and cell viability showed no adverse effect in the presence of h-BN/HA, suggesting the potential use of the produced materials as safe biomaterials in bone tissue engineering. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2384-2392, 2018.

Phenprobamate dependence: a case report.

Phenprobamate (3-phenylpropylcarbamate) is a centrally acting muscle relaxant with mild sedative and anticonvulsant effects. Muscle relaxants can enhance and prolong the effect of narcotic drugs and enable to obtain same effect with a smaller amount of alcohol or illicit substance. Almost all of the centrally acting muscle relaxants have varying sedative effects on which their abuse potential mainly depends. Data related to abuse of carisoprodol, meprobamate, baclofen takes place in the literature. However, to our knowledge this is the first case report about abuse of and tolerance to phenprobamate. We aimed to attract attention to important points of prescribing drugs that have abuse potential like in our case who was using up to 16000 mg/day phenprobamate.