INTRODUCTION: Rhinitis medicamentosa (RM) is a nonallergic form of rhinitis, mostly associated with prolonged, excessive, and improper use of topical decongestants. The only effective treatment for this is nasal steroids. This study aimed to reverse the mucosal changes in RM by the use of surfactant. Different molecules were applied to each group to compare surfactant’s effectiveness.
METHODS: Thirty rats were divided into five groups. All groups were treated with topical oxymetazoline 0.05% for 30 days. Loss of cilia, congestion, edema, goblet cell growth, and increase in mucous glands, squamous metaplasia, and chronic inflammatory cell infiltration were set as the main parameters. Rats in group 5 were sacrificed; all proved the presence of mucosal changes in compliance with RM. All groups were continued to be treated with oxymetazoline even during the histopathological examination period of 15 days. Treatment modalities of each group for 15 days were as follows: saline wash (0.09% NaCl) in group 1, mometasone furoate monohydrate 50 μg 0.05% in group 2, surfactant wash solution 1 drop/100 cc in group 3, and intranasal surfactant solution with mometasone furoate monohydrate 0.05% in group 4. All rats were decapitated and sent for histopathological evaluation at the end of day 60.
RESULTS: A significant regression in the nasal mucosal congestion was found in groups treated with saline and mometasone furoate (p=0.005). No significant difference was found between groups when evaluating for regression of loss of cilia but unpredictably was seen in saline group by 83%. Surfactant/mometasone furoate combination therapy was found to be significantly ineffective for treatment of edema (p=0.013). No statistical difference was found between the groups in terms of chronic inflammatory cell infiltration (p=0.115). Squamous metaplasia was observed in all treatment groups, and there was no statistically significant difference between the groups (p=0.076).
DISCUSSION AND CONCLUSION: Surfactant or its combination with nasal steroid is not significantly effective in the treatment of RM.

Objective: Random flaps are often the first choice of technique in plastic surgery, however, necrosis developing in the distal portion of the flap during angiogenesis may necessitate additional surgery. Prolonged treatment is expensive in terms of labor, time, and morale. Several drugs have been investigated as a means of improving the viability of random flaps, and while satisfactory results have been reported, potential side effects due to systemic use and high costs have prevented widespread clinical use. This study examined capsaicin as a resource for improved viability and angiogenesis in random flaps.

Methods: Random-pattern, dorsal, McFarlane skin flaps were created in 60 male Wistar albino rats weighing 180–230 g (experimental group: n=30; control group: n=30) and sutured back into place. Capsaicin 0.1% cream was applied on the flap postoperatively and topically twice daily for 7 days in the experimental group. The necrosis rate was calculated using Sasaki’s paper template method.

Results: The ratio of the necrotic portion of the flap to the total flap was 22.9±8.94% in the experimental group and 36.8±10.05% in the control group. Analysis of polymorphonuclear leukocyte infiltration, lymphocyte ratio, capillary proliferation, and other parameters indicated that the application of capsaicin cream had a positive effect on flap viability in some zones in the experimental group.

Conclusion: Significantly less necrosis was seen in the experimental group. The results suggest that capsaicin 0.1% cream may increase the viability of random pattern skin flaps. However, differences in transdermal application characteristics between species, between individuals, and even between regions in a single individual demonstrate the need for additional studies.

Objective: This study is an examination of the protective effects of alpha-lipoic acid (ALA) on cerebral vasospasm in an experimental rat model with subarachnoid hemorrhage (SAH) using biochemical, pathological, and histomorphometric analyses.

Methods: A total of 28 albino Wistar rats were randomly categorized into 4 groups (n=7 each): Group (G)1, no experimental intervention; G2, subjected to SAH; G3, subjected to SAH and given physiological saline (100 mg/kg); and G4, subjected to SAH and treated with ALA (100mg/kg).

Results: No statistically significant decrease in malondialdehyde level, the end product of lipid peroxidation, was observed among the drug groups (G3 and G4). Furthermore, there was no statistical increase in paraoxonase level, an endogenous antioxidant enzyme, among the drug groups (G3 and G4). Thin sections of the basilar artery were morphologically examined, and severe luminal narrowing and vessel wall thickening were observed in the SAH groups (G2 and G3). In the ALA group (G4), vessel wall thickness measurements revealed no statistically significant difference compared with the other SAH groups (G2 and G3); however, G4 rats were found to have larger luminal diameters than those in G3.

Conclusion: These findings suggest that ALA had no effect on malondialdehyde-associated lipid peroxidation and paraoxonase activity; however, it had a favorable effect on basilar artery luminal diameter in the treatment of cerebral vasospasm following SAH.

INTRODUCTION: Coronavirus disease 2019 (COVID-19)-related infections emerging from China that spread worldwide show a wide range of clinical courses from asymptomatic presentation to respiratory failure and even death. Similar to non-COVID-19 infections, obesity, age, and comorbidities can also affect the clinical course of the disease. This study aimed to investigate the effect of obesity on the clinical course and mortality of patients hospitalized with COVID-19 pneumonia.
METHODS: Between March 11 and April 30, 2020, patients hospitalized with COVID-19 pneumonia were retrospectively analyzed. Patients were classified as having severe and mild disease based on oxygen, non-invasive mechanical ventilation (NIMV), and invasive (IMV) mechanical ventilation requirements. Two groups were evaluated based on body mass index (BMI) of ≥25 and ≥30 kg/m2.
RESULTS: Of the 125 patients, 82 (65.6%) were men, and their mean age was 51.77±4.99 years. Their mean BMI was 27.76±4.76 kg/m2. The difference of the mean BMI between the patients with severe and mild disease was statistically significant (28.8±5.36 and 26.9±4.10, respectively) (p=0.028). BMI of ≥25 and ≥30 kg/m2 were noted in 43.4% and 20.8% of patients with severe and mild disease, respectively, which was statistically significant (p=0.007). Moreover, 70.6% of 17 patients older than 65 years with BMI of ≥25 kg/m2 had a severe clinical course (p=0.021). Among patients requiring NIMV, 59.1% and 31.8% had a BMI of ≥25 and 30 kg/m2, respectively. Among patients requiring IMV, 66.7% and 37.5% had a BMI of ≥25 and 30 kg/m2, respectively. No statistically significant difference was found between BMI and NIMV and IMV need. Death occurred in 14.8% of the patients. No statistically significant difference was found between the BMI of those who died and survived (p=0.768).
DISCUSSION AND CONCLUSION: Bu kohort çalýþmasý, aþýrý kilo ve obezitenin hastalýk þiddetini deðerlendirmede ve tahminde önemli bir faktör olduðunu ve özellikle VKÝ ≥30 kg/m2 olan hastalarýn takiplerinde dikkatli olunmasý gerektiðini göstermiþtir.

INTRODUCTION: Diabetes Mellitus Type 2 (DM2) is characterized by varying degrees of insulin resistance, impaired insulin secretion, and increased glucose production. Some people with DM2 have more complications such as nephropathy, retinopathy, and neuropathy. The earliest stage of renal impairment occurs with prolonged microalbuminuria. This study aimed to determine the incidence of the most common microvascular complications in DM2 patients.
METHODS: We retrospectively evaluated the data of 126 patients who had undergone treatment in 2014. It includes anamnesis, laboratory, and physical examination data from the patient histories. All patients with early stage DM2 were separated into two groups based on the presence of albuminuria: Group I - macroalbuminuria and Group II - microalbuminuria (<300 mg). Analysis and statistical processing of the collected data were performed to evaluate microvascular complications and determine the incidence of albuminuria in the studied population.
RESULTS: The prevalence of macroalbuminuria was 60.3% (76 patients). In both groups, as in the total sample, the frequency of women was higher (57.9%). The prevalence of macroalbuminuria was strongly influenced by age (≥65 years) of the patients (72.4%, average age = 69.8±11.1 years). Microalbuminuria has been proven to be an extremely significant marker for development of microvascular complications in DM2 (retinopathy 39.5%, neuropathy 52.6%, and nephropathy 54%).
DISCUSSION AND CONCLUSION: Early diagnosis of microvascular complications and an adequate therapeutic approach is needed to prevent disability. Therefore, it is important to introduce the screening for the presence of microalbuminuria in practice, which will identify patients at increased risk of developing microvascular complications.

INTRODUCTION: Pain control for a post-dural puncture headache (PDPH) can be challenging. Epidural blood patching (EBP) is recommended; however, EBP is an interventional procedure with the risk of bleeding, infection, and adverse neurological effects. The aim of this study was to evaluate the effects of a transnasal sphenopalatine ganglion block (SPGB) as supportive PDPH treatment.
METHODS: Pregnant women undergoing a cesarean section under spinal anesthesia who developed PDPH were included in this prospective randomized study. The enrolled subjects were randomly assigned to 2 groups: a medical treatment group (n=10) and a group that would receive medical treatment with the addition of SPGB (n=10). Visual analog scale (VAS) scores were recorded at the time of admission, and at 4, 12, and 24 hours after treatment.
RESULTS: There was no statistically significant difference between the 2 groups in terms of age, height, weight, or body mass index. The mean VAS values at the baseline, 12th hour, and 24th hour were similar between the groups. However, the mean VAS score at the fourth hour was significantly lower in the block group (p=0.002).
DISCUSSION AND CONCLUSION: A unilateral SPGB is a rapid and effective method to treat PDPH. However, the safety of this technique requires further research due to complications encountered, including a seizure.

INTRODUCTION: Formalin fixation results in decrease in the size of resection materials up to 57% in different tissues. The objective of this study was to determine the effects of formalin fixation on the longitudinal size and tumor size of resected colon tissue because of a sigmoid colon tumor.
METHODS: This prospective study was conducted with 40 consecutive sigmoid colon tumor patients who underwent elective resection between January and December 2016. The surgeon conducting the study opened up the specimens within 15 minutes of resection, and the total length of the resected colon, size of the tumor, and proximal and distal surgical margin distances were then measured. The pathologist then recorded the measurements, without applying any stretch.
RESULTS: The mean total length, proximal surgical margin distance, distal surgical margin distance, and size of the tumor in the resected material were 32.9 cm, 16.7 cm, 12.1 cm, and 4.8 cm, respectively. Postformalin fixation values were 22.0 cm, 10.6 cm, 7.4 cm, and 4.2 cm, respectively, in the same order (p=0.00 for all).
DISCUSSION AND CONCLUSION: The results of the present study revealed 34% shrinkage in the total size of colon material following fixation. The effect of formalin fixation on shrinkage should be considered in cases where there is an unexpected proximity to surgical margins, as shown by the pathology results.

INTRODUCTION: The aim of this study was to determine whether aortic, iliac, and femoral artery bifurcation angles were different in diabetic patients with and without diabetic foot, and whether angle differences assessed based on computed tomography angiography (CTA) imaging could predict the development of diabetic foot.
METHODS: A total of 111 patients with diabetes mellitus (DM) were included in the study: 61 with diabetic foot and 50 without diabetic foot. The aortic, right and left iliac, and right and left femoral bifurcation angles were measured using CTA images and evaluated retrospectively with the Sectra PACS system (Sectra Medical Systems GmbH, Koln, Germany).
RESULTS: When the values of the control and diabetic foot groups were compared, there was no statistically significant difference between the aortic bifurcation angle (p=0.438), right (p=0.223) and left (p=0.459) iliac bifurcation angles, or the right (p=0.080) and left (p=0.064) femur bifurcation angles.
DISCUSSION AND CONCLUSION: The results revealed no significant difference in the bifurcation angles of the aorta and lower extremity arteries in diabetic patients with and without diabetic foot, and suggested that the changes in vascular geometry caused by DM may not be a major factor in the development of diabetic foot.

INTRODUCTION: To evaluate the short term outcomes of Ahmed glaucoma valve (AGV) implantation in refractory glaucoma.
METHODS: A total of 31 cases who had undergone AGV implantation between January 2018 and March 2019 for refractory glaucoma were retrospectively evaluated. The patients, with a visual acuity of at least light perception, had postoperative follow-up records of at least 6 months were included in the study. Preoperative and postoperative best corrected visual acuity (BCVA), intraocular pressure (IOP), number of topical antiglaucoma medications and central corneal thickness (CCT) were recorded. Any postoperative complications were noted.
RESULTS: The surgical outcome was graded as complete success for IOP between 5-22 mmHg without antiglaucomatous medication; qualified success for IOP between 5-22 mmHg with antiglaucomatous medication; and failure for IOP >22 mmHg despite medication. The sum of the complete success and qualified success groups was defined as total success. The mean follow-up time was 12.94±4.98 months. The preoperative mean IOP levels and topical antiglaucoma medication numbers decreased from 40.84±8.27 mmHg to 13.84±2.95 mmHg and 3.68±0.54 to 1.10±1.35 respectively at the final postoperative examination. There were no significant differences between preoperative and postoperative CCT and BCVA levels (p>0.05). The most common (n=3) complication was encapsulated cyst formation in the AGV plate region. The complete, qualified and total success rates were 45.2% (n=14), 54.8% (n=17) and 100% (n=31), respectively.
DISCUSSION AND CONCLUSION: Although the mean preoperative IOP levels are quite high in refractory glaucoma cases, in short term, AGV implantation is an effective surgery for lowering IOP. With longer follow-ups, it will be possible to show the sustainable impact of AGV implantation on lowering IOP.

INTRODUCTION: Stroke is one of the most common causes of morbidity and mortality in the world and therapy is time-sensitive. The biggest obstacles to optimal treatment are pre-hospital transport delays and hesitation to administer intravenous tissue plasminogen activator (iv-tPA) and perform a mechanical thrombectomy (MT). A number of educational sessions were held in Istanbul to address these problems. This study examined the effects of this training.
METHODS: This retrospective study was designed to analyze the effectiveness of stroke treatment training programs provided to 2645 medical personnel in Istanbul, Turkey. The transport time, accuracy rate of stroke diagnosis, and treatment parameters of a 1-month period in 2017 and the same month in 2018 after the training were evaluated.
RESULTS: In all, 1628 suspected stroke patients who were transported to a hospital by ambulance in October 2017 (n=796) and October 2018 (n=832) were included. There was a minimal but meaningful decrease in pre-hospital transportation time (p<0.05). In 2017, 27% of the patients who were transported to the hospital with the suspicion of stroke were ultimately diagnosed with acute stroke, while 36% were diagnosed with acute stroke in 2018 (p<0.05). Applications of iv-tPA and MT to acute stroke patients also significantly increased in 2018 (tPA: 14% vs 26%, p=0.003; MT: 6% vs 13%, p=0.034).
DISCUSSION AND CONCLUSION: The analysis indicated that the educational programs targets were successful based on an increase in the diagnosis of stroke and use of iv-tPA and MT.

INTRODUCTION: Food and beverage preferences and exercise activities suppress the desire to smoke and extend the cessation period. The aim of the present study was to investigate effects of food consumption and physical activities on the success of a smoking cessation program.
METHODS: In our retrospective cohort study, demographics, smoking cessation therapy features, levels of addiction, treatment results, food preferred in case of desire to smoke during follow-up, and physical activities of 119 patients monitored within the scope of smoking cessation program in our site were recorded. The data of the groups with successful and unsuccessful smoking cessation were analyzed by comparison.
RESULTS: The successful group had more patients who quit smoking within the first one month in the treatment process and gained weight than the unsuccessful group (p<0.001 and p<0.001, respectively). Compared to the successful group, the unsuccessful group recorded a higher level of addiction and relapse (p=0.04, p=0.001, respectively). The use of varenicline and nicotine gum among pharmacological treatments did not differ between groups, nicotine patch was more frequently used higher in the unsuccessful group (p=0.046). The successful group also had more patients who consumed hedonic diet among the behavioral strategies in case of urge to smoke (p=0.04).
DISCUSSION AND CONCLUSION: The preference for hedonic foods in case of urge to smoke in patients who underwent smoking cessation treatment and implementing multiple strategies are associated with the success of the treatment, unlike exercise activity. This study may provide preliminary support for an eating strategy using a dietary plan and multi-strategy for the success of smoking cessation programs.

INTRODUCTION: Research has shown that hepatitis C infection, metabolic syndrome (MS), and non-alcoholic fatty liver syndrome are associated. This study was designed to assess the parameters of MS in people with hepatitis C antibodies.
METHODS: We enrolled 104 patients, including 52 men and 52 women who visited our hospital and had anti-hepatitis C virus (HCV) positivity. In the patient group, different examinations were performed as per the MS criteria in the Adult Treatment Panel (ATP) III and International Diabetes Federation (IDF) guidelines.
RESULTS: As per the ATP III criteria, the prevalence of MS was 36.5% (n=38) in the total population, 55.8% (n=29) in women, and 17.3% (n=9) in men in our study. When the IDF criteria were applied, the MS prevalence was 48.1% (n=50) in the total population, 65.4% (n=34) in women, and 30.8% (n=16) in men.
DISCUSSION AND CONCLUSION: In our study, the prevalence of MS was significantly higher in female patients with HCV antibodies than in male patients.

INTRODUCTION: The aim of this study was to compare the clinical efficacy and safety of an ultrasound-guided combined sciatic-femoral nerve block (SFNB) with spinal anesthesia (SA) in lower limb surgical procedures in terms of clinical properties, postoperative analgesia, and adverse outcomes.
METHODS: This prospective, randomized study comprised 60 patients aged 18–65 years with an American Society of Anesthesiologists physical status of I-III scheduled for a lower limb surgical procedure. The patients were randomly divided into 2 groups to receive either SA (n=30) or an ultrasound-guided combined SFNB (n=30). The duration of the intervention, time to achieve surgical anesthesia, analgesia duration, intraoperative hemodynamic parameters, patient satisfaction, quality of the postoperative analgesia, and adverse outcomes were recorded and analyzed.
RESULTS: The duration of the intervention, time to onset of sensorial and motor block, time to start of surgery, motor block reversal time, and time to first postoperative analgesic were significantly longer in the SFNB group (p<0.001). Significantly fewer patients required rescue analgesia in the first postoperative 24 hours compared with the SA group (p<0.001). The intraoperative hemodynamic parameters and adverse outcomes were similar in both groups.
DISCUSSION AND CONCLUSION: SFNB is a safe and efficient alternative regional anesthesia technique to SA in lower limb surgical interventions, and particularly for high risk cases where SA is contraindicated. The prolonged duration of postoperative analgesia and reduced need for postoperative analgesic drug consumption were superior to SA in terms of postoperative pain management.

INTRODUCTION: Cases diagnosed as atypical small acinar proliferation (ASAP) in prostate transrectal ultrasound (TRUS) biopsies typically require rebiopsies, which are invasiveand associated with increased risk of complications. Therefore, reduction in the rates of ASAP diagnoses during initial biopsy interpretation will decrease the need forrebiopsy and limit the burden of new diagnostic procedures. The current study aimed to investigate patient demographics, serum PSA levels, and histopathological features of cases identified as “ASAP” during initial prostate biopsies and as “benign” or “malignant” in the rebiopsies.
METHODS: This retrospective study included 187 cases and 257 core biopsies with a diagnosis of ASAP. Initial age and serum PSA levels were recorded, and the cores were analyzed histopathologically. The presence of nuclear enlargement, prominence of nucleoli, cytoplasmic amphophilia, luminal acellular secretions, cristalloids, infiltrative growth pattern, atrophy, inflammation, and number of the suspicious acini were recorded. Adenocarcinomas were identified using the Gleason score.
RESULTS: The mean age and serum PSA levels were significantly higher in the intermediate-high grade malignant group compared to the other groups, while nuclear enlargement (>2 times) and prominent nucleoli were more frequently observed in the malignant group compared to the benign group. Amphophilic cytoplasm and luminal acellular amorphous eosinophilic secretions were more frequently observed in malignant groups, while the benign group exhibited higher rates of inflammation.
DISCUSSION AND CONCLUSION: The findings of the current study showed enlargement of the nuclei (≥2 times), nucleolar prominence, amphophilic cytoplasm, luminal amorphous acellular secretion, and absence of inflammation were associated with malignancy. Moreover, higher mean age and serum PSA level were related with intermediate-high grade malignancy, and consideration of these factors during evaluation of initial TRUS biopsies may decrease the prevalence of ASAP diagnoses and prevent unnecessary interventions.

INTRODUCTION: The relationship between the surgeon’s experience/volume of performed operations and postoperative results of thyroid surgery is a pressing issue that has been widely discussed in recent publications. This study aimed to compare the complication rates in thyroidectomy operations performed before and after specialization and evaluate the effect of specialization on the outcomes of thyroid surgeries.
METHODS: The study included patients who had undergone thyroidectomy with or withoutneck dissection due to benign or malign thyroid diseases in a single tertiary reference hospital between April 2013 and March 2017. The patients were divided into two groups: those who were operated on before specialization (BS) and after specialization (AS). Age, gender, operation type, postoperative hypocalcemia, incidental parathyroidectomy, recurrent laryngeal nerve (RLN) injury, and postoperative bleeding or hematoma were compared between the groups.
RESULTS: Of the thyroid patients, 776 were operated on (367 (47%) and 409 (53%) of the BS and AS groups, respectively). No significant difference was found between the two groups regarding the postoperative Ca2+ level, while the parathormone was significantly lower in the BS group (p=0.2 and p=0.02, respectively). In addition, postoperative transient hypocalcemia was significantly less common in the AS group (p<0.001). The incidental parathyroidectomy rate was significantly higher in the BS group (p<0.01). Postoperative transient hoarseness developed in 15 (4%) patients in the BS group and in 2 (0.5%) patients in the AS group. Twelve patients had unilateral vocal cord paralysis, all of whom were in the BS group (p<0.01). No significant difference exists between the groups regarding bleeding (p=0.5).
DISCUSSION AND CONCLUSION: This study indicated that specialization in thyroid surgery significantly reduced complications (e.g., hypocalcemia, incidental parathyroidectomy, and RLN injury).

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), sometimes referred to as an invisible killer, has changed all of our lives, including the daily practices of medical personnel and the approach to anesthesia. We must wear protective equipment and special suits, aprons, and 2 or 3 pairs of gloves. Our faces are obscured by masks and goggles and shields. We move with difficulty and have limited vision. Communication with patients is limited; they cannot see our facial expressions of smiles or concern. They only hear our voice, which may also be muffled. We look more like robots than someone demonstrating assistance, love, or compassion. We are strangers to our infected patients. When thinking about the type of anesthesia for pregnant patients who have the disease caused by SARS-CoV-2, coronavirus2019 (COVID-19), 3 factors taken into consideration ranked according to importance are the safest method for healthcare providers, ease of application, and difficulties associated with movement and vision. The patient’s wishes are secondary. Have priorities changed?

Methemoglobinemia is a complication that develops when ferrous hemoglobin is oxidized to a ferric state. It may be congenital due to structural hemoglobin defects or acquired through causes such as exposure to local anesthetic drugs or intake of toxins. Methemoglobinemia is characterized by cyanosis when the blood level exceeds 10%, and at higher levels it may cause tissue hypoxemia, coma, cardiovascular collapse, or even death. The primary mechanism used to reduce the methemoglobin level in the body is the nicotinamide adenine dinucleotide phosphate-cytochrome b5 reductase pathway. This case report is a presentation of the diagnosis and treatment of prilocaine-induced methemoglobinemia in 2 recently circumcised infants admitted to the pediatric emergency department.

The presence of hair in the urethra can lead to recurrent, uncomfortable complications following various operations. A 76 years old male patient who admitted with voiding difficulty underwent internal urethrotomy and laser ablation treatment for hairy urethra. The case is presented and discussed with the relevant literature.