Abdullah Ayçiçek

Aerobic and Anaerobic Exercise Capacities in Obstructive Sleep Apnea and Associations with Subcutaneous Fat Distributions

Obesity is a strong risk factor for the development and progression of sleep apnea. Responses to exercise by patients with obstructive sleep apnea syndrome (OSAS) are clinically relevant to reducing body weight and cardiovascular risk factors. This study aimed to clarify the aerobic and anaerobic exercise capacities and their possible relationships with other findings in patients with OSAS. Forty patients (30 males, 10 females) and 40 controls (30 males, 10 females) were enrolled in this study. Questionnaires (excessive daytime sleepiness, daytime tiredness, morning headache, waking unrefreshed, and imbalance), overnight polysomnography, indirect laryngoscopy, and aerobic and anaerobic exercise tests were performed. Triceps, subscapular, abdomen, and thigh skinfold thicknesses were measured. Subcutaneous abdominal fat (abdomen skinfold) was significantly higher in OSAS patients than in controls. Maximal anaerobic power and anaerobic capacity were not different significantly between the patients and controls. We found that aerobic capacity was significantly lower in OSAS patients than in controls. Aerobic capacity was negatively correlated with upper-body subcutaneous fat (triceps and subscapular skinfolds) but not correlated with subcutaneous abdominal fat in OSAS patients. In multivariate analyses using all patients, the apnea-hypopnea index remained a significant independent predictor of aerobic capacity after controlling for a variety of potential confounders including body mass index. Our data confirm that central obesity (subcutaneous abdominal fat) is prominent in patients with OSAS. Our results suggest that lower aerobic exercise capacity in patients with OSAS might be due to daily physical activity that is restricted by OSA itself. This study also suggests that the degree of subcutaneous abdominal fat cannot be used for predicting aerobic capacity level. We think that upper-body subcutaneous fat might be suitable for determining the physical fitness of patients with OSAS.

The prevalence of obstructive sleep apnoea syndrome in ankylosing spondylitis patients

OBJECTIVE To assess the prevalence of obstructive sleep apnoea syndrome (OSAS) in AS patients. METHODS Thirty-one patients with AS were included in the study. The demographic data, spinal mobility measures and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores were recorded for each patient. All participants underwent one night of sleep recording, which was performed using a polysomnography (PSG). Pulmonary function test (PFT) was performed for all subjects and symptoms of OSAS were questioned. RESULTS Seven (22.6%) of 31 AS patients had OSAS according to PSG assessments. The mean BMI, disease duration, BASDAI score, neck circumference and occiput-wall distance were higher in patients with OSAS, but the differences were not significant. The mean ages of patients with OSAS were significantly higher than the patients without OSAS. The prevalence of OSAS in patients under the age of 35 years was found to be 6.3%, whereas the prevalence of OSAS in patients at the age of 35 years or over was 40.0% (P = 0.037). The prevalence of OSAS in AS patients with a disease duration <5 years was 11.8% and its prevalence in AS patients with a disease duration of >or=5 years was 35.7% (P = 0.198). PFT was restrictive in 16 (53.3%) patients and obstructive in none. CONCLUSIONS The prevalence of OSAS in AS patients is higher than reported in the general population. The diagnosis of OSAS should be kept in mind and OSAS symptoms should be considered especially in AS patients at the age of >or=35 years and in AS patients with a disease duration of >or=5 years.

Neutrophil-to-lymphocyte ratio as a new, quick, and reliable indicator for predicting diagnosis and prognosis of idiopathic sudden sensorineural hearing loss.

Introduction Idiopathic Sudden sensorineural hearing loss (ISSNHL) is a common otologic emergency. Recently, the cause of ISSNHL, which is still unclear, has been focused on chronic inflammation. Neutrophil-to-lymphocyte ratio (NLR) is a new and quick inflammatory marker, which is being measured routinely in CBC tests without any cost. We aimed to investigate the relationship between ISSNHL and inflammation by using NLR. Materials and Method Forty-seven patients diagnosed with ISSNHL and 45 age- and sex-matched healthy subjects were enrolled in the study. An automated blood cell counter was used for NLR measurements. The hearing assessments of the patients were carried out by an audiometer, and audiometric patterns were assessed initially and after 1 month of the treatment. All the patients were treated with prednisone in the dose of 1 mg/kg per day, with a progressive dose reduction maintained for at least 2 weeks. Then, the patients were divided into 2 groups as “ recovered” and “unrecovered” according to their response to the treatment. Results The mean NLR, neutrophil, and lymphocyte values in patients with ISSNHL were significantly higher than the control group (p < 0.001, p < 0.001, and p = 0.004, respectively). In addition, NLR levels were higher in unrecovered patients compared with the recovered ones (p < 0.001). Conclusion This is the first study investigating the relationship between NLR levels and ISSNHL and its prognosis. While evaluating ISSNHL, determining NLR should not be overlooked as a quick and reliable indicator for predicting the diagnosis and the prognosis of the disease.

Neutrophil-to-lymphocyte ratio as a novel-potential marker for predicting prognosis of Bell palsy.

Bell palsy can be defined as an idiopathic, acute, facial nerve palsy. Although the pathogenesis of Bell palsy is not fully understood, inflammation seems to play important role. Neutrophil‐to‐lymphocyte (NLR) ratio was defined as a novel potential marker to determine inflammation and it is routinely measured in peripheral blood. Our goal was to investigate the relationship between Bell palsy and inflammation by using NLR.

Variations of supraorbital foramina in living subjects evaluated with multidetector computed tomography

We aimed to evaluate the anatomic variations of supraorbital foramina/notches in living subjects using multidetector CT (MDCT) related to age, sex, and side.

Incidence of auditory neuropathy among the deaf school students

OBJECTIVE We aimed to determine the incidence of auditory neuropathy (AN) among the deaf school students that have severe hearing loss. METHOD All students having severe hearing loss constituting a total of 75 at Deafness school in Afyon Province of Turkey were enrolled in the study. The etiological factors about the hearing loss were determined by performing an individual file survey and by interviewing the teachers and parents. First, all the children were subjected to an otolaryngologic examination. Then, auditory brainstem response (ABR) and transient evoked otoacoustic emissions (TEOAE) tests were done to all students enrolled in the study. RESULTS The ages of the children were between 6 and 17 (mean age 11.9) and 32 (42.9%) of them were girls and 43 (57.1%) were boys. Three cases (4%) were diagnosed as AN in our study, however, no risk factors were determined in two of them. A history of hearing loss following a vaccination was found in only one patient. CONCLUSION Our data show that the incidence of AN in the children with severe hearing loss is not negligible. Therefore, our results suggest that automatic ABR should be also used with OAE as a routine application in the neonatal screening programmes, since the solely use of OAE in the neonatal screening programmes may result in the delay of the diagnosis of the children with AN.

Laryngeal Fracture due to Blunt Trauma Presenting with Pneumothorax and Pneumomediastinum

Aim: Injuries due to traffic accidents are frequent in childhood, and they have high mortality and morbidity. Laryngeal injury due to a traffic accident is a rare pathology and might be missed if not suspected. Here we present a laryngeal fracture in a child after a blunt chest trauma during a traffic accident that presented with pneumomediastinum and pneumothorax. Case: A 14-year-old girl was referred for pneumomediastinum. Her physical examination was normal except subcutaneous emphysema, edema and tenderness in the cervical area, hoarseness, facial and extremity abrasions and ecchymoses. Chest tomography revealed pneumothorax and pneumomediastinum, and cranial tomography revealed maxillofacial fractures. Upper airway damage was suspected, flexible endoscopy revealed right vocal cord paralysis and cervical tomography revealed thyroid cartilage fracture. The fracture was repaired and tracheotomy was performed. She was discharged on postoperative day 6. Facial fractures were repaired in another center. Tracheotomy was removed on postoperative day 20. Her hoarseness, although decreased, still persists. Conclusion: Pneumomediastinum is a rare result of a laryngeal fracture and if not suspected, the fracture can easily be missed. It should be kept in mind after blunt cervical trauma with pneumomediastinum and/or pneumothorax. Direct endoscopy and cervical tomography may be necessary for the differential diagnosis.

Grisel's Syndrome: A Rare Complication following Adenotonsillectomy.

Grisels syndrome is a nontraumatic atlantoaxial subluxation which is usually secondary of an infection or an inflammation at the head and neck region. It can be observed after surgery of head and neck region. Etiopathogenesis has not been clearly described yet, but increased looseness of paraspinal ligament is thought to be responsible. Patients typically present with painful torticollis. Diagnosis of Grisels syndrome is largely based on suspicion of the patient who has recently underwent surgery or history of infection in head and neck region. Physical examination and imaging techniques assist in diagnosis. Therefore, clinicians should be aware of acute nontraumatic torticollis after recently applied the head and neck surgery or undergone upper respiratory tract infection. In this paper, a case of an eight-year-old male patient who had Grisels syndrome after adenotonsillectomy is discussed with review of the literature.

Can Helicobacter pylori cause inflammation in the middle ear

OBJECTIVES To investigate whether Helicobacter pylori causes inflammation in the normal middle ear and in the middle ear with effusion. METHODS Sixteen adult New Zealand white rabbits were divided into two gropus equally. Group I was representing histamine-induced middle ear inflammation and Group II was representing normal middle ear. While H. pylori was inoculated in the right ears, physiologic saline was inoculated in the left ears of the rabbits in both groups. Results were evaluated clinically, histopathologically and microbiologically. Fishers exact test was used for statistical analysis. RESULTS In Group I, clinical scores of the inflammation in the right ears were higher than the left ears scores at the 7th day. Histopathological scores of the inflammation in the right ears were higher than the left ears scores at the 7th day. Also, H. pylori was isolated in 6 of the 8 right ears of the rabbits. In Group II, while clinical scores of the inflammation in the right ears scores were higher than the left ears scores at the 7th day, histopathological scores were not significantly different between both ears. Also, no H. pylori was isolated in right ears of the rabbits. CONCLUSIONS Effusion in the middle ear induced by histamine is an appropriate medium for H. pylori reproduction and it also aggravates the inflammation process. In contrary, H. pylori did not cause inflammation in the normal middle ear. We suggest that H. pylori does not play a role in the etiology of otitis media with effusion alone, but it contributes to the inflammation process in the presence of an effusion.

Expression of cyclooxygenase-1 and 2 in chronic tonsillitis

OBJECTIVES Prostaglandins are critical mediators of inflammation and affect both humoral and cell-mediated immune responses. Recent findings show that T and B cells express COX-2 upon activation. The purpose of this study is to investigate the potential occurrence of COX-1 and COX-2 immunoreactivity in cases of chronic tonsillitis and to determine the sites of their expression. In addition, their expression in adult patients is compared with that in child patients. MATERIALS AND METHODS Immunohistochemical techniques were used to evaluate the expression of the enzymes COX-1 and COX-2, in chronic tonsillitis tissue specimens from adults (n = 15) and children (n = 15). RESULTS There was no staining in surface epithelium or reticulated crypt epithelium. COX-1 and COX-2 expressions were observed mainly in the intraepithelial lymphoid cells in reticulated crypt epithelium and subepithelial cells. Also, COX-1 and COX-2 stained cells were found in the germinal center. There was no difference of the expressions of COX-1 and COX-2 among adults and children. The only significant difference noted between the adults and children was that, the adults had rich subepithelial plasma cells. CONCLUSION Activated B and T cells express COX-1 and COX-2 in paraffin-embedded tissue sections of chronic tonsillitis. Further studies need to be performed to elucidate expression of COX enzymes and their immunologic role in tonsil diseases. They will play an important role in the treatment of chronic tonsillitis. Additional studies are warranted to study the effects of NSAIDs and selective COX-2 inhibitors in chronic tonsillitis.