Is bronchial provocation test positivity associated with blood eosinophil count and cut-off value?

OBJECTIVE: Asthma is characterized by airway hyperresponsiveness due to chronic inflammation in the airways. One of the main cells involved in airway inflammation is eosinophils. In the current study, a bronchial provocation test (BPT) was performed to demonstrate airway hyperresponsiveness. We investigated the relationship between BPT and blood eosinophil count and the cut-off value of blood eosinophil count. PATIENTS AND METHODS: In this study, we retrospectively evaluated the data of 246 patients who visited our immunology and allergy clinic, a tertiary reference center, with asthma symptoms between May 2017 and March 2020 and underwent BPT with methacholine for the diagnosis of asthma. The cases were grouped according to the level of BPT positivity and negativity. RESULTS: Of 246 patients, BPT was positive in 90 (36.6%) and negative in 156 (63.4%). The blood eosinophil measurement of the BPT-positive cases was found to be statistically significantly higher than that of the BPT-negative cases (135 vs. 119 cells/µl, respectively, p=0.029). When BPT is grouped according to positivity levels, there was no statistically significant difference in blood eosinophil measurements between subgroups (p=0.174). As a result of the evaluations, the cut-off point obtained for the blood eosinophil count was determined as ≥226 cells/µl. For the blood eosinophil count, for the cut-off value of ≥226 cells/µl, sensitivity was 30.0%, specificity 87.7%, positive predictive value 58.7%, and negative predictive value 68.3%. CONCLUSIONS: This study shows that BPT positivity is associated with blood eosinophil count. The cut-off value (≥226 cells/µl) determined for blood eosinophil count may be helpful when planning BPT and evaluating the diagnosis of asthma.

Oxaliplatin-induced hypersensitivity reactions: risk factors and management.

OBJECTIVE: Chemotherapy-related adverse reactions have been steadily increasing in recent years. In patients who develop oxaliplatin-induced hypersensitivity reactions (HSRs), prognosis and quality of life are adversely affected. Proper management of cancer patients enables them to safely receive first-line treatments. This study aimed to assess the risk factors in oxaliplatin-induced HSRs and the effectiveness of the rapid desensitization protocol. PATIENTS AND METHODS: In the study, 57 patients treated with oxaliplatin between October 2019 and August 2020 in the Medical Oncology Department of Elazig City Hospital were retrospectively evaluated. We analyzed patients' clinical histories to reveal any associations with the development of oxaliplatin-induced HSRs. Moreover, we re-evaluated 11 patients with oxaliplatin-induced HSRs through infusion time or desensitization procedures. RESULTS: Of 57 patients treated with oxaliplatin, 11 (19.3%) had HSRs. Patients with HSRs were younger and had higher peripheral blood eosinophil counts than those without HSRs (p=0.004, p=0.020, respectively). Prolongation of the infusion time was effective in the re-administration of oxaliplatin in six of the hypersensitive patients. Rapid desensitization protocol was performed for a total of 11 cycles in four patients with recurrent HSRs, and their chemotherapy regimens were successfully completed. CONCLUSIONS: This retrospective study has revealed that younger ages and higher peripheral eosinophil counts could be predictive for oxaliplatin-induced HSR. Furthermore, the study confirms that prolongation of the infusion time and rapid desensitization protocol are effective in patients with HSRs.

Simulation and experimental measurement of radon activity using a multichannel silicon-based radiation detector.

In this study, high-precision radiation detector (HIPRAD), a new-generation semiconductor microstrip detector, was used for detecting radon (Rn-222) activity. The aim of this study was to detect radon (Rn-222) activity experimentally by measuring the energy of particles in this detector. Count-ADC channel, eta-charge, and dose-response values were experimentally obtained using HIPRAD. The radon simulation in the radiation detector was theoretically performed using the Geant4 software package. The obtained radioactive decay, energy generation, energy values, and efficiency values of the simulation were plotted using the root program. The new-generation radiation detector proved to have 95% reliability according to the obtained dose-response graphs. The experimental and simulation results were found to be compatible with each other and with the radon decays and literature studies.

Comparison of the protective effects of intratympanic dexamethasone and methylprednisolone against cisplatin-induced ototoxicity.

OBJECTIVE: This study aimed to compare the efficacies of intratympanic dexamethasone and methylprednisolone in preventing in cisplatin-induced ototoxicity in rats. METHODS: Experimental groups of rats (n = 8 each) received intratympanic isotonic saline, intraperitoneal cisplatin and intratympanic isotonic saline, intraperitoneal cisplatin and intratympanic dexamethasone, or intraperitoneal cisplatin and intratympanic methylprednisolone. Distortion product otoacoustic emission thresholds were compared on days 0 and 10 in all rats, and correlations between drug effects and changes in cochlear histology were evaluated. RESULTS: Distortion product otoacoustic emission thresholds were comparable in groups III and IV (p > 0.05). Significant protection against cisplatin-induced ototoxicity was seen in groups III and IV compared with group II (p < 0.05). Dexamethasone and, to a lesser extent, methylprednisolone protected against cellular apoptosis in cisplatin-induced ototoxicity. CONCLUSION: Dexamethasone (and possibly methylprednisolone) may be clinically useful as an intratympanic chemopreventive agent to treat cisplatin ototoxicity. Future clinical studies should investigate the use of dexamethasone for this purpose in adult patients.

The potential role of clinical pharmacists in elderly patients during hospital admission.

The aim of this study was to show the potential impact of services directed by clinical pharmacists, including medication reconciliation and medication review, on the hospital admission process for elderly patients. This study was conducted in an internal medicine ward between April 24 and July 25, 2014. Patients hospitalized due to any reason were eligible if they were 65 years or older and regularly used at least one medication at home. The clinical pharmacist evaluated potentially inappropriate medications (PIM), medication related problems (MRPs) and medication discrepancies at the time when these eligible elderly patients were admitted to the hospital. The physician acceptance rate as related the clinical pharmacist's recommendation was evaluated retrospectively. A total of 133 elderly patients (mean age 76.62 ± 8.12 years old; 70 female) were included in the study. Out of 394 medication discrepancies, 88.32% were found to be unintended discrepancies among 111 elderly patients upon hospital admission. PIM was found in 19.55% of these cases. A total of 396 MRPs among 115 patients were identified, with the most common being that the drug had not been taken/administered at all. The doctor acceptance rate of the clinical pharmacist's recommendation was found to be 85.60%. In conclusion, it was found that medication related problems and inappropriate medication utilization at admission could be prevented at a high rate of success by clinical pharmacist-driven medication reconciliation and medication review services.

Structural and dielectric properties of yttrium-substituted hydroxyapatites.

Hydroxyapatite (HAp) samples doped with 0, 2 and 4 at.% of yttrium (Y) were characterized using X-ray diffraction (XRD), Fourier transform infrared (FTIR) spectroscopy, scanning electron microscopy attached with energy dispersive X-ray (EDX) spectroscopy, antimicrobial activity tests and dielectric studies. The hydroxyl groups observed in FTIR spectra confirmed the formation of HAp phase in the studied samples. The crystallite size, crystallinity degree and lattice parameters of the samples were changed with Y content. The volume of the unit cell was gradually decreased with the addition of Y. Undoped and Y-containing HAp samples were screened to determine their in vitro antimicrobial activities against the standard strains. It was found that no samples have any antimicrobial effect. The relative dielectric permittivity and dielectric loss are affected by Y content. While the alternating current conductivity increases with increasing frequency, it decreases with increasing Y content.

Does gestational diabetes result in cochlear damage?

BACKGROUND: Glucose metabolism has a significant impact on inner-ear physiology. Therefore, hearing may be affected in gestational diabetes. METHOD: A matched case-control study was performed to evaluate 27 patients with gestational diabetes and 31 non-diabetic pregnant women with similar demographic characteristics. A medical history was taken for each participant, and otological inspections and high-frequency audiometry tests were performed. RESULTS: There were no significant differences in average pure tone air-bone hearing thresholds between the groups (p > 0.05). However, evaluation of high-frequency hearing thresholds indicated significantly increased auditory thresholds at 10 kHz and 12 kHz for right ears and at 8, 10, 12 and 14 kHz for left ears in the gestational diabetes group (p < 0.001). CONCLUSION: An investigation into cochlear damage in gestational diabetic patients showed significant high-frequency hearing loss. Further studies are needed to validate these findings in different ethnic groups and geographical populations.

Allergic rhinitis and its impact on asthma classification correlations.

OBJECTIVE: Allergic rhinitis is inflammation of the nasal mucosa following exposure to allergens. A few studies have investigated how the Allergic Rhinitis and its Impact on Asthma classification correlates with symptom severity and skin prick test results in allergic rhinitis patients. Our objective was to evaluate such a correlation. MATERIALS AND METHODS: The study population consisted of 268 patients who had allergic symptoms and were diagnosed with allergic rhinitis. RESULTS: Analysis of the Allergic Rhinitis and its Impact on Asthma classification with regard to symptom severity revealed that there were statistically significant differences between the groups for nasal symptoms, wheezing, eye itching/watering and eye redness. Symptom frequency and severity increased gradually towards the moderate to severe persistent allergic group. There was a statistically significant difference between the groups for grass pollen and house dust mite allergy. CONCLUSION: The Allergic Rhinitis and its Impact on Asthma classification, which takes symptoms and quality of life into consideration in addition to allergen exposure, is a useful classification system for allergic rhinitis.

Location of the middle cranial fossa dural plate in patients with chronic otitis media.

AIM: This study aimed to determine whether or not the middle cranial fossa dural plate is located lower (i.e. more caudally) in patients with chronic otitis media, relative to adjacent structures. METHODS: The authors retrospectively investigated computed tomography temporal bone scans of 267 ears of 206 patients who had undergone surgery with a diagnosis of chronic otitis media, together with scans of 222 ears of 111 patients without chronic otitis media. The depth of the middle cranial fossa dural plates was recorded. RESULTS: The mean depth of the middle cranial fossa dural plate was 4.59 mm in the study group and 2.71 mm in the control group (p < 0.001). The middle cranial fossa dural plate was located lower in the right ear in both the study and control groups. CONCLUSION: The middle cranial fossa dural plate was located lower in patients with chronic otitis media, and in the right ears of both patients and controls. Surgeons should take this low location into consideration, and take extra care, during relevant surgery on patients with chronic otitis media.

Lewy body-like α-synuclein aggregates resist degradation and impair macroautophagy.

Cytoplasmic α-synuclein (α-syn) aggregates, referred to as Lewy bodies, are pathological hallmarks of a number of neurodegenerative diseases, most notably Parkinson disease. Activation of macroautophagy is suggested to facilitate degradation of certain proteinaceous inclusions, but it is unclear if this pathway is capable of degrading α-syn aggregates. Here, we examined this issue by utilizing cellular models in which intracellular Lewy body-like α-syn inclusions accumulate after internalization of pre-formed α-syn fibrils into α-syn-expressing HEK293 cells or cultured primary neurons. We demonstrate that α-syn inclusions cannot be effectively degraded, even though they co-localize with essential components of both the autophagic and proteasomal protein degradation pathways. The α-syn aggregates persist even after soluble α-syn levels have been substantially reduced, suggesting that once formed, the α-syn inclusions are refractory to clearance. Importantly, we also find that α-syn aggregates impair overall macroautophagy by reducing autophagosome clearance, which may contribute to the increased cell death that is observed in aggregate-bearing cells.

Left Atrial Appendage Thrombus Despite Anticoagulation.

The American College of Cardiology Foundation/American Heart Association task force on practice guidelines recommend therapeutic anticoagulation for at least 3 weeks prior to cardioversion in patients with atrial fibrillation of 48-hour duration or longer, or when the duration of atrial fibrillation is unknown. This case report demonstrates the presence of thrombi in the left atrial appendage despite adequate anticoagulation, challenging the current guidelines. Therapeutic anticoagulation for at least 3 weeks followed by transesophageal echocardiography in search of thrombus may enhance thromboembolic safety of elective cardioversion. Atrial fibrillation (AF) and heart failure (HF) have emerged as major cardiovascular epidemics in developed nations over the past decade. They share similar risk factors, seem to mutually accelerate progression and are associated with increased morbidity and mortality. Their relationship involves complex hemodynamic, neuro-hormonal, inflammatory and electrophysiologic mechanisms, which go beyond just mutual risk factors. This review focuses on updates in AF and HF with a hope of better understanding this relationship and the management of this complex duo.

Exogenous α-synuclein fibrils induce Lewy body pathology leading to synaptic dysfunction and neuron death.

Inclusions composed of α-synuclein (α-syn), i.e., Lewy bodies (LBs) and Lewy neurites (LNs), define synucleinopathies including Parkinson's disease (PD) and dementia with Lewy bodies (DLB). Here, we demonstrate that preformed fibrils generated from full-length and truncated recombinant α-syn enter primary neurons, probably by adsorptive-mediated endocytosis, and promote recruitment of soluble endogenous α-syn into insoluble PD-like LBs and LNs. Remarkably, endogenous α-syn was sufficient for formation of these aggregates, and overexpression of wild-type or mutant α-syn was not required. LN-like pathology first developed in axons and propagated to form LB-like inclusions in perikarya. Accumulation of pathologic α-syn led to selective decreases in synaptic proteins, progressive impairments in neuronal excitability and connectivity, and, eventually, neuron death. Thus, our data contribute important insights into the etiology and pathogenesis of PD-like α-syn inclusions and their impact on neuronal functions, and they provide a model for discovering therapeutics targeting pathologic α-syn-mediated neurodegeneration.

Bifid inferior turbinate: a case report.

OBJECTIVES: A bifid inferior turbinate is an extremely rare anatomical variation and has been reported in only two cases to date. Including the present report, the uncinate processes were missing in all three patients reported. It is suggested that, in the reported patient, bifid inferior turbinate coexisted with a developmental anomaly of the uncinate process, and that the bifid inferior turbinate represented two separate turbinates originating from the same site. CASE REPORT: We present the first reported case of bilateral bifid inferior turbinates, with a secondary middle turbinate, in a patient complaining of nasal obstruction. CONCLUSION: We suggest that the superior part of the bifid inferior turbinate may have been formed by severe medial displacement and inferior rotation of the uncinate process, and that the bifid inferior turbinate is an anatomical abnormality of the uncinate process.

Is there a relationship between myringosclerosis and atherosclerosis?

OBJECTIVE: Myringosclerosis and atherosclerosis are two different pathologies seen in different parts of the body. Both of these occur following a similar physiopathological process. However this has not previously been adequately discussed in the literature. Trauma to either the tympanic membrane or to the intimal layer of the arterial wall results in the formation of a sclerotic plaque. The goal of this study was to investigate the relationship between myringosclerosis and atherosclerosis. PATIENTS: A total of 421 patients with the diagnosis of coronary artery disease were included in the study. All of the patients were evaluated for the presence of atherosclerosis by coronary angiography and for myringosclerosis by otoscopic examination. MAIN OUTCOME MEASURES: The presence of myringosclerotic plaques, plaque dimensions and bilateral involvement of tympanic membranes were compared in the groups with and without atherosclerosis. RESULTS: Amongst the 316 patients (75.0%) shown to have atherosclerosis, 65 (20.5%) also had myringosclerosis. Amongst the 105 patients without atherosclerosis, 24 (22.8%) had myringosclerosis. There was no statistically significant relationship between atherosclerosis and myringosclerosis (p > 0.05). Neither plaque dimensions nor bilateral involvement of the ears showed significant difference between the two groups (p >0.05 and p >0.05, respectively). CONCLUSIONS: We conclude that there is no similar genetic tendency between atherosclerosis and myringosclerosis. The significance of the plaque dimensions and the bilateral involvement of tympanic membranes have not been satisfactorily discussed in the literature and this is the first time that they are being addressed. In contrast to the reported articles, there is no relationship between atherosclerosis and myringosclerosis other than being similar pathological processes occurring as a result of endothelial-epithelial damage.

Adenoid cystic carcinoma of the parotid gland presenting as temporal bone neoplasm: a case report.

PROBLEM: Temporal bone tumours are rare head and neck cancers that may involve both the parotid and the neck. In cases with concomitant temporal bone and parotid tissue involvement, tumour origin determination can be challenging. A tumour with parotid and temporal bone involvement is usually of temporal origin. The tumour may also be a rare parotid neoplasm with intratemporal invasion through the facial nerve, such as adenoid cystic carcinoma. These are slow-growing, yet locally aggressive tumours marked by late-stage distant metastases. CASE REPORT: We describe a case of parotid adenoid cystic carcinoma invading the temporal bone via the facial nerve, presenting as primary temporal bone tumour with parotid tissue involvement. We emphasize the significance of intracranial involvement by perineural invasion. CONCLUSION: Tumours mimicking temporal bone neoplasms can originate from the parotid tissue and invade through the facial nerve. Preoperative fine needle biopsy evaluation is indispensable for malignancy type determination and surgical planning.

Ceruminous gland carcinoma of the external auditory canal presenting as chronic otitis media.

OBJECTIVE: Ceruminous neoplasms of the external ear canal are rare. Classification, clinical behavior, and management of these tumours are controversial. We report a case of carcinoma originating from the ceruminous glands of the external ear canal (EAC), operated based on a diagnosis of chronic otitis media with polyp. CASE REPORT: A 48-year-old man presented with left ear discharge and hearing loss. Clinical examination showed a well-circumscribed polypoid mass limited to the EAC. There was no history of bloody ear discharge or radiological findings of bony erosion suggestive of malignancy. Our preliminary diagnosis was chronic otitis media with polyp formation. Tympanoplasty was performed. Histopathology revealed a ceruminous carcinoma, and an additional operation involving lateral temporal bone dissection was performed, followed by 60 Gy radiation therapy. CONCLUSION: Ceruminous carcinomas should be considered in the differentialdiagnosis of middle and external ear pathologies in cases of soft tissue mass in the EAC.

The association of laryngoceles with squamous cell carcinoma of the larynx presenting as a deep neck infection.

OBJECTIVES: We present a case of an external laryngocele with laryngeal carcinoma. INTRODUCTION: A laryngocele is a rare benign lesion of the larynx resulting from an abnormal dilation of the laryngeal saccule filled with air. When the neck of the laryngocele is obstructed, it fills with mucus and is called a laryngopyocele. RESULTS: There may be a relationship between laryngoceles and squamous cell carcinomas of the larynx. A review of the literature found a reported association between laryngoceles and carcinomas of the larynx of between 4.9 and 54%. In this report, we present a case of an external laryngocele associated with laryngeal carcinoma. Another important point of this case is that a deep neck infection was the first symptom. CONCLUSION: In the light of the cases presented in the literature, patients with a deep neck infection should undergo CT imaging and patients with laryngoceles must also be examined with direct laryngoscopy.

The role of Helicobacter pylori infection in the cause of squamous cell carcinoma of the larynx.

OBJECTIVE: Helicobacter pylori can cause chronic infection that has been linked to the development of both benign and malignant disease of the aerodigestive tract. The purpose of this study was to determine the link between H pylori infection and squamous cell carcinoma of the larynx (SCCL). METHODS: We estimated the presence of IgG antibodies against H pylori antigens by using ELISA technique in the sera of 26 patients with SCCL and 32 matched controls without carcinoma of the larynx. RESULTS: The incidence of seropositivity of patients with SCCL was 73.07% and of controls was 40.62%. These data support an etiologic role for H pylori infection on development of SCCL (chi(2) = 4.85, P< 0.05). CONCLUSION: H pylori infection of the upper aerodigestive tract might result in mucosal disruption, allowing for subsequent transformation by known carcinogens such as tobacco and alcohol.