Are there any differences at gray matter sites between severe obstructive sleep apnea patients and healthy controls?

OBJECTIVES

Obstructive sleep apnea (OSA) is a disease that may cause many medical conditions. Neurocognitive disorders may be triggered by OSA. In recent studies, selectively decreased gray matter tissue was observed in patients with OSA. We aimed to determine if there was a substantial difference in patients with extreme OSA by comparing the microstructural changes in different gray matter sub-areas with healthy controls using diffusion-weighted imaging methods.

METHODS

We studied 15 diagnosed severe OSA subjects before any treatment and 32 healthy control subjects. High resolution Magnetic Resonance Imaging (MRI) T1 and T2-weighted scans were visually examined to assess any major brain lesions.

RESULTS

There were no statistically significant differences of age and gender between the groups.The left and right globus pallidus, putamen and thalamus values did not differ significantly between OSA and control subjects. Right putamen values was negatively correlated with Apnea Hypopnea Index (AHI), supine AHI and non-REM AHI in OSA subjects, but no correlations appeared with left putamen values. The other gray matter parameters did not show any correlations with PSG parameters. AHI, Supine AHI, Non-Supine AHI, REM and NON-REM AHI values was not show any correlation with Right and Left Putamen volume sizes.

CONCLUSIONS

We made a morphological comparison of various gray matter areas of OSA patients and healthy volunteers in our study. We observed a significant decrease in right putamen gray matter volumes in patients with higher AHI values. Decreased cognitive functions are found in patients with OSA. In order to demonstrate this cognitive loss in patients with morphologically there is a need for further prospective studies with larger sample sizes.

The role of TAS2R38 genotype in surgical outcomes and culturable bacteria in chronic rhinosinusitis with or without nasal polyps

BACKGROUND

Recent studies reported the relationship between genetic variations and TAS2R38, which is a bitter taste receptor expressed in the cilia of human sinonasal epithelial cells, among the predisposing factors playing role in immune response to upper respiratory tract bacterial infection. The present study aims to examine the relationship of TAS2R38 genotype with the active microorganism and the effect of genotype on the surgical outcomes among chronic rhinosinusitis patients.

METHODOLOGY

34 patients undergoing endoscopic sinus surgery (ESS) for chronic rhinosinusitis with or without polyps (23 CRSwNP, 11 CRSsNP) and 30 patients undergoing septoplasty surgery for isolated nasal septum deviation were included. All the patients were genotyped for TAS2R38. Scoring was made using endoscopic Modified Lund-Kennedy and radiological Lund-Mackay systems preoperatively. Sino-Nasal Outcome Test with 22 items (SNOT-22) was implemented preoperatively and postoperatively. Nasal swab culture samples were taken intraoperatively from CRS patients and the active microorganism were isolated.

RESULTS

In the TAS2R38 genotyping of the study group, PAV/PAV was found in 32.4% of patients, PAV/AVI in 47.1%, and AVI/AVI in 20.6%. In the control group, PAV/PAV was found in 26.7%, PAV/AVI in 36.7%, and AVI/AVI in 36.7%. In the study group, there was no statistically significant difference between the CRS and CRS subgroups in terms of TAS2R38 genotype distributions. The changes in patients' preoperative and postoperative SNOT-22 scores were similar between the genotypes. Proliferation was detected in culture in the whole AVI-AVI group, 81.8% of PAV-PAV group, and 56.3% of PAV-AVI group but the difference was not found to be statistically significant. The proliferation level of Staphylococcus epidermidis by TAS2R38 genotype was found to be statistically significantly higher among patients, who had AVI-AVI genotype, in CRSwNP.

CONCLUSIONS

We did not find a statistically significant relationship between the TAS2R38 genotype and CRS subtype, sinonasal bacterial infection risk increase and surgical success rate in CRS patients. Long-term and large-scale studies are needed, which are to be carried out by individual genotyping and sequencing to provide more information on the effects of these genetic variants.

An evaluation of the change in serum SCUBE-1 levels with CPAP treatment in patients with severe obstructive sleep apnea

OBJECTIVE

Signal peptide CUB-EGF domain-containing protein 1 (SCUBE-1) is a cell surface protein, wherein inflammation causes an increase in serum. The aim of this study was to compare serum SCUBE-1 levels in OSA patients and to investigate the serum SCUBE-1 change with CPAP treatment.

METHODS

Blood samples were obtained from 61 severe OSA patients and from 25 control subjects evaluated as simple snorers. The 61 patients with severe OSA were treated with CPAP therapy and were recalled for follow up after 1 year. Evaluation was made after 1 year of CPAP therapy.

RESULTS

Serum SCUBE-1 values were significantly higher in patients with severe OSA. The SCUBE-1 values significantly decreased after treatment with CPAP.

CONCLUSION

Serum SCUBE-1 values in OSA patients showed a significant reduction in SCUBE-1 levels following 1 year of CPAP treatment.

Serum hepcidin and paraoxonase levels in patients with severe, moderate, and mild obstructive sleep apnea hypopnea syndrome (OSAS): A comparison between OSAS patients and simple snoring patients

OBJECTIVE

To investigate the importance of hepcidin and paraoxonase in obstructive sleep apnea syndrome (OSAS).

METHODS

Eighty-eight patients with sleep disorders were included and divided into four groups: simple snoring (SS), mild, moderate, and severe OSAS. All patients underwent polysomnography. The hepcidin and paraoxonase levels were examined and compared between the groups.

RESULTS

There were significant differences between the four groups in terms of paraoxonase levels. In the SS group, the paraoxonase value was significantly higher than in the other three groups. In the analysis, Apnea Hypopnea Index (AHI) was negatively correlated with paraoxonase levels.

CONCLUSION

A significant difference was found between the OSAS groups with respect to paraoxonase enzyme, and a negative correlation with AHI was observed. Paraoxonase level could be used as a biomarker in OSAS. No significant data was found for hepcidin levels; therefore, hepcidin cannot be used as a biomarker in OSAS.

The diagnostic importance of periostin as a biomarker in chronic rhinosinusitis with nasal polyp

PURPOSE

The current studies in the literature report that periostin contributes to the formation of nasal polyps and may be a molecular biomarker for chronic rhinosinusitis with nasal polyps (CRSwNP). This study aims to investigate the effect of periostin in determining polyp burden in CRSwNP patients and evaluate its impact on postoperative surgical results and its functionality as a biomarker.

METHODS

The study included 26 patients who underwent endoscopic sinus surgery due to CRSwNP and 30 patients who were scheduled to undergo septoplasty due to isolated nasal septum deviation. We performed preoperative Lund-Mackay scoring and preoperative and postoperative SNOT-22 and Modified Lund-Kennedy scoring for the patients. Tissue and serum samples were collected from all patients in surgery and another serum sample was taken from CRSwNP patients at postoperative month 6.

RESULTS

Tissue eosinophil (p < 0.001), preoperative serum (p < 0.001), and tissue (p = 0.002) periostin were significantly higher in the CRSwNP group. We observed a statistically significant positive correlation between tissue eosinophil values and tissue periostin values in CRSwNP patients (p = 0.004). We found a statistically significant positive correlation between the tissue periostin values and postoperative SNOT-22 scores of the CRSwNP group patients (p = 0.005).

CONCLUSION

According to the results of our study, we think that periostin can be used as a biomarker in the prediction, determination of disease severity, and prognosis of CRSwNP. Comprehensive cohort studies with larger patient series are needed to provide more information on the role and effects of periostin in cases of CRSwNP undergoing surgical treatment.

Reliability of CIR-S using the subperiosteal pocket technique under 2 years of age

OBJECTIVE

It is aimed in this study to investigate the reliability of the cochlear implant receiver-stimulator (CIR-S) placement using unfixed subperiosteal tight pocket technique and the postoperative soft tissue changes that occur around the CIR-S, in toddlers under 2 years of age.

METHODS

Nonsyndromic toddlers with normal radiological findings and who were planned to have cochlear implantation were included in the study. Preoperative and postoperative complications, device migration, and postoperative soft tissue changes occurred around the CIR were analyzed using objective methods.

RESULTS

Twenty-six toddlers aged between 12 and 24 months who met the study criteria were followed up for a mean follow-up duration of 18 months. No intraoperative and postoperative surgical complications and device migration were observed in any of the cases included in the study.

CONCLUSION

It was concluded as a result of this study that cochlear implant receiver-stimulator placement using the subperiosteal pocket technique is reliable in toddlers under 2 years of age, provided that the small incision tight subperiostal pocket technique is performed meticulously without fixation and well drilling, and that device-protective changes occur in the tissues around the CIR-S over time with the use of the device and as the child skull develops.

Operating Room Educational Climate Scale for Surgical Specialty Residents: Scale Development and Validation

AIM

The present study aims to develop a scale in Turkish language for evaluating the surgical specialty residents' perceptions of educational climate in the operating room, with an emphasis on learning in the operating suite and planning the relevant change for improved and standardized training.

MATERIAL AND METHODS

Three surgeons from different disciplines provided expert opinions and a focus group meeting was held on the necessity, scope, and specificity of the items. The 5-point Likert type draft scale consisted of 28 items including ten negative statements scored reversely and having total scores ranging between 28-140 points. There were 5 subscales: educational process, teamwork, communication, operating room infrastructure, and surgical skills education. For assessing the validity and reliability, 172 surgical specialty residents from three hospitals in different locations were asked to answer the paper-based scale items anonymously. Confirmatory factor analysis (CFA) was used to test validity, whereas Cronbach's alpha reliability coefficients were calculated for internal consistency.

RESULTS

CFA revealed a chi-square, standard deviation, chi-square/standard deviation, and a p-value of 783.73, 340, 2.27, and 0.001, respectively. Cronbach's alpha coefficient for educational process, teamwork, communication, operating room infrastructure, and surgical skills education subscales were calculated to be 0.61, 0.61, 0.63, 0.70, and 0.72, respectively. Cronbach's alpha coefficient for all items was 0.89. Results indicated acceptable construct validity and internal consistency of the scale.

CONCLUSION

The newly developed scale was proven as a reliable and valid measurement instrument that can be used within the Turkish health system setting for assessing and improving the educational climate in the operating room.

Is orienteering associated with allergic rhinitis in adolescents?

BACKGROUND

Allergic rhinitis (AR) is a disease that reduces athletic performance. Environmental allergen exposure is higher in outdoor sports (such as orienteering) than indoor sports. The main purpose of this study was to investigate the AR frequency in orienteers comparing with indoor athletes.

METHODS

Sixty adolescent athletes (33 orienteers, 27 basketball players) enrolled this prospective study. AR diagnosis was made by both history (ISAAC questionnaire) and physical examination. Nasal endoscopy was performed to observe objective findings (concha hypertrophy, mucosal paleness, serosity, septum deviation, adenoid hypertrophy). Epidermal prick test, pulmonary function test, total IgE and serum eosinophil levels were also assessed.

RESULTS

AR was diagnosed in 21 (35%) athletes. 14 (42.4%) were orienteers and 7 (25.9%) were basketball players (P=0.144). Endoscopic findings and skin test positivity were also seen at higher percentages in orienteers with no significance. Training age (sport duration), total IgE levels and skin test positivity were significantly higher in rhinitic orieenters than non-rhinitic orieenters (P=0.046, P=0.0001, and P=0.004, respectively).

CONCLUSIONS

Although adolescent orieenters had some higher allergic parameters than indoor athletes, they were not found more susceptible to AR. It seems that the frequency of AR increases with longer training age in orieentering sport. This study is the first report about AR in adolescent orienteers. Future researchs should more focus on comparing allergic conditions between outdoor and indoor sports.

Sensorineural hearing loss in β-thalassemia patients treated with iron chelation

The predictive value of pure-tone audiometry (PTA) in the early detection of ototoxicity has been questioned, particularly in the higher frequencies. Otoacoustic emissions testing appears to be more sensitive to cochlear insult than conventional PTA. We conducted a cross-sectional descriptive study to compare the efficacy of distortion-product otoacoustic emissions (DPOAE) testing with that of PTA as a method of audiologic monitoring. Our study group was made up of 159 patients (318 ears)-69 males (43.4%) and 90 females (56.6%), aged 5 to 61 years (mean: 23.59 ± 12.55). All patients had been diagnosed with either β-thalassemia major (BTM) or β-thalassemia intermedia (BTI), and all had received at least 1 year of treatment within the previous year with an iron chelator-either deferasirox, desferrioxamine (deferoxamine in the United States), deferiprone, or a combination of desferrioxamine and deferiprone. PTA and DPOAE evaluations were performed by the same audiologist using the same audiometer for all patients. In the right ears, the overall incidence of ototoxicity as manifested by sensorineural hearing loss was 39.0% on PTA and 22.0% on DPOAE testing; in the left ears, the corresponding figures were 27.7 and 19.5%, respectively. There were no statistically significant differences in the incidence of ototoxicity between the BTM and BTI groups with any of the four different drug regimens on PTA (p = 0.765, p = 0.378, p = 0.265, and p = 0.579, respectively) or on DPOAE testing (p = 0.890, p = 0.263, p = 0.390, and p = 0.340, respectively). Based on these data, we found no significant difference between PTA and DPOAE testing in their ability to detect ototoxicity. We conclude that periodic testing with both PTA and DPOAE is necessary for patients with suspected β-thalassemia in order arrive at a prompt diagnosis and initiate timely management.

Can we use serum copeptin levels as a biomarker in obstructive sleep apnea syndrome?

OBJECTIVE

The aim of this study was to compare serum copeptin levels in patients with obstructive sleep apnea syndrome (OSA) and simple snorers without sleep apnea; and to investigate relationships between copeptin levels and polysomnographic parameters.

METHODS

Serum copeptin levels were determined using enzyme-linked immunosorbent assay in 47 patients with OSA and 12 patients without OSA (control group). Full-night polysomnography was performed in each patient. Patients with OSA were divided into three groups according to their Apnea Hypopnea Index (AHI) scores: mild OSA (5 < AHI < 15), moderate OSA (15 < AHI < 30), and severe OSA (AHI > 30).

RESULTS

A total of 59 patients were included in the study. There were 23 female (39.0%) and 36 male (61.0%) subjects. The range of ages of study subjects was between 27 and 63 (mean 44.75 ± 9.64) years. According to the AHI values, patients were classified into four groups: simple snoring (n = 13), mild OSA (n = 10), moderate OSA (n = 15), and severe OSA (n = 21). Statistically significant differences between AHI groups in terms of age, Epworth score, and neck circumference. According to multiple comparison results for age, the difference between simple snoring and moderate OSA was statistically significant. According to multiple comparison results for Epworth score, the difference between simple snoring and severe OSA was statistically significant. According to multiple comparison results for neck circumference, a similar result was found like Epworth Sleepiness Scale score. The difference between AHI groups by gender was tested by a Pearson χ(2) test and was found to be statistically significant. There was no statistically significant difference among AHI groups in terms of copeptin. There was a statistically significant correlation of copeptin with AHI during rapid eye movement (REM) sleep; however, the correlation coefficient was not sufficiently large.

CONCLUSIONS

Increased serum copeptin concentration may reflect a response to stress in some diseases. This is well documented especially in cardiovascular diseases; however, we could not find any difference in OSA groups in terms of copeptin levels.

Serum soluble tumour necrosis factor related apoptosis-inducing ligand level and peripheral eosinophil count in patients with nasal polyposis

BACKGROUND

Nasal polyposis is one of the most common inflammatory pathologies of the nasal cavity. Eosinophilic inflammation plays an important role in the pathogenesis. This study aimed to investigate soluble tumour necrosis factor related apoptosis-inducing ligand levels and eosinophil count in nasal polyposis patients.

METHODS

The study was performed on 24 adult nasal polyposis patients and 24 age-matched healthy individuals. The patients had not received any medical or surgical treatment. Pre-operative computed tomography scans were assessed using the Lund-MacKay grading system, and soluble tumour necrosis factor related apoptosis-inducing ligand levels were measured with a sandwich enzyme-linked immunosorbent assay.

RESULTS

Compared with controls, eosinophil levels in nasal polyposis patients were increased (p = 0.024), but there was no significant difference in soluble tumour necrosis factor related apoptosis-inducing ligand levels (p = 0.529). The Lund-MacKay mean grading was 12.43 ± 6.9. There was no correlation between soluble tumour necrosis factor related apoptosis-inducing ligand level and Lund-MacKay grading and eosinophil count.

CONCLUSION

There was no relationship between soluble tumour necrosis factor related apoptosis-inducing ligand level and blood eosinophil or clinical markers; however, soluble tumour necrosis factor related apoptosis-inducing ligand level remains of interest for future studies.

Analysis of serum cytokine levels in larynx squamous cell carcinoma and dysplasia patients

BACKGROUND

Although the imbalance of cytokines in Head and Neck Squamous Cell Carcinoma (HNSCC) is well known, there is scarce data regarding its occurrence during dysplasia, before the malignant transformation.

OBJECTIVE

To determine whether laryngeal dysplasia patients show a different cytokine profile than patients with cancer and healthy controls.

METHODS

Seventeen newly diagnosed, untreated larynx squamous cell carcinoma (SCC) and six laryngeal dysplasia patients as well as 22 healthy controls were analyzed for circulating cytokines. A flowcytometry Th1/Th2 cytokine array kit was used to quantitatively measure Interleukin-2 (IL-2), IL-4, IL-6, IL-10, Tumor Necrosis Factor-α (TNF-α) and Interferon-γ (IFN-γ) levels. Additionally, IL-8 levels were determined through ELISA.

RESULTS

IL-6, IL-8 and IL-10 were determined to be statistically increased in SCC patients (p<0.05). IL-8 and IL-10 levels were also higher in SCC patients than dysplasia patients (p<0.05). Additionally, IL-6 and IL-10 were all found to be markedly increased in dysplasia patients compared with controls (p<0.05).

CONCLUSION

Our results demonstrate an imbalance of IL-6 and IL-10 not only in HNSCC but also in laryngeal dysplasia.

Detection of human bocavirus in children with upper respiratory tract infection by polymerase chain reaction

BACKGROUND

The aim of this study was to investigate whether in children with middle ear effusions (MEE), adenoid and tonsil tissues are associated with human bocavirus (HBoV).

MATERIALS AND METHODS

A total of 124 patients (56 females (45.2%) and 68 males (54.8%)) with chronic adenotonsillitis and serous otitis media under the age of 15 were recruited. Two hundered four samples (113 adenoid (55.4%), 68 tonsil (33.3%), and 23 middle ear effusion (11.3%)) were analyzed for the presence of HBoV using polymerase chain reaction (PCR).

RESULTS

HBoV was detected in only 6 (4.8%) adenoid tissue samples each belonging to a different patient.

CONCLUSIONS

Our findings are consistent with the results of other studies, reporting approximately 5 - 10% of the samples being positive for HBoV. To understand the detailed role of HBoV in the etiology of RTI in children, further studies would be needed.

Substance P and vasoactive intestinal peptide levels in middle ear effusions of children

CONCLUSION

This is the first report demonstrating high levels of substance P (SP) that inversely correlate with vasoactive intestinal peptide (VIP) levels in middle ear effusions (MEEs) of patients with otitis media with effusion (OME). Increased SP and decreased VIP levels might play a role in the pathogenesis of chronic OME.

OBJECTIVE

The etiology of OME is multifactorial, and neurogenic inflammation may play a significant role. SP and VIP levels were not evaluated previously in MEEs of children with OME.

METHODS

Fifty patients aged 2-12 years (mean age 5.24 ± 2.64) were included in the study. MEEs were classified as mucoid or serous based on the gross appearance. SP and VIP levels were determined using ELISA.

RESULTS

High levels of SP were detected in MEEs. In addition SP levels were significantly higher in serous samples (2910.55 ± 307.96 vs 2218.55 ± 262.30 pg/ml). There were also age-dependent changes, such that SP levels were significantly higher in children aged 2-3 years compared with those who were 4-5 and 6-12 years old. VIP levels were undetectable in 30% of patients and the mean level of VIP was 50.91 ± 16.01 pg/ml in serous middle ear effusions and 54.86 ± 15.91 pg/ml in mucoid MEEs.

Multiple sialolithiasis in sublingual gland causing dysphagia

Background:

Sialolithiasis is a common disease of the major salivary glands, but it is rarely seen in the sublingual gland. Patients commonly experience pain and/or swelling, but dysphagia is presented in extended lesions.

Case Report:

In this report we present a 67-year-old woman who had 268 sialoliths in the sublingual gland, forming a huge mass and causing dysphagia. The diameter of the largest sialolith was approximately 4 mm. The diagnosis of sialolithiasis was confirmed pathologically.

Conclusions:

Multiple sublingual gland sialoliths are considered rare; they may cause symptoms like dysphagia and speech difficulty. To our knowledge our patient had more sialoliths in a sublingual gland than any previous reports in the literature.

305 Incidence of Allergy in Patients With Benign Lesions of the Vocal Cords

Background

Methods

Results

Conclusions

Pathogenesis of rhinitis in rats with experimentally induced hypothyroidism

BACKGROUND

Hypothyroidism is accepted as one of the hormonal factors leading to non-allergic rhinitis. Nasal obstruction and runny nose due to an increase in submucosal connective tissue and mucous gland hypertrophy are the prominent symptoms in hypothyroidism-induced rhinitis at humans. The aim of this study was to analyze the biochemical and histopathological changes in the nasal mucosa of the rats with thyroidectomy-induced hypothyroidism and to compare them with those of a control group.

METHODS

A total of 60 adult male Wistar Albino rats were included in the study. The rats constituting the test and the control groups were randomly divided into 3 subgroups (T1-3 and C 1-3). While the rats in the test group underwent thyroidectomy, in the control group the incision was sutured without any interventions after exposure of thyroid tissues of the rats. The nasal and paranasal sinus regions of all the rats were carefully dissected and tissue samples were obtained for pathological examinations.

RESULTS

In the rats in T1, T2, and T3, the decrease in serum glucuronic acid levels before and after thyroidectomy was statistically significant (p = 0.001, p = 0.003, and p = 0.002, respectively). The difference between the test and the control groups was statistically significant in terms of inflammation at the end of 12 weeks (p = 0.002).

CONCLUSIONS

An increase in acid mucopolysaccharidase production due to TSH has been suggested to cause congestion in tissues. Although our study supports the data in the literature up to date, we consider that further clinical and experimental studies are necessary for this verification.

Detection of Helicobacter pylori in adenotonsiller tissue specimens by rapid urease test and polymerase chain reaction

In recent studies, there have been many arguments concerning Helicobacter pylori being reservoir in adenotonsillar tissue. In this study, our objective was to detect whether adenoid and/or tonsillar tissue of patients diagnosed with chronic adenotonsillitis was a reservoir for H. pylori. This study was performed with 47 patients with the diagnosis of chronic tonsillitits and adenoid hypertrophy. Helicobacter pylori was searched by rapid urease test (RUT) and polymerase chain reaction (PCR). Presence of H. pylori glmM gene (formerly named as ureC gene) was tested using ureC and ureC2 primers. Fifty-five specimens used in the study were made up of 35 adenoid and 20 tonsil tissues. Rapid urease test was positive in three (5.5%) specimens. Helicobacter pylori was not detected in any of the patients by PCR. Further studies are needed to clarify the possible role of H. pylori in upper aerodigestive tract diseases such adenotonsillitis.