MyoPS: A benchmark of myocardial pathology segmentation combining three-sequence cardiac magnetic resonance images.

Assessment of myocardial viability is essential in diagnosis and treatment management of patients suffering from myocardial infarction, and classification of pathology on the myocardium is the key to this assessment. This work defines a new task of medical image analysis, i.e., to perform myocardial pathology segmentation (MyoPS) combining three-sequence cardiac magnetic resonance (CMR) images, which was first proposed in the MyoPS challenge, in conjunction with MICCAI 2020. Note that MyoPS refers to both myocardial pathology segmentation and the challenge in this paper. The challenge provided 45 paired and pre-aligned CMR images, allowing algorithms to combine the complementary information from the three CMR sequences for pathology segmentation. In this article, we provide details of the challenge, survey the works from fifteen participants and interpret their methods according to five aspects, i.e., preprocessing, data augmentation, learning strategy, model architecture and post-processing. In addition, we analyze the results with respect to different factors, in order to examine the key obstacles and explore the potential of solutions, as well as to provide a benchmark for future research. The average Dice scores of submitted algorithms were 0.614±0.231 and 0.644±0.153 for myocardial scars and edema, respectively. We conclude that while promising results have been reported, the research is still in the early stage, and more in-depth exploration is needed before a successful application to the clinics. MyoPS data and evaluation tool continue to be publicly available upon registration via its homepage (www.sdspeople.fudan.edu.cn/zhuangxiahai/0/myops20/).

Enamel wear against monolithic zirconia restorations: A meta-analysis and systematic review of in vitro studies.

OBJECTIVE: An assessment was performed to identify and evaluate dental enamel wear caused by monolithic zirconia restoration. Literature searches were conducted in PubMed, Science Direct, Cochrane Evidence, and the Cochrane Library up to May 2020. MATERIAL AND METHODS: Studies were selected for systematic review according to the inclusion (articles conducted on the wear of enamel samples opposing monolithic zirconia) and exclusion (case reports, non-English articles, and monolithic zirconia samples facing other materials rather than human enamel) criteria. Of those, articles on polished and glazed monolithic zirconia subjected to a 50 N vertical load with a range of 240,000-250,000 cycles, equivalent to 1 year of in vivo mastication, were included in the meta-analysis. RESULTS: In total, 3968 articles were pooled. Twenty-five articles met the inclusion criteria for the systematic review. Three studies were included in the meta-analysis. The results showed that the enamel wear against monolithic zirconia was within the statistically accepted level. Moreover, the polished monolithic zirconia surface caused less enamel wear than the glazed surface. CONCLUSION: This review indicates that monolithic zirconia restorations cause acceptable antagonist enamel wear. Moreover, the meta-analysis results agreed that the final restoration's surface texture plays an essential role in the wear process. CLINICAL SIGNIFICANCE: Monolithic zirconia restorations have been widely used in dental practice because they eliminate the chipping problems resulting from using veneered restorations. With recent technology development, monolithic zirconia has obtained more esthetic features and a more natural look. However, due to the high strength and surface roughness of monolithic zirconia, wear on the antagonist's teeth was detected. The results showed that this wear amount was statistically acceptable and lower than other ceramics such as feldspathic porcelain and enamel. Furthermore, surface treatment methods must be applied to minimize tooth wear, as polished or glazed surfaces interfere with enamel loss.

Comparison of demographic and clinical characteristics of hospitalized COVID-19 patients with severe/critical illness in the first wave versus the second wave.

Due to current advances and growing experience in the management of coronavirus Disease 2019 (COVID-19), the outcome of COVID-19 patients with severe/critical illness would be expected to be better in the second wave compared with the first wave. As our hospitalization criteria changed in the second wave, we aimed to investigate whether a favorable outcome occurred in hospitalized COVID-19 patients with only severe/critical illness. Among 642 laboratory-confirmed hospitalized COVID-19 patients in the first wave and 1121 in the second wave, those who met World Health Organization (WHO) definitions for severe or critical illness on admission or during follow-up were surveyed. Data on demographics, comorbidities, C-reactive protein (CRP) levels on admission, and outcomes were obtained from an electronic hospital database. Univariate analysis was performed to compare the characteristics of patients in the first and second waves. There were 228 (35.5%) patients with severe/critical illness in the first wave and 681 (60.7%) in the second wave. Both groups were similar in terms of age, gender, and comorbidities, other than chronic kidney disease. Median serum CRP levels were significantly higher in patients in the second wave compared with those in the first wave [109 mg/L (interquartile range [IQR]: 65-157) vs. 87 mg/L (IQR: 39-140); p < 0.001]. However, intensive care unit admission and mortality rates were similar among the waves. Even though a lower mortality rate in the second wave has been reported in previous studies, including all hospitalized COVID-19 patients, we found similar demographics and outcomes among hospitalized COVID-19 patients with severe/critical illness in the first and second wave.

Could Some Laboratory Parameters Predict Mortality in COVID-19?

BACKGROUND: The number of confirmed cases of COVID-19 continues to increase worldwide and threatens public health. Our aim in this study is to examine the relationship between some laboratory parameters and hematological ratios with the severity of the disease and hospital mortality. METHODS: This study was designed as a retrospective cohort. The clinical data of 743 COVID-19 diagnosed patients who were eligible for hospitalization between March 16, and May 15, 2020 analyzed, retrospectively. The patients were separated into two groups as discharged from hospital (n = 681) and dead in hospital (n = 62). ROC curves and cutoff values of NLR (Neutrophil/Lymphocyte Ratio), PLR (Platelet/Lymphocyte Ratio), MLR (Monocyte/ Lymphocyte Ratio), CRP, and ferritin upon admission to hospital were calculated for the two groups. Binary Logistic Regression used to determine independent risk factors for mortality. RESULTS: The difference between both groups for age, duration in hospital, WBC, neutrophil, lymphocyte, NLR, PLR, MLR, CRP, and ferritin values were statistically significant. NLR had the highest area under the curve with a cutoff of 5.5 in the ROC curve [(AUC: 0.892, 95% CI: 0.844 - 0.939); Sensitivity = 85%, Specificity = 84%]. NLR, MLR, PLR, CRP and Ferritin groups have significant effects on the survival times of the Covid-19 patients. According to logistic regression analysis, increments of NLR (OR = 18.1, 95% CI: 6.4 - 51.4), CRP (OR = 5.5, 95% CI: 2.5 - 12.2), and age (OR = 2.7 95% CI: 1.3 - 5.5) values proportionally increase the death probability. CONCLUSIONS: NLR, CRP, and age are independent risk factors for mortality from COVID-19. We believe that evaluating these parameters together during diagnosis will be important in predicting the prognosis of the disease and in treatment approaches.

Cytokine storm in severe COVID-19 pneumonia.

In this study, laboratorial parameters of hospitalized novel coronavirus (COVID-19) patients, who were complicated with severe pneumonia, were compared with the findings of cytokine storm developing in macrophage activation syndrome (MAS)/secondary hemophagocytic lymphohistiocytosis (sHLH). Severe pneumonia occurred as a result of cytokine storm in some patients who needed intensive care unit (ICU), and it is aimed to determine the precursive parameters in this situation. Also in this study, the aim is to identify laboratory criteria that predict worsening disease and ICU intensification, as well as the development of cytokine storm. This article comprises a retrospective cohort study of patients admitted to a single institution with COVID-19 pneumonia. This study includes 150 confirmed COVID-19 patients with severe pneumonia. When they were considered as severe pneumonia patients, the clinic and laboratory parameters of this group are compared with H-score criteria. Patients are divided into two subgroups; patients with worsened symptoms who were transferred into tertiary ICU, and patients with stable symptoms followed in the clinic. For the patients with confirmed COVID-19 infection, after they become complicated with severe pneumonia, lymphocytopenia (55.3%), anemia (12.0%), thrombocytopenia (19.3%), hyperferritinemia (72.5%), hyperfibrinogenemia (63.7%) and elevated lactate dehydrogenase (LDH) (90.8%), aspartate aminotransaminase (AST) (31.3%), alanine aminotransaminase (ALT) (20.7%) are detected. There were no significant changes in other parameters. Blood parameters between the pre-ICU period and the ICU period (in which their situation had been worsened and acute respiratory distress syndrome [ARDS] was developed) were also compared. In the latter group lymphocyte levels were found significantly reduced (p = 0.01), and LDH, highly sensitive troponin (hs-troponin), procalcitonin, and triglyceride levels were significantly increased (p < 0.05). In addition, there was no change in hemoglobin, leukocyte, platelet, ferritin, and liver function test levels, including patients who developed ARDS, similar to the cytokine storm developed in MAS/sHLH. COVID-19 pneumonia has similar findings as hyperinflammatory syndromes but does not seem to have typical features as in cytokine storm developed in MAS/sHLH. In the severe patient group who has started to develop ARDS signs, a decrease in lymphocyte level in addition to the elevated LDH, hs-troponin, procalcitonin, and triglyceride levels can be a predictor in progression to ICU admission and could help in the planning of anti-cytokine therapy.

Comparative Analysis of Three Different Drug Distribution Schemes for Smoking Cessation.

OBJECTIVE: This study aimed to compare the success rate of 3 different drug prescription policies: Free drugs with online system prescription, free drugs with doctor's prescription, and drugs paid for by patients with doctor's prescription. MATERIAL AND METHODS: The effect of 2 different Ministry of Health (MoH) projects with free-of-charge and self-payment pharmacotherapies for smoking cessation were compared. Patients who completed 6 months of pharmacotherapy and follow-up were evaluated. The first period was free-of-charge medication, which was determined by an online system, the following period was the self-payment period, and the third period was free medication, which was prescribed by a doctor. In all the groups, smoking habits in pack years and comorbidities of the patients were recorded, and pulmonary function tests (PFTs) and expiratory carbon dioxide (CO2) measurements were performed. Patients who had an expiratory CO2 level >5 ppm at the control visits were accepted as quitters. RESULTS: A total of 829 patients with 438 patients in the first free-of-charge period (group 1), 111 in the self-payment period (group 2), and 280 in the second free-of-charge period (group 3) were enrolled in the study. Smoking cessation rates were significantly higher in the self-payment medication group (25%) according to the MoH's free-of-charge project groups. There was no difference in smoking cessation rates between the 2 free-of-charge medication project groups (15% in group 1 and 11% of group 3). Among all the patients, we compared 124 patients who quit smoking with 705 patients who did not. The quitters were older, mostly male, and heavier smokers. In addition, the number of patients with chronic obstructive pulmonary disease and obstructive PFT rates were higher among the quitters. Their dependency score, PFTs, and the use of free medication was lower, and treatment duration was longer. Independent factors that increased smoking cessation success were longer treatment duration, lower dependency score, and self-payment of medication. CONCLUSION: Free medications provided via 2 different modalities did not increase the smoking cessation success. Paying for the medication, lower dependency score, and longer treatment duration increased smoking cessation success independently.

Changes in antimicrobial resistance and outcomes of health care-associated infections.

To describe the change in the epidemiology of health care-associated infections (HAI), resistance and predictors of fatality we conducted a nationwide study in 24 hospitals between 2015 and 2018. The 30-day fatality rate was 22% in 2015 and increased to 25% in 2018. In BSI, a significant increasing trend was observed for Candida and Enterococcus. The highest rate of 30-day fatality was detected among the patients with pneumonia (32%). In pneumonia, Pseudomonas infections increased in 2018. Colistin resistance increased and significantly associated with 30-day fatality in Pseudomonas infections. Among S. aureus methicillin, resistance increased from 31 to 41%.

Mediastinal lymphadenopathy may predict 30-day mortality in patients with COVID-19.

PURPOSE: There is scarce data on the impact of the presence of mediastinal lymphadenopathy on the prognosis of coronavirus-disease 2019 (COVID-19). We aimed to investigate whether its presence is associated with increased risk for 30-day mortality in a large group of patients with COVID-19. METHOD: In this retrospective cross-sectional study, 650 adult laboratory-confirmed hospitalized COVID-19 patients were included. Patients with comorbidities that may cause enlarged mediastinal lymphadenopathy were excluded. Demographics, clinical characteristics, vital and laboratory findings, and outcome were obtained from electronic medical records. Computed tomography scans were evaluated by two blinded radiologists. Univariate and multivariate logistic regression analyses were performed to determine independent predictive factors of 30-day mortality. RESULTS: Patients with enlarged mediastinal lymphadenopathy (n = 60, 9.2%) were older and more likely to have at least one comorbidity than patients without enlarged mediastinal lymphadenopathy (p = 0.03, p = 0.003). There were more deaths in patients with enlarged mediastinal lymphadenopathy than in those without (11/60 vs 45/590, p = 0.01). Older age (OR:3.74, 95% CI: 2.06-6.79; p < 0.001), presence of consolidation pattern (OR:1.93, 95% CI: 1.09-3.40; p = 0.02) and enlarged mediastinal lymphadenopathy (OR:2.38, 95% CI:1.13-4.98; p = 0.02) were independently associated with 30-day mortality. CONCLUSION: In this large group of hospitalized patients with COVID-19, we found that in addition to older age and consolidation pattern on CT scan, enlarged mediastinal lymphadenopathy were independently associated with increased mortality. Mediastinal evaluation should be performed in all patients with COVID-19.

Clinical characteristics of adult patients hospitalized with laboratory-confirmed COVID-19 pneumonia.

BACKGROUND: The clinical spectrum of COVID-19 has a great variation from asymptomatic infection to acute respiratory distress syndrome and eventually death. The mortality rates vary across the countries probably due to the heterogeneity in study characteristics and patient cohorts as well as treatment strategies. Therefore, we aimed to summarize the clinical characteristics and outcomes of adult patients hospitalized with laboratory-confirmed COVID-19 pneumonia in Istanbul, Turkey. METHODS: A total of 722 adult patients with laboratory-confirmed COVID-19 pneumonia were analyzed in this single-center retrospective study between March 15 and May 1, 2020. RESULTS: A total of 722 laboratory-confirmed patients with COVID-19 pneumonia were included in the study. There were 235 (32.5%) elderly patients and 487 (67.5%) non-elderly patients. The most common comorbidities were hypertension (251 [34.8%]), diabetes mellitus (198 [27.4%]), and ischemic heart disease (66 [9.1%]). The most common symptoms were cough (512 [70.9%]), followed by fever (226 [31.3%]), and shortness of breath (201 [27.8%]). Lymphocytopenia was present in 29.7% of the patients, leukopenia in 12.2%, and elevated CRP in 48.8%. By the end of May 20, 648 (89.7%) patients had been discharged and 60 (8.5%) patients had died. According to our study, while our overall mortality rate was 8.5%, this rate was 14.5% in elderly patients, and the difference was significant. CONCLUSIONS: This case series provides characteristics and outcomes of sequentially adult patients hospitalized with laboratory-confirmed COVID-19 pneumonia in Turkey.

COVID-19 Pulmonary Infection with Pneumothorax in a Young Patient.

Coronavirus disease (COVID-19), first reported in December 2019 in Wuhan, China, has spread all over the world in a short time and was declared as a pandemic by the World Health Organization (WHO). During COVID-19 pandemic, chest computed tomography (CT) imaging has become an important tool with high sensitivity for diagnosis due to the low positive rate of the real-time reverse-transcriptase polymerase chain reaction (RT-PCR). Furthermore, the chest CT has played an important role in the diagnosis of underlying pulmonary lesions. In this case report, we present a patient who was admitted to the emergency department with fever, cough and left shoulder pain, and was subsequently diagnosed with both COVID-19 and pneumothorax following chest CT and RT-PCR test. Key Words: COVID-19, Coronavirus, Pneumothorax, Tomography.

Performance of pneumonia severity index and CURB-65 in predicting 30-day mortality in patients with COVID-19.

OBJECTIVE: The aim of the study was to analyze the usefulness of CURB-65 and the pneumonia severity index (PSI) in predicting 30-day mortality in patients with COVID-19, and to identify other factors associated with higher mortality. METHODS: A retrospective study was performed in a pandemic hospital in Istanbul, Turkey, which included 681 laboratory-confirmed patients with COVID-19. Data on characteristics, vital signs, and laboratory parameters were recorded from electronic medical records. Receiver operating characteristic analysis was used to quantify the discriminatory abilities of the prognostic scales. Univariate and multivariate logistic regression analyses were performed to identify other predictors of mortality. RESULTS: Higher CRP levels were associated with an increased risk for mortality (OR: 1.015, 95% CI: 1.008-1.021; p < 0.001). The PSI performed significantly better than CURB-65 (AUC: 0.91, 95% CI: 0.88-0.93 vs AUC: 0.88, 95% CI: 0.85-0.90; p = 0.01), and the addition of CRP levels to PSI did not improve the performance of PSI in predicting mortality (AUC: 0.91, 95% CI: 0.88-0.93 vs AUC: 0.92, 95% CI: 0.89-0.94; p = 0.29). CONCLUSION: In a large group of hospitalized patients with COVID-19, we found that PSI performed better than CURB-65 in predicting mortality. Adding CRP levels to PSI did not improve the 30-day mortality prediction.

Cytotoxicity of Different Nano Composite Resins on Human Gingival and Periodontal Ligament Fibroblast Cell Lines: An In Vitro Study.

The aim of this study is to determine the cytotoxicity of three different nano composite resins (CRs) on human gingival fibroblast (hGF) and periodontal ligament fibroblast (hPDLF) cell lines. These CRs selected were nanohybrid organic monomer-based Admira Fusion (AF), nanohybrid Bis-(acryloyloxymethyl) tricyclo 5.2.1.0.sup.2,6 decane-based Charisma Topaz (CT), and supra nano filled resin-based Estelite Quick Sigma (EQS). MTT assay was performed to assess the cytotoxicity of CRs at 24 h and one week. AF and EQS applied on hGF cells at 24 h and one week demonstrated similar cytotoxic outcomes. Cytotoxicity of CT on hGF cells at one week was higher than 24 h (p = 0.04). Cytotoxicity of CT on hGF cells was higher at 24 h (p = 0.002) and one week (p = 0.009) compared to control. All composites showed higher cytotoxicity on hPDLF cells at one week than the 24 h (AF; p = 0.02, CT; p = 0.02, EQS; p = 0.04). AF and EQS demonstrated lower cytotoxicity on hPDLF cells than the control group at 24 h (AF; p = 0.01, EQS; p = 0.001). CT was found more cytotoxic on hPDLF cells than the control (p = 0.01) and EQS group (p = 0.008) at one week. The cytotoxicity of CRs on hGF and hPDLF cells vary, according to the type of composites, cell types, and exposure time.

Intra- and Inter-Rater Reliability of Ultrasound Measurements of Supraspinatus Tendon Thickness, Acromiohumeral Distance, and Occupation Ratio in Patients With Shoulder Impingement Syndrome.

OBJECTIVES: This study aims to evaluate the intra- and inter-rater reliability coefficients of the supraspinatus tendon thickness, acromiohumeral distance, and occupation ratio in patients with shoulder impingement syndrome. PATIENTS AND METHODS: The study included 83 patients (21 males, 62 females; mean age 51.6±11.0 years; range, 26 to 70 years) with shoulder impingement syndrome. The supraspinatus tendon thickness, acromiohumeral distance, and occupation ratio values were obtained one week apart by two observers. The intraclass correlation coefficient (ICC), minimum detectable change, and standard error of measurement were calculated. RESULTS: The first observer had excellent intra-rater reliability in all measurements (ICC >0.90) with minimum detectable change of 0.740-0.047 mm and standard error of measurement of 0.017-0.26 mm. The second observer had excellent intra-rater reliability in supraspinatus tendon thickness and acromiohumeral distance measurements (ICC >0.90) with minimum detectable change of 0.498-0.770 mm and standard error of measurement of 0.18-0.28 mm and good intra-rater reliability in the occupation ratio measurement (ICC; 0.75-0.90) with minimum detectable change of 0.060 mm and standard error of measurement of 0.022 mm. Inter-rater reliability coefficients were 0.916 (95% confidence interval [CI]; 0.873-0.945) for supraspinatus tendon thickness, 0.943 (95% CI; 0.914-0.963) for acromiohumeral distance with minimum detectable change of 0.673 mm and standard error of measurement of 0.243 mm and 0.790 (%95 CI; 0.693-0.853) for occupation ratio with minimum detectable change of 0.077 mm and standard error of measurement of 0.028 mm. CONCLUSION: These findings suggest that ultrasonographic measurements of the supraspinatus tendon thickness, acromiohumeral distance and occupation ratio can be reliable and consistent for clinical evaluation of patients with shoulder impingement syndrome in terms of supporting diagnosis and monitoring the treatment effect.

Comparison of effects of low-level laser therapy and extracorporeal shock wave therapy in plantar fasciitis treatment: A randomized, prospective, single-blind clinical study.

OBJECTIVES: The aim of this study is to compare the efficacy of extracorporeal shock wave therapy (ESWT) and low-level laser therapy (LLLT) in terms of fascia thickness, heel pain, and foot functions in patients with plantar fasciitis (PF). PATIENTS AND METHODS: Between April 2015 and October 2015, a total of 34 patients (5 males, 29 females; mean age 51.5±10.8 years; range, 18 to 65 years) with PF were randomized into two treatment groups to receive either ESWT or LLLT using closed envelope method. The patients were evaluated before and after treatment and one month after treatment using the visual analog scale (VAS)-pain, Foot Function Index (FFI), and plantar fascia thickness measured by ultrasonography. RESULTS: A significant improvement in the VAS-pain and FFI scores and plantar fascia thickness was observed in both groups after treatment and one month after treatment, compared to pre-treatment values (p<0.05). Changes over time in these outcome parameters were not different between study groups (p>0.05). CONCLUSION: Our study results suggest that both ESWT and LLLT seem to be effective on pain, foot functions, and fascia thickness in the treatment of PF.Presented at the 26th National Congress of Physical Medicine and Rehabilitation, April 25-29, 2017 Antalya, Turkey.

Different VDR, VDBP genotypes and vitamin D levels may effect obstructive sleep apnea syndrome.

Obstructive sleep apnea syndrome (OSAS) is a highly prevalent disorder which results in markedly reduced (hypopnea) or absent (apnea) airflow at the nose/mouth. Since vitamin D deficiency has found in an association with some disorders it is thought to be related with OSAS progression. The aim of this study is to investigate the association between VDR, VDBP mutations, vitamin D level and some environmental risk factors with OSAS. Fifty individuals who were diagnosed as OSAS were selected as patients, 50 healthy volunteers without any disease were selected as controls. FokI (rs2228570) and BsmI (rs1544410) mutations in VDR; rs4588 and rs7041 mutations in VDBP were investigated with quantitative real-time polymerase chain reaction (qPCR). Other risk factors were also investigated. Results were evaluated statistically. Statistically significant differences were observed according to the baseline characteristics between the groups, When groups were compared with each other, CA genotype in rs4588, CC genotype in rs2228570 and AA genotype in rs1544410 mutations were found statistically significant in patients whereas TC genotype in rs2228570 and GA genotype in rs1544410 mutations were found statistically significant in controls. When the relation between risk factors and genotypes were investigated, statistically significant associations were detected for body mass index (BMI), waist circumference, Apnea-Hypopnea Index (AHI), excessive daytime sleepiness (EDS), vitamin D and triglyceride levels. VDR and VDBP mutations were found highly related with OSAS. Possible tracking of these mutations and risk factors may help to understand the metabolism as well as the progression of the disease.

VDBP, VDR Mutations and Other Factors Related With Vitamin D Metabolism May Be Associated With Type 1 Diabetes Mellitus.

Type 1 diabetes mellitus (T1DM) is an insulin dependent autoimmune disorder resulting the progressive destruction of pancreatic beta cells. Another possible factor considered to be related with T1DM is vitamin D deficiency. Therefore in this study it was aimed to investigate the associations between T1DM, vitamin D binding protein (VDBP) and vitamin D receptor (VDR) gene mutations which are related with vitamin D metabolism. Fifty five T1DM paitents and 40 healthy volunteers were recruited to the study. FokI (rs2228570), BsmI (rs1544410) mutations in VDR; rs4588 and rs7041 polymorphisms in VDBP were investigated with real-time polymerase chain reaction (RT-PCR). Other risk factors related with T1DM were also investigated. Results were evaluated statistically. Statistically significant relations were found in glucose, HbA1c, TSH, higher 25[OH]D, free vitamin D, calcium, albumin, log25[OH]D, retinopathy, higher than 30 mg/day microalbuminuria in T1DM patients. Also statistically significant association was found between C allele in Fok1 and T1DM in patients. When the relation between the risk factors and mutations were investigated, it was found that VDBP, free vitamin D and bioactive vitamin D were significantly associated with rs7041 mutation in VDBP whereas HDL was significantly associated with rs2228570 mutation in VDR. Other studies with larger data sets may demonstrate more reliable statistical results to rule out genotype-phenotype correlations of the disease.

Prevalence estimation and familial tendency of common forefoot deformities in Turkey: A survey of 2662 adults.

OBJECTIVE: This survey was designed to evaluate the prevalence estimations of HV, bunionette, hammertoe as well as their relations to shoe wearing and also familial tendency, in Turkey. MATERIAL AND METHODS: Two thousand six hundred sixty two volunteers (1615 females and 1047 males) with a mean age of 34.15 ± 14.23 (range; 18 to 96) years were asked to answer the predetermined questionnaire between January and June, 2016. Hallux valgus, hammertoe and bunionette images were provided as references and every adult participant without any known forefoot problems or past forefoot surgery history was asked to rate his/her foot and to respond the questions about family history and shoe wearing habits. Responses were statistically analyzed. RESULTS: The prevalence estimations of hallux valgus, bunionette and hammertoe were calculated as 54.3%, 13.8% and 8.9% and positive family history rates were 53.2%, 61.2% and 56.1%, respectively. All three deformities were more common in females than in males (p < 0.001). Nonetheless the older age group reported significantly higher prevalence rates for only HV (p < 0.001). Likewise, among the three deformities, females reported a higher rate of positive family history only in HV compared to men (p < 0.001). Constricting shoe wear was found to affect HV incidence in women (p < 0.001) and bunionette incidence in both sexes (p < 0.01). CONCLUSION: This study concludes that forefoot deformities are common with high familial tendency. Hence it is worthwhile to work on molecular genetics and this may enable the anticipation of forthcoming deformities in order to take early action in prevention, in nearly the half of the population.

Liver Apparent Diffusion Coefficient Changes during Telaprevir-Based Therapy for Chronic Hepatitis C.

BACKGROUND: Diffusion-weighted imaging (DWI) has become an established diagnostic modality for the evaluation of liver parenchymal changes in diseases such as diffuse liver fibrosis. AIMS: To evaluate the parenchymal apparent diffusion coefficient value (ADC) changes using diffusion-weighted imaging (DWI) during telaprevir-based triple therapy. STUDY DESIGN: Diagnostic accuracy study. METHODS: Seventeen patients with chronic hepatitis C virus (HCV) virus and twenty-five normal volunteers were included. All of the patients took 12-weeks of telaprevir-based triple therapy followed by 12-weeks of PEGylated interferon and ribavirin therapy. They were examined before treatment (BT), as well as 12-weeks (W12) and 24-weeks (W24) after treatment by 3 Tesla magnetic resonance imaging (MRI). DWI was obtained using a breath-hold single-shot echo-planar spin echo sequence. Histopathologically, liver fibrosis was classified in accordance with the modified Knodell score described by Ishak. Quantitatively, liver ADCs were compared between patients and normal volunteers to detect the contribution of DWI in the detection of fibrosis. In addition, liver ADCs were compared during the therapy to analyze the effect of antiviral medication on liver parenchyma. RESULTS: The liver ADC values of fibrotic liver parenchyma were significantly lower than those of the healthy liver parenchyma (p<0.001). However, we were not able to reach a sufficiently discriminative threshold value. The ADC values showed a declining trend with increasing fibrotic stage. No statistically significant correlation (p=0.204) was observed. Compared with those before treatment, the liver ADC values after telaprevir-based triple therapy were significantly decreased at W12. A significant increase in the liver ADC values was also observed after the cessation of telaprevir therapy at W24 with a return to initial values. CONCLUSION: Liver ADC values appear to indicate the present but not the stage of liver fibrosis. DWI may be a helpful research tool for the assessment of antiviral drug effects.

Protease Inhibitors Drug Resistance Mutations in Turkish Patients with Chronic Hepatitis C.

BACKGROUND: Drug resistance development is an expected problem during treatment with protease inhibitors (PIs), this is largely due to the fact that Pls are low-genetic barrier drugs. Resistance-associated variants (RAVs) however may also occur naturally, and prior to treatment with Pls, the clinical impact of this basal resistance remains unknown. In Turkey, there is yet to be an investigation into the hepatitis C (HCV) drug associated resistance to oral antivirals. MATERIALS AND METHODS: 178 antiviral-naïve patients infected with HCV genotype 1 were selected from 27 clinical centers of various geographical regions in Turkey and included in the current study. The basal NS3 Pls resistance mutations of these patients were analyzed. RESULTS: In 33 (18.5%) of the patients included in the study, at least one mutation pattern that can cause drug resistance was identified. The most frequently detected mutation pattern was T54S while R109K was the second most frequently detected. Following a more general examination of the patients studied, telaprevir (TVR) resistance in 27 patients (15.2%), boceprevir (BOC) resistance in 26 (14.6%) patients, simeprevir (SMV) resistance in 11 (6.2%) patients and faldaprevir resistance in 13 (7.3%) patients were detected. Our investigation also revealed that rebound developed in the presence of a Q80K mutation and amongst two V55A mutations following treatment with TVR, while no response to treatment was detected in a patient with a R55K mutation. CONCLUSION: We are of the opinion that drug resistance analyses can be beneficial and necessary in revealing which variants are responsible for pre-treatment natural resistance and which mutations are responsible for the viral breakthrough that may develop during the treatment.

Evaluation of Dual Therapy in Real Life Setting in Treatment-Naïve Turkish Patients with HCV Infection: A Multicenter, Retrospective Study.

BACKGROUND: Before the introduction of direct-acting antivirals in the treatment of chronic hepatitis C patients, the combination of peginterferon alpha and ribavirin was the standard therapy. Observational studies that investigated sustained virological response (SVR) rates by these drugs yielded different outcomes. AIMS: The goal of the study was to demonstrate real life data concerning SVR rate achieved by peginterferon alpha plus ribavirin in patients who were treatment-naïve. STUDY DESIGN: A multicenter, retrospective observational study. METHODS: The study was conducted retrospectively on 1214 treatment naïve-patients, being treated with peginterferon alpha-2a or 2b plus ribavirin in respect of the current guidelines between 2005 and 2013. The patients' data were collected from 22 centers via a standard form, which has been prepared for this study. The data included demographic and clinical characteristics (gender, age, body weight, initial Hepatitis C virus RNA (HCV RNA) level, disease staging) as well as course of treatment (duration of treatment, outcomes, discontinuations and adverse events). Renal insufficiency, decompensated liver disease, history of transplantation, immunosuppressive therapy or autoimmune liver disease were exclusion criteria for the study. Treatment efficacy was assessed according to the patient's demographic characteristics, baseline viral load, genotype, and fibrosis scores. RESULTS: The mean age of the patients was 50.74 (±0.64) years. Most of them were infected with genotype 1 (91.8%). SVR was achieved in 761 (62.7%) patients. SVR rate was 59.1% in genotype 1, 89.4% in genotype 2, 93.8% in genotype 3, and 33.3% in genotype 4 patients. Patients with lower viral load yielded higher SVR (65.8% vs. 58.4%, p=0.09). SVR rates according to histologic severity were found to be 69.3%, 66.3%, 59.9%, 47.3%, and 45.5% in patients with fibrosis stage 0, 1, 2, 3 and 4, respectively. The predictors of SVR were male gender, genotype 2/3, age less than 45 years, low fibrosis stage, low baseline viral load and presence of early virological response. SVR rates to each peginterferon were found to be similar in genotype 1/4 although SVR rates were found to be higher for peginterferon alpha-2b in patients with genotype 2/3. The number of patients who failed to complete treatment due to adverse effects was 33 (2.7%). The number of patients failed to complete treatment due to adverse effects was 33 (2.7%). CONCLUSION: Our findings showed that the rate of SVR to dual therapy was higher in treatment-naïve Turkish patients than that reported in randomized controlled trials. Also peginterferon alpha-2a and alpha-2b were found to be similar in terms of SVR in genotype 1 patients.