Introduction: Diseases of the external ear encompass a wide range of conditions, including infections, neoplasms, and congenital anomalies. These conditions can significantly impact a patient's quality of life, necessitating accurate diagnosis and management. This study aims to evaluate the clinicopathological features of external ear diseases in a tertiary care setting. Materials and Methods: A retrospective analysis was conducted on 70 patients presenting with external ear diseases over a five-year period. Inclusion criteria comprised patients with confirmed diagnoses of external ear diseases, while exclusion criteria included incomplete medical records and non-consenting patients. Data were collected on demographic characteristics, clinical presentation, diagnostic methods, and histopathological findings. Results: The study included 70 patients, with a mean age of 45 years. The most common conditions were otitis externa (40%), benign neoplasms (30%), and malignant neoplasms (10%). Sebaceous Cysts were the most common benign neoplasm, accounting for 57.1% of cases. Chondromas were the second most common benign neoplasm, representing 28.6% of cases. Other benign neoplasms constituted 14.3% of cases, which may include conditions such as lipomas, fibromas, or papillomas. Squamous Cell Carcinoma (SCC) was the most common malignant neoplasm, representing 71.4% of cases. Basal Cell Carcinoma (BCC) accounted for 28.6% of malignant cases.  Conclusion: This study highlights the diverse spectrum of external ear diseases and underscores the importance of histopathological evaluation in diagnosing and managing these conditions. Early diagnosis and appropriate treatment are crucial for improving patient outcomes.

Background: Obesity presents significant challenges in airway management due to altered anatomy, reduced functional residual capacity, and increased risk of rapid desaturation. This study aims to evaluate the effectiveness of various airway management strategies in obese patients undergoing surgery under general anesthesia. Methods: This retrospective study included 180 patients with a body mass index (BMI) ≥30 kg/m² who underwent elective or emergency surgical procedures at a tertiary care center. Data on patient demographics, airway assessment parameters, techniques used (including patient positioning and airway device), and outcomes were analyzed. The primary outcome was first-pass success rate; secondary outcomes included difficult intubation incidence and airway-related complications. Results: Video laryngoscopy (VL) showed a significantly higher first-pass success rate (88.1%) compared to direct laryngoscopy (63.3%, p<0.001). Difficult intubation was more frequent in patients with neck circumference >40 cm and Mallampati grade III/IV. The ramped position improved visualization and reduced complications. Logistic regression confirmed these as independent predictors. Conclusion: Airway management in obese patients is optimized by using video laryngoscopes, ramped positioning, and preoperative risk stratification based on neck circumference and Mallampati grade. Institutional protocols should integrate these strategies to enhance safety.

Background: Coronavirus Disease 2019 (COVID-19) has been associated with a wide spectrum of respiratory complications. Post-recovery pulmonary sequelae remain a growing concern, especially regarding long-term functional impairments. Objectives: To assess the alterations in pulmonary function among patients recovered from COVID-19 and correlate these changes with the severity of the initial infection and radiological findings. Methods: A total of 100 post-COVID-19 patients, assessed 4–6 weeks post-recovery, underwent spirometry to evaluate pulmonary function. Demographic data, clinical symptoms, and radiological findings (HRCT) were also analyzed. The severity of the initial infection was categorized as mild, moderate, or severe based on clinical and radiological criteria. Results: Among the 100 participants, 38% had normal pulmonary function, while 42% demonstrated restrictive patterns, 14% obstructive, and 6% mixed patterns. Patients with moderate and severe COVID-19 were more likely to exhibit abnormal spirometry findings. Dyspnea on exertion and fatigue were reported by 48% and 65% of patients, respectively. Six-minute Walk test (6MWT) desaturation (≥4% drop in SpO₂) occurred in 28% of patients. Radiological abnormalities persisted in 35% of patients, of whom 85.7% had restrictive defects. Conclusions: A significant proportion of post-COVID-19 patients demonstrated pulmonary function abnormalities, particularly those recovering from moderate to severe illness. These findings underscore the importance of pulmonary follow-up and rehabilitation in post-COVID-19 care.

Background: The Circle of Willis (CoW) is a critical anastomotic structure in cerebral circulation, yet its anatomical variability remains incompletely characterized. This study aimed to investigate the morphometric features and variants of the CoW in a human cadaveric cohort. Methods: Fifty cadaveric brains (28 male, 22 female; mean age 61.3 ± 9.7 years) were dissected to analyze the CoW. Vessel diameters and lengths were measured using digital calipers (precision: 0.01 mm). Configurations were classified as complete or incomplete, and variants such as hypoplasia, aplasia, and fetal-type posterior cerebral artery (PCA) were recorded. Statistical analysis assessed gender differences and side-to-side asymmetry. Results: A complete CoW was observed in 44% of specimens (n = 22), while 56% (n = 28) were incomplete. The most frequent variant was unilateral posterior communicating artery (PComA) hypoplasia (32%, n = 16), followed by bilateral PComA hypoplasia (16%, n = 8) and AComA hypoplasia (20%, n = 10). Mean vessel diameters included: internal carotid artery (ICA) 4.8 ± 0.6 mm, ACA A1 segment 2.3 ± 0.4 mm, and PComA 1.8 ± 0.6 mm. Fetal-type PCA occurred in 20% (n = 10). Asymmetry (>1 mm) was noted in 36% (n = 18), predominantly in the ACA A1 segment. No significant gender differences were found (p = 0.58 for variants; p = 0.31 for ICA diameter). Inter-observer variability was <5%. Conclusions: The CoW exhibits considerable anatomical variability, with incomplete configurations and PComA hypoplasia being prevalent. These findings enhance understanding of cerebrovascular anatomy for clinical and research applications.

Introduction:  Intraocular pressure (IOP) is regulated by the balance between the production and outflow of aqueous humor, with IOP homeostasis primarily maintained through adjustments in aqueous humor outflow resistance Methods A randomized, comparative study was conducted on 146 ocular hypertensive patients attending OPD at tertiary care hospital. All the patient demographical status, symptoms, prescription pattern, IOP were noted at baseline and after treatment was measured at 1^st, 2^nd and 3^rd weeks. The observations and results were systematically tabulated and data were analyzed using SPSS software. An unpaired t-test and Anova test was used to determine statistical significance between all the groups. p value <0.05 considered statically significant and p <0.005 considered as highly significant. Results: Among 146 ocular hypertensive patient’s majority of the were male (65.75%) with in the age group of 36 to 40 years (32.87%) followed by 31 to 35 (26.02%) respectively. 116 (79.45%) having bilateral ocular hypertension. The patients having symptoms of pain 132 (90.41%), dryness of eye 124 (84.93%), redness of eye 98 (67.12%), Improper vision 74 (50.68%) and Headache 26 (17.80%) respectively. As per sociodemographic status having majority of the patients having myopia 114 (78.08%) with high blood pressure 97(66.43%) and diabetes mellitus 86 (58.90%) respectively. After treatment with ocular hypotensive drugs the majority of the patient shows significant reduction in IOP after 3 weeks of treatment with different classes of ocular hypotensive drugs p (<0.05) respectively Conclusion Ocular hypotensive drugs shows better improvement in IOP in ocular hypertensive patients. 

Introduction During the past few years there has been an increase in the number of one-stage interventions for the septic revisions of the total knee and total hip replacement prosthetics, even though the most frequently used method in these situations remains the two-stage revision. The objective of this review is to identify and analyze data from field literature regarding the outcomes of these two techniques. Review The results were similar, with a mid-value of 12.8% (range 0-33%) reinfection rate in one-stage and a mid-value of 14.6% (range 0-42%) reinfection rate in two-stage revision. A fixed spacer was used in 31.7% of cases with two-stage revision and an articulating spacer in 68.3% of cases. The functional results were similar, with a KSS score of 80 for the one-stage revision, and of 78 for the two-stage revision. The knee joint mobility was higher after the two-stage revision. The reinfection rate was 23% for the fixed spacer and 8% for the articulating one. Regarding the post-operative functional score, this was similar for both techniques. For the one-stage revision, the KSS score values were between 72 and 88 with a mid-value of 80 and for the two-stage revision the KSS score was between 64 and 86 with a mid-value of 78. Conclusions Our data supports the use of single stage revision for periprosthetic knee infection, in carefully selected patients, as an alternative to a two-stage procedure. In these cases, the one-stage procedure was associated with a similar reinfection rate and similar functional outcomes as the two-stage. The one-stage revision reduces the hospitalization, the cost and more important the patient’s surgery stress.

Introduction The coronavirus responsible for SARS-CoV-2 infection is an encapsulated RNA virus, member of the Nidovirales order. Its transmission is mainly through Flügge's droplets, but other ways of transmitting the infection have been demonstrated, the presence of viral RNA was detected in feces, sperm, hematogenous, mucous tissue. Review Our paper is a review of a series of retrospective case studies from February 2020-present, from the specialized literature, aiming at SARS-CoV-2 infection in pregnant women, as well as the hypothesis of its vertical transmission. Conclusions In conclusion, a certainty diagnosis is difficult to establish, due to the low number of infections in pregnant women, but also by the limitations of test methods: once by the relatively low sensitivity and specificity of tests (RT-PCR-sensitivity 70%, immunological: antibody determination of IgM type has a specificity of 80-95%, and in the case of IgG type antibodies, the sensitivity increases over time and inversely proportional to the symptoms). Another limitation in establishing a positive diagnosis is the difficulty of visualizing the virus in electronic microscopy, which is why identifying susceptible fetal organs, lung tissue, heart, digestive tract, through immunohistochemistry studies, could be a solution to highlight coronavirus infection and a step forward in demonstrating the hypothesis of vertical transmission.

Introduction Since December 2019, severe acute respiratory syndrome coronavirus-2 SARS-CoV-2, the etiologic agent of COVID-19, has been widely spreading through the world and has become a global pandemic, according to the World Health Organization. Most pediatric patients with COVID-19 are asymptomatic or show only mild symptoms, However, an increase in the number of the children with SARS-CoV-2 presented with a significant systemic inflammatory response similar to Kawasaki syndrome, known as multisystem inflammatory syndrome in children (MIS-C) or pediatric inflammatory multisystem syndrome (PIMS), supporting the idea that COVID-19 is a triggering factor. Methods A comprehensive search strategy was designed to retrieve all articles published from October 2019 to 30 June 2020, by using the terms COVID-19, SARS-CoV-2, Coronavirus, Kawasaki, multisystem inflammatory syndrome, Kawasaki syndrome, cytokine storm and myocarditis in several electronic databases and Government Agencies Websites (PubMed, Google Scholar, Centers for Disease Control and Prevention, WHO and UK Royal College of Pediatrics and Child Health). Retrospective observational studies, case series, and case report studies about the main clinical characteristics, laboratory results, treatment, and patients' responses were included. Conclusions MIS-C leads to serious life-threatening conditions in children and adolescence, including toxic shock syndrome (TSS) and cardiac involvement. This paper aimed to bring this subset of children to the attention of clinicians to optimize early recognition and management of this syndrome during the pandemic. We summarized the main clinical pictures, defined laboratory findings, and illustrated the optimal treatment of children with MIS-C related to SARS-CoV-2 to help clinicians to reduce mortality and morbidity of the disease.

Introduction The retrograde ejaculation could be a postoperative complication in the prostate hyperplasia surgery and a cause of male infertility in couples. We hereby report such a case which was managed with positive outcome. Case report The paper presents the case of a couple diagnosed and successfully treated for primary male infertility. The 61-year-old male partner had ejaculatory dysfunction with complete retrograde ejaculation, in urine, as a result of a transurethral resection of the prostate (TURP). The recovery of the male reproductive cells from urine and the use of assisted reproductive techniques, through the intracytoplasmic injection of sperm cells into the oocyte, have resulted in a healthy child. Conclusions The particularities of this case lie in the recognition of the importance of the urological and reproductive aspects occurred as postoperative complications due to the TURP. The detailing of the postoperative risks and the adequate substantiation of surgical protocol for benign prostate hyperplasia need to take into account the reproductive wishes and the future planning of a possible pregnancy for the couple.

Introduction Fungal rhinosinusitis is an acute or chronic disease that implies an inflammatory response or allergic reaction of rhinosinusal mucous membrane, due to the presence of fungi at this level. Methods We present a retrospective study on patients diagnosed with chronic fungal rhinosinusitis based on endoscopic and radiologic criteria and treated surgically by endoscopic approach in the ENT&HNS Department "Sfânta Maria” Hospital, Bucharest. The aim of the study was to determine the type of fungal sinusitis (non-invasive sinusitis - fungus ball or acute invasive sinusitis), the complications and treatment difficulties. Results After selection of the patients according to the inclusion criteria, there were 72 patients with non-invasive fungal sinusitis and two patients with invasive fungal sinusitis. The incidence among female patients was more than double than in males. Maxillary sinus was the most involved sinus, followed by sphenoid sinus. Most complications occurred due to sphenoid fungal sinusitis (4.05%), while both patients with invasive sinusitis presented major rhino-orbital and endocranial complications. Management of the patients included endoscopic sinus surgery: middle meatal antrostomy (78.37%), sphenoidotomy (17.56%), ethmoidectomy (1.35%) and extended sinus surgery – sinuses, orbit, endocranial (2.70%). Conclusions The most frequent form of fungal sinusitis was the non-invasive one (fungus ball) while invasive sinusitis was fortunately a rare condition. Surgical treatment is the main option. Medical treatment is adjuvant mainly in severe cases, as there are no proofs regarding its efficacy in regular cases such as fungus ball. Although the incidence of complications is low, when they occur they could be life-threatening. Extended endoscopic sinus surgery is required in order to remove all the necrotic tissue.

Introduction The objectives of the study were to report the prevalence as well as the characteristics of the extended-spectrum β-lactamases (ESBL) and carbapenemases producing Enterobacteriaceae isolated from patients in provincial Hospital Hassan II in Settat-Morocco. Methods From January 2012 to December 2014, non-duplicate 183 strains of Enterobacteriaceae were isolated from hospitalized patients. Resistance genes were characterized by polymerase chain reaction with specific primers for ESBL, carbapenemases and AmpC cephalosporinases. PCR products of ESBL genes were sequenced. The molecular epidemiology was investigated using pulsed field gel electrophoresis (PFGE). Results The overall prevalence of ESBL producing Enterobacteriaceae (ESBL-E) was 24.59% (45/183), among these, 44.4% (n=20) were Klebsiella pneumoniae, 42.2% (n=19) were Escherichia coli, 11.1% (n=5) were Enterobacter cloacae and 2.2% (n=1) were Morganella morganii. The most frequent ESBL genes were blaCTXM-15(35/45, 77.8%). Plasmid mediated Amp-C β-lactamases DHA-1 was found in one E. cloacae. The prevalence of carbapenemases producing Enterobacteriaceae (CPE) isolates was 5.46% (10/183) and all these CPE isolates were found to carry the blaOXA-48 gene. Previously hospitalization, diabetes mellitus, urinary tract infection, central venous catheter and mechanical ventilation were found as significant risk factors. PFGE typing for carbapenemase producing strains revealed five pulsotypes for K. pneumoniae and three for E. cloacae. Conclusions Our data have shown a high frequency of ESBL and CPE with the emergence of CTX-M-15 and OXA-48 producers. This remarkable increase at the provincial hospital Hassan II in Settat urges us to opt for specific strategies for regular surveillance.

Introduction Necrotising fasciitis (NF) is a rare, life-threatening, infectious condition that requires early diagnosis and treatment. To the best of our knowledge, there is no study in literature that has determined a scoring system and/or predictor(s) of mortality from easily obtainable (non-physician-related) NF patient admission data. Objectıves: to determine predictor(s) of the outcome of NF from the above-mentioned early admission patient parameters. It was also aimed to ascertain from real life data whether sodium-glucose co-transporter 2 (SGLT2) inhibitor, a new oral hypoglycemic agent, increases the risk and frequency of NF as has been suggested. Methods A retrospective evaluation was made of the data of a total of 106 patients diagnosed with NF. Early obtainable patient data (age, gender, the presence of diabetes mellitus (DM), laboratory measures, causative pathogens) were recorded and analyzed according to the outcome results (survival or death). Results The mean age of the patients was 58±16 years old. Death occurred in 32 of the 106 patients with NF. Age, the presence of DM, serum creatinine level, blood platelet (PLT) count, and Acinetobacter or Klebsiella spp. as causative pathogens of NF were significantly associated with mortality. Using these parameters, a pilot model to predict mortality was developed. Despite the increased use of SGLT2 inhibitors, no drug-related NF cases were encountered. Conclusions Using the above-mentioned model, the mortality of NF patients can be predicted from simple and obtainable data. Further studies are needed to confirm and validate this pilot model.

Introduction The disease caused by a virus called SARS-CoV-2, which first appeared in China in late 2019 and can be transmitted from human to human, was named COVID-19 and the World Health Organization declared COVID-19 a pandemic on March 12th, 2020. In this study, we aim to find the impact of this outbreak on emergency practices. Methods Patients admitted to Sakarya University Training and Research Hospital adult emergency department between the dates 20/03/2018-03/04/2018, 20/03/2019-03/04/2019 and 20/03/2020-03/04/2020 were included in the study. The emergency department admissions between these dates were retrospectively investigated and analyzed statistically. Results During the study period, a total 36,341 patients, of which 15,048 between 20/03/2018 and 03/04/2018, 15,048 between 20/03/2019 and 03/04/2019, and 6,245 between 20/03/2020 and 03/04/2020 were admitted to the Sakarya University Training and Research Hospital adult emergency department. Of the patients, 16588 were female and 19753 were male. A 4-tier triage system is applied in our hospital. According to the triage system, 19270 patients were admitted to the Green Room, 8312 patients to the Trauma Room and 8759 patients to the Yellow Room. A statistically significant difference was found in the distribution of departments admitted by the patients by year. Admissions, especially between 17:00 and 24:00, decreased significantly. There was a statistically significant decrease in the admissions of foreign nationals to the emergency department in 2020, compared to the previous years. Conclusions In the emergency departments of hospitals that serve COVID-19 patients, there may be a decrease in patient admissions compared to previous years.

Introduction This study aims to assess the efficacy of magnetic resonance imaging (MRI), mammography and ultrasound (US) in detection of breast cancer presenting as mass or non-mass lesions. Methods MRI was performed in 53 patients with a suspected breast cancer based on mammography and US features. US or mammography-guided biopsies were obtained in patients with BI-RADS category 4-5. Histopathological results were considered as the gold standard for diagnosis, and based on histopathology results, mammography and MRI characteristics of mass, non-mass benign or malign lesions were evaluated. Results A benign pathology was detected in 22 cases (41.5%) and malignant pathology in 31 cases (58.4%). The mean age was 37.3 years in patients with a benign diagnosis and 50.5 years in patients with a malignant diagnosis. Overall, 21 (68%) of the malignant cases had a mass appearance and 10 (32%) had a non-mass appearance, 90% of malignant lesions were isointense or hypointense on T2-weighted images. The positive predictive value (PPV) for malignancy was 78.2% with peripheral contrast enhancement, 88% with hypointensity on T2-weighted images and 83.3% in heterogeneous contrast enhancement. PPV for benignity was 100% with homogeneous contrast enhancement, 100% dark internal septa in the mass, and 54.5% with regional contrast enhancement. The most common type enhancement curve was type 2 with plateau detected in 20 cases out of the whole study population. Conclusions Although MRI is more sensitive in characterization of breast lesions, correlation with BI-RADS category and histopathology allows more accurate clinical decisions and better outcomes by avoiding false positivity, unnecessary medical intervention and concerns. MRI findings of breast lesions should be evaluated together with mammography and ultrasonography.

The increase in the number of SARS-CoV-2 infection cases earlier this year and the proclamation of the pandemic by the World Health Organization has changed the human behavior globally. First of all, the pandemic had a strong psychological impact, with people continuously exposed to alarming news, uncertainties surrounding the virus and the possible consequences on their health. Home quarantine, with restricted freedom of movement, has induced panic and hysteria among people. We remember that at the beginning of the pandemic, the supermarkets were stormed, and their shelves were emptied by people trying to stock up out of fear of the unknown. Such situations have not been encountered only in our country but have been present globally.