Transoral laser microsurgery for T1 glottic cancer with anterior commissure: Identifying clinical and radiological variables that predict oncological outcome.

PURPOSE: The involvement of the anterior commissure (AC) is regarded to be a risk factor for poor results after transoral laser microsurgery (TLM) for early glottic cancer. The objective of this study was to determine how AC-related clinical and radiological factors affected oncological outcomes in a cohort of patients with T1 stage early glottic carcinoma involving the anterior commissure who were treated with TLM with negative surgical margins. METHODS: Retrospective analysis was performed on clinical, radiological, and follow-up data of patients consecutively treated with TLM at a tertiary academic center between November 2011 and August 2021 for T1 glottic squamous cell carcinoma involving the anterior commissure. Recurrence-free survival (RFS), local control with laser alone (LCL), laryngeal preservation (LP), and overall survival (OS) rates (Kaplan-Meier) were the primary outcome metrics. RESULTS: In our series, 5-year OS probability was 75.1%, RFS was 64.8%, LCL was 73.8%, and LP was 83.4%. OS and RFS were higher in patients with early stages of AC pattern than in patients with advanced stage (p = 0.004, p = 0.034, respectively). Vertical extension ratio was found to be associated with OS and RFS (p = 0.023, p = 0.001, respectively), and thyroid cartilage interlaminar angle with LCL by multiple Cox regression analysis (p = 0.041). CONCLUSION: TLM remains a valuable treatment option for AC involvement. AC3 type involvement and elevated vertical extension ratio were associated with negative prognosis. There have been signs that thyroid cartilage with a narrow angle increases recurrence. Alternative modalities should be kept in mind in the treatment decision of these cases.

Three-Dimensional (3D) Analysis of Orbital Morphometry in Healthy Anatolian Adults: Sex, Side Discrepancies, and Clinical Relevance.

Background and objective The complex structural integrity of the orbit is crucial for visual functions. Three-dimensional (3D) reconstructions from radiological images have revolutionized anatomical understanding, eliminating the limitations of two-dimensional (2D) imaging and offering intricate spatial details for complex structures. The aim of this study was to analyze the detailed morphometry of the orbit in healthy Anatolian adults, considering sex, side discrepancies, and clinical relevance using 3D models reconstructed from multidetector computed tomography (MDCT) images. Materials and methods Fifty-six (44.44%) males and 70 (55.56%) females (total: 126, mean age: 48.62) MDCT images were randomly selected and 3D skull models were reconstructed using 3D Slicer software. Measurements were conducted in millimeters (mm) for transverse and vertical diameters, circumference of the orbital opening, orbital wall lengths, as well as intraorbital and extraorbital distances. Results The method of measurements showed high reproducibility of results. The mean values for transverse and vertical diameters, circumference of the orbital opening, medial and lateral wall lengths, roof and floor lengths, and intraorbital and extraorbital distances were 40.23±2.12 mm (p<0.001), 34.94±2.16 mm (p=0.365), 44.74 ±3.02 mm (p<0.001), 46.30±2.69 mm (p<0.001), 51.26±2.91 mm (p<0.001), 49.01±3.22 mm (p<0.001), 126.10±5.71 mm (p<0.001), 19.63±2.35 mm (p=0.026), and 94.09±4.84 mm (p<0.001), respectively. Conclusion The study's high measurement reproducibility contributes significantly to the existing literature and clinical practice. These findings offer specific insights into Anatolian orbital morphometry, aiding in surgical planning, implant placement, and diagnostic assessments. The precise measurement values serve as a reliable reference for clinicians, facilitating the identification of normal and abnormal orbital anatomy and enhancing patient care. We believe this study provides valuable data for craniofacial and ophthalmological research, benefiting both clinical practice and future research endeavors in these fields.

Forensic age estimation with ankle MRI: Evaluating distal tibial and calcaneal epiphyseal fusion.

Forensic authorities often request age estimation from forensic experts, particularly in cases related to sexual abuse, child pornography, illegal migration, marriage, etc. The most commonly used method in this regard is radiological methods. Because of the potential dangers of radiation exposure outside of clinical indications, new researches are focusing on non-ionizing and non-invasive technologies. This study aimed to demonstrate the applicability of age estimation in living individuals from ankle magnetic resonance images as a non-ionizing method, and to determine whether it is compatible with individuals' real ages and to establish a database. Ankle MRI images of patients aged between 7 and 26 years who applied to the Cukurova University Faculty of Medicine Balcali Hospital between January 2011 and December 2020 were retrospectively evaluated. A six-stage staging method proposed by Lu et al. was applied to the distal tibial and calcaneal epiphyseal ossification points by examining ankle MRI images of a total of 331 patients, 197 males and 134 females. In the study, images obtained from a sagittal section fast spin echo T1-weighted sequence, with a section thickness of 3-4 mm, were evaluated. As a result of the study, Stage 1 in both distal tibial and calcaneal epiphysis was observed only in patients under 18 years of age in both sex. In males, stage 2 in distal tibial epiphyseal ossification was observed under 18 years of age, except for one case, and stage 5 in both distal tibial and calcaneal epiphyseal ossification was observed in almost all cases over 18 years of age in males. According to the results of our study, magnetic resonance imaging was found to be a non-ionizing method that could be used in addition to other radiological methods aimed at determining the 18-year age limit in age estimation. Multicenter, comparative, and prospective studies conducted by experienced researchers are needed to enable the routine use of MRI in age estimation.

Vinorelbine-related tetraplegia due to severe peripheral neuropathy.

INTRODUCTION: Vinorelbine, a semi-synthetic vinca alkaloid with anticancer activity by binding to tubulin, has shown to be successful in the treatment of cancer types including advanced non-small cell lung cancer, uterine cancer, and metastatic breast cancer. Myelosuppression, hematological effects, nausea, vomiting, exhaustion, and neuropathy are some of the most typical side effects of vinorelbine. We discuss the unusual presentation of vinorelbine-induced tetraplegia in a breast cancer patient. CASE REPORT: A 66-year-old patient with breast cancer, who was followed up with adjuvant aromatase inhibitor therapy after mastectomy, presented with lung and bone metastases. She progressed in the follow-ups after receiving platinum and taxane chemotherapy, vinorelbine treatment was then started. The patient complained of weakness, weariness, and trouble walking after receiving a total dose of 180 mg. Tetraplegia was found after a neurological assessment. MANAGEMENT AND OUTCOME: It was thought that vinorelbine was responsible for the recent acute weakness. The patient's vinorelbine treatment was stopped. During follow-up, upper extremity paresis regressed, while lower extremities muscle strength remained unchanged. DISCUSSION: Vinorelbine, frequently used in oncology practice, causes some side effects. Although very rare in the literature, in this case severe peripheral neuropathy has been reported in the follow-up of post-vinorelbine quadriparesis.

Pediatric posterior reversible encephalopathy syndrome: Age related clinico-radiological profile and neurologic outcomes.

BACKGROUND: The aim of this study was to analyze the characteristics of pediatric posterior reversible encephalopathy syndrome (PRES) to determine clinical and radiologic differences between younger and older age groups, and to identify risk factors for development of any neurologic sequelae. METHODS: The study cohort consisted of confirmed pediatric PRES patients in a tertiary care university hospital from January, 2015, to December, 2020. Demographic and clinical properties, radiological manifestations, and neurologic outcomes were noted. Children aged ≤6 years were compared with those older than 6 years and factors affecting neurologic outcomes were evaluated. RESULTS: The most common underlying diseases were oncological (37%) and kidney diseases (29%). Epileptic seizures were the most frequent symptoms at initial clinical presentation. The regions in the brain that were most commonly involved were the occipital region (n = 65, 96%), the parietal region (n = 52, 77%), and the frontal lobe (n = 35, 54%). Magnetic resonance imaging (MRI) findings were consistent with atypical patterns in most of the study cohort (71%). Patients with unfavorable clinical outcomes (n = 13, 19.1%) had longer initial seizure times and longer encephalopathy times, lower leucocyte and absolute neutrophil counts, and lower neutrophil to lymphocyte ratios. No relationship was found between MRI findings, involvement patterns, and neurologic outcomes. CONCLUSIONS: No clinically specific differences between two different age groups were found. Atypical imaging manifestations of pediatric PRES in our study had an incidence that was as high as those found in earlier adult studies. Multivariate logistic regression analysis showed that the initial neutrophil to lymphocyte ratio, absolute neutrophil counts, and white cell counts could not predict poor neurologic outcomes.

The impact of applying challenge-based gamification program on students' learning outcomes: Academic achievement, motivation and flow.

Despite the growing attention towards gamification in learning context, challenge-based gamification application has rarely been subjected to testing in education. In recognition of this void, and grounded on gamification principles, we developed Educhall web-based program. Drawing on self-determination theory, and flow theory the present study aims to explore how the application of this challenge-based gamified program in to learning process of students can increase students' motivation, flow, and academic success through the generated competition and challenge. The study applied a random experimental research design within distance learning context with 30 university students of control group and 30 students of experimental group who used the Educhall application for one academic semester. In line with self-determination theory, it was statistically evidenced that application of challenge-based gamified learning method increased level of academic performance and overall motivation. Of the motivational sub factors, experimental group reported significantly higher confidence level and satisfaction towards the course. Furthermore, grounded on flow theory, the study showed that challenge-based gamified learning increased flow level of learners but not significantly which warrants further data collection and experimental research in future studies. Implications for research and practice are discussed.

Efficacy of the endovascular ovarian vein embolization technique in pelvic venous congestion syndrome.

Purpose: Pelvic pain, either related or unrelated to menstruation, is especially common in women of reproductive age. Thirty-nine per cent of all women suffer from chronic pelvic pain at some point in their lives, and pelvic venous congestion syndrome (PVCS) is the cause of this pain in 30% of cases. The aim of this study was to determine factors affecting the success of endovascular venous embolization used in the treatment of PVCS, and to present the long-term treatment results. Material and methods: The data of 144 female patients who underwent endovascular ovarian vein embolization for PVCS between January 2012 and July 2020 were retrospectively analysed. Results: Pain management was determined to be very successful in 37 (25.6%) patients, successful in 55 (38.1%), and unsuccessful in 52 (35.3%). Treatments using a coil alone were significantly more successful in pain management than those involving the use of different materials in addition to the coil (p = 0.036). In addition, patients with unilateral insufficiency before the procedure were found to have more successful pain management than those with bilateral insufficiency (p = 0.041). Reproductive/postmenopausal state and parity did not have a statistically significant effect on treatment efficacy (p = 0.250 and p = 0.573, respectively). Conclusions: Endovascular pelvic venous embolization is an important option in the treatment of PVCS due its less invasive and reproducible nature.

Clinical, radiological, and genetic variation in pontocerebellar hypoplasia disorder and our clinical experience.

Pontocerebellar hypoplasia (PCH) constitutes a heterogeneous neurodegenerative/neurodevelopmental disorder of the pons and cerebellum with onset in the prenatal period. Our study aimed to present different clinical and radiological manifestations of our genetically diagnosed PCH patients. METHOD:  Six patients were enrolled in this study from September 2018 to March 2021. All the clinical radiological and genetic investigations were done at Cukurova University Medical School. RESULTS: Five children were diagnosed genetically and categorized under one of the types of PCH (type 10,7,11). Homozygous mutations in CLP1 In PCH type 10, TOE1 in PCH type 7, and TBC1D23 in PCH type 11 were respectively detected. Pateint with PCH type 11 and female patient with PCH type 7 could walk and speak few words. Male patient with PCH type 7 had disorder of sex development. CONCLUSION: According to our study, PCH is a rare neurodegenerative disease, although some types are static as PCH11 male gender and PCH7 female gender. Some clinical features are specific to a definite type. PCH7 express disorders of sex development most apparent in 46 XY. Some ethnic groups could express distinct subtypes. PCH10 is seen in the Turkish population. Radiological imaging is beneficial in pre-diagnosis; all the patients had different pons and cerebellar hypoplasia degrees. Genetic testing like whole exome sequencing -next-generation sequencing is essential in setting the definite diagnosis and determining the type/subtype of PCH.

Evaluation of bone health in patients with mucopolysaccharidosis.

INTRODUCTION: This study aimed to evaluate the relationship between clinical findings, height and weight standard deviation scores, 25-hydroxyvitamin D3 (25(OH)D3) level, and dual-energy X-ray absorptiometry (DXA) results in patients diagnosed with mucopolysaccharidosis (MPS), where effective current treatments such as enzyme replacement therapy (ERT) can be accessed. MATERIALS AND METHODS: 25(OH)D3 level was measured in 126 patients with MPS (17 with MPS I, 14 with MPS II, 18 with MPS III, 33 with MPS IVA, and 44 with MPS VI; 24-524 months). DXA was performed in 45 of these patients (8 with MPS I, 4 with MPS II, 4 with MPS III, 12 with MPS IVA, and 17 with MPS VI; 62-197 months; all patients were under 18 when DXA was performed) to assess bone mineral density (BMD) of the lumbar spine. RESULTS: In total, 67.5% patients had a short stature, and 50% of them were underweight for their age. Of the patients, 13.5% were immobile, 28.6% had 25(OH)D3 deficiency, and 30.2% had an insufficient level of 25(OH)D3. BMD z score of 45 patients was - 2.5 ± 1.7. In 40% patients, it was < - 2. However, after correction for height-for-age z score (HAZ), HAZ-adjusted BMD z score was - 0.1 ± 0.9. In 2.2% patients, it was < - 2. CONCLUSION: The low BMD z score prevalence reported with DXA was misleadingly higher in children with MPS and short stature. To prevent exposure to unnecessary antiresorptive treatments in these children, the effect of severe short stature and bone geometry on DXA measurements should be considered; further studies on bone health are warranted.

A rare lesion of breast: Hydatid cyst.

Hydatid cyst (HC) is a lesion most commonly seen in the liver but can occur in many parts of the body. Breast involvement with HC is extremely rare. It can be isolated or accompanied by other organ involvements. In this report, we present a 46-year-old female with isolated HC located in the right breast. In the ultrasonography and MR images of the patient, the lesion was compatible with the HC, and homogenous dens lesion was shown on mammography. Diagnosis of HC was confirmed pathological. With this study, it was aimed to emphasize the radiological findings of isolated breast HC.

Magnetic resonance imaging evaluation of incidentally detected hyperechoic liver lesions: comparison of two modalities in terms of detection, diagnosis, and morphological features.

OBJECTIVE: This study aimed to investigate and compare the ultrasonography and contrast-enhanced magnetic resonance imaging characteristics of incidentally detected hyperechoic focal liver lesions. METHODS: Seventy-four patients (29 males and 45 females) who had undergone a B-mode ultrasonography and contrast-enhanced magnetic resonance imaging examination were included in this study. A total of 91 hyperechoic lesions detected on ultrasonography were evaluated. The ultrasonography features of these hyperechoic lesions were recorded, and the results were compared with those acquired from contrast-enhanced magnetic resonance imaging. The results were compared statistically using the Shapiro-Wilk, McNemar, and Wilcoxon signed-rank tests. RESULTS: A corresponding lesion was found on contrast-enhanced magnetic resonance imaging in 72 of the 91 (79.1%) hyperechoic lesions detected on ultrasonography. Forty-one (56.9%) of the magnetic resonance imaging-defined lesions were typical hemangiomas, while 10 (13.9%) were focal steatosis areas and 4 (5.6%) were diagnosed with hepatocellular carcinoma. In contrast, 6 lesions (8.3%) were diagnosed as simple hepatic cysts, 4 (5.6%) as sclerosing hemangioma, 2 (2.8%) as thrombosed hemangioma, 1 (1.4%) as focal nodular hyperplasia, 1 (1.4%) as hamartoma, 2 (2.8%) as hydatid cysts, and 1 (1.4%) as hepatic lipoma. No statistically significant differences were found between ultrasonography and magnetic resonance imaging in terms of the segmental classification of the true positive lesions based on contour structures and lesion area measurements (p=0.558, p=0.375, and p=0.636, respectively). CONCLUSIONS: Incidentally detected hyperechoic zones may not necessarily be detected on magnetic resonance imaging. This may be secondary to focal hepatic steatosis or false interpretation of the radiologist. Lesions requiring therapy must be considered in the differential diagnosis.

Evaluation of the olfactory bulb volume and morphology in patients with coronavirus disease 2019: can differences create predisposition to anosmia?

SUMMARY OBJECTIVE: This study aimed to investigate whether the volume and morphology of the olfactory bulb are effective in the occurrence of anosmia in patients after COVID-19 infection. METHODS: The olfactory bulbus volume was calculated by examining the brain magnetic resonance imaging of cases with positive (+) COVID-19 polymerase chain reaction test with and without anosmia. Evaluated magnetic resonance imaging images were the scans of patients before they were infected with COVID-19. The olfactory bulbus and olfactory nerve morphology of these patients were examined. The brain magnetic resonance imaging of 59 patients with anosmia and 64 controls without anosmia was evaluated. The olfactory bulb volumes of both groups were calculated. The olfactory bulb morphology and olfactory nerve types were examined and compared between the two groups. RESULTS: The left and right olfactory bulb volumes were calculated for the anosmia group and control group as 47.8±15/49.3±14.3 and 50.5±9.9/50.9±9.6, respectively. There was no statistically significant difference between the two groups. When the olfactory bulb morphology was compared between the two groups, it was observed that types D and R were dominant in the anosmia group (p<0.05). Concerning olfactory nerve morphology, type N was significantly more common in the control group (p<0.05). CONCLUSIONS: According to our results, the olfactory bulb volume does not affect the development of anosmia after COVID-19. However, it is striking that the bulb morphology significantly differs between the patients with and without anosmia. It is clear that the evaluation of COVID-19-associated smell disorders requires studies with a larger number of patients and a clinicoradiological approach.

Evaluation of the interference of lamotrigine on the analysis of synthetic cannabinoids in urine by the immunoassay method.

We aimed to evaluate the interference of lamotrigine (LMG) on the synthetic cannabinoids metabolite-K2/1 (SCm/K1) urine test by Homogeneous Enzyme Immunoassay (Immune-SCm/K1). This study consists of two parts: case-control and interference effect research. In the case-control study, two groups using LMG and a non-use of LMG were formed, all of them non-SC users. In the interference effect research, four groups were formed by adding either a LMG stock solution or a LMG user's urine to a SCm/K1 negative urine, and Immune-SCm/K1 test calibrators and quality control (QC) materials. Immune-SCm/K1, SCm/K1 by LC/MS-MS and LMG tests were performed on all samples in the study. The case-control study was performed on a total of 55 participants (mean age 39.76 ± 9.84 years). Both groups were statistically insignificant in terms of age and gender. Urine LMG levels were 5.71 ± 10.61 mg/L in the LMG group and <0.30 mg/L in the control group. Immune-SCm/K1 results were 35.84 ± 7.62 ng/mL in the LMG group, <3.00 ng/mL in the control group and the LC/MS-SCm/K1 urine test of both groups were found to be 'NEGATIVE'. Results were interpreted as a cross-reaction in the interference study and a statistically significant relationship was found between LMG levels and Immune-SCm/K1 levels in the SCm/K1 negative samples (groups 1 and 2) (R2 = 0.9341 and R2 = 0.9941, respectively; p < .001). LMG interference was observed in SCm/K1 positive samples ranging from -6.17 to 714.77%. LMG in the specimen interferes with the Immune-SCm/K1 screening test and causes false positivities.

Diagnostic performance and interobserver agreement of CO-RADS: evaluation of classification in radiology practice.

PURPOSE: We aimed to evaluate the use of the COVID-19 reporting and data system (CO-RADS) among radiologists and the diagnostic performance of this system. METHODS: Four radiologists retrospectively evaluated the chest CT examinations of 178 patients. The study included 143 patients with positive reverse transcriptase-polymerase chain reaction (RT-PCR) test results and 35 patients whose RT-PCR tests were negative but whose clinical and/or radiological findings were consistent with COVID-19. Fleiss' kappa (κ) values were calculated, and individual observers' scores were compared. To investigate diagnostic efficiency, receiver operating characteristic (ROC) curves were calculated for each interpreter. RESULTS: The interpreters were in full agreement on 574 of 712 (80.6%) evaluations. The common Fleiss' κ value of all the radiologists combined was 0.712 (95% confidence interval [CI] 0.692-0.769). A reliable prediction on the basis of RT-PCR and clinical findings indicated the mean area under the curve (AUC) of Fleiss' κ value as 0.89 (95% CI 0.708-0.990). General interpreter agreement was found to range from moderate to good. CONCLUSION: The interpreter agreement for CO-RADS categories 1 and 5 was reasonably good. We conclude that this scoring system will make a valuable contribution to efforts in COVID-19 diagnosis. CO-RADS can also be of significant value for the diagnosis and treatment of the disease in cases with false-negative PCR results.

Evaluation of the contour of the pancreas: types and frequencies.

PURPOSE: Pancreas contour variations can sometimes be misdiagnosed as mass lesions. This study aimed to evaluate normal pancreatic contour morphology, variations, frequency and the development of the uncinate process. METHODS: Out of 1183 consecutive computed tomography images taken in our hospital for various reasons (e.g. malignity, donor), 899 suitable images were included in the study. The following variations were identified: globular, elongated or globular-elongated contours of the pancreas head, protrusions of the body-tail surfaces and globular, lobular, globular-lobular, tapered and bifid contours of the tail. Hypoplasia and aplasia of the uncinate process were identified. All images were evaluated retrospectively by two radiologists. RESULTS: Of the 899 patients, 504 (56.1%) were males. The mean age of the patients was 53.9 ± 14.7 (range 18-89). Hypoplasia of the uncinate process was found in 72 (8%) patients; aplasia was seen in 11 (1.2%) patients. Thirty-one (3.5%) of the pancreatic head variations were globular, 49 (5.4%) elongated and three (0.3%) elongated-globular. In patients with pancreatic uncinate process developmental anomaly, contour variations were also detected in the head of the pancreas. The pancreatic body-tail showed protrusions anteriorly in 76 (8%) patients and posteriorly in 11 (1.2%) patients. Seventy-two (8%) of the pancreatic tail variations were globular, 39 (4.4%) were globular-lobular, 18 (2%) were tapered and 17 (1.8%) were bifid. CONCLUSION: Patients with pancreatic uncinate process developmental anomaly also have contour variations in the head of the pancreas. Pancreatic uncinate process developmental anomaly was seen in 9.2%. Pancreatic tail contour variation was 16.2%. The pancreatic body-tail showed protrusion in 9.2% of patients.

Evaluation of erectile dysfunction in patients with asthma.

OBJECTIVES: The aim of the current study was to investigate Erectile dysfunction (ED) in asthma patients without comorbidity and the relationship between the level of asthma control and ED. METHODS: Forty male patients aged 24-50 years with controlled-to-uncontrolled asthma and 20 healthy volunteers were included in this study. The International Index of Erectile Function Questionnaire (IIEF) for ED was used. RESULTS: Evaluation of the IIEF scores for ED showed that 23 (57.5%) of the asthma patients and 4 (20.0%) of the controls had various degrees of ED, and the difference was statistically significant. In total, 25% of asthma patients had mild ED, 22.5% moderate ED, and 10% severe ED. Severe, moderate and mild ED was more frequent in the asthma group. Of the 23 patients who had various degrees of ED, 13 were in the uncontrolled asthma group. While all asthma patients with severe ED were in the uncontrolled asthma group, of the 9 asthma patients with moderate ED, 6 were in the uncontrolled asthma group, 2 were in the partially controlled asthma group and one was in the controlled asthma group. Additionally, of the 10 asthma patients with mild ED, 3 were in the uncontrolled asthma group, 2 were in the partially controlled asthma group and 5 were in the controlled asthma group. CONCLUSION: The current study showed that ED is frequent and more severe in asthma patients than controls with same age. A highly negative correlation was found between ED degree and asthma control severity.

Evaluation of the olfactory bulb volume and morphology in patients with coronavirus disease 2019: can differences create predisposition to anosmia?

OBJECTIVE: This study aimed to investigate whether the volume and morphology of the olfactory bulb are effective in the occurrence of anosmia in patients after COVID-19 infection. METHODS: The olfactory bulbus volume was calculated by examining the brain magnetic resonance imaging of cases with positive (+) COVID-19 polymerase chain reaction test with and without anosmia. Evaluated magnetic resonance imaging images were the scans of patients before they were infected with COVID-19. The olfactory bulbus and olfactory nerve morphology of these patients were examined. The brain magnetic resonance imaging of 59 patients with anosmia and 64 controls without anosmia was evaluated. The olfactory bulb volumes of both groups were calculated. The olfactory bulb morphology and olfactory nerve types were examined and compared between the two groups. RESULTS: The left and right olfactory bulb volumes were calculated for the anosmia group and control group as 47.8±15/49.3±14.3 and 50.5±9.9/50.9±9.6, respectively. There was no statistically significant difference between the two groups. When the olfactory bulb morphology was compared between the two groups, it was observed that types D and R were dominant in the anosmia group (p<0.05). Concerning olfactory nerve morphology, type N was significantly more common in the control group (p<0.05). CONCLUSIONS: According to our results, the olfactory bulb volume does not affect the development of anosmia after COVID-19. However, it is striking that the bulb morphology significantly differs between the patients with and without anosmia. It is clear that the evaluation of COVID-19-associated smell disorders requires studies with a larger number of patients and a clinicoradiological approach.

A GIS and microsimulation-based MCDA approach for evaluation of pedestrian crossings.

Pedestrian crossings are sites in which vehicles and pedestrians can crash into each other, and are very important in terms of urban traffic. Drivers and pedestrians are more likely to violate traffic regulations, and thus adversely affect traffic safety and flow, in streets that have many such crossings. Careful planning of pedestrian crossing locations provides a solution to these problems. In this study, a corridor-based analysis of such sites is performed. Twenty-four criteria that are considered to affect pedestrian crossing locations and traffic flow aredetermined. Based on these criteria, the most suitable pedestrian crossing scenario is identified using Geographical Information Systems (GIS). The Analytic Hierarchy Process (AHP) and VlseKriterijuska Optimizacija I Komoromisno Resenje (VIKOR) from Multi-Criteria Decision Analysis (MCDA) methods are used to evaluate the pedestrian crossing locations, and PTV VISSIM is used to examine the impact of these sites on traffic. The proposed method is then applied to a case study of Erzurum, Turkey that involves determining the best pedestrian crossing scenario. The results show that the most suitable scenario is S.2. In terms of the evaluation criteria, this alternative scenario provides an improvement of up to 50 % over the current situation. Finally, a sensitivity analysis is performed to reveal the effect of changing the criteria weights on the evaluation process.

Religion, Culture, and Autopsy: A Survey With Muslim Religious Officials.

The autopsy maintains its significance both forensically and medically despite enormous developments in antemortem and postmortem diagnostic methods. The present study probes the knowledge, attitude, and behavior of religious officials in our city toward autopsy and make an evaluation of how religion and culture affect those factors.The study consists of 219 Imams (male) and 69 Quran instructors (female) who serve in urban and rural regions of Kahramanmaras and approved informed consent forms.Two hundred thirty (79%) of the participants stated that the autopsy was an appropriate process according to Islam; 1 (0.3%) stated that it was inappropriate, whereas 57 (19.8%) were observed to have no idea regarding its appropriateness.The mean knowledge score that participants had about autopsy was determined to be 7.45 ± 1.73 (min = 1, max = 10).On the other hand, 240 participants (83.3%) stated that it was important for the religious officials to inform the society about the autopsy.The negative attitude toward autopsy stems from the lack of knowledge and traditions. The religious officials could help the doctors to change the negative attitude stemming from tradition toward the autopsy.

Death by Wheat-Loaded Cartridge: A Case Report.

The materials used to produce shotgun ammunition can have different properties depending on the purpose, and ammunition can be fabricated or loaded manually. In Turkey, wheat-loaded cartridges are manufactured for use as sound cartridges. This ammunition is understood by the public to be harmless. However, we present a case of a 13-year-old adolescent boy who was wounded from a contact shot to the chest. An entrance wound measuring 7 cm and 5 cm in diameter was seen on the skin. Wheat grains could not be detected in the internal organs and were only observed between the chest muscles around the entrance wound. A plastic wad was also found in this area. The cause of death was internal bleeding due to internal organ injury. Wheat-loaded cartridges are not visible on x-ray and are difficult to detect visually in the wound.