Local allergic rhinitis - a narrative review.

This narrative review aims to provide an up-to-date definition of local allergic rhinitis (LAR), its classification, mechanisms, comorbidities, recommendations for diagnosis and treatment, and define needs in this area. Both 'PubMed' and 'Science Direct' literature was reviewed systematically, and a manual search for studies not previously encountered in the databases was also carried out. Published studies were identified in PubMed covering the period from 1947 to 2022. The following keyword search strategy was used: (local allergic rhinitis* OR entopy* OR local Immunoglobulin E * OR nasal specific Immunoglobulin E). LAR involves Type 2 nasal inflammation with local IgE and cannot be diagnosed by systemic methods, such as skin prick or blood IgE tests. A nasal allergen challenge is necessary for diagnosis. LAR can respond to usual AR treatments, including allergen specific immunotherapy (AIT). LAR is a novel entity that requires additional investigation in terms of prevalence, proper diagnosis, treatment, and prognosis. The target outcomes and possible benefits of this review are to achieve a consensus for the study and diagnosis of LAR and increase interest in this area.

The intranasal trigeminal system: roles in rhinitis (allergic and non-allergic).

The aim of this paper is to review intranasal trigeminal system and associated reflexes. The literature survey was performed on PubMed, ProQuest Central database of Kirikkale University and Google Scholar. The intranasal trigeminal system and associated reflexes play an important role in humans in both health and disease, including in rhinitis of non-allergic and mixed type. The intranasal trigeminal nerve provides sensory perception to the lining of the nose, supplying information on how patent the nasal airway is and responding to various chemical signals. The reflexes known to exist within the intranasal trigeminal system are nasobronchial reflex, trigemino-cardiac reflex, nasogastric reflex, and nasal cycle. The intranasal trigeminal system and its reflexes play a vital role in normal human physiology. Alterations in how this system operates may underlie multiple forms of rhinitis and more research is needed to fully understand the mechanisms involved.

Mechanisms and solutions for nasal drug delivery - a narrative review.

The aim of this paper is to review mechanisms and solutions for nasal drug delivery. Literature survey was performed via PubMed, Google Scholar, Google, and ProQuest Central database of Kirikkale University. The nasal lining presents a large area of endothelium of variable permeability and with a rich vascular supply. Advantages of this route include eliminating first-pass metabolism and being easily accessible. The nasal route enables some agents which are otherwise difficult to administer to enter the systemic circulation, for example, low molecular mass compounds with high polarity, peptides, or proteins. There are three principal factors that influence the extent to which drugs can be absorbed through the nasal lining, namely the physico-chemical characteristics of the drug molecule itself, the action of the mucociliary system within the nose, and the presence of any factors increasing nasal absorption. A key factor limiting the use of the intranasal route of administration is insufficient absorption through the nasal mucosa. A number of drugs in development cannot be administered intranasally because their bioavailability following nasal administration is too low. There has been considerable research focus on methods to enhance absorption via the nasal mucosa. In this chapter, we review the literature related to this problem and discuss potential solutions.

Daptomycin versus teicoplanin in the treatment of osteomyelitis: Results of the Göztepe retrospective cohort study.

OBJECTIVES: Daptomycin is highly effective against Gram-positive multidrug-resistant bacteria. Publications on daptomycin in osteomyelitis treatment are limited. PATIENTS AND METHODS: In this multicenter retrospective cohort study, the aim was to evaluate the outcomes of osteomyelitis cases having received daptomycin or teicoplanin. This multicenter retrospective cohort study gathered data from seven centers located in five cities of Turkey. Study inclusion criteria were as follows: (a) magnetic resonance imaging and/or direct X-ray revealed osteomyelitis or biopsy pathologic examination results concomitant with osteomyelitis. Chi-squareand Student t-tests were used for statistical comparison. RESULTS: A total of 72 patients, 38 cases in the daptomycin group and 34 cases in the teicoplanin group diagnosed with osteomyelitis fulfilling the study inclusion criteria, were included in the study. Clinical success at the end of induction therapy was achieved in 32/38 cases in the daptomycin cohort vs. 30/34 cases in the teicoplanin cohort (p: 0.73). CONCLUSION: Although this is a limited experience in a small but well-defined cohort, our data suggest that daptomycin may be a safe alternative to glycopeptides in osteomyelitis treatment. A randomized controlled clinical study involving larger cohorts may increase the available evidence.

Carbonic anhydrase I and II autoantibody levels in primary hypertension: our preliminary results.

OBJECTIVE: The pathogenesis of primary hypertension (HT) is still not completely clear, although autoimmunity has been implicated in recent years. Carbonic anhydrase (CA) is an enzyme involved in a number of important metabolic processes. CA I and II autoantibodies have been linked to various autoimmune diseases. However, CA I and II autoantibody levels in primary HT have not been previously investigated. The purpose of this study was, therefore, to investigate levels of CA I and II autoantibodies in primary HT. PATIENTS AND METHODS: Fifty-six patients newly diagnosed with primary HT and 33 healthy individuals were included in the study. Twenty-four-hour ambulatory blood pressure monitoring was performed following office controls. Blood specimens were collected under appropriate conditions for CA I and II autoantibody level investigation and biochemical tests. Urine sodium and protein excretion were measured after 24 h. Demographic and biochemical parameters and CA I and II autoantibody levels were then compared between the patient and healthy groups. RESULTS: CA II autoantibody and uric acid levels were significantly higher in the hypertensive group than in the control group (p=0.005, and p<0.001, respectively). CA II autoantibody (exp ß: 79.06 CI: 4.44-1407.02) (p=0.003) and uric acid elevation (exp ß: 2.10 CI: 1.31- 3.34) (p=0.002) were identified as independent predictors of HT development at logistic regression analysis. CONCLUSIONS: CA II autoantibody levels were higher in hypertensive patients, and this elevation is an independent predictor of HT development.

Fast off-line FPSE-HPLC-PDA determination of six NSAIDs in saliva samples.

A fast off-line FPSE-HPLC-PDA method has been reported that allows simultaneous clean up and determination of six non-steroidal anti-inflammatory drugs (NSAIDs) in saliva samples from healthy volunteers. Particularly, furprofen, indoprofen, ketoprofen, fenbufen, flurbiprofen, and ibuprofen were chromatographically resolved. Benzyl paraben was chosen as the internal standard (BzPB, IS). These target compounds were successfully extracted from human saliva using fabric phase sorptive extraction (FPSE) and then analysed in the liquid chromatographic system by means of a short analytical column (Symmetry C18, 75 × 4.6 mm, 3.5 µm) using acetonitrile (AcN) and phosphate buffer (PBS, 30 mM; pH = 2.5) as the mobile phases. The method, validated through the calculation of all analytical parameters in accordance of International Guidelines, was applied to real saliva sample analysis collected from informed volunteers. The proposed approach that included the use of sol-gel polytetrahydrofuran (sol-gel PTHF) sorbent immobilized on cellulose support and C18 stationary phase used in HPLC, showed high potential as a fast tool for future clinical and forensic applications. The herein reported results encourage potential future application of FPSE in the forensic field. Furthermore, the FPSE membrane was tested in dried saliva spot mode (DSS) in order to check its potential use as a sampling device, also for forensic applications.

Comparison of mental health, quality of sleep and life among patients with different stages of chronic kidney disease and undergoing different renal replacement therapies.

BACKGROUND: The present study aimed to investigate and compare mental health, health-related quality of life, and sleep levels of patients with various stages of chronic kidney disease (CKD) and undergoing different renal replacement therapies and analyze the factors affecting these parameters. METHODS: Overall, 140 patients with a mean age of 43 ± 14 years were recruited into this study. Study groups [controls and patients with CKD undergoing predialysis, hemodialysis (HD), peritoneal dialysis, kidney transplantation (KT)] were evaluated using Short Form Health Survey-36 (SF-36), Kidney Disease Quality of Life-36 (KDQoL-36), Pittsburgh Sleep Quality Index (PSQI), and General Health Questionnaire-12 (GHQ-12). RESULTS: The KT group had the highest scores in physical and mental components of the subscales of SF-36 and KDQoL-36 but the lowest scores in PSQI and GHQ-12, indicating the best results in terms of mental health and quality of life, and sleep. Serum albumin and hemoglobin levels were positively correlated with several subscales of quality of life. Significant negative correlations were observed among PSQI, GHQ-12, and subscale scores of SF-36 and KDQoL-36. The HD group showed significantly lower scores in the subscales of symptoms and burden of kidney disease of KDQoL-36. CONCLUSION: KDQoL was worse in the HD group and better in the KT group than in other groups. Serum albumin and hemoglobin levels, and Kt/V (dialyzer clearance of urea multiplied by dialysis time and normalized for urea distribution volume ) values of patients with CKD exerted a linear and significant effect on the quality of life, which showed a significant positive correlation with the quality of sleep and mental health. In contrast, serum calcium x phosphorus levels showed an inverse correlation with the subscale scores of KDQoL. HIPPOKRATIA 2020, 24(2): 51-58.

The relationship between dermatological findings and serum interleukin 31 and serum uridine diphosphate glucose ceramide glucosyltransferase levels among patients with chronic kidney disease.

BACKGROUND: Cutaneous diseases are observed with increasing duration and severity of renal disease in patients with chronic kidney disease (CKD). This study aimed to elucidate dermatological manifestations at different stages of CKD and determine their relationship with interleukin 31 (IL-31), a T-cell cytokine that induces severe pruritus, and uridine diphosphate (UDP)-glucose ceramide glucosyltransferase (UGCG), an enzyme that metabolizes ceramide, which plays an important role in moisturizing epidermis. METHODS: In this retrospective cohort study 145 patients with a mean age of 46 ± 17 years were categorized into hemodialysis (group 1), peritoneal dialysis (group 2),  kidney transplant (group 3), CKD (group 4), and healthy control (group 5) groups. Serum IL-31 and  UGCG levels were measured using enzyme-linked immunosorbent assay, and clinical dermatologists evaluated dermatological manifestations. RESULTS: In the overall cohort, pruritus was significantly and inversely correlated with glomerular filtration rate and serum hemoglobin and albumin levels (p <0.005). Additionally, pruritus was significantly more frequent in group 2 than in group 5; and significantly less frequent in group 3 than in groups 1, 2, and 4 (p =0.01). In group 4, the patients with longitudinal nail ridges had significantly higher serum IL-31 levels than those without longitudinal nail ridges in their nails (p =0.02). Furthermore, in group 2, the patients with pruritus had significantly lower UGCG levels than those without pruritus (p =0.045). CONCLUSION: IL-31 might play a role in the development of longitudinal nail ridges, whereas UGCG might provide protection from pruritus and xerosis in patients with CKD.  HIPPOKRATIA 2019, 23(2): 75-80.

The use of an ostial stent does not increase the success rate of endoscopic dacryocystorhinostomy.

OBJECTIVE: This prospective, controlled study assessed how placing a stent into a newly formed ostium affects ostial patency, success and complication rates in endoscopic dacryocystorhinostomy patients. METHODS: In group 1 (40 eyes of 36 patients), both silicone tube intubation and tube stenting were performed. In group 2 (36 eyes of 34 patients), only silicone tube intubation was performed. Success, operative time and post-surgical complications were investigated two months post-operatively in each group. RESULTS: The success rates were 92.5 per cent and 83.3 per cent for groups 1 and 2 respectively, but the difference was not statistically significant (p = 0.294). The complication rates also differed between the two groups, but this was again insignificant. CONCLUSION: Compared with the use of a silicone tube alone, the addition of an ostial stent did not significantly increase the success rate of endoscopic dacryocystorhinostomy.

Comparison of the effects of nasal steroids and montelukast on olfactory functions in patients with allergic rhinitis.

OBJECTIVE: Olfactory dysfunction is one of the comorbidities associated with allergic rhinitis (AR) and AR is one of the common causes of olfactory problems. We aimed to evaluate by the Sniffin' Sticks test the effects on olfactory functions of nasal steroids and leukotriene antagonists used for allergic rhinitis. METHODS: Thirty patients with seasonal rhinitis were included in this study. Patients were randomly divided into three groups of 10 patients; group 1 received montelukast sodium and mometasone furoate (MF) therapy, group 2 received only montelukast, and group 3 only MF. Patients' olfactory functions were determined using the Sniffin' Sticks olfactory test before and after a month treatment. RESULTS: Threshold, discrimination, identification, and the sum of threshold, discrimination, and identification (TDI) values were not significantly different among the groups before treatment. For Group 1 and Group 3 patients, there were statistically significant differences in threshold, discrimination, identification, and TDI values before and after treatment (P<0.05) (Wilcoxon signed ranks analysis). For Group 2 patients, the before and after treatment values of threshold, discrimination, identification, and TDI showed no significant difference (P>0.05). CONCLUSION: According to the findings of our study, MF is superior to montelukast in improving olfactory function. Although montelukast has been shown to be effective against AR symptoms, its effect on olfactory function was not demonstrated in this study.

Potential protective effect of resveratrol on acoustic trauma: electron microscopy study.

OBJECTIVE: To investigate the potential preventive effect of resveratrol in rats exposed to acoustic trauma (AT). MATERIALS AND METHODS: In this experimental study, Wistar albino rats were divided into three groups: Group 1 (Control, n = 6), Group 2 (AT, n = 6), and Group 3 (resveratrol + AT). The rats in Group 2 were exposed to AT. The rats in Group 3 received resveratrol (300 mg/kg/day) via gavage for 7 days. On day 7, the rats were exposed to AT 10 min following resveratrol treatment. Histological sections of the cochleae were examined using light microscopy, transmission (TEM), and scanning electron microscopy (SEM). RESULTS: The cochlear hair cells, stereocilia, and Deiters' cells of the control group appeared normal in all microscopic evaluations. In Group 2, light microscopy revealed predominantly inner hair cell loss, although the outer hair cells were affected. TEM and SEM examination showed severe loss of stereocilia and SEM revealed stereocilia arranged in an asymmetric array. The cochlear structure in Group 3 appeared well preserved under the light microscope, and although TEM and SEM revealed stereocilia loss, the hair cells and stereocilia appeared near normal compared with those of Group 2. CONCLUSIONS: Resveratrol may have a protective effect against AT damage in the cochlea, most likely through its antioxidant activity. Our results may be useful for studies in humans exposed to AT and noise-induced hearing loss related to chronic exposure to occupational noise.

Thiol/disulphide homeostasis as a novel indicator of oxidative stress in sudden sensorineural hearing loss.

OBJECTIVES: To investigate a novel oxidative stress marker, thiol/disulphide literature homeostasis, in patients with idiopathic sudden sensorineural hearing loss, and to compare the results with healthy controls for the first time. METHODS: Thirty-two patients with idiopathic sudden sensorineural hearing loss and 30 healthy individuals were included in the study. Serum native thiol, total thiol and disulphide levels were measured, and disulphide/native thiol and disulphide/total thiol ratios were determined in all subjects. RESULTS: Serum native thiol and total thiol levels were significantly lower in patients with sudden sensorineural hearing loss compared with controls (p < 0.05). Of the 32 patients, 25 had lower native thiol levels than controls (333.2 ± 73.9 vs 381.8 ± 35.6 µmol/l, p = 0.002) and 24 had lower total thiol levels (375.1 ± 74.3 vs 426.1 ± 39.3 µmol/l, p = 0.002). CONCLUSION: The changes in oxidative markers evident in a significant number of patients may be associated with oxidative stress, which may, in turn, have caused sudden sensorineural hearing loss in those patients.

Do viral infections have a role in benign paroxysmal positional vertigo?

OBJECTIVES: To investigate the role of viral infection in benign paroxysmal positional vertigo (BPPV). METHODS: In this retrospective study, 483 patients with BPPV were included in the study group. The control group consisted of 461 healthy subjects. In both groups, serologic analysis of viral agents (HSV1, HSV2, Herpes zoster, EBV, CMV, adenovirus, influenza, and parainfluenza virus) was performed. RESULTS: With the exception of influenza and parainfluenza, all viral serology values were higher in the BBPV group than the control group. We also observed seasonal variation. The BPPV group exhibited elevated values for HSV1 and adenovirus in March and May, for Herpes zoster, adenovirus, and influenza in April, for HSV1 in June, and for HSV1 and CMV in September, compared to the control group. In October, the BPPV group showed increased values for all of the viruses studied, compared to the control group. CONCLUSION: BPPV is associated with positive viral serology, particularly during certain months of the year, mainly in spring and autumn. Viral infection might promote BPPV attacks due to the development of vestibulopathy or induce secondary BPPV via viral infection-related neurolabyrinthitis.

The results of national newborn hearing screening (NNHS) data of 11,575 newborns from west part of Turkey.

OBJECTIVE: In this study, we aimed to review the National Newborn Hearing Screening (NNHS) programme data obtained from Corlu, located in west part of Turkey for the last 4 years. SUBJECTS AND METHODS: A total 11575 newborns that were either born in Çorlu State Hospital or referred from other Health Care Centers, between September 2009 and November 2012 were included into the study. Automated-Transient Evoked Otoacoustic Emission (A-TEOAE) test and Automated-Auditory Brainstem Response (A-ABR) were used as screening tests. When the newborn had failed at the initial A-TEOAE test, then the test was repeated after 15 days. If the same result was obtained at the second test; the newborns were referred for ENT examination. A-TEOAE and A-ABR screening tests were performed as the third stage evaluation. The failed newborns were referred for clinical ABR test. RESULTS: Out of 11575 newborns, 593 (5.12%) had failed the test and they were referred for clinical ABR. Out of these 593 neonates, 470 had passed the diagnostic ABR test at the referral center. Bilateral and unilateral sensori-neural hearing loss (SNHL) was detected at 15 and 7 babies respectively, 10 of 22 of these babies had risk factors such as family history of hearing loss, and parental consanguinity. CONCLUSIONS: The final hearing impairment and risk factor rates of our study was similar with literature. Although referral rates and the number of default babies gradually decreased in the last 4 years; definitive diagnosis and hearing aid initiation times need to improvement.

Piperacillin/tazobactam vs. cefoperazone/sulbactam in adult low-risk febrile neutropenia cases.

AIM: The aim of this study was to compare the efficacy of piperacillin/tazobactam (P/T) and cefoperazone/sulbactam (C/S) in the empirical treatment of adult neutropenic fever. METHODS: Data and outcomes of low-risk adult cases with neutropenic fever and treated with P/T (4.5 g q6h) or C/S (2 g q8h) between 2005 and 2011 June were extracted from our database. Risk evaluation was made according to criteria of Multinational Association for Supportive Care in Cancer (MASCC) and a score of ≥ 21 was considered as low risk. Data were collected prospectively by daily visits and evaluated retrospectively. Primary outcome was - fever defervescence at 72 h in combination with success without modification (referring to episodes where the patient recovered from fever with disappearance of signs of infection without modification to initial empirical treatment). All-cause mortality referred to death resulting from a documented or presumed infection or unidentified reason during the treatment and 30-day follow-up period. RESULTS: A total of 172 patients (113 cases P/T and 59 cases C/S) fulfilled the study inclusion criteria. Persistent response in P/T arm was 73.5%, whereas it was 64.5% in C/S arm (p > 0.05). Rates of any modification were also similar in both treatment arms. All-cause mortality during the treatment and 30-day follow-up period was not significantly different (P/T: 4/113 vs. C/S: 2/59, p > 0.05). There was no severe adverse effect requiring antibiotic cessation in both cohorts. CONCLUSION: In conclusion, our data suggest that C/S may be a safe alternative to P/T in the empirical treatment of adult low-risk febrile neutropenia cases.

Supraclavicular neuropathy after surgical treatment of clavicular fractures: comparison of two incisions.

PURPOSE Of THE STUDY: To compare the clinical results of clavicular fractures operated by superior locking plate using either horizontal or vertical incision by physical examination and nerve conduction tests. MATERIAL AND METHODS: Between January 2010 and January 2013, 63 patients with displaced midshaft clavicle fracture were treated with superior locking plate (22 female, 41 male) with either horizontal (n = 38) or vertical incisions (n = 25). Mean interval between trauma and surgery was 3 days (1 to 8 days). Electrodiagnostic tests were performed to 15 patients who felt numbness across their shoulder or chest and ASES test was performed to each of the patient 12 weeks postoperatively. IBM SPSS Statistics 22 (IBM SPSS, Türkiye) programme was used for statistical analysis. Student t-test was used for comparison of normally distributed parameters (quantity) and continuity (yates) test was used. p < 0.05 was accepted to be statistically signifiant. RESULTS: 8 patients of the horizontal incision group and 7 patients of the vertical incision group described numbness across their shoulders. 14 patients had abnormal sensorial electrodiagnostic fidings. Comparison of electrodiagnostic fidings did not reveal any statistical signifiance. The mean ASES score of the affected shoulder was 76.39 ±1.20 in the horizontal group, in the vertical group it was found to be 79.00 ± 2.5 ( p < 0.01). CONCLUSIONS: Electrodiagnostic study revealed similar results in both groups. According to these results, signifiant difference in mean ASES scores of both groups was not related to sensorial injury of the supraclavicular nerve.

Perspective on rhabdomyolysis-induced acute kidney injury and new treatment options.

AIM: The purpose of this study was to assess the role of caspase-dependent apoptosis, caspase 1, calpain 1, inducible nitric oxide synthase (iNOS) and endothelial nitric oxide synthase (eNOS) and the protective effect of grape seed proanthocyanidin extract (GSPE) in the development of rhabdomyolysis-induced acute kidney injury (AKI). MATERIALS AND METHODS: Twenty-one rats were divided into 3 groups - control, rhabdomyolysis and rhabdomyolysis + GSPE. Rhabdomyolysis was induced in the rhabdomyolysis and rhabdomyolysis + GSPE groups with the injection into both hind limbs of 10 ml/kg hypertonic (50%) glycerol following 24-hour dehydration on the 6th day. The rhabdomyolysis + GSPE group was given GSPE at 100 mg/kg by gavage for 7 days. The experiment was concluded 48 h after glycerol injection. Blood specimens were collected, and kidney tissues were extracted for histopathological examination. RESULTS: We identified an increase in blood urea nitrogen, creatinine, histopathological score, iNOS, caspase 3, caspase 1 and calpain 1 expression in the rhabdomyolysis group compared to the controls and a decrease in eNOS expression. In the rhabdomyolysis + GSPE group, however, there was a decrease in these mediators, together with an increase in eNOS expression. CONCLUSION: This study shows for the first time in the literature that calpain 1 is involved in the pathogenesis of rhabdomyolysis-induced AKI, and that GSPE may have a renoprotective effect.