The relations of circulating agouti-related peptide and leptin with altered sleep architecture in patients with active Cushing's disease: a pilot study.

AIM: To evaluate sleep architecture of patients with Cushing's disease (CD) and to explore whether agouti-related peptide (AgRP) and/or leptin play a permissive role in sleep alterations in patients with active CD. METHODS: We performed polysomnography on 26 patients with active CD and age 26 age- and sex-matched control subjects. Blood samples were obtained from all participants for the analyzes of AgRP and leptin. The laboratory and sleep-related parameters were compared. RESULTS: The groups were similar in age, gender, and body mass index. The CD group had reduced sleep efficiency (71.6 ± 12.1% vs. 78.8 ± 12.6%, p = 0.042) and increased wake after sleep onset (WASO%) (24.7 ± 13.1% vs. 17.4 ± 11.6%, p = 0.040) as compared to control group. Seventeen patients with CD (65.4%) and 18 control subjects (69.2%) had obstructive sleep apnea. Serum AgRP (13.2 ± 7.4 pg/ml vs. 9 ± 3.1, p = 0.029), leptin (59.5 mcg/l, [IQR] 32.6-94.6 vs. 25.3 mcg/l, [IQR] 12.9-57.5, p = 0.007) were higher in CD group. AgRP and leptin correlated negatively with total sleep time, sleep efficiency, stage N2 sleep (%), and positively with WASO%. In multiple regression analyses, serum cortisol (ß = - 0.359, p = 0.042) and AgRP (ß = - 0.481, p = 0.01) were significant predictor of sleep efficiency. AgRP was also significant predictor of WASO% (ß = 0.452 and p < 0.05). CONCLUSIONS: Active CD carries an increased risk of impaired sleep efficiency and continuity which may worsen health-related quality of life. Elevated circulating AgRP and, to a lesser extent, leptin may be associated with decreased sleep efficiency and continuity in patients with CD. Patients with CD who have subjective sleep symptoms should be screened with polysomnography.

Evaluation of Exhaled Carbon Monoxide Levels in Individuals Exposed to Passive Tobacco Smoke in Indoor and Outdoor Environments: How Far Can We Getaway Under the Same Roof?

INTRODUCTION: Besides direct exposure, indirect contact with tobacco smoke significantly contributes to numerous health issues. Unfortunately, people are unaware that the precautions taken in closed environments are inadequate to deal with this issue. We conducted this study to assess carbon monoxide (CO) levels of people exposed to tobacco smoke indoors and outdoors. METHODS: Our study between May and June 2023 included individuals exposed to tobacco smoke indoors (n=100) and outdoors (n=100). Our control group included 100 people who had never been exposed to healthy tobacco smoke and agreed to participate in our research. The amount of CO exhaled was measured by observing how long people were in contact with tobacco smoke and how close they were to it. Questionnaires were asked of the study participants about the harms and awareness of tobacco smoke exposure. RESULTS: Exhaled CO levels were 1.46 ± 0.1 ppm in people exposed to tobacco smoke indoors, 1.1± 0.03 ppm in people exposed to smoke outside, and 1.1± 0.02 ppm in the control group. The statistical analysis revealed that individuals exposed to tobacco smoke in the indoor environment had significantly higher exhaled CO levels than those in the outdoor and the control groups (p=0.006). In the correlation analysis of time and distance in the indoor environment with the exhaled CO level, there was no statistically significant difference between time and space (r= -0.168, p=0.09, r=0.09, p=0.37, respectively). While less than half of both groups were aware of second-hand tobacco smoke, individuals exposed to tobacco smoke in the outdoor environment were more familiar (p<0.001). CONCLUSION: Despite the precautions, indoor tobacco smoke exposure is severe because of second- and third-hand smoke. Raising individual awareness and enhancing the steps should be our top concern to prevent future health problems.

Efficacy of Kinesio® tapes in obstetrical brachial plexus injury: a randomized controlled trial.

OBJECTIVES: The purpose of this study was to investigate the effectiveness of Kinesio® tape application associated to exercise in patients with obstetric brachial plexus injury (OBPI). MATERIALS AND METHODS: Ninety patients with Erb-Duchenne palsy secondary to OBPI participated in a 3-month study, in 2 groups; study group (n = 50) and control group (n = 40). Both followed the same physical therapy program, while the study group also received Kinesio® taping over the scapula and forearm. The patients were evaluated, pre- and post-treatment, using the Modified Mallet Classification (MMC), Active Movement Scale (AMS), and active range of motion (ROM) of the plegic side. RESULTS: There were no statistically significant intergroup differences in age, gender, birth weight or plegic side (p > 0.05), or in pre-treatment MMC and AMS scores (p > 0.05). There were significant differences in favor of the study group for Mallet 2 (external rotation) (p = 0.012), Mallet 3 (hand on the back of the neck) (p < 0.001), Mallet 4 (hand on the back) (p = 0.001) and total Mallet score (p = 0.025), and for AMS shoulder flexion (p = 0.004) and elbow flexion (p < 0.001). ROM results before and after treatment (within groups) showed significant improvement in both groups (p < 0.001). CONCLUSION: Since this a was a preliminary study, the results should be interpreted with caution in terms of clinical efficacy. The results suggest that associating Kinesio® taping to conventional treatment helps functional development in patients with OBPI.'

Evaluation of the Relationship between Exhaled CO Levels with Clinical Course and Parenchymal Involvement in COVID-19.

BACKGROUND: COVID-19, caused by the SARS-CoV-2 virus, has infected nearly 270 million people over the past two years. We aimed to determine the exhaled CO levels of patients hospitalized with COVID-19 pneumonia and its correlation with parenchymal involvement. METHODS: Between September 2021 and December 2021, 74 patients who were hospitalized in the infectious diseases service of our hospital and whose delta variant COVID-19 infection was confirmed with real-time PCR method were included in the study. The patients were analyzed in 3 groups: moderate COVID-19 (group 1), severe COVID-19 without macrophage activation syndrome (MAS) (group 2), and severe COVID-19 with MAS (group 3). RESULTS: While it was observed that the exhaled CO levels were higher in patients in Group 3 at the time of hospitalization than in patients in Group 1 and 2, it was determined that no significant difference was observed between the groups at the time of discharge (p < 0.001, 0.213). CT scores obtained at the time of hospitalization were also observed to be statistically significantly higher in patients in Group 3 when compared to patients in Group 1 and 2 (p = 0.002). In the correlation analysis of the exhaled CO levels and the CT scores at the time of hospitalization, a statistically significant positive correlation was observed (r = 0.628, p < 0.001). CONCLUSIONS: In COVID-19, which has a high affinity for lung tissue compared to other known viral lower respiratory tract infections, the exhaled CO level may be a non-invasive parameter that can be used in the evaluation of parenchymal involvement and clinical course.

Evaluation of the Relationship between CRP/Albumin Ratio and Pulmonary Function Parameters in Patients with Post-Acute COVID-19.

BACKGROUND: Novel coronavirus disease 2019 (COVID-19), which has been a global pandemic for nearly 2 years, presents with highly variable clinical manifestations in both the acute and post-acute periods. This study evaluated the relationship between CRP/albumin ratio and pulmonary function at 12 weeks in patients with post-acute COVID-19. METHODS: The study included 157 patients with a previous diagnosis of COVID-19 pneumonia who presented to our outpatient clinic with symptoms of post-acute COVID-19 (12 weeks after first testing positive) between July 2021 and October 2021. Patients who had non-severe pneumonia were included in group 1, severe pneumonia that did not require intensive care in group 2, and severe pneumonia that required intensive care in group 3. RESULTS: At 12 weeks, group 3 had significantly lower percent predicted forced expiratory volume in 1 second (FEV1%), percent predicted forced vital capacity (FVC%), percent predicted diffusing capacity of the lungs for carbon monoxide (DLCO%), and oxygen saturation (SO2) compared to patients in groups 1 and 2 (p = 0.001, 0.04, 0.001, and 0.001, respectively). CRP/albumin ratio was significantly lower in group 2 compared to groups 1 and 3 (p = 0.001). Correlation analysis independent of age and comorbidity showed that CRP/albumin ratio was negatively correlated with SO2, FEV1%, FVC%, and DLCO%. CONCLUSIONS: CRP and albumin levels have prognostic significance during acute COVID-19 infection. The negative correlation between CRP/albumin ratio and respiratory function observed in our study suggest this parameter may be used in the follow-up of patients presenting at 12 weeks with post-acute COVID-19 symptoms.

Pleiotropic effects of pitavastatin: a pilot study using the saphenous vein endothelial cell model of endothelial injury and prevention of atherosclerosis.

OBJECTIVE: Cardiovascular diseases are responsible for the majority of deaths on a global scale. Atherosclerosis is the main risk factor for cardiovascular disorders and represents a complex phenomenon associated with endothelial dysfunction and inflammation. Statins, especially atorvastatin (ATV) and pitavastatin (PTV), are common agents used to control ongoing atherosclerotic events in the body to minimize cardiovascular disease-based deaths. MATERIALS AND METHODS: The present study aimed at comparing the efficacy of ATV and PTV in a cell line model of inflammation. Human saphenous vein cells were treated with TNF-alpha to mimic atherosclerotic conditions, and the cells were divided into 7 groups, including control, DMSO, TNF-alpha (10 ng/mL-6 hours), ATV (50 µM/24 hours), PTV (2 µM/24 hours), ATV (50 µM/24 hours)+TNF-alpha (10 ng/mL-6 hours) and PTV (2 µM/24 hours)+TNF-alpha (10 ng/mL-6 hours). The expression levels of 20 proinflammatory cytokines and chemokines were investigated in these groups using a human atherosclerosis antibody array. RESULTS: Possible pathway interactions were determined by STRING and PANTHER analyses. Comparison with the effect of ATV indicated that PTV reduced the levels of 4 proinflammatory cytokines: CCL11, CSF2, CCL20, and TGFB1 (p<0.05). CONCLUSIONS: Pleiotropic effects of pitavastatin against cardiovascular diseases appeared to be better; however, additional studies are required to compare statins and to identify new drugs that maintain broader protection from the risks of cardiovascular diseases.

Full-mouth Rehabilitation of Hypocalcified-type Amelogenesis Imperfecta With Chairside Computer-aided Design and Computer-aided Manufacturing: A Case Report.

BACKGROUND: This case report describes the complete full-mouth treatment of hypocalcified amelogenesis imperfecta (AI) by chairside computer-aided design and computer-aided manufacturing (CAD/CAM). CASE SUMMARY: After several years of interrupted dental care, a 17-year-old female patient presented with pain and also esthetic and functional discomfort. With loss of enamel and dyschromia affecting all teeth, the diagnosis was hypocalcified AI. Affected tissues were eliminated, gingivectomy with laser was performed, an indented jig was used to record the centric relationship during optical impressions, and 28 full ceramic crowns were created by chairside CAD/CAM in four sessions. The patient reported rapid pain relief and an overall improvement of well-being. CONCLUSION: AI sequelae can be treated promptly and conservatively with chairside CAD/CAM, obtaining esthetic and functional results.

Evaluation of hyaluronic matrix efficacy in sinus augmentation: a randomized-controlled histomorphometric and micro-computed tomography analysis.

The objective of the present study was to test the hypothesis that the addition of hyaluronic acid-based matrix to collagenated heterologous bone graft for sinus augmentation would enhance bone formation compared to collagenated heterologous bone graft alone in the early healing period, by micro-computed tomography and histomorphometry. Thirteen systemically healthy patients requiring bilateral two-stage maxillary sinus augmentation (residual crest height≤4mm) were enrolled in this split-mouth prospective randomized controlled study. One sinus side as a control group was grafted with only collagenated heterologous bone graft; the other region as a test group was grafted with hyaluronic matrix and collagenated heterologous bone graft. Bone biopsy samples were taken after 4 months during the dental implant surgery and analyzed using micro-computed tomography and histomorphometric parameters. According to the micro-computed tomography and histomorphometric results, a significantly higher percentage of new bone was observed in the test group when compared to the control group after 4 months of healing. This study confirmed the hypothesis that the addition of hyaluronic matrix to collagenated heterologous bone graft for sinus augmentation enhances bone formation compared to collagenated heterologous bone graft alone in the early healing period.

Management of Amelogenesis Imperfecta: A 15-Year Case History of Two Siblings.

OBJECTIVE: Amelogenesis imperfecta (AI) is a heterogenous genetic disorder that interferes with normal enamel formation in the absence of systemic disorders. The patients' main concerns are caries susceptibility, poor esthetics, and generalized sensitivity. There is a broad clinical spectrum, from discolorations to consequent enamel alterations. This case report describes the 15-year case study and the full-mouth rehabilitation of two siblings affected by a hypocalcified AI. Clinical Considerations: In these two patients, conservative care with stainless steel crowns and direct composite restorations was undertaken to restore function and esthetics and to reduce sensitivities in primary and mixed dentitions. The difficulties in monitoring resulted in severe infectious complications (dental abscess with cutaneous fistula), important dental defects, and loss of spaces with subsequent malocclusion. In the young adult dentition, they were treated by extractions, root canal therapies, and new restorations: stainless steel crowns for permanent molars, direct composite restorations (with strip crowns) for incisors and maxillary canines (to improve the crown morphology as well as to mask the discolorations and the malpositions), and adjusted composite crown molds using a thermoforming procedure for premolars and the mandibular canines. The main difficulties were rapid tooth surface loss, bonding to atypical enamel, developing dentition, long-term follow-up. CONCLUSION: Restoring function and esthetics in AI-affected patients is a challenge from primary to adult dentition. Early corrections are essential to avoid dental damage and for psychological benefits. This clinical report highlights the adhesive rehabilitation for anterior and premolar areas and the difficulty of patient follow-up.

Medial olivocochlear reflex in ankylosing spondylitis patients.

OBJECTIVE: Ankylosing spondylitis (AS) is a chronic systemic inflammatory disease. Via autoimmune mediators, AS can damage the auditory system similar to other systems. Otoacoustic emission studies in AS patients showed that the damage that causes hearing loss was in the outer hair cells. The medial olivocochlear (MOC) reflex is used to evaluate the MOC efferent system (MOES), which includes the outer hair cells. The aim of this study was to evaluate the presence of subclinical damage in the inner ear with the aid of the MOC reflex test in AS patients with no hearing complaints. PATIENTS AND METHODS: Thirty-four patients with AS and a control group of 30 healthy volunteers with similar demographic characteristics were evaluated in the study. Otoacoustic emission responses, MOC reflex results, and frequency-specific and total suppression findings were compared between the groups. The relationship between clinical and laboratory findings for the AS patients, and the MOC reflex data were also investigated. RESULTS: Reduced MOC reflex response (p = 0.04) and suppression (p = 0.019) were detected in AS patients. When the clinical and laboratory findings for the AS patients and the MOC reflex test results were compared, a significant correlation was found only between the MOC reflex and the erythrocyte sedimentation rate. CONCLUSION: The results showed that AS can damage the inner ear, especially the MOES, and can reduce the MOC reflex response without clinical hearing loss.

Rhinoscintigraphic analysis of nasal mucociliary function in patients with Bell's palsy.

OBJECTIVE: Mucociliary transport (MCT) is an important defense mechanism of the respiratory tract. One of the major factors determining MCT is the ciliary activity of the respiratory epithelium. Rhinoscintigraphy is the most commonly used method for the analysis of mucociliary activity. The aim of this study was to investigate the effect of facial paralysis on the nasal mucociliary clearance. MATERIALS AND METHODS: This study included 38 Bell's palsy patients as the study group and 10 subjects without any history of paranasal sinus disease or facial paralysis as the control group. A drop of technetium 99m-labeled macroaggregated albumin (Tc-99m MAA) was placed posterior to the head of the inferior turbinate and followed with a gamma camera. MCT rate was measured as the velocity of Tc-99m MAA drop. RESULTS: The mean MCT rate was 4.27 ± 0.76 millimeters per minute (mm/min) on 20 sides of 10 healthy controls, 4.11 ± 2.91 mm/min on the affected sides of the patients with Bell's palsy, and 6.03 ± 3.13 mm/min on the nonparalyzed sides of the patients. MCT rate was statistically significantly faster in the nonparalyzed side when compared to the paralyzed side in Bell's palsy patients (P = 0.001). MCT rates were not significantly different in the control group and paralyzed sides of the Bell's palsy patients (P = 0.810). The MCT rate was statistically significantly faster in the nonparalyzed sides of Bell's palsy patients when compared to the controls (P = 0.017). CONCLUSION: This study showed a faster MCT rate on the nonparalyzed side in Bell's palsy patients when compared to the paralyzed side and the control subjects. A compensatory mechanism could be the underlying reason for faster MCT on the nonparalyzed side. Further studies on larger patient groups are needed to investigate the effect of facial paralysis on the MCT and changes of facial nerve function on the opposite, nonparalyzed side of the face.

Endoscopic cartilage tympanoplasty in chronic otitis media.

OBJECTIVES: The use of endoscopic techniques is becoming more widespread in otological and neuro-otological surgery. One such procedure, endoscopic tympanoplasty, is used in chronic otitis media treatment. This study aimed to analyse the results of endoscopic transcanal cartilage tympanoplasty. METHODS: Data of tubotympanic chronic otitis media patients who underwent transcanal endoscopic type I cartilage tympanoplasty between June 2012 and May 2013 were analysed. The main outcome measures were graft success and hearing improvement. RESULTS: Graft success rates were 94.3 per cent and 92.5 per cent at post-operative months one and six, respectively. Post-operative air-bone gap values were significantly improved over pre-operative values (p < 0.01). CONCLUSION: Transcanal endoscopic type I cartilage tympanoplasty is a minimally invasive, effective and reliable surgical treatment option for chronic otitis media.

Diagnostic value of the wideband acoustic absorbance test in middle-ear effusion.

OBJECTIVES: This study aimed to investigate the diagnostic value of wideband acoustic absorbance testing in otitis media with effusion. METHODS: This prospective study compared middle-ear wideband acoustic absorbance rates in three paediatric patient groups: a healthy group of 34 volunteers; 48 patients diagnosed with otitis media with effusion; and 28 patients with chronic effusion but no sign of effusion during myringotomy. The diagnostic value of absorbance testing was analysed with the receiver operating characteristic test. RESULTS: The wideband acoustic absorbance rate was significantly lower in the otitis media with effusion group than in both the otitis media and healthy groups at the 0.375-2 kHz averaged mean absorbance (p < 0.017 and p < 0.001, respectively). Receiver operating characteristic analysis showed the highest diagnostic value for the 0.375-2 kHz averaged mean (area under the curve 0.984), followed by those at 1 and 1.5 kHz (area under the curve: 0.973 and 0.967, respectively). CONCLUSION: The wideband acoustic absorbance test is more accurate for detecting middle-ear effusion compared with conventional 226-Hz tympanometry. Its practicality and objectivity suggest that the wideband acoustic absorbance test may be a better alternative for diagnosing otitis media with effusion.

Surface Treatments of Zirconia to Enhance Bonding Durability.

This article reviewed the surface treatments used most often to improve adhesion between zirconia and adhesive cements, focusing on their capacity to provide long-term bonding. Traditional and new treatments for zirconia bonding were searched. Some new treatments were discussed along with topographical views of the modified zirconia. New methods, such as selective infiltration etching and the low-fusing glassy porcelain application are promising, but more research is needed.

'Vitamin D and cognition in older adults': updated international recommendations.

BACKGROUND: Hypovitaminosis D, a condition that is highly prevalent in older adults aged 65 years and above, is associated with brain changes and dementia. Given the rapidly accumulating and complex contribution of the literature in the field of vitamin D and cognition, clear guidance is needed for researchers and clinicians. METHODS: International experts met at an invitational summit on 'Vitamin D and Cognition in Older Adults'. Based on previous reports and expert opinion, the task force focused on key questions relating to the role of vitamin D in Alzheimer's disease and related disorders. Each question was discussed and voted using a Delphi-like approach. RESULTS: The experts reached an agreement that hypovitaminosis D increases the risk of cognitive decline and dementia in older adults and may alter the clinical presentation as a consequence of related comorbidities; however, at present, vitamin D level should not be used as a diagnostic or prognostic biomarker of Alzheimer's disease due to lack of specificity and insufficient evidence. This population should be screened for hypovitaminosis D because of its high prevalence and should receive supplementation, if necessary; but this advice was not specific to cognition. During the debate, the possibility of 'critical periods' during which vitamin D may have its greatest impact on the brain was addressed; whether hypovitaminosis D influences cognition actively through deleterious effects and/or passively by loss of neuroprotection was also considered. CONCLUSIONS: The international task force agreed on five overarching principles related to vitamin D and cognition in older adults. Several areas of uncertainty remain, and it will be necessary to revise the proposed recommendations as new findings become available.

Effect of chlorhexidine application on the long-term shear bond strength to dentin of a resin-modified glass ionomer.

PURPOSE: The aim of this study was to investigate the effect of chlorhexidine digluconate (CHX) application on the shear bond strength (SBS) of a resin-modified glass ionomer cement (RMGIC) to polyalkenoic acid-preconditioned dentin after 24 hours, six months, and 12 months of water storage at 37°C. MATERIALS AND METHODS: Cylindrical molds, placed on flat, polyalkenoic acid (Cavity Conditioner® [GC]) preconditioned dentin surfaces of 90 human teeth embedded in resin, were filled with Fuji II LC® (GC), a RMGIC, with (n=45) or without (n=45) the prior application of a 0.05% CHX solution. Within each group, SBS was determined after 24 hours (n=15), six months (n=15), and 12 months (n=15) of storage in water at 37°C. The results were analyzed with two-way analysis of variance followed by Tukey multiple means comparisons (p<0.05). The type of bond failure (adhesive/cohesive/mixed) was noted and the results were analyzed with chi-square test (p<0.05). RESULTS: After 24 hours, the SBS of RMGIC was not significantly different with (9.0 ± 2.8 MPa) or without (8.3±0.6 MPa) the application of CHX. After six months, however, SBS increased significantly in the group without CHX (12.7±3.4 MPa) but remained unchanged in the CHX group (9.4±4.0 MPa). Similar results without CHX (12.6±3.8 MPa) and with CHX (9.5±3.2 MPa) were obtained after 12 months. No significant differences in the type of debonding were found between the various groups tested. CONCLUSION: The application of 0.05% CHX after dentin preconditioning did not seem to have affected the 24-hour SBS of RMGIC. However, the six- and 12-month SBS was significantly lower for CHX-treated samples, possibly as a result of CHX interference with both the bonding mechanism and the maturation reaction of RMGIC.

Could Helicobacter pylori play a role in the aetiopathogenesis of tympanosclerosis?

AIM: The aetiology of tympanosclerosis is not yet clear. This prospective, controlled, clinical study investigated the relationship between Helicobacter pylori and tympanosclerosis aetiology. MATERIALS AND METHODS: The study included 14 patients with tympanosclerosis and 26 with other forms of chronic otitis media. All patients underwent surgery for chronic otitis media. Mucosal biopsies were taken, and examined for H pylori using the Campylobacter-Like Organism (CLO) test. RESULTS: Tympanoplasty was performed in 29 patients (72.5 per cent), radical mastoidectomy in eight (20 per cent) and myringoplasty in three (7.5 per cent). The presence of H pylori was tested in all tympanosclerosis biopsies, but in only 26.9 per cent of biopsies from other forms of chronic otitis media. A statistically significant difference in H pylori presence was found (p ≤ 0.01). CONCLUSION: This study represents a preliminary investigation of the association between H pylori and tympanosclerosis development.

A mass at fat density in the parotid gland: dermoid cyst or lipoma.

A mass at fat density in the parotid gland: dermoid cyst or lipoma. Dermoid cysts (DC) of the head and neck are uncommon and account for only 7% of all dermoid cysts in the body. DCs of the parotid gland are even rarer. In this article, a 42-year-old female patient with DC of the parotid gland is presented and discussed with a brief review of the literature. Radiologic findings suggested that the mass was a lipoma, but observation of a hair in the cyst during surgery changed the clinical diagnosis to DC; this suspicion was confirmed by pathological analysis. Although DCs are rare among the parotid masses, they should be kept in mind during the differential diagnosis.

Constraint induced movement therapy: efficacy in a Turkish stroke patient population and evaluation by a new outcome measurement tool.

AIM: The purpose of this study was to show if constraint induced movement therapy (CIMT) is effective in a Turkish stroke patient population and whether the effectiveness could be measured by a different evaluation tool, i.e. Kocaeli Functional Evaluation Test (KFET). METHODS: Twenty-five patients with subacute or chronic stroke were included in the study. At the beginning, all the patients received a conventional rehabilitation programme for 3 weeks. Seventeen patients who had no improvement in upper extremity functioning with this conventional programme received CIMT for 3 weeks. Active range of motion (ROM) and modified Ashworth scale of the plegic upper extremity were noted; Wolf Motor Function Test (WMFT) and KFET were performed to each patient before and after CIMT. RESULTS: Active ROM of shoulder flexion (P<0.001), abduction (P<0.001), and external rotation (P=0.005), wrist flexion (P=0.025), and extension (P<0.01) of the plegic upper extremity improved significantly after CIMT. There were significant improvements in functional ability scale (P<0.05 for all parameters) and performance time results of 13 (P<0.05 for all parameters) out of 15 parameters of WMFT. Significant improvements were observed in quality-ability scores of every subunit of each activity (P<0.05 for all parameters) and performance time scores (P<0.05 for all parameters) of KFET. CONCLUSIONS: CIMT is found to be a noteworthy treatment for improving the function of the hemiplegic upper extremity in this Turkish patient population.

An aberrant internal carotid artery in the temporal bone presenting as a middle-ear mass: a case report.

OBJECTIVE: To draw attention to the possibility of an aberrant internal carotid artery behind an intact tympanic membrane presenting as a middle-ear mass. CASE: A 48-year-old female patient presented with a hearing impairment in her right ear that had started 10 years ago. Otoscopic examination revealed a retro-tympanic mass. A high resolution computed tomography scan of the temporal bone was performed that showed protrusion of the internal carotid artery into the middle ear. Magnetic resonance angiography provided excellent visualisation of the internal carotid artery. Finally, a diagnosis of an aberrant internal carotid artery was made and the patient was evaluated with a conservative approach. CONCLUSION: All retro-tympanic masses should ideally be visualised with a computed tomography scan of the temporal bone before any middle-ear surgery, such as tympanotomy and biopsy, and it is essential for every otologist who undertakes myringotomy and middle-ear surgery to know about this rare entity.