Paranasal Sinus Fungus Ball, Anatomical Variations and Dental Pathologies: Is There Any Relation?

Objective: The purpose of this study was to investigate the relationship between anatomical variations and the fungus ball (FB), and the association between odontogenic etiologies and the maxillary sinus FB. Methods: We analyzed the clinical records of 66 patients who underwent endoscopic sinus surgery for FB. The anatomical variations determined were nasal septal deviation (NSD) and direction, presence of Onodi and Haller cell, concha bullosa and lateral recess of the sphenoid sinus. Further, dental X-ray records were reviewed to detect any possible odontogenic etiologies in patients with maxillary sinus FBs. Results: There were 41 female and 25 male patients. Positive fungal culture was found in 60 patients (91%) and the causative fungus was Aspergillus species in all cases. The correlation between NSD and localization of the maxillary sinus FB was statistically significant (p=0.0409). Maxillary sinus FB was more common on the concave side of the NSD. Presence of dental pathologies was significantly associated with maxillary sinus FB compared to the healthy side (p=0.0011). For sphenoid sinus FB, NSD was detected in a similar number for both the affected and unaffected side and there were no significant correlations (p>0.05). However, the relationship between sphenoid sinus FB and presence of lateral recess was significant (p=0.0262). Conclusion: Our study revealed that the maxillary sinus FB was more common on the concave side of the deviated septum. Also, dental pathologies or a presence of dental treatment history were associated with maxillary sinus FB.

Does the Charlson comorbidity index help predict the risk of death in COVID-19 patients?

Objective: Comorbidities are diseases that coexist with a disease of interest or an index disease, which can directly affect the prognosis of the disease of interest or indirectly affect the choice of treatment. The Charlson comorbidity index (CCI) is the most widely used comorbidity index. In this study, it was aimed to examine the predictive role of the CCI score on the mortality of patients with COVID-19. Methods: We have retrospectively analyzed COVID-19 patients whose diagnosis was confirmed by PCR and who were hospitalized in two centers between April 2020 and December 2020. The severity of comorbidity of the patients was categorized into five groups according to the CCI score: CCI score 0, CCI score 1-2, CCI score 3-4, CCI score 5-6, and CCI score ≥7. Factors affecting mortality and differences between groups classified by CCI were determined by logistic regression analysis and one-way analysis of variance. Results: A total of 1,559 COVID-19 patients were included in the study and 70 (4.49%) patients had deceased. Half of the study population (n=793, 50.9%) had different comorbidities. The CCI score was 3.8±2.7 in deceased patients and 1.3±1.9 in surviving individuals. There was a positive correlation between CCI scores and mortality in COVID-19 patients, with each point increase in the CCI score increasing the risk of death by 2.5%. CCI score of 4 and above predicted mortality with 87.2% sensitivity and 97.9% negative predictive value. Five (0.6%) of 766 patients with CCI scores of 0, 16 (3.6%) of 439 patients with CCI scores of 1-2, 13 (6.9%) of 189 patients with CCI scores of 3-4, and a CCI score of 5, 13 (15.7%) of 83 patients with -6 and 23 (28.0%) of 82 patients with a CCI score of ≥7 died. Conclusion: CCI is a simple, easily applicable, and valid method for classifying comorbidities and estimating COVID-19 mortality. The close relationship between the CCI score and mortality reveals the reality of how important vaccination is, especially in this group of patients. Increasing awareness of potential comorbidities in COVID-19 patients can provide insight into the disease and to improve outcomes by identifying and treating patients earlier and more effectively.

Cross-cultural adaptation and validation of the Turkish version of the sinus and nasal quality of life survey (SN-5).

Objective: The Sinus and Nasal Quality of Life (QoL) Survey (SN-5) is a valid questionnaire that evaluates the QoL of the pediatric population associated with sinonasal diseases and symptoms. The aims of this study were to translate the SN-5 test to Turkish language (SN-5t), evaluate the internal consistency of the test and test-retest reliability and validate the translation for further use in studies in Turkish language. Methods: In this prospective study, 50 healthy subjects and 50 patients, age between 2 and 12, with sinonasal symptoms prolonged over 1 month were included to the study. Families of healthy subjects were asked to fill the SN-5t twice with 1-week interval. The patient group completed test once prior the treatment and once 4 weeks after the treatment. Cronbach's test was performed to test internal consistency and Spearman's test was performed to evaluate test-retest validity. Results: The median value of the pre-treatment tests of the patient group and control group was 25 (23-28) and 14.25 (12-16), respectively. A statistically significant difference was found between groups (p<0.001). Area under the receiver operating characteristics (ROC) curve (Aroc) value was calculated as 0.992 which stated the strong diagnostic accuracy, and the cutoff point was defined as 16.5. Cronbach's alpha value of 0.75 was found. The Spearman's rank correlation coefficient value (Spearman's rho) was calculated as 0.946. Conclusion: The Turkish translation of the SN-5 is a consistent and valid test with high sensitivity and specificity that can be used in studies including Turkish speaking population.

Evaluation of the effects of COVID-19 on pregnancy, fetus and newborn, and treatment management.

Objective: During pregnancy, changes occur in many systems, including the immune system. In line with our experience in the previous years, COVID-19 infections have negative effects on pregnancy. In our study, it was aimed to evaluate the effects of COVID-19 on pregnancy, fetus and newborn, and treatment management. Methods: In our study, 63 patients followed up between April 1, 2020 and April 1, 2021, were evaluated. Demographic data, symptoms, laboratory data, treatments, clinical course and delivery characteristics of the patients, as well as pathologies in the fetus and newborn were investigated retrospectively. The obtained data were statistically analyzed with Statistical Package for the Social Sciences. Results: In this study, 63 pregnant COVID-19 patients aged 19-37 years were included in the study. Fifty of the patients had symptoms of COVID-19 at the time of admission. At the time of admission, 13 patients required oxygen, and ten of these patients had severe radiological involvement. Seven patients were admitted to the intensive care unit, and three of them required invasive mechanical ventilation and deceased afterward. All newborns were found negative for the COVID-19 polymerase chain reaction test. Low birth weight has been detected in eight newborns and low Apgar score in 2 of them. Respiratory distress was observed in four newborns and they were discharged from intensive. Conclusion: Pregnant women have more disadvantages in the course of COVID-19 and have worse maternal outcomes. In addition, treatments such as Lopinavir/Ritonavir and hydroxychloroquine did not have any effect. These patients should be carefully evaluated and followed up.

The Role of CO-RADS Scoring System in the Diagnosis of COVID-19 Infection and its Correlation with Clinical Signs.

BACKGROUND: Computed tomography (CT) evaluation systematics has become necessary to eliminate the difference of opinion among radiologists in evaluating COVID-19 CT findings. INTRODUCTION: The objectives of this study were to evaluate the efficiency of CO-RADS scoring system in our patients with COVID-19 as well as to examine its correlation with clinical and laboratory findings. METHODS: The CO-RADS category of all patients included in the study was determined by a radiologist who did not know the rtRT-PCR test result of the patients, according to the Covid-19 reporting and data system of Mathias Prokop et al. Results: A total of 1338 patients were included. CT findings were positive in 66.3%, with a mean CO-RADS score of 3,4 ± 1,7. 444 (33.1%) of the patients were in the CO-RADS 1-2, 894 (66.9%) were in the CO-RADS 3-5 group. There were positive correlations between CO-RADS score and age, CMI, hypertension, diabetes mellitus, chronic pulmonary diseases presence of symptoms, symptom duration, presence of cough, shortness of breath, malaise, CRP, and LDH, while CORADS score was negatively correlated with lymphocyte count. The results of the ROC analysis suggested that those with age ≥40 years, symptom duration >2 days, CMI score >1 and/or comorbid conditions were more likely to have a CO-RADS score of 3-5. CONCLUSION: The CO-RADS classification system is a CT findings assessment system that can be used to diagnose COVID-19 in patients with symptoms of cough, shortness of breath, myalgia and fatigue for more than two days.

Tocilizumab treatment in severe COVID-19: a multicenter retrospective study with matched controls.

Coronavirus disease-2019 (COVID-19) associated pneumonia may progress into acute respiratory distress syndrome (ARDS). Some patients develop features of macrophage activation syndrome (MAS). Elevated levels of IL-6 were reported to be associated with severe disease, and anti-IL-6R tocilizumab has been shown to be effective in some patients. This retrospective multicenter case-control study aimed to evaluate the efficacy of tocilizumab in hospitalized COVID-19 patients, who received standard of care with or without tocilizumab. Primary outcome was the progression to intubation or death. PSMATCH (SAS) procedure was used to achieve exact propensity score (PS) matching. Data from 1289 patients were collected, and study population was reduced to 1073 based on inclusion-exclusion criteria. The composite outcome was observed more frequently in tocilizumab-users, but there was a significant imbalance between arms in all critical parameters. Primary analyses were carried out in 348 patients (174 in each arm) after exact PS matching according to gender, ferritin, and procalcitonin. Logistic regression models revealed that tocilizumab significantly reduced the intubation or death (OR 0.40, p = 0.0017). When intubation is considered alone, tocilizumab-users had > 60% reduction in odds of intubation. Multiple imputation approach, which increased the size of the matched patients up to 506, provided no significant difference between arms despite a similar trend for intubation alone group. Analysis of this retrospective cohort showed more frequent intubation or death in tocilizumab-users, but PS-matched analyses revealed significant results for supporting tocilizumab use overall in a subset of patients matched according to gender, ferritin and procalcitonin levels.

A disease that is difficult to diagnose and treat: evaluation of 343 spondylodiscitis cases.

OBJECTIVE: Spondylodiscitis is an important clinical a problem requiring serious approaches. In this study, we sought to raise awareness by examining the epidemiology and laboratory, clinical, and radiological findings of spondylodiscitis, which sometimes has a delayed diagnosis and which can be difficult to treat. METHODS: In total, 343 patients with spondylodiscitis were included in the study. RESULTS: The patients were classified as having as pyogenic (n = 153, 44.6%), brucellar (n = 138, 40.2%), or tuberculous (n = 52, 15.2%) spondylodiscitis. Meanwhile, 281 patients underwent magnetic resonance imaging, 71 underwent computed tomography, and 17 underwent scintigraphy for diagnosis. The rates of involvement at more than two segments and paraspinal abscess were significantly higher in tuberculous spondylodiscitis. However, disc involvement was significantly more common in brucellar and pyogenic spondylodiscitis. CONCLUSION: The incidence of spondylodiscitis has increased substantially, especially in the young population. The invasive procedures and high rate of culture negativity make the diagnosis difficult. Therefore, clinical and radiological findings are useful in the diagnosis of spondylodiscitis. Despite the high rate of culture negativity, every effort should be made to identify the causative organism using invasive methods.

Evaluation of the factors affecting the necessity for revision surgery in choanal atresia.

OBJECTIVE: This study aims to compare the effects of different surgical techniques for congenital choanal atresia (CCA), and particular emphasis is given to the analysis of the factors affecting the surgical outcome. The necessity for revision surgery and surgical outcomes were retrospectively investigated in patients undergoing revision surgery according to a recently proposed classification system. MATERIAL AND METHOD: A retrospective study was conducted on patients operated for CCA between January 2007 and December 2018 at a university hospital. Data in the medical records, including patient age when the initial surgery was performed, gender, additional anomalies and medical conditions, the duration of gestation, side and type of atresia, type of surgery and need for revision surgery were reviewed. RESULTS: Forty-five patients treated for CCA in our university hospital were screened. The mean follow-up duration was 82.16 months. Revision surgery was required in 9 of 26 cases, which are included in the study (34.6%). Fourteen patients presented with bilateral CCA, while 12 were unilateral cases. Sixteen patients (61.5%) had comorbid medical conditions. While the removal of vomer and mucoperiosteal flap use affects successful surgical repair, no differences were observed in choanal atresia type, laterality, use of stent and the presence of additional medical conditions. CONCLUSION: The most important factors affecting surgical success for CCA are the removal of the vomer and closure of all bare bone tissues using a mucoperiosteal flap. Use of stents provides no additional benefit, apart from preventing synechiae formation.

Comparison of two pandemics: H1N1 and SARS-CoV-2.

OBJECTIVE: We aimed to compare the clinical, epidemiological, and prognostic features of the H1N1 pandemic in 2009 and the severe acute respiratory syndrome coronavirus 2 pandemic in 2020. METHODS: This retrospective study involved subjects from seven centers that were admitted and found to be positive for H1N1 or COVID-19 real-time polymerase chain reaction test. RESULTS: A total of 143 patients with H1N1 and 309 patients with COVID-19 were involved in the study. H1N1 patients were younger than COVID-19 ones. While 58.7% of H1N1 patients were female, 57.9% of COVID-19 patients were male. Complaints of fever, cough, sputum, sore throat, myalgia, weakness, headache, and shortness of breath in H1N1 patients were statistically higher than in COVID-19 ones. The duration of symptoms until H1N1 patients were admitted to the hospital was shorter than that for COVID-19 patients. Leukopenia was more common in COVID-19 patients. C-reactive protein levels were higher in COVID-19 patients, while lactate dehydrogenase levels were higher in H1N1 ones. The mortality rate was also higher in H1N1 cases. CONCLUSIONS: The severe acute respiratory syndrome coronavirus 2 pandemic is a major public health problem that continues to affect the world with its high rate of contagion. In addition, no vaccines or a specific drug for the benefit of millions of people have been found yet. The H1N1 pandemic is an epidemic that affected the whole world about ten years ago and was prevented by the development of vaccines at a short period. Experience in the H1N1 pandemic may be the guide to prevent the COVID-19 pandemic from a worse end.

Bilateral Ethmoidal Mucocele Causing Proptosis in a Child.

OBJECTIVES: Paranasal sinus mucocele is a benign cystic lesion, lined with respiratory epithelium and filled with mucoid secretions, which is generally seen in the ethmoid or frontal sinuses. Inflammation, trauma, fibrosis, neoplasm, and previous surgery play a role in etiology. Treatment of this condition requires marsupialization and drainage. Endoscopic surgery is the gold standard procedure. METHODS: A 2-year-old boy was referred to our clinic with a diagnosis of bilateral ethmoid mucocele causing proptosis in the right eye. General clinical examinations and routine blood analysis revealed normal health condition of the patient and comorbidities such as cystic fibrosis (CF) and/or ciliary dysfunction were excluded. The patient was operated with an endoscopic endonasal approach. RESULTS: As far as we know, our article reports the first case of bilateral ethmoidal sinus mucocele with no underlying comorbidity, such as cystic fibrosis or ciliary dyskinesia. CONCLUSIONS: Children are rarely affected by mucocele and if present at early age, there is usually an underlying cause. In pediatric patients with signs and symptoms suggestive of a mucocele, it is important to rule out other benign and malignant paranasal sinus pathologies. Marsupialization and drainage via endoscopic endonasal approach is the preferred treatment modality.

Evaluation of Diarrhea in Patients with COVID-19.

BACKGROUND/AIMS: The COVID-19 disease, which was declared epidemic by the WHO, is a global emergency public health problem. Patients with extrapulmonary symptoms are the group of patients who should be considered for person-to-person transmission in the community. In our study, it was aimed to investigate the characteristics of patients with COVID-19-related diarrhea symptoms. MATERIALS AND METHODS: The study was conducted retrospectively in CO-VID-19 rtRT-PCR-positive patients in 5 medical centers. Three or more loose/liquid stools per day or increased number of defecations compared to normal defecation were defined as diarrhea. The patients were analyzed in 2 groups as those with and without diarrhea. RESULTS: One thousand eighty-six patients were included in the study. Seventy-eight (7.2%) of the patients had diarrhea. Diarrhea was watery in 54 (69.2%) patients while with blood and mucus in 18 (23.1%) patients. Diarrhea continued for an average of 5.2 ± 1.6 (2-11) days. The clinical and laboratory findings of patients with diarrhea were more serious than those without diarrhea. Diarrhea is more common in the elderly and people with comorbid disease, and patients with diarrhea had higher CMI score and CRP and higher complaints of fever, cough, shortness of breath, myalgia, and fatigue. CONCLUSIONS: The presence of diarrhea should indicate a suspected COVID-19 infection and suggest testing for early diagnosis of the disease. It should be kept in mind that the course of the disease may be more severe in these patients, and precautions should also be taken in terms of fecal transmission during discharge.

Comparison of two pandemics: H1N1 and SARS-CoV-2

SUMMARY OBJECTIVE: We aimed to compare the clinical, epidemiological, and prognostic features of the H1N1 pandemic in 2009 and the severe acute respiratory syndrome coronavirus 2 pandemic in 2020. METHODS: This retrospective study involved subjects from seven centers that were admitted and found to be positive for H1N1 or COVID-19 real-time polymerase chain reaction test. RESULTS: A total of 143 patients with H1N1 and 309 patients with COVID-19 were involved in the study. H1N1 patients were younger than COVID-19 ones. While 58.7% of H1N1 patients were female, 57.9% of COVID-19 patients were male. Complaints of fever, cough, sputum, sore throat, myalgia, weakness, headache, and shortness of breath in H1N1 patients were statistically higher than in COVID-19 ones. The duration of symptoms until H1N1 patients were admitted to the hospital was shorter than that for COVID-19 patients. Leukopenia was more common in COVID-19 patients. C-reactive protein levels were higher in COVID-19 patients, while lactate dehydrogenase levels were higher in H1N1 ones. The mortality rate was also higher in H1N1 cases. CONCLUSIONS: The severe acute respiratory syndrome coronavirus 2 pandemic is a major public health problem that continues to affect the world with its high rate of contagion. In addition, no vaccines or a specific drug for the benefit of millions of people have been found yet. The H1N1 pandemic is an epidemic that affected the whole world about ten years ago and was prevented by the development of vaccines at a short period. Experience in the H1N1 pandemic may be the guide to prevent the COVID-19 pandemic from a worse end.

The Simplified Nasal Septal Deviation Evaluation System and Nasal Obstruction Symptom Evaluation Scale Correlation.

Nasal septal deviation (NSD) is a common condition in otorhinolaryngology practice. The aim of this study was to investigate the possible relationship between localization and severity of NSD, and related complaints as well as to suggest a simplified assessment method for NSD. Seventy-five patients who complaint nasal obstruction were enrolled this study. The affected nasal cavity was divided into 4 separate sections as follows: antero-superior (AS), antero-inferior (AI), postero-superior (PS), and postero-inferior (PI). Each section was determined according to its relationship to the both superior edge and head of the inferior turbinate. The NSD score was calculated separately for each section according to its relationship with lateral nasal wall. The NSD-related complaints were assessed via the Nasal Obstruction Symptom Evaluation (NOSE) scale. There were 42 male and 33 female patients, with an age range of 18 to 44 years. The mean NSD score was 2.18 ±â€Š0.63 for AS section, 1.92 ±â€Š0.67 for AI section, 1.54 ±â€Š0.70 for PS section, and 1.18 ±â€Š0.60 for PI section. The mean total NSD score was 6.84 ±â€Š1.97 while the mean NOSE score was 12.5 ±â€Š5.11. There was a strong positive correlation between total NSD and NOSE scores when the NSD score was 6 or more (r = 0.9556). This correlation was also present when each section was evaluated separately. The strongest correlation was detected for AS section deviations. Our septal classification system provides a simple and effective evaluation of NSDs. The NSDs which affect internal valve are more related with nasal obstruction and patients' discomfort.

A Rarely Seen Mass of Nasal Cavity: Seromucinous Hamartoma.

Seromucinous hamartoma (SH) is a rarely seen benign polypoid mass of the sinonasal tract. Although the most common presentation symptom is nasal obstruction, most of the patients are asymptomatic. In this paper, the authors present an additional case of SH and discuss its differential diagnosis. A 34-year-old male patient presented with progressive nasal obstruction and serous nasal discharge for several months. A well-defined polypoid mass was detected in the left nasal cavity during the endoscopic assessment. Preoperative biopsy was reported as benign polypoid lesion. The mass was resected via transnasal endoscopic approach and final pathological examination was notified as SH.The SH is an uncommon tumor, originates from nasal septum in the most cases and presents as a well-circumscribed polypoid mass. Radiological imaging modalities and biopsy should be performed to distinguish from the sinonasal malignancies. Complete surgical excision is recommended treatment and recurrence is almost never.

Foot self-care in diabetes mellitus: Evaluation of patient awareness.

AIMS: To assess diabetic patients' knowledge and practices regarding foot care. METHODS: This study was conducted as a cross-sectional study in 1030 patients between November 2017 and February 2018.The descriptive survey instrument was developed by the investigators. Survey content and format were based on prior surveys and guidelines. The survey sought socio-demographic characteristics of the patients and the level of knowledge about diabetic foot care practice. RESULTS: 29.5% of patients had bad foot care, 49.6% of patients had moderate foot care and 20.8% of patients had good foot care. There were no significant differences between patient groups in regard to age, gender, foot infection history and having undergone amputation surgery. We found that patients who good at foot care had higher education status (p<0.001), were more likely live in a city (p<0.001), had higher income (p<0.001), had been trained about foot care (p<0.001) and were more likely to have type I DM (p=0.015). Disease duration was longer in those who had good foot care compared to the other groups (p=0.010). CONCLUSIONS: The mean knowledge and practice scores of our patients were moderate, indicating that much is to be done for the education of patients on this matter. We also found that knowledge about the importance of this practice, education status and disease duration had significant influence on the practice of foot-care in patients with DM.

Paranasal sinus volumes and headache: is there a relation?

PURPOSE: The aim of the study is to investigate the relation between paranasal sinus volumes and headache in patients with no other rhinologic causes. METHODS: Two hundred patients with chronic headache and 99 subjects with no headache or facial pain history in the last 6 months were included in the study. Paranasal computed tomography (CT) scans of both patient and control groups were evaluated. Sixty one patients were excluded from the study due to possible rhinogenic headache CT findings such as secretions and contact points. Sinus volume index (SVI) formula created by Barghouth et al. in 2002 was used to calculate paranasal sinus volumes: SVI = ½. A × B × C. Mann-Whitney U test was used to compare an independent continuous variable and a continuous variable with non-normal distribution. RESULTS: In the patient group, the total sinus, frontal sinus, and maxillary sinus volumes were found to be significantly lower than those of the control group (p < 0.001). Although the total sphenoid sinus volume was found to be lower in the patient group, there was no significant difference between the two groups (p = 0.013). CONCLUSION: Although rhinogenic findings are often related to secondary headache, the relation between paranasal sinus volume and headache is scarcely investigated in the literature. Our study showed that paranasal sinus volumes might have a role in secondary headaches. Furthermore, in contrast to the literature, our study showed a significant relation between headache and smaller paranasal sinus volumes.

A Practical Recommendation for Teaching Neck Anatomy During Neck Dissection in the Operating Room.

Anatomy knowledge is not only essential for surgeons but also has importance for anyone who performs an invasive procedure on a patient, and provides examination and diagnosis of patients and sharing of these findings to the patient and other medical professionals. It is accepted that most surgical procedures could facilitate anatomic perception in surgical internships. There is an educational tendency to explore innovative instructional tools and methods that can help support current education styles. This study investigates the effect of a green laser pointer on students' perceptions and educational effectiveness when neck dissection is performed in the operating room.