Predictive value of P wave parameters, indices, and a novel electrocardiographic marker for silent cerebral infarction and future cerebrovascular events

BACKGROUND

Silent cerebral infarction (SCI) is a neuronal injury without a clinically apparent stroke or transient ischaemic attack. Left atrial cardiomyopathy is closely associated with SCI. P wave changes in the electrocardiogram (ECG) provide significant information about the development of atrial cardiomyopathy. This study evaluated the role of P wave parameters and indices and a novel ECG parameter in predicting SCI, future cerebrovascular events, and atrial fibrillation/flutter.

MATERIALS AND METHODS

A total of 272 patients were retrospectively screened and divided into two groups according to SCI. Cerebrovascular events and atrial fibrillation/flutter were defined as the study's outcomes. P wave parameters, indices, and a novel ECG parameter called the P wave ratio (PWR) were calculated from ECGs, and the relationship between SCI and outcomes was investigated.

RESULTS

The maximum P wave duration (PWD), P wave dispersion (PWdisp), PWD measured from the D2 lead (PWDD2), P wave peak time measured from the D2 lead (PWPTD2), PWPT measured from the V1 lead (PWPTV1), and P wave terminal force (PWTFV1) were significantly longer in the SCI group. Both partial and advanced inter atrial block (IAB) were significantly high in the SCI group. The novel parameter P wave ratio (PWR) was significantly longer in the SCI group (0.55 ± 0.08 vs. 0.46 ± 0.09; p < 0.001). In multivariate regression analysis, PWdisp (OR: 1.101, p < 0.001), PWPTD2 (OR: 1.095, p = 0.017), and PWR (OR: 1.231, p < 0.001) were found to be independent predictors of SCI. Cox regression analysis revealed that the PWR (HR 1.077; 95% CI 1.029-1.128; p = 0.001) was associated with cerebrovascular events and atrial fibrillation/flutter.

CONCLUSION

In our study, we observed that PWR could be a valuable parameter for predicting SCI and future cerebrovascular events.

The histopathological and electrophysiological effects of thymoquinone and methylprednisolone in a rabbit traumatic facial nerve paralysis model

OBJECTIVE

We aimed to determine the effects of methylprednisolone and thymoquinone on nerve healing in a traumatic facial nerve paralysis animal model.

SUBJECTS AND METHODS

Twenty-four rabbits were randomly divided into 4 groups: group I: control group received no medication and no trauma; group II: sham group received no medication after facial nerve trauma group III: 5mg/kg/day thymoquinone administered; group IV: 1mg/kg/day methylprednisolone administered. An initial electrophysiological assessment was performed in all the animals. The buccal branch of the facial nerve was then clipped to form a traumatic facial paralysis model. The drugs were administered for two weeks once a day. At the end of the second month, the electrophysiological assessments were performed and the distal part of the traumatic facial nerve were dissected and examined under light microscopy.

RESULTS

Best nerve regeneration was observed in the control and the thymoquinone groups, respectively, whereas the weakest regeneration was determined in the sham group. Thymoquinone and methylprednisolone significantly increased nerve recovery, as measured by histopathological scores and electrophysiological assessment. In the thymoquinone group, due to postoperative amplitude, axon diameter and thickness of myelin sheath values were significantly further increased nerve regeneration compared to that of the methylprednisolone group and these values were close to those of the values of the control group.

CONCLUSION

Thymoquinone was slightly better than methylprednisolone for functional nerve recovery. The neuroprotective effect of thymoquinone was attributed to its antioxidant and anti-inflammatory effects. Thymoquinone can have a new treatment option to ameliorate the nerve injury.

The predictive effect of initial complete blood count of intensive care unit patients on mortality, length of hospitalization, and nosocomial infections

OBJECTIVE

The mean platelet volume (MPV) can be used as an indicator of platelet activation. However, it has been shown that the platelet/lymphocyte ratio (PLR) can provide useful predictive information about inflammation and aggregation pathways. The neutrophil/lymphocyte ratio (NLR) may also be helpful as a marker of systemic or local inflammation. The main objective of this study evaluated to unselected critically ill patients the relationship of initial MPV, NLR, and PLR with mortality, length of hospitalization, and the risk of developing nosocomial infections in ICU patients.

PATIENTS AND METHODS

In this retrospective study, we evaluated consecutive patients at our tertiary nine-bed ICU. One hundred seventy-three patients who were followed up during a 1-year period were included.

RESULTS

MPV levels were found to be higher in patients who died in the hospital (p = 0.05). In addition, there was a significant positive correlation between expected mortality rate and MPV among non-survivors (p = 0.009). NLR levels were higher among non-survivors, but this difference was not statistically significant (p = 0.435). PLR levels were similar between non-survivors and survivors (p = 0.173). The initial NLR and PLR were significantly higher in patients with nosocomial infections. NLR and PLR had a significant positive correlation with length of hospitalization (p = 0.006 and p = 0.027, respectively).

CONCLUSIONS

In our study, we found that high PLR and NLR may be indicators for the development of nosocomial infections. Moreover, the length of hospitalization may be prolonged in patients with high PLR and NLR.

The impact of topical and systemic enoxaparin sodium use on traumatic tympanic membrane perforation and myringosclerosis

The objective of this study is to investigate the effect of topical and systemic enoxaparin sodium on the healing pattern of experimentally induced tympanic membrane perforation and formation of myringosclerosis. A total of 24 Wistar-Albino strain rats were included in the study. Standard myringotomies were performed on each rat. In the first group, isotonic serum physiologic was dropped on external ear canal (control group). Topical enoxaparin was dropped on external ear canal and daily topical doses of enoxaparin were dropped on external ear canal of the rats for 14 days (topical treatment group). Third group received subcutaneous injections of enoxaparin for 14 days (systemic treatment group). Five micrometer thick sections of the bullae of the rats were stained with H&E. Inflammation, edema and sclerotic lesions and neovascularization observed in the lamina propria layer of the tympanic membrane, and total thickness of the tympanic membrane were evaluated. In intergroup comparisons, significant difference in the distribution pattern of severity of inflammation in all three groups was not observed (p = 0.784, p > 0.05). Total TM thickness differed among all three groups (p = 0.028, p < 0.05). A statistically significant difference was observed between the systemic enoxaparin and the control groups (p = 0.022, p < 0.05). A statistically significant difference was observed between the topical enoxaparin and the control groups (p = 0.037, p < 0.05). However, comparison between the topical and systemic treatment groups could not reveal any statistically significant intergroup difference (p = 0.682, p > 0.05). A significant difference was not observed among three groups as for the distribution of myringosclerotic plaques, severity of edema and neovascularization in the lamina propria (p = 0.539, p > 0.05), (p = 0.063, p > 0.05), (p = 0.152, p > 0.05). Topical and systemic enoxaparin treatment did not prevent formation of sclerotic plaques; however, it decreased TM thickness significantly in comparison with the control group.

Evaluation of hearing loss in patients with Graves' disease

Hearing loss has commonly been reported in association with thyroid disorders and during treatment with propylthiouracil. The relationship between hyperthyroidism and the auditory system has not been previously investigated. The aim of this cross-sectional, case-control study was to investigate hearing loss in patients with Graves' disease (GD). The study population consisted of patients with newly diagnosed GD and healthy controls. Pure tone audiometry at frequencies of 250, 500, 1000, 2000, 4000 and 8000 Hz, along with immittance measures including tympanometry and acoustic reflex tests, were performed in all participants. Twenty-two GD patients and 22 healthy controls consented to inclusion in the study. The differences between groups with regards to age and gender distribution were statistically insignificant (P = 0.567 and P = 0.757, respectively). The hearing thresholds of right and left ears were also similar in both groups (P > 0.05). When single-ear evaluations were taken into account (total of 44 ears for both groups), hearing thresholds in the GD group were significantly higher than healthy controls at all frequencies (P < 0.05). Following testing at the designated frequencies, the only significant effect of thyrotoxicosis was observed with frequencies of 4000 and 8000 Hz. The odds ratio for having hearing loss at a frequency of 8000 HZ associated with GD was 14.97 (95% confidence interval 4.03-55.64). In patients with GD, right and left pure tone audiometric findings at a frequency of 8000 Hz correlated positively with FT3, FT4 and negatively with TSH. Our results are highly suggestive of a decrease in hearing ability in patients with GD, particularly at high frequencies. Further studies are needed to help elucidate the mechanisms behind hearing loss which develops in association with GD.

Investigation of hearing in patients with allergic rhinitis

The aim of the current study is to investigate hearing function in patients with allergic rhinitis. Fifty-eight patients with positive skin prick test (Group 1) (116 ears) and 31 subjects with negative skin prick test (62 ears) as group 2 were included. Pure tone audiometry at 250, 500, 1000, 2000, 4000 and 8000 Hz and immittance measures, including tympanometry and acoustic reflex tests, were performed in both groups. There was statistically significant difference between pure-tone threshold of the group 1 and group 2 at 8000 Hz (p< 0.05). Based on our study, the patients with allergic rhinitis had better hearing than the control group at 8000 Hz.

Imaging findings and clinical features of patients with multiple myeloma with the prognostic effect of bone marrow focal and diffuse infiltration patterns on spine MRI

AIM

Aim of this study was to evaluate the prognostic effect of the magnetic resonance imaging (MRI) infiltration type as diffuse or focal patterns on spine magnetic resonance imaging (MRI), as well as other imaging and clinical features of patients with multiple myeloma.

METHODS

A retrospective analysis of 35 patients with multiple myeloma was performed in this study. Patients were mean of 56.5 ± 12.4 year old, male/female ratio=1.3. Patients were at stage 2 and one at stage 3. Skeletal surveys were obtained in all patients, additionally bone scintigraphy (N.=25), CT (N.=22), and spine MRI (N.=16) were conducted. On imaging, lesion number, size and distribution and characteristics were assessed. On MRI, bone marrow involvements were assessed as focal and diffuse patterns (mild, moderate, and severe). All patients were followed-up with MRI for a median of 8.5 months (range, 1-105). Statistical analysis for bone marrow infiltration on MRI was performed using Kaplan-Meier survival test.

RESULTS

Patients with diffuse infiltration pattern on MRI survived as median 13.0 months (range, 1-105), whereas cases with only focal pattern survived as median 3.5 months (range, 1-27). There was no difference between these groups (P=0.071). The disease-free survivals were not different, either (P=0.118). Scintigraphy, CT, and MRI detected more lesions in flat bones except for cranium where craniography was successful.

CONCLUSION

It was not possible to find any further effect of the diffuse MRI infiltration type beyond focal infiltration on overall and disease-free survivals. Among typical findings of the radiography, spherical, punched-out lesions were seen, but lesion uniformity was not seen.

Expression of histamine receptors (H(1), H(2), and H(3)) in the rabbit endolymphatic sac: an immunohistochemical study

OBJECTIVE

The endolymphatic sac (ES) is part of the membranous labyrinth of the inner ear. Its central role in immunologic activity within the inner ear has been confirmed by numerous studies. The aim of this study was to investigate the expression of histamine receptors (H(1), H(2), H(3)) in the rabbit ES.

METHODS

A total of 10 healthy male New Zealand white rabbits weighing 2 to 3 kg were used in the experiments. For immunohistochemical studies, immunostaining was performed according to the avidin-biotin-peroxidase complex technique.

RESULTS

Serial sections of the ES of rabbits revealed the presence of H(1), H(2), and H(3) receptor immunoreactivity. Immunoreactive cells for all H(1), H(2), and H(3) were found in the epithelial and subepithelial layers of the duct and the proximal ES. In conclusion, this study showed the immunohistochemical localization of H(1), H(2), and H(3) receptors in the ES of rabbits. These receptors may be important in the homeostasis of the inner ear. In addition, they may be target receptors in the medical treatment of inner ear disorders such as endolymphatic hydrops.

An alternative model for stapedectomy training in residency program: sheep cadaver ear

To determine the usefulness of sheep cadaver ear as a complementary model for training of stapedectomy at residency programs, 2 of our 4 year residents were included in the study and each operated 20 sheep ears. All routine steps of stapedectomy operation were performed, and their success and complication scores were recorded. Performance of residents for stapedectomy and teflon piston placement in sheep ears were evaluated by the authors. Success of both residents improved progressively. Success and complications were impressively better in the second 10 ears than the initial 10 for each resident. Both residents had better outcomes in last 10 ears. Sheep cadaver ear is an excellent model for stapedectomy training in residency and helps to improve surgical skills. We offer sheep cadaver ear training model especially in the countries where obtaining human cadaver temporal bone is difficult.

An aberrant internal carotid artery in the temporal bone presenting as a middle-ear mass: a case report

Objective:

To draw attention to the possibility of an aberrant internal carotid artery behind an intact tympanic membrane presenting as a middle-ear mass.

Case:

A 48-year-old female patient presented with a hearing impairment in her right ear that had started 10 years ago. Otoscopic examination revealed a retro-tympanic mass. A high resolution computed tomography scan of the temporal bone was performed that showed protrusion of the internal carotid artery into the middle ear. Magnetic resonance angiography provided excellent visualisation of the internal carotid artery. Finally, a diagnosis of an aberrant internal carotid artery was made and the patient was evaluated with a conservative approach.

Conclusion:

All retro-tympanic masses should ideally be visualised with a computed tomography scan of the temporal bone before any middle-ear surgery, such as tympanotomy and biopsy, and it is essential for every otologist who undertakes myringotomy and middle-ear surgery to know about this rare entity.

Mutational falsetto: intervention outcomes in 45 patients

Objective:

The aim of this study was to evaluate the outcomes of therapeutic intervention in patients with mutational falsetto, by applying perceptual and acoustic analysis before and after voice therapy.

Materials and methods:

Forty-five consecutive patients with mutational falsetto were studied retrospectively. Acoustic analysis (i.e. fundamental frequency, jitter, shimmer, and formants one, two and three) was performed using the Multi-Dimensional Voice Program. Perceptual voice analyses were performed, including graded severity–roughness–breathiness–aesthenicity–strain assessment.

Results:

Subjects' fundamental frequency, voice formants one, two and three, jitter, and shimmer were greater before than after treatment. There were statistically significant differences between pre- and post-treatment average values for fundamental frequency, jitter and shimmer. There were also statistically significant differences between pre- and post-treatment average values for formants one and two. These results were maintained after six months of follow up, and there was no significant difference between results at three- and six-month follow up. According to perceptual evaluation, each subject's voice had altered from mutational falsetto to chest voice by completion of the intervention. Thus, all of the patients successfully lowered their modal speaking voice to an appropriate level.

Conclusion:

In the light of objective evaluations, and by applying the study treatment protocol, these results suggest that normal voice can be maintained after intervention, at six months' follow up.

Evaluation of hearing loss in patients with ankylosing spondylitis

AIMS

The aim of this study was to investigate hearing loss in patients with ankylosing spondylitis.

STUDY DESIGN

Prospective, case-control study.

METHODS

Fifty-nine ankylosing spondylitis patients (118 ears) and 52 healthy control subjects (104 ears) were included. Pure tone audiometry at 250, 500, 1000, 2000, 4000 and 6000 Hz and immittance measures, including tympanometry and acoustic reflex tests, were performed in the patients and controls.

RESULTS

Sensorineural hearing loss was found in 21 patients (35.5 per cent), bilateral in 15 patients and unilateral in six. Pure tone thresholds significantly differed between patients and controls at all frequencies (p<0.05). There was no statistically significant difference between the right and the left ears' thresholds at all frequencies, except at 4000 Hz in ankylosing spondylitis patients. The right ears' thresholds were higher than those of the left ears. Patients' pure tone average (PTA) thresholds were significantly different from those of controls in all three PTA groups (i.e. 250 Hz; 500, 1000 and 2000 Hz; and 4000 and 6000 Hz) (p<0.05). The differences were most prominent in the higher frequencies.

CONCLUSION

Our findings suggest a decreased hearing level in ankylosing spondylitis patients, mostly at high frequencies, although the pure tone thresholds of patients and controls significantly differed at all frequencies.

Evaluation of hearing and cochlear function by DPOAE and audiometric tests in patients with ankylosing spondilitis

The aim of this study was to investigate cochlear functions in patients with ankylosing spondilitis (AS). Prospective, case control study. Twenty-eight AS patients (56 ears) and 25 healthy control subjects (50 ears) were included in the study. Pure-tone audiometry at 250, 500, 1,000, 2,000, 4,000, 6,000 Hz and immittance measures including tympanometry and acoustic reflex and DPOAEs (Distortion Product Otoacoustic Emission) testing were performed in the patients and controls. Pure-tone audiometry findings of the patients and controls were significantly different in all frequencies (P < 0.05). Sensorineural hearing loss was found in 10 patients (35%) that was bilateral in seven and unilateral in three patients. On DPOAE testing, there was no statistically significant difference between the levels of noise floor of the patients and controls (P > 0.05). However, the DPOAE responses of the patients and controls were significantly different in 3,000, 4,000, 5,000 and 6,000 Hz frequencies (P < 0.05). There is a damage of outer hair cells in patients with AS, and damaged outer hair cell regions mostly corresponds to the basal and mid-portions of the cochlea.

Investigation of Helicobacter pylori in the Middle Ear of the Patients with Chronic Otitis Media by CLO Test and 14C Urea Breath Test

OBJECTIVE

The aim of this study was to investigate the presence of Helicobacter pylori by CLO test in the middle ear of the patients with chronic otitis media. We also investigated the relationship between H. pylori in the stomach and in the middle ear by 14C urea breath test (14C UBT) for the possible source of this bacterium.

STUDY DESIGN

A prospective controlled clinical study.

METHODS

Tissue samples were obtained from the middle ear mucosa of 41 patients undergoing ear surgery for chronic suppurative otitis media and placed in the CLO test kit. C UBT was performed in 24 patients and 20 normal subjects.

RESULTS

The CLO test results were positive in 22 patients (53.6%). Results of 14C UBT that was performed in 24 patients were positive in 19 patients (79.1%) and were positive in 6 control subjects (30%).

CONCLUSION

Fifty-three percent of the middle ear mucosae obtained from 41 patients with chronic otitis media were shown to be positive for H. pylori, and although our results suggest that the source of this bacterium is the stomach, further clinical studies are needed.

Collagenous fibroma (desmoplastic fibroblastoma)

A Collagenous Fibroma (Desmoplastic Fibroblastoma) is a rare, benign, slowly growing, fibroblastic, soft tissue lesion. Here, the case of a 28-year-old woman, who presented with a 1-year history of a slowly growing painless mass in the right anterior aspect of her neck, is described. This type of tumor was first described by Evans in 1995, and named as a Desmoplastic fibroblastoma but was renamed, by Nielsen in 1996 as a Collagenous Fibroma. This type of tumor is frequently reported in men with a mean age at occurance of 50 years. Clinically, a Collagenous fibroma presents as a firm, well-circumscribed subcutaneous, or intramuscular, painless mass of long duration. They are mostly located in the neck and extremities. The tumors range in size from 1 to 20 cm and predominantly occurs within the subcutaneous tissue, but fascial and skeletal muscle involvement is common. The treatment of a Collagenous Fibroma is a total surgical excision. No tumor recurrence has been reported the literature during the follow-up period and no tumor recurrence was observed in our case at the 1-year follow-up.

Role of free radicals and antioxidants in nasal polyps

OBJECTIVES/HYPOTHESIS

The aim of this study is to determine the role of free radicals and antioxidants in nasal polyps.

STUDY DESIGN

Prospective, randomized, controlled study.

METHODS

Thirty-one patients with nasal polyposis and a control group consisting of 19 patients with septal deviation and lower turbinate hypertrophy were included in the study. Levels of the antioxidants retinol, beta-carotene, alpha-tocopherol, and ascorbic acid were measured from the sera of the patients with nasal polyposis and the control group. Plasma levels of superoxide dismutase activity (SOD), glutathione peroxidase (GSHPX) activity, and reduced glutathione (GSH) were also obtained. As a peroxidation product, the levels of the malondialdehyde-thiobarbituric acid (MDA) combination were measured from the plasma of patient and control groups. Measurements of MDA, GSH, and alpha-tocopherol levels were also taken from the polyp tissue and turbinate mucosa of the control group.

RESULTS

The blood levels of antioxidants and MDA as an oxidant were significantly different in the patient group compared with the control group (P <.01). The tissue levels of antioxidants and MDA were significantly different in the patients with polyposis compared with the control group (P <.01). The blood and tissue anti-oxidant levels were found to be decreased, and MDA levels as an oxidant increased significantly in the patient group with polyposis when compared with the control group, and there was a negative correlation between oxidative stress and antioxidants.

CONCLUSION

This study demonstrates that oxidative stress and tissue and blood antioxidants in the patients with polyposis were significantly different compared with the control group. The blood and tissue antioxidant levels decreased, and MDA levels, as an oxidant, increased significantly in the patient group with polyposis when compared with the control group. The current study demonstrates that there is strong evidence related to oxidative stress in the pathogenesis of nasal polyposis, and antioxidants can have a preventive role in free-radical-mediated tissue damage in nasal polyposis.

High-dose thiotepa, melphalan and carboplatin (TMCb) followed by autologous stem cell transplantation in patients with advanced breast cancer: a retrospective evaluation

This study was conducted to evaluate the efficacy of high-dose thiotepa, melphalan and carboplatin (TMCb) regimen in 27 patients undergoing autologous stem cell transplantation (ASCT) for metastatic breast cancer. A total of 27 patients with stage IV breast cancer underwent ASCT following thiotepa (500 mg/m(2)), melphalan (100 mg/m(2)) and carboplatin (1200-1350 mg/m(2)). Of 27 patients, 17 had refractory relapse, eight had responding relapse, and two had no evidence of disease (NED) at the time of transplant. In all, 11 patients had only bone disease, nine had bone plus visceral disease, three had only visceral disease, and two had locoregional recurrent disease. The median time from diagnosis to transplant was 1081 days (range 180-2341). Staging for evaluation of response was performed 4-6 months after transplantation. Five patients were not evaluable (NE) for response because of NED at transplant (n=2) or early death due to transplant-related complications (n=3) (two of viral pneumonia and one of regimen-related toxicity) occurring at a median of 4 days (range 11-46) post-transplant. One of the two patients who was NED at the time of transplant is still NED on day 760 post-transplant. Seven of 15 refractory (47%) and 5/7 (71%) responsive patients with evaluable disease achieved a complete response of all measurable disease or all soft-tissue disease with at least improvement in bone lesions. Of 27 patients (37%),(10) are alive and progression-free, a median of 582 days (range 410-1380) after treatment, 6/17 (35%) with refractory disease and 4/10 (40%) with responsive disease. The probability of progression-free survival (PFS) for all patients was 0.50. The probabilities of PFS at 2 years for patients with refractory (n=17) and responsive (n=10) disease were 0.42 and 0.60, respectively. PFS at 2 years for the 14 patients who were NED or achieved CR/PR(*) following-HDC was 0.67. PFS at 2 years for patients who did not achieve CR/PR(*) following-DHC was 0.33. These preliminary data suggest that high-dose TMCb followed by autologous stem cell transplantation is an effective regimen for patients with advanced breast cancer and may be comparable to some previously used regimens.