Ocular surface assessment and morphological alterations in meibomian glands with non-contact meibography in electronic cigarette smokers.

PURPOSE: The study aimed to evaluate the ocular surface and meibomian gland morphology in electronic cigarette (e-cigarette) smokers. METHODS: The upper and lower eyelids of 25 male e-cigarette smokers and 25 healthy male non-smoker patients were evaluated using Sirius meibography. Meibomian glands loss was automatically calculated using Phoenix meibography imaging software module, with the result obtained as percentage loss. Ocular Surface Disease Index (OSDI) questionnaire, tear breakup time test, and Schirmer II test were administered and performed in all cases. RESULTS: The mean e-cigarette smoking duration was 4.9 ± 0.9 (range, 3.4-7) years. While the mean Schirmer II test value was 9.16 ± 2.09 mm in e-cigarette group, it was 11.20 ± 2.14 mm in control group (p=0.003). Mean tear breakup time was 6.96 ± 2.31 seconds in e-cigarette group and 9.84 ± 2.13 seconds in control group (p=0.002). The mean OSDI value was 28.60 ± 6.54 and 15.16 ± 7.23 in e-cigarette and control groups, respectively (p<0.001). In Sirius meibography, the average loss for the upper eyelid was 23.08% ± 6.55% in e-cigarette group and 17.60% ± 4.94% in control group (p=0.002), and the average loss for the lower eyelid was 27.84% ± 5.98% and 18.44% ± 5.91%, respectively (p<0.001). Additionally, a significant positive correlation was identified between the loss rates for both upper and lower eyelid meibography with e-cigarette smoking duration (r=0.348, p<0.013 and r=0.550, p<0.001, respectively). CONCLUSION: Long-term e-cigarette smoking causes damage to the meibomian glands; therefore, meibomian gland damage should be considered in ocular surface disorders due to e-ci-garette smoking.

Ocular surface assessment and morphological alterations in meibomian glands with non-contact meibography in electronic cigarette smokers / Avaliação da superfície ocular e das alterações morfológicas nas glândulas meibomianas através de meibografia sem contato em usuários de cigarros eletrônicos

ABSTRACT Purpose: The study aimed to evaluate the ocular surface and meibomian gland morphology in electronic cigarette (e-cigarette) smokers. Methods: The upper and lower eyelids of 25 male e-cigarette smokers and 25 healthy male non-smoker patients were evaluated using Sirius meibography. Meibomian glands loss was automatically calculated using Phoenix meibography imaging software module, with the result obtained as percentage loss. Ocular Surface Disease Index (OSDI) questionnaire, tear breakup time test, and Schirmer II test were administered and performed in all cases. Results: The mean e-cigarette smoking duration was 4.9 ± 0.9 (range, 3.4-7) years. While the mean Schirmer II test value was 9.16 ± 2.09 mm in e-cigarette group, it was 11.20 ± 2.14 mm in control group (p=0.003). Mean tear breakup time was 6.96 ± 2.31 seconds in e-cigarette group and 9.84 ± 2.13 seconds in control group (p=0.002). The mean OSDI value was 28.60 ± 6.54 and 15.16 ± 7.23 in e-cigarette and control groups, respectively (p<0.001). In Sirius meibography, the average loss for the upper eyelid was 23.08% ± 6.55% in e-cigarette group and 17.60% ± 4.94% in control group (p=0.002), and the average loss for the lower eyelid was 27.84% ± 5.98% and 18.44% ± 5.91%, respectively (p<0.001). Additionally, a significant positive correlation was identified between the loss rates for both upper and lower eyelid meibography with e-cigarette smoking duration (r=0.348, p<0.013 and r=0.550, p<0.001, respectively). Conclusion: Long-term e-cigarette smoking causes damage to the meibomian glands; therefore, meibomian gland damage should be considered in ocular surface disorders due to e-ci­garette smoking.

RESUMO Objetivo: Avaliar a superfície ocular e a morfologia da glândula meibomiana em usuários de cigarros eletrônicos. Métodos: Foram avaliadas através de meibografia Sirius as pálpebras superiores e inferiores de 25 usuários de cigarros eletrônicos do sexo masculino e 25 pacientes não usuários saudáveis, também do sexo masculino. A perda nas glândulas meibomianas foi calculada automaticamente com o módulo de software de imagem de meibografia Phoenix. O resultado foi obtido como perda percentual. O questionário Ocular Surface Disease Index (OSDI), o teste do tempo de ruptura lacrimal e o teste de Schirmer II foram administrados em todos os casos. Resultados: A duração média do uso de cigarros eletrônicos foi de 4,9 ± 0,9 anos (intervalo de 3,4-7 anos). O valor médio do teste de Schirmer II foi de 9,16 ± 2,09 mm no grupo de usuários de cigarros eletrônicos e de 11,20 ± 2,14 mm no grupo controle (p=0,003). O valor médio do teste do tempo de ruptura lacrimal foi de 6,96 ± 2,31 segundos no grupo de usuários de cigarros eletrônicos e 9,84 ± 2,13 segundos no grupo controle (p=0,002). O valor médio do Ocular Surface Disease Index foi de 28,60 ± 6,54 e 15,16 ± 7,23 para os grupos de usuários de cigarros eletrônicos e controle, respectivamente (p<0,001). Na meibografia de Sirius, a perda média para a pálpebra superior foi de 23,08 ± 6,55% para o grupo de usuários de cigarros eletrônicos e 17,60 ± 4,94% para o grupo controle (p=0,002), e a perda média para a pálpebra inferior foi de 27,84 ± 5,98% e 18,44 ± 5,91%, respectivamente (p<0,001). Além disso, foi observada uma correlação positiva significativa entre a taxa de perda na meibografia palpebral superior e inferior com a duração do tabagismo eletrônico, respectivamente de (r=0,348, p<0,013) e (r=0,550, p<0,001). Conclusão: O uso prolongado de cigarros eletrônicos causa danos às glândulas meibomianas. Portanto, esses danos devem ser considerados em distúrbios da superfície ocular devidos ao uso desses dispositivos.

Analysis of optical coherence tomography angiographic findings of prematurely born children and its relationship with macular edema of prematurity.

PURPOSE: To compare foveal avascular zone (FAZ) area, foveal vascular density (VD), and foveal thickness in pre- and full-term children and to evaluate their relationship with cystoid macular edema (CME) in the prematurity period using spectral domain optical coherence tomography angiography (SD-OCTA). METHODS: OCTA imaging was performed at 4-6 years of age in 90 eyes of 45 prematurely born children and 50 eyes of 25 term children. Subjects were divided into three groups: prematurely born with CME (group 1); prematurely born without CME (group 2); healthy, term children (group 3). Imaging results in the three groups were compared. RESULTS: FAZ area was significantly larger in group 3 than in groups 1 and 2 (P < 0.001 [ANOVA]). FAZ area was found to be correlated with birth weight (r = 0.511; P < 0.001) and gestational age (r = 0.532; P < 0.001). No significant relationship was found between history of CME and FAZ area. CONCLUSIONS: In our study cohort, FAZ area was smaller in prematurely born children and was correlated with older gestational age and higher birth weight. CME in the neonatal period did not seem to affect retinal microvascular development in premature infants.

Comparison of bevacizumab, ranibizumab and aflibercept in retinopathy of prematurity treatment.

PURPOSE: To compare the efficacy and refractive outcomes of intravitreal bevacizumab, ranibizumab and aflibercept in retinopathy of prematurity (ROP) treatment. METHODS: We analyzed the files of patients treated with intravitreal bevacizumab, ranibizumab and aflibercept for ROP, retrospectively. A total of 187 eyes of 111 patients were included. Recurrence time after initial treatment, recurrence rate, age and rate of additional treatment, refractive outcomes in age 1, 2 and 3 were evaluated and compared between the groups. RESULTS: Fifty-four eyes of 30 patients formed bevacizumab group (Group-1), 77 eyes of 47 patients formed ranibizumab group (Group-2) and 56 eyes of 34 patients formed aflibercept group (Group-3). No significant difference was found in gender, gestational age, birth weight and risk factors between the groups (p>0.05). Success rate was higher in group 3, but the difference was not significant (p = 0.174) (74.1% in group-1, 62.4% in group-2 and 76.8% in group-3). Recurrence rate was higher in group 2, but the difference was not significant (p = 0.158) (25.9% in group-1, 37.6% in group-2 and 23.2% in group-3). Recurrence time after initial treatment was significantly shorter in group 2 (p < 0.01). Additional treatment rate was also higher, and the age of additional treatment was lower in group-2 (p < 0.05 and p < 0.01, respectively). We found refractive values more myopic in ages of 1, 2 and 3 in group 1. CONCLUSIONS: Bevacizumab, ranibizumab and aflibercept are effective treatment alternatives for ROP. We observed more frequent and much earlier recurrence in eyes treated with ranibizumab. A myopic shift was found in bevacizumab group. We also emphasize the necessity of longer follow-ups for infants treated with anti-VEGF drugs.

Evaluation of the Findings of Patients Who Underwent Sutureless Flanged Transconjunctival Intrascleral Intraocular Lens Implantation with or without Pars Plana Vitrectomy.

PURPOSE: To compare the visual outcomes and complications of patients who underwent flanged transconjunctival sutureless intrascleral intraocular lens (SIS IOL) implantation after anterior and pars plana vitrectomy. METHODS: All patients who underwent flanged transconjunctival SIS IOL fixation using a 27-gauge needle between September 2017 and November 2019 and were followed up for at least six months were evaluated. The cases in which anterior vitrectomy was performed were classified as Group 1, and those that underwent pars plana vitrectomy were classified as Group 2. The best-corrected visual acuity (BCVA), spherical equivalent values, corneal endothelial cell density, and intraocular pressures were compared between the two groups before and after the operation. Intraoperative and postoperative complications were assessed. RESULTS: The study included 108 eyes of 108 patients who were included in the study. Group 1 consisted of 48 patients and Group 2 comprised of 60 patients. When the findings between Groups 1 and 2 were compared in the postoperative period, there was no statistically significant difference in terms of the mean intraocular pressure increase, endothelial cell density, BCVA, and spherical equivalent value (P=0.818, 0.601, 0.368, and 0.675, respectively). When all the patients were considered as a single group, the mean spherical value at the sixth postoperative month was 0.3 ± 2.2 D (min-max, (-5.5)-(+6)), the mean cylindrical value was -1.7 ± 2.4 D (min-max, (-9.25)-(+4)), and the mean spherical equivalent value was -0.5 ± 2.3 D (min-max, (-6.5)-(+6)). CONCLUSION: The flanged transconjunctival SIS IOL fixation technique performed using a 27-gauge needle is safe and effective in the patient group with aphakia and lens/IOL dislocation or subluxation. However, in patients planned to undergo flanged transconjunctival SIS IOL implantation, pars plana vitrectomy seems to be a more suitable option than anterior vitrectomy to reduce complications.

Incidentally Detected Gastrointestinal Wall Thickness on Abdominal Computed Tomography; What Does it Mean for Endoscopy?

BACKGROUND: The clinical significance of gastrointestinal wall thickening (GWT) on abdominal computed tomography (CT) is not certain, yet. Despite the need for clinical guidelines describing the importance and evaluation of GWT on a CT scan, there have been few studies evaluating these incidental imaging abnormalities. The aim of this study is to endoscopically evaluate certain etiologies that cause incidental GWT found on CT. METHODS: This retrospective cohort study was carried out with patients who had incidentally detected GWT on a CT scan at the Kanuni Sultan Süleyman Training and Research Hospital between February 2016 and December 2018. RESULTS: A total of 129 patients (62 males and 67 females; mean age 57.5 years, range: 26-87 years) were included in the study. Abnormalities observed during endoscopy at the exact site of the GWT noted on a CT image were found in 114 patients (99%): upper endoscopy revealed malignancy in 33 (29%), gastritis in 63 (52%), hiatal hernia in 19 (16%), a gastric ulcer in 7 (6%), and alkaline gastritis in 3 (2%). Colonoscopy revealed malignancy in 4 (33%), benign polyps in 5 (35%), colonic ulcer in 2 (16%), and 2 patients (16%) had normal findings. Malignancy was detected more frequently in the cardioesophageal region compared with the antrum (P=0.020). CONCLUSION: In this study, detection of GWT on CT often indicated pathologies which were subsequently confirmed endoscopically. Pathological findings were detected in 83% of these patients, with approximately 30% determined to be malignant. Endoscopic evaluation is recommended when GWT is reported on a CT scan.

Imaging findings in patients after the bomb explosion in Somalia on December 28, 2019.

INTRODUCTION: This study aimed to present the radiological findings of injuries in victims as a result of a suicide bombing in Mogadishu, Somalia. METHODS: Of the 82 injured cases admitted to the emergency department within the first six hours after the explosion, those who were radiologically evaluated were included in this retrospective and descriptive study. To analyze and identify the distribution of primary, secondary, and tertiary injuries, they were classified according to the body areas as head-neck, thorax, abdominopelvic, extremity, and vertebra. RESULTS: The mean age (mean ± SD) of 63 patients included in the study was 28.6 ± 10.2 years. Twenty-four (38.1%) of the injured patients were female and 39 (61.9%) were male. Secondary blast injury was the most common type of injury in the study group with a rate of 39/63 (62%). The total number of bomb fragments was 235, of which 113 (47.8%) were seen in the head and neck region, followed by 86 (36.5%) in the extremities. There were 10 patients (15.9%) with lung injury and 13 (20.6%) with tympanic membrane perforation due to the primary blast mechanism. CONCLUSION: Radiological imaging plays an important role in identifying specific findings and patterns of explosive injuries. Therefore, we consider that patients with stable hemodynamics should be radiologically examined for a fast and accurate diagnosis or treatment.

Endoscopic Hernia Repair: A Novel Technique for the Repair of Inguinal Hernia in a Cadaver Model.

BACKGROUND: The techniques of total extraperitoneal and transabdominal preperitoneal hernia repair have been conducted for laparoscopic repair of inguinal hernia since long. However, they offer significant disadvantages of requiring general anesthesia, producing negative cosmetic outcomes, and other serious complications. We examined the feasibility of applying an endoscopic method alternative to total extraperitoneal and transabdominal preperitoneal for laparoscopic repair of inguinal hernia in a cadaver model so as to overcome the disadvantages of the presently available techniques. METHODS: A total of 4 male and 2 female cadavers [aged 18 y and above, body mass index (BMI) <40 kg/m2], who were planned for a routine autopsy between January 24 and 26, 2020 were selected for the present study conducted at the Forensic Medicine Institute. Twelve laparoscopic repair surgeries of inguinal hernia were performed in 6 of these cadavers using both the inguinal areas. RESULTS: We conducted a total of 12 surgeries on 4 male (mean age: 43.25 y; BMI: 29.05 kg/m2) and 2 female cadavers (mean age: 76.50 y; BMI: 26.60 kg/m2). A 7×5-cm-shaped mesh was used for both the sexes. For the fixation of the mesh, a titanium tacker was used in pubic tubercle and tendon conjoint, whereas for the fixation of ligamentum inguinale, 2/0 PDS was used in 3 surgeries, 2/0 15-cm V-Loc was used in another 3 surgeries, and titanium tacker was used in 6 surgeries. CONCLUSIONS: We demonstrated that the technique of endoscopic surgery that offers the advantages of open inguinal surgery in a cadaver model can be combined with the presently used laparoscopic intervention so as to combine all the advantages, especially for patients who are not suitable for general anesthesia, who are experiencing a recurrence after laparoscopic intervention, and who do not want any visible scares resultant from the surgery. For future studies, we suggest that the proposed technique be applied to inguinal hernia patients to ascertain clearer results.

Are YouTube Videos Useful in Informing Patients about Keratoplasty?

Purpose: The objective of this study was to analyze the quality of videos on YouTube as educational resources about keratoplasty surgery.Methods: The first 100 videos found after the keyword "keratoplasty for patients" was used in the YouTube search engine were included in the study. General video assessment included duration, views, likes, dislikes, and comments. The quality and accuracy of the information were evaluated by 2 independent ophthalmologists using DISCERN score, Journal of the American Medical Association (JAMA) score, global quality score and usefulness scoring system. Interobserver agreement and individual correlations of the data of each video were statistically analyzed.Results: Eighty-four of the first 100 videos met the inclusion criteria. The mean DISCERN score was 42.11, the mean JAMA score was 1.82, the mean global quality score was 2.35, and the mean usefulness score was 2.01. Twenty-eight (33.3%) of the surgical procedures described in the videos were penetrating keratoplasty, 18 (21.4%) were DMEK, 13 (15.5%) were DALK, four (4.8%) were DSAEK, and one (1.2%) was keratoprosthesis, while the remaining 20 (23.8%) videos did not mention any surgical procedure. Of the 84 videos, 26 (31%) had been uploaded by physicians, 46 (54.8%) by university/private health institutions, 11 (13.1%) by health channels, and one (1.2%) by a patient.Conclusion: YouTube is an important platform that can be used by patients to acquire information about keratoplasty. Increasing the number of uploads of informative keratoplasty videos by healthcare professionals will provide higher quality, more reliable, and more instructive content in this area.

Ischemia-Modified Albumin Levels and Thiol-Disulphide Homeostasis in Diabetic Macular Edema in Patients with Diabetes Mellitus Type 2.

PURPOSE: It was aimed to assess the role of thiol-disulphide homeostasis and ischemia-modified albumin (IMA) level in the development of diabetic macular edema (DME) in patients with diabetes mellitus type 2 (T2DM). MATERIALS AND METHODS: Sixty-six study patients were divided into two groups. Group I included 43 patients with T2DM and DME, and Group 2 included 23 patients with T2DM without eye involvement. A novel colorimetric method was used to assess thiol-disulphide homeostasis. Between the two groups IMA, total anti-oxidant, and total oxidant levels were measured and compared. RESULTS: In Group 1, total and native thiol levels and disulphide levels were lower compared to Group 2 (p = .025, p < .001 and p = .013, respectively). Disulphide/native thiol, disulphide/total thiol ratios and native thiol/total thiol were similar between the groups. Total anti-oxidant level (TAL) reduced whereas total oxidant level (TOL) increased in Group 1 compared to Group 2 (p = .001, p = .002, respectively). Albumin level decreased, whereas IMA level increased in Group 1 compared to Group 2 (p < .001 for both). CONCLUSIONS: The disruption in thiol/disulphide homeostasis, increased IMA and oxidative stress have an impact on the development of diabetic macular edema.

Effect of macular edema in the premature period on refraction in infants screened and treated for retinopathy of prematurity.

BACKGROUND: To determine the effect of macular edema on refraction in infants with retinopathy of prematurity (ROP) at the ages of one, two and three years using Optical Coherence Tomography (OCT). METHODS: Optical coherence tomography (OCT) was performed to detect and categorize edema in 280 eyes of 280 premature infants. The cross-sectional spectral domain OCT imaging of the macular region was performed between weeks 36 and 42 to assess macular development. Refraction measurement was performed during follow-up at the ages of one, two and three years. Macular thickness, choroidal thickness, macular edema severity, and the spherical, cylindrical and spherical equivalent (SE) values were measured. RESULTS: A positive correlation was found between macular thickness in the premature period and the SE value at age one and a negative correlation at age three. No correlation was found between gestational age and the SE value, but there was a positive correlation between birth weight and the SE value at ages one and two. Although no correlation was determined between edema and gestational age or between edema and birth weight, the prevalence of macular edema in infants with ROP was significantly higher than that of infants without this disease. CONCLUSIONS: Macular edema during the premature period can have an impact on refraction at the ages one, two and three years by effecting the emmetropization process.

Prevalence of primary open-angle glaucoma in a Somalia population.

PURPOSE: To determine the prevalence of primary open-angle glaucoma (POAG) in patients over 40 years that presented to our tertiary hospital in Somalia Mogadishu. METHODS: This prospective cross-sectional study included 1550 patients older than 40 years that presented to the ophthalmology clinic of Somalia Mogadishu - Turkey Training and Research Hospital. The patients were evaluated in terms of age, gender, intraocular pressure, and optical cup/disk (C/D) ratio, and central corneal thickness measurements were taken. RESULTS: The prevalence of glaucoma in the study population over the age of 40 years was 7%. The prevalence of glaucoma was 40% in the 40-50-year group, 6.8% in the 50-60-year group, 7% in the 60-70-year group, 9.9% in the 70-80-year group, and 12.3% in the 80-90-year group. The prevalence of glaucoma statistically significantly increased with advancing age (p < 0.001). The mean intraocular pressure was measured as 16.7 ± 3.3 mmHg for the overall patient population, 16.3 ± 2.9 mmHg for the female patients, and 17.1 ± 3.1 mmHg for the male patients. The mean intraocular pressure of the patients diagnosed with POAG was 27.3 ± 4.2 mmHg, and their mean corneal thickness was 507.9 µm, which was significantly lower than the value of the patients without POAG (545.8) (p < 0.001). The mean C/D ratio was calculated as 0.56 ± 0.21 for the patients with POAG and general 0.24 ± 0.16 for the overall patient population, indicating a statistically significant difference (p < 0.001). CONCLUSIONS: A high rate of POAG is seen in patients over 40 years of age in Somalia. The mechanism underlying POAG needs to be investigated in this population.

Causes of Blindness in the Adult Population in Somalia.

Objectives: To evaluate the causes and frequency of blindness among the adult Somali population according to the World Health Organization (WHO) criteria. Materials and Methods: The data of 2,605 patients over 18 years old who presented to our tertiary hospital in Mogadishu (the capital of Somalia) were evaluated. Patients with best corrected visual acuity of less than 3/60 in both eyes were categorized as bilaterally blind and those with best corrected visual acuity of less than 3/60 in one eye but 3/60 or better in the other eye were classified as monocularly blind, as per the WHO classification. Results: Of 2,605 patients, 1,251 (48%) were female and 1,354 (52%) were male. Among these, 256 patients were determined to have blindness in one or both eyes and were included in the study. The patients ranged in age from 19 to 85, and the mean age was 52.4±14.6 years. The overall blindness rate in the Somali population was 9.8%. In the monocularly blind group, the most common factor was trauma complication (23.6%), followed by cataract (19%) and diabetic retinopathy (13.2%). In the bilaterally blind group, the most common factors were cataract (26.9%), diabetic retinopathy (21.1%), and glaucoma (15.4%). Conclusion: Trauma is the leading cause of blindness due to the security conditions in the country. Establishing and increasing the number of free public health centers in Somalia can reduce the frequency of blindness.

The effect of electronic cigarette smoking on retinal microcirculation: Enlargement of the foveal avascular zone.

BACKGROUND: To evaluate retinal microcirculation in electronic cigarette (e-cigarette) smokers using optical coherence tomography angiography (OCTA). METHODS: OCTA measurements were performed on the left eyes of 21 e-cigarette smokers and 21 healthy controls. Superficial and deep foveal, perifoveal and parafoveal vessel densities, outer retina and choriocapillaris flow area, foveal avascular zone (FAZ), and central macular thickness were evaluated in both groups. RESULTS: The FAZ area was larger in e-cigarette smokers than the control group, and the difference was statistically significant (p = 0.003). The superficial foveal, superficial total, deep foveal and deep total vascular densities were significantly lower in the e-cigarette group compared to the control group (p = 0.011, p = 0.012, p = 0.022, and p = 0.041, respectively). Central macular thickness was lower in the e-cigarette smokers but the difference was not statistically significant (p = 0.678). CONCLUSIONS: E-cigarette smoking causes enlargement of the FAZ area and decreases vascular densities.

The Effect of Hemodialysis on Axial Length, Ocular Surface, and Intraocular Pressure in Patients with End-Stage Renal Failure.

PURPOSE: To evaluate the changes in intraocular pressure (IOP), central corneal thickness (CCT), axial length, and ocular surface in patients with end-stage renal failure after single-session hemodialysis treatment and to examine the correlation of these findings with systemic hemodynamic parameters. PATIENTS AND METHODS: A total of 112 eyes of 112 patients enrolled in a hemodialysis treatment program for three times a week (approximately four hours per session) for at least three months in our hospital between December 2019 and March 2020 were included in the study. Approximately 30 minutes before and after hemodialysis, the best-corrected visual acuity measurement, slit-lamp examination, IOP measurement, and dilated fundus examination with the Goldmann applanation tonometer were performed in all patients. The axial length measurement was undertaken by ultrasonic biometry, and the CCT measurement by ultrasonic pachymetry. The ocular surface evaluation was performed based on the tear breakup time (BUT), basal secretion time (BST) and keratoepitheliopathy score. Blood pressure, serum osmolarity, and body weight were measured before and after hemodialysis. RESULTS: The mean IOP decreased from 12.2 ± 3.5 to 10.8 ± 2.2 mmHg, and the mean decrease was 1.4 ± 2 mmHg, indicating statistical significance (p<0.001). The mean CCT dropped from 502 ± 41.2 to 494.1 ± 35.4 µm, and the mean decrease was 8.1 ± 7.7 µm, which also indicated a statistically significant change (p<0.001). The mean axial length was reduced from 23.1 ± 0.8 to 22.9 ± 0.8 mm. The reduction in the axial length was significant with an average value of 0.26 ± 0.15 mm (p<0.001). When the ocular surface changes were examined, BUT decreased from 7.4 ± 3.1 to 6.3 ± 2.5 s, BST from 8.6 ± 1.7 to 6.6 ± 1.3 mm, and the keratoepitheliopathy score increased from 0.36 ± 0.61 to 1.59 ± 0.93, and all these changes were statistically significant (p<0.001). There was a significant correlation between the axial length change and the IOP change (r=0.202, p=0.03). A significant correlation was also observed between BST and plasma colloid osmotic pressure (r=-0.268, p=0.004). In addition, there was a strong correlation between serum osmolarity and the keratoepitheliopathy score (r=-0.437, p<0.001). CONCLUSION: Hemodialysis causes significant changes in IOP, CCT, axial length, and ocular surface. These changes should be considered in the ophthalmological examination of patients after the hemodialysis session.

Cancer Incidence and Distribution at a Tertiary Care Hospital in Somalia from 2017 to 2020: An Initial Report of 1306 Cases.

PURPOSE: To determine the type, frequency and distribution of all cancers in Somalia from 2017 to 2020. PATIENTS AND METHODS: This retrospective and descriptive study included the review of a total of 5238 pathology reports obtained from the medical records of the Somalia Turkey Recep Tayyip Erdogan Education and Research Hospital. Patient characteristics, lesion localization, and histopathology were recorded. Patients with an unconfirmed cancer diagnosis, borderline tumors, intraepithelial neoplasms and metastatic cancers were excluded from the study. The cases were classified according to gender, age, and organ involvement. RESULTS: Of the 1306 patients included in the study, 50.9% (n=666) were female and 49.1% (n=640) were male, and the mean age was 51.1±19.4 years. Of the cases, 5.1% (n=67) were pediatric (0-17 years) and 35.8% (n=468) were in the 18-50 years range. The most common cancer was esophageal cancer (EC) for the overall data (n=284; 21.7%) and in both genders. EC peaked in the fifth decade, and the most common histological type was squamous cell carcinoma (n=256; 91.1%). Liver cancer was the second most common cancer overall (n=99; 7.6%) and in men (n=67; 10.5%). Cervical cancer was the second most common cancer among women (n=88; 13.3%) and ranked fourth in terms of overall incidence (n=88; 6.7%). Breast cancer was the third most common overall (n=95; 7.3%) and in women (n= 87; 13.1%). CONCLUSION: This study shows that in Somalia, EC is the most common cancer in both genders. These high rates in Somalia suggest that environmental factors and dietary habits may have an effect. To reduce the incidence of EC and prevent its development, the population of Somalia should be educated and effective planning should be undertaken.

Different approaches in diagnosis, follow-up and treatment of acute biliary pancreatitis: Results of attitude survey.

BACKGROUND: Acute biliary pancreatitis is one of the most frequently encountered diseases among general surgeons in emergency surgical diseases. Differences in diagnosis and treatment management of these patients, varying from physician to physician, are common in clinical practice. We aimed to present these differences and discuss the results in the light of current guidelines in the literature. METHODS: In this study, 21 questions were prepared regarding the physicians' approach in the diagnosis, follow-up and treatment of acute biliary pancreatitis (Appendix).The questionnaires were completed by face to face interviews with 94 general surgery specialists at the 20th National Surgery Congress. RESULTS: In this study, 38 (40%) of the physicians who answered the questionnaire were working in the Training and Research Hospital, 27 (29%) in the State Hospital, 19 (20%) in the University Hospital and nine in private health care was working in the establishment. 85% of the physicians were general surgery specialists with 10 years of experience. 53% (50) of the surgeons reported that they had less than five cases of acute biliary pancreatitis each month, and 35% (34) stated that they wanted amylase value daily for follow-up. Ultrasonography and computed tomography were the most commonly used imaging modalities and 15% of the respondents indicated that each patient underwent magnetic resonance cholangiopancreatography. 45% of surgeons stated that antibiotics were started at the time of diagnosis of pancreatitis. The percentage of surgeons who did not undergo cholecystectomy early in patients with mild to moderate pancreatitis was 60%. The reason for not preferring surgery in the early period was the most frequent operation difficulty with 40% and not supporting the operation in the early period. CONCLUSION: According to the attitude survey results, there are differences between general surgery specialists in the diagnosis, follow-up and treatment of acute biliary pancreatitis.

Assessment of Doppler flow parameters of the retrobulbar arteries and internal carotid artery in patients with glaucoma: the significance of ophthalmic artery peak ratio and the intima-media thickness of the internal carotid artery.

PURPOSE: The objective of this study was to analyze flow parameters of the central retinal artery (CRA), ophthalmic artery (OA), and internal carotid artery (ICA) assessed by color Doppler ultrasound. METHODS: Thirty-five patients with primary open-angle glaucoma (PAAG), 65 patients with normal-tension glaucoma (NTG), and 45 healthy controls, a total of 145 patients were included in this study and study participants were divided into three groups. All study participants underwent color Doppler ultrasound to assess blood flow parameters of CRA, OA and ICA. RESULTS: Comparisons among three groups revealed that pulsatility index and resistive index of the OA were significantly higher and peak ratio and end-systolic volume were significantly lower in patients with NTG or PAAG compared to healthy controls (p < 0.001 for all). As with OA, resistive index of the CRA was statistically significantly higher in patients with glaucoma (PAAG and NTG) compared to healthy controls (p < 0.001). The peak systolic volume and intima-media thickness of the ICA were statistically significantly higher in patients with PAAG compared to the other two groups (p < 0.001). ROC curve analysis of the CRA resistive index, OA resistive index and OA peak ratio in patients with glaucoma (PAAG and NTG) revealed that the sensitivity and specificity were 89% and 88%; 86% and 84%; 84% and 82%, respectively, at cutoff values of 0.64, 0.78 and 0.59, respectively. CONCLUSIONS: Ophthalmic artery peak ratio and ICA intima-media thickness may be useful parameters in the diagnosis of patients with glaucoma.

Bomb Explosion: Ocular Effects of Primary, Secondary and Tertiary Mechanisms.

PURPOSE: To report the type and severity of ocular injuries sustained by the survivors of a bomb-loaded explosion that occurred in Mogadishu, Somalia on December 28, 2019. PATIENTS AND METHODS: The recorded data included age, gender, wounded eye, initial examination of ocular injuries and associated systemic injuries, initial visual acuity, anterior and posterior segment examinations. The type of injury (open vs closed globe), the injured zone of the globe, and the presence of a relative afferent pupil defect were evaluated in all cases where possible. RESULTS: After the explosion, ocular injuries were detected in 28 of 114 patients in our hospital. Thirty-two eyes of 28 patients were included in the study. The mean age was 32.4±6.7 years. The number of open-globe injuries was more than that of closed-globe injuries (26 vs 6; 81.25% vs 18.75%, respectively). Zone 1 was the most affected zone in open-globe injuries (18/26 eyes, 61.6%), followed by Zone 3 in six (23%) patients and Zone 2 in four (15.4%) patients. Sixteen open-globe injuries were laceration type (61.5%) and 10 (38.5%) were rupture type. An intraocular foreign body was detected in eight (30.8%) eyes with open-globe injuries. A total of 28 patients had 11 (39.3%) isolated eye injuries, whereas 17 (60.7%) had concomitant systemic injuries. CONCLUSION: The frequency of blast-related ocular injuries is increasing. Today, the increase in the use of vehicle-borne improvised explosives in terrorist-related explosions leads to more frequent and serious ocular injuries.

Head and neck injuries after a bomb explosion: Diagnostic findings and treatment approaches.

OBJECTIVE: To identify the types and severity of head, face and neck (HFN) injuries, which occurred as a result of a bomb explosion and reached serious life-threatening levels, using radiological imaging methods, and to discuss the options of treatment at the time of presentation. METHODS: Of the 16 patients brought to the emergency department, 14 with HFN injuries were included in the study. Computed tomography (CT) and radiography scans were performed at the time of presentation in all patients, except for one. The injuries were divided into three groups according to their localization as head, face, and neck. RESULTS: A subgaleal hematoma was seen in 10 of 11 (78.5%) patients with head injuries. Eight (57.1%) of nine patients with facial injury had fractures and/or ocular injury in the orbital wall, and seven (50%) patients had maxillofacial bone fractures. Among ocular trauma cases, open-globe injuries were detected in three patients (21.4%), closed-globe in two (14.2%), and both types in three (21.4%). Of the five (35.7%) patients with secondary blast injuries in the neck, three (21.4%) had laryngeal trauma (Zone 2) due to shrapnel, localized in the false vocal cord, epiglottis, and thyrohyoid membrane, respectively. Emergency surgery was performed on a patient with a specific laryngeal injury. CONCLUSION: We consider that in patients presenting to the emergency department with blast HFN injuries, after providing airway patency and hemodynamic stability, CT and CT angiography should be performed because these modalities guide the treatment accurately and promptly.