Head to head comparison of diagnostic performance of three non-mydriatic cameras for diabetic retinopathy screening with artificial intelligence.

BACKGROUND: Diabetic Retinopathy (DR) is a leading cause of blindness worldwide, affecting people with diabetes. The timely diagnosis and treatment of DR are essential in preventing vision loss. Non-mydriatic fundus cameras and artificial intelligence (AI) software have been shown to improve DR screening efficiency. However, few studies have compared the diagnostic performance of different non-mydriatic cameras and AI software. METHODS: This clinical study was conducted at the endocrinology clinic of Akdeniz University with 900 volunteer patients that were previously diagnosed with diabetes but not with diabetic retinopathy. Fundus images of each patient were taken using three non-mydriatic fundus cameras and EyeCheckup AI software was used to diagnose more than mild diabetic retinopathy, vision-threatening diabetic retinopathy, and clinically significant diabetic macular oedema using images from all three cameras. Then patients underwent dilation and 4 wide-field fundus photography. Three retina specialists graded the 4 wide-field fundus images according to the diabetic retinopathy treatment preferred practice patterns of the American Academy of Ophthalmology. The study was pre-registered on clinicaltrials.gov with the ClinicalTrials.gov Identifier: NCT04805541. RESULTS: The Canon CR2 AF AF camera had a sensitivity and specificity of 95.65% / 95.92% for diagnosing more than mild DR, the Topcon TRC-NW400 had 95.19% / 96.46%, and the Optomed Aurora had 90.48% / 97.21%. For vision threatening diabetic retinopathy, the Canon CR2 AF had a sensitivity and specificity of 96.00% / 96.34%, the Topcon TRC-NW400 had 98.52% / 95.93%, and the Optomed Aurora had 95.12% / 98.82%. For clinically significant diabetic macular oedema, the Canon CR2 AF had a sensitivity and specificity of 95.83% / 96.83%, the Topcon TRC-NW400 had 98.50% / 96.52%, and the Optomed Aurora had 94.93% / 98.95%. CONCLUSION: The study demonstrates the potential of using non-mydriatic fundus cameras combined with artificial intelligence software in detecting diabetic retinopathy. Several cameras were tested and, notably, each camera exhibited varying but adequate levels of sensitivity and specificity. The Canon CR2 AF emerged with the highest accuracy in identifying both more than mild diabetic retinopathy and vision-threatening cases, while the Topcon TRC-NW400 excelled in detecting clinically significant diabetic macular oedema. The findings from this study emphasize the importance of considering a non mydriatic camera and artificial intelligence software for diabetic retinopathy screening. However, further research is imperative to explore additional factors influencing the efficiency of diabetic retinopathy screening using AI and non mydriatic cameras such as costs involved and effects of screening using and on an ethnically diverse population.

[A New Case of Fournier's Gangrene Caused by Actinotignum schaalii]. / Actinotignum schaalii'nin Etken Oldugu Yeni Bir Fournier Gangreni Olgusu.

Actinotignum schaalii (formerly known as Actinobaculum schaalii) is an anaerobic or facultative anaerobic gram-positive bacillus that can be found commensally in the urogenital region. It can be overlooked because it grows slowly and is difficult to identify with classical microbiology laboratory techniques. Colonies become visible after 48-72 hours of incubation on blood agar in anaerobic or CO2-rich media. While it typically causes urinary tract infection in older individuals, cases of bacteremia, vertebral osteomyelitis, endocarditis and cellulitis have been reported. Fournier's gangrene caused by A.schaalii has been reported very rarely so far. Fournier's gangrene has been defined as necrotizing fasciitis of the external genitalia, perineal and perianal region. Diabetes, immunosuppression, peripheral vascular disease, urethral anomalies, chronic alcoholism and smoking are important predisposing factors. In addition, approximately 25% of the cases have no known or identifiable etiology. The bacteria causing the infection may originate from skin, urogenital or intestinal microbiota. In this case report, a new case of Fournier's gangrene caused by A.schaalii was presented. A 65-year-old male patient admitted to the emergency department with the complaints of pain, swelling, redness in the left testis and also nausea, vomiting and chills that started three days ago. Physical examination revealed increased diameter of the scrotum, intense hyperemia of the skin and foci of necrosis. It was learned that the patient had no known chronic disease other than benign prostatic hyperplasia. The patient reported smoking of 25 packs of cigarettes per year. Routine laboratory tests revealed leukocyte= 32.41 x 109/L, neutrophil= 89.9%, procalcitonin= 1.62 ug/L, CRP= 265.07 mg/L and the patient was operated with the diagnosis of Fournier's gangrene. Gram staining of the abscess specimen obtained during the operation showed gram-positive bacilli both inside and outside the leukocytes. After 24 hours, grampositive bacilli were detected in the Gram staining of thin, transparent/gray colonies grown on 5% sheep blood and chocolate agar. The isolate was identified as A.schaalii by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) VITEK® MS (bioMérieux, France) microbial identification system. VITEK®2 ID ANC (bioMérieux, France) bacterial identification card was also used for comparison but the bacteria could be identified. As a result of the sequence analysis performed for confirmation, it was shown to be 100% homologous with Actinobaculum schaalii (GenBank accession no: FJ711193.1). For susceptibility tests, 5% sheep blood Schaedler agar was used and incubated in anaerobic environment. According to the minimal inhibitory concentration (MIC) results evaluated after 48 hours, penicillin was found to be 0.032 mg/L, clindamycin 0.125 mg/L, ciprofloxacin 0.19 mg/L, ceftazidime 4 mg/L, and amoxicillin 0.19 mg/L. The primary cause that initiated the infection in the case could not be identified, but it was thought that the presence of prostatic hyperplasia and smoking history may have contributed to the occurence or the progress of the disease. It is noteworthy that the ciprofloxacin MIC result was quite low compared to other studies. In addition, this study revealed the value of MALDI-TOF MS based methods in identification. In conclusion, it is thought that a significant proportion of A.schaalii infections may be overlooked due to the difficulty in growth and identification. Increasing the diagnostic power of clinical microbiology laboratories for poorly identified bacteria and renewing the databases of commercial identification systems are important for the early and accurate diagnosis and treatment of serious infections that may occur with such agents.

Proximal nailfold videocapillaroscopy findings of patients with idiopathic macular telangiectasia type 2.

PURPOSE: Idiopathic macular telangiectasia type 2 (IMT) is a neurodegenerative disease characterized by bilateral, idiopathic, and perifoveal retinal telangiectatic vessel formations. We aimed to compare proximal nailfold videocapillaroscopy (NV) findings between patients with IMT and healthy individuals and evaluate the optical coherence tomography angiography (OCTA) parameters of the patients with IMT according to their NV findings. METHODS: The study included 43 patients with IMT and 92 healthy controls of similar age and gender without any additional diseases. The OCTA and NV findings of the patients and controls were examined. RESULTS: The mean age was 59.76 ± 5.73 years in the IMT group and 58.23 ± 4.96 years in the control group. Of the 43 patients with IMT, 19 were found to have increased capillary tortuosity, six had microhemorrhage, and 18 had bizarre capillaries (P < 0.001). In the IMT group, the total vascular density value of the superficial capillary plexus was higher among the patients with capillary microhemorrhage (P = 0.001), and the subfoveal choroidal thickness was lower among those with increased capillary tortuosity and bizarre capillaries (P = 0.04 and P = 0.07, respectively). CONCLUSION: This is the first study in which the NV findings of patients with IMT were compared with those of a control group. We found higher rates of increased capillary tortuosity, microhemorrhage, and bizarre capillaries in the IMT group compared to the controls. We consider that this situation is caused by microvascular damage. We also think that IMT is a systemic disease that affects both proximal nailfold capillaries and eye vessels.

Evaluation of Optic Disc, Retinal Vascular Structures, and Acircularity Index in Patients with Idiopathic Macular Telangiectasia Type 2.

BACKGROUND: We aimed to compare the retinal, optic disc vascular density (ODVD) values, and acircularity index (AI) of patients with idiopathic macular telangiectasia type 2 (IMT) and healthy individuals using the optical coherence tomography angiography (OCTA) device. METHODS: The study included 39 patients with IMT and 37 healthy controls. The OCTA findings of the patients and controls were examined. RESULTS: The total, parafoveal and perifoveal vascular density of the superficial capillary plexus, choriocapillaris blood flow, inside-disc ODVD, retinal nerve fiber layer (RNFL), and retinal thicknesses were found to be statistically significantly lower, and the foveal avascular zone value was statistically significantly higher in the IMT group compared to the control group (p = 0.001, p = 0.01, p = 0.02, p = 0.01, p = 0.009, p = 0.002, p = 0.02, respectively). There was a statistically significant negative correlation between best-corrected visual acuity (BCVA) and AI (p = 0.02), and a statistically significant positive correlation between peripapillary vascular density and BCVA (p = 0.04). CONCLUSIONS: We consider that the lower retinal, choriocapillaris, ODVD values, and retinal and RNFL thicknesses in the patients with IMT compared to the controls were due to vascular damage, remodeling, fibrosis, proliferation, and Müller cell damage. Ellipsoid zone defect, AI, and peripapillary vascular density are important indicators in the evaluation of visual acuity in these patients.

Malignant Colorectal Polyps: Are Pathology Reports Sufficient for Decision Making?

AIM: This study aims to assess the completeness of pathology reports of T1 colorectal cancers from different healthcare centers and the change of treatment decision after reevaluation of the polyps. MATERIALS AND METHODS: In this single-center retrospective cohort study, several pathology reports of endoscopically excised malignant colorectal polyps at diverse healthcare centers in Turkey were reassessed at a comprehensive cancer center in Istanbul. Reassessment was mainly focused on core elements such as the size of invasive carcinoma, histologic type and grade, tumor extension, surgical margin (deep and mucosal), and lymphovascular invasion. RESULTS: Sixty-seven endoscopically resected malignant polyps were analyzed. The mean age of patients was 62.2 years and 38 (58%) patients were males. Tumor size, histologic type and grade, surgical margin (deep and mucosal), and lymphovascular invasion were reported in 11%, 100%, 31%, 9%, and 19%, respectively. All 5 prognostic factors were reported only in 1 (1.5%) pathology report. Because of the missing (incomplete) data, the pathologic examination of 59 (88%) patients was determined to be inadequate to make an accurate treatment decision. CONCLUSION: Several variables are not considered and frequently missing for decision-making, suggesting the reassessment of the specimen by a second pathologist at a high-volume comprehensive cancer center.

Is Triple D Score Effective to Predict the Stone-Free Rate After Shockwave Lithotripsy in Pediatric Population?

Introduction: Triple D score was developed using skin-to-stone distance (SSD), stone density (SD), and stone volume (SV) for prediction of extracorporeal shockwave lithotripsy (SWL) outcomes in adults. SWL is the first-line treatment method for kidney stones <2 cm in children, however, it was not validated in the pediatric population. This article aims to validate Triple D score in pediatric patients. Materials and Methods: Of the 269 children treated with SWL between 2007 and 2021, a total of 147 children who had adequate follow-up data and evaluated with noncontrast CT before SWL were included in the study. Parameters were calculated for each of the SV, SSD, and SD variables. Receiver operator characteristic analysis was used to set cutoff values. Triple D scores were calculated, and success rates were determined for each score. Stone-free status was determined as complete clearance after 3 months of final SWL. Results: The median age of the study group was 7 years (range 1-16). Ninety-three of the 147 (63%) children had stone-free status. Mean SV, SSD, and SD values were significantly higher in the SWL-failed group than in the stone-free group after detecting cutoff values of 155 mm3, 6.5 cm, and 550 HU, respectively. Stone-free rates were detected as 23.8%, 35.1%, 74.0%, and 92.0% with the Triple D scores of 0, 1, 2, and 3 points. Conclusions: Our study confirms that Triple D scores support the SWL outcomes in the pediatric population. We believe that our research on Triple D score validation in children is of great clinical importance although various factors may affect to predict the success of SWL. IRB Approval: 2021/514/194/14.

Evaluation of retinal and optic disc vascular structures in patients with familial Mediterranean fever (FMF) via optical coherence tomography angiography.

INTRODUCTION: Familial Mediterranean fever (FMF) is an auto-immune disease characterized by fever and serositis. With this study, we aimed at comparing the retinal vascular structures of FMF patients and healthy individuals using optical coherence tomography angiography (OCTA) device. MATERIALS AND METHODS: Sixty-nine patients with FMF and 52 healthy controls who were matched by age and sex, didn't have any comorbidities and were admitted to our clinic for routine ophthalmic examination were enrolled in the study. Sixty-nine eyes of 69 patients and 52 eyes of 52 healthy controls that were not disqualified due to the exclusion criteria were included in the study. OCTA images of the patients and controls were analyzed. RESULTS: The mean average age (± SD) of 69 FMF patients included in the study was 39.86 ± 13.16. Forty-nine patients were female, and twenty patients were male. Total vascular density of deep capillary plexus (DCP) and vascular density of DCP parafovea of the FMF patients were found to be statistically significantly lower than those of the controls (p = 0.045, p = 0.034, respectively), while total retinal parafoveal thickness, total retinal perifoveal thickness, outer retinal parafoveal thickness and outer retinal perifoveal thickness were statistically significantly higher in the patient group compared with the control group (p = 0.012, p = 0.014, p = 0.013, p = 0.009, respectively). CONCLUSIONS: This study found reduced vascular density and increased retinal thickness in patients with FMF compared to controls. Larger studies are required to further explore the effect of FMF on the retina.

Optic disc and retinal vessel densities assessment by optical coherence tomography angiography in patients with keratoconus.

BACKGROUND: This study aimed to evaluate retinal and optic disc vascular changes in patients with keratoconus (KC) using optical coherence tomography angiography (OCTA). METHODS: Thirty-two eyes of 22 patients with KC and 24 eyes of 24 age- and sex-matched healthy controls were included in this study. Corneal topography and OCTA were performed. Quantitative vessel density of the macular superficial capillary plexus (SCP), macular deep capillary plexus (DCP), and radial peripapillary capillaries (RPC); choriocapillaris flow area; and choroidal thickness were compared between the KC and control groups. RESULTS: SCP and DCP vessel densities showed a significant reduction in the KC group compared to that in the control group (p < 0.001 and p < 0.001 in the whole image and parafovea, respectively). Choriocapillaris flow area was significantly higher in patients with KC than in the control group (p = 0.003). The foveal avascular zone area did not significantly differ between the two groups (p = 0.949). RPC inside disc vessel density was significantly decreased in the KC group compared to that in the control group (p < 0.001). CONCLUSION: This study revealed important macular, choroidal, and optic disc vessel densities changes in patients with KC. Macular whole vessel density and parafoveal vessel density of the SCP and DCP decreased, while choriocapillaris flow area increased in patients with KC.

The Role of FDG Positron Emission Tomography/Contrast--Enhanced Computed Tomography in Preoperative Staging and Postoperative Follow-up in Rectal Cancer Surgery.

<b> Introduction:</b> F-18 fluorodeoxyglucose (F18-FDG) positron emission tomography-computed tomography (PET/CT) is a valuable functional imaging modality for the clinical diagnosis which provides physiological information based on the altered tissue metabolism. </br></br> <b> Aim:</b> This study aims to investigate the effectiveness of F-18 fluorodeoxyglucose (F18-FDG) positron emission tomography-computed tomography (PET/CT) in preoperative staging and postoperative local recurrence and distant metastases in patients with rectal cancer. </br></br> <b> Material and methods:</b> The imaging of 726 patients with rectal cancer who were operated on at Istanbul University, Istanbul School of Medicine and had F18-FDG PET/CT, CT, and magnetic resonance imaging (MRI) scans between September 2005 and October 2016 were retrospectively analyzed. Of these patients, 170 who had pre- and postoperative PET/CT scans, had their CT scans included in the study. The sensitivity and specificity of PET/CT in preoperative staging and detection of postoperative local recurrence and distant metastases were analyzed. </br></br> <b> Results:</b> Of the patients, 101 were males and 69 were females with a median age of 62.27 (range, 31 to 89) years. The sensitivity and specificity of preoperative PET/CT in detecting liver metastases were 100% (confidence interval [CI]: 66.37-100%) and 94.2% (CI: 89.72-100%), respectively (Cohen's kappa [κ]: 1.00; P < 0.001). The sensitivity and specificity of postoperative PET/ CT in diagnosing liver metastases were 100% (CI: 88.06-100%) and 98% (CI: 9-100%), respectively (Cohen's κ: 1.00; P < 0.001). The sensitivity and specificity of preoperative PET/CT in detecting lung metastases were 100% (CI: 66.37-100%) and 91.8% (CI: 89.72-100%), respectively (Cohen's κ: 1.00; P < 0.001). The sensitivity and specificity of postoperative PET/CT in detecting lung metastases were 100% (CI: 91.4-100%) and 96% (CI: 95.8-100%), respectively (Cohen's κ: 1.00; P < 0.001). The sensitivity and specificity of PET/CT in preoperative staging of pathological pelvic lymph nodes were 100% (CI: 63.06-100%) and 94.29% (CI: 80.84-99.3%), respectively (Cohen's κ: 0.860; P < 0.001). The sensitivity and specificity of postoperative PET/CT in detecting local recurrences were 100% (CI: 78.2-100%) and 76.74% (CI: 61.37-88.24%), respectively (Cohen's κ: 0.219; P < 0.08). </br></br> <b>Results:</b> Given the fact that PET/CT can detect all primary rectal cancer in preoperative staging, it can be effectively used in selected cases, particularly in those suspected of local and advanced disease and with metastases (T3N0, T3N1, and/or T4N1). Due to a relatively low specificity in detecting local recurrences postoperatively, PET/CT can be combined with further modalities.

Changes in choroidal blood flow in patients with macular hole after surgery.

INTRODUCTION: A macular hole (MH) is a defect that occurs in the retina and involves all layers. In this study, we aimed to investigate the preoperative and postoperative choriocapillaris blood flow (CBF) changes in patients with MH and the role of CBF in the pathogenesis of the disease using optical coherence tomography angiography (OCTA). MATERIAL METHOD: This is a retrospective study examining eyes with MH. The study included 25 operated eyes of 25 patients and contralateral eyes of 18 patients. CBF and subfoveal choroidal thickness were examined using the OCTA images of the patients before surgery and at the first, third and sixth months after surgery. RESULTS: The mean CBF value of the patients was 1.57±0.20 mm² preoperatively, 1.94±0.13 mm² at the postoperative first month, 1.98±0.12 mm² at the third month, and 2.00±0.10 mm² at the sixth month. The increases in the CBF values between the preoperative period and the postoperative measurements were statistically significant (p<0.0001 for all). In the preoperative period, the CBF value of the contralateral eyes was 2.07±0.10 mm². The preoperative CBF value of the contralateral eyes was higher compared to that of the eyes with MH (p<0.0001). There was no significant difference between the preoperative CBF value of the contralateral eyes and the postoperative sixth-month value of the eyes with MH (p = 0.065). CONCLUSION: The preoperative and postoperative third-month CBF values of the eyes with MH were found to be lower than those of the contralateral eyes, but there was no difference between the postoperative sixth-month CBF value of the eyes with MH and the preoperative CBF value of the contralateral eyes. We consider that the eyes with MH achieve similar CBF values to the contralateral eyes in an average of six months after successful surgery.

HCV Genotype Distribution of Patients with Chronic Hepatitis C in Istanbul.

OBJECTIVES: Hepatitis C virus (HCV), which has no protective vaccine, is a common cause of chronic hepatitis, which is a severe public health threat. There are differences in nucleotide and amino acid sequences in different regions of the HCV genome. As a result of these differences, HCV has been shown to have at least seven major genotypes and many subtypes. In Turkey, the prevalence of genotype 1 is between 51.7% and 97.1%, the highest rate among all genotypes, while subtype 1b is the genotype with the highest rate. It is important to detect mixed genotype infection reliably as it causes treatment failure. This study aims to reveal the distribution of the HCV genotypes in our hospital in Istanbul over the years and to contribute to the epidemiological data of Turkey. METHODS: For this purpose, 385 patient samples sent to Sisli Hamidiye Etfal Training and Research Hospital, Clinical Microbiology Laboratory for HCV genotype determination between January 2016 and June 2019 were evaluated retrospectively. Anti-HCV was screened by enzyme immunoassay and confirmation was performed by Line immunoassay. HCV genotyping assays targeting highly conserved 5'UTR and most variable region NS5B regions were used. RESULTS: The most common genotype was genotype 1 (81.3%) with 313 cases and subtypes 1a and 1b were detected at the rates of 10.9% and 67.8%, respectively. In addition, genotype 3, 2, 4, 5 were detected at the rates of 8.8%, 3.4%, 2.9%, 0.8%, respectively and mixed genotype was found in 2.9% of cases. Although genotype 5 is seen in South Africa, it is found in the Middle East region, albeit at a low rate. In our study, it was observed that genotype 5 was detected in different years from patients of Syrian origin. CONCLUSION: In this study, genotype 1 was the most common genotype with a rate of 81.3% and subtype 1b was 67.8%, in accordance with the literature. However, genotypes 3, 2, 4 and 5 were also present at low rates. It is important to monitor these rare genotypes since some of them are dominant in surrounding countries. In addition, 2.9% of HCV mixed genotype was detected and this should be considered concerning management of HCV infection.

Comparison of Iliac and Femoral Autograft Practices in Pemberton Pelvic Osteotomy.

BACKGROUND: There is no consensus in regard to grafts used after pelvic osteotomy in developmental dysplasia of the hip in the literature. The aim of this study was to compare iliac and femoral autografts used after Pemberton pelvic osteotomy (PPO). METHODS: In this prospective, randomized study, 60 hips with dysplasia of the hip were included. All patients underwent open reduction, PPO, and femoral shortening osteotomy. Iliac autograft (group I; n=30 hips; mean age, 39.07; range, 18 to 72 mo) and femoral autograft (group II; n=30 hips; mean age, 42.53; range, 19 to 70 mo) were used to fill the iliac osteotomy. The height and width of the iliac and femoral autografts were measured intraoperatively. Anteroposterior pelvic radiographs were obtained on the 45th day, and in the 2nd, 3rd, 6th, and 12th months postoperatively. Acetabular index angle, height of the graft, loss of graft position, graft resorption, operative time, blood loss, and union time were compared between the groups. RESULTS: There was a significant difference in each group in terms of loss of graft height between the intraoperative measurement and the postoperative measurement at the 6th week and 3rd month. The intraoperative width of the grafts was significantly greater, loss of graft height was significantly less, and the amount of bleeding was significantly lower in group II (P<0.001 for all 3). However, time to union was significantly shorter in group I (P<0.001). There was no significant difference between the groups in terms of acetabular index angle at the last controls. There were loss of graft position in 2 cases and graft resorption in 1 case for group I, but no such cases occurred for group II. CONCLUSIONS: Graft height and position loss, donor site morbidity, and graft resorption were less in the femoral autografts group compared with the iliac autografts group in the treatment PPO with femoral shortening osteotomy. LEVEL OF EVIDENCE: Level II.

Nosocomial Infection Agents of Sisli Hamidiye Etfal Training and Research Hospital: Comparison of 1995 and 2017 Data.

OBJECTIVES: Healthcare-associated infections (HCAI), which are important causes of mortality and morbidity, are high cost but preventable infections. This study aimed to determine hospital infections and isolates in Sisli Hamidiye Etfal Training and Hospital and to determine our local data. The changes in the distribution of the isolates in this process were evaluated by comparing the data of 1995 and today. METHODS: Materials sent to the microbiology laboratory of our hospital in 1995 and 2017 from the patients hospitalized in the period between June 1-December 31 were evaluated concerning hospital infection. The standard manual methods were used in 1995, while in 2017, MALDI-TOF MS was used for identification and BD Phoenix automated system for antibiotic susceptibility. RESULTS: In 1995, in total, 100 bacteria were isolated from pediatric and adult patients, of which 48 Pseudomonas aeruginosa (48/100), 37 Klebsiella spp (37/100). In 2017, Acinetobacter baumannii causing an important resistance problem was found to be increased in number. The main hospital infection causes were Acinetobacter baumannii (37/179), Klebsiella spp (41/179). In 2017, bacterial diversity was also increased. CONCLUSION: Isolated strains, as in the past, are gram-negative bacteria, Pseudomonas spp decreased in 2017, and Acinetobacter spp increased. The findings suggest that the automated systems used in microbiology laboratories may have a role in the detection of bacterial diversity.

Optic Coherence Tomography Angiography Findings of Bilateral Choroidal Neovascularization Associated with Optic Disc Drusen Treated with Intravitreal Aflibercept Injection.

PURPOSE: The purpose of this case report is to present the findings of optical coherence tomography angiography (OCTA) of a patient with bilateral choroidal neovascularization (CNV) associated with optic disc drusen (ODD), who was treated with intravitreal aflibercept injection. Case presentation. A 14-year-old girl presented with a complaint of visual loss and metamorphopsia in her both eyes. Best-corrected visual acuity (BCVA) was 20/32 and 20/25, respectively, in the right and left eyes. Intraocular pressure and anterior segment examination were normal. Dilated fundus examination revealed elevated optic discs with blurred margins in both eyes. In addition, slightly elevated yellow lesion extending from optic nerve head to the macula was observed bilaterally. The patient underwent imaging with colour fundus photography, fundus autofluorescence (FAF), fundus fluorescein angiography (FFA), spectral-domain optic coherence tomography (SD-OCT), OCTA, orbital ultrasonography (USG), and computed tomography (CT). In particular, OCTA demonstrated clearly the large circular CNV complex in the right eye and the CNV structure in the left eye containing slightly activated main trunk and minimal vessel loops in the papillomacular region. CNV secondary to bilateral ODD was suspected. Intravitreal aflibercept injections were performed in 3 doses to the right eye and a single dose to the left eye. After the injections, BCVA reached its complete level in both eyes. SD-OCT revealed irregularity of RPE in the temporal region of the optic disc and complete regression of the subretinal fluid. Interestingly, the entire CNV complex including the main trunk completely disappeared in OCTA. CNV complex was not observed in OCTA during 1-year follow-up, and peripapillary and macular vascular density measurements did not show any significant change. BCVA was preserved, and no additional injections were needed. CONCLUSION: It is possible that OCTA can be used for detailed evaluation of CNV associated with ODD, response to anti-VEGF treatment, and peripapillary and macular vascular density. There is a need for further studies to confirm the changes such as disappearance of CNV in OCTA after injection as we observed in our patient.

A highly-sensitive rapid test for the diagnosis of streptococcal pharyngitis: BD veritor ™ system.

INTRODUCTION: The diagnosis of streptococcal pharyngitis is very important to prevent complications such as acute rheumatic fever. Throat culture is the gold standard method for the diagnosis of streptococcal pharyngitis, however, rapid antigen tests (RAT) have been developed for faster diagnosis. The purpose of this study is to evaluate the efficacy of the BD Veritor ™ System (USA) rapid antigen assay in detecting Group A Streptococcus (GAS) in throat swab samples. METHODS AND MATERIALS: A total of 12,391 throat swabs, taken with a double swab, were evaluated. The BD Veritor ™ System was used for the detection of GAS antigen. Simultaneous throat cultures were performed. RESULTS: Throat culture yielded positive for 18.5% (2291) while 19.1% (2369) were positive with RAT. The sensitivity of BD Veritor ™ System was determined as 94.1% and specificity as 97.9%, while positive predictive value, negative predictive value and accuracy were determined as 91.0%, 98.7%, 97%, respectively. When all age groups were included, the rate of GAS positivity was 18.5% and this ratio increased to 27.3% in the five-15 age group. CONCLUSION: Our study, conducted with quite a large number of patients, yielded high sensitivity for the BD Veritor System. When the RAT is negative, the necessity of culture for pediatric patients should not be forgotten.

Functional outcomes and quality of life in adult ipsilateral femur and tibia fractures.

OBJECTIVE: The aim of our study is to evaluate the functional outcomes and quality of life in adult ipsilateral femur and tibia fractures. METHODS: 26 patients (21 male, 5 female; mean age 30 years, range: 18 to 66) treated for adult ipsilateral femur and tibia fractures were evaluated retrospectively. For femur fractures, intramedullary nails were used in 15 patients (12 antegrade, 3 retrograde), plate in 11 patients (10 locked-plate, and 1 blade-plate with a 95 degree angle). For tibia fractures, locked-plate were used in 13 patients, intramedullary nails in 9 patients, external fixator in 3 patients and multiple screws in 1 patient. According to Blake and McBryde classification, 17 fractures were type I, 9 fractures were type II (7 type 2A and 2 type 2B). The functional outcomes were evaluated by Karlström and Olerud criteria, and quality of life was evaluated by Short Form-36. The mean follow-up duration was 4.4 years (range: 1.1 to 7.3 years). RESULTS: The functional outcomes were excellent in 6 patients, good in 8 patients, acceptable in 6 patients and poor in 6 patients. The mean values of quality of life scales were; physical function: 64.8, physical role limitation: 60.5, pain: 68.2, general health: 63.3, vitality: 58.4, social function: 68.2, emotional role limitation: 62.7, and mental health: 65.8. CONCLUSION: Adult ipsilateral femur and tibia fractures are severe injuries and adversely affect the quality of life and functional outcomes. The quality of life scales should be used along with functional outcome scores in evaluating these injuries. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE: Adult ipsilateral femur and tibia fractures cause severe morbidity. Functional outcomes and quality of life scales should be used together to evaluate these fractures. Karlström and Olerud criteria for functional outcomes and Short Form-36 scales for quality of life are suitable methods to evalute these fractures.

Complicated or not complicated: Stoma site marking before emergency abdominal surgery.

BACKGROUND: Marking a stoma site preoperatively decreases the possibility of experiencing later stoma-related problems and improves the quality of life of patients in the postoperative period. Those best equipped to perform this procedure are ostomy nurses and colorectal surgeons, as they receive the stoma therapy education during their training programs. The aim of this study was to compare the rate of stoma problems and quality of life of patients who underwent an operation that included stoma creation (elective or urgent) with and without preoperative stoma siting. The approach and behavior of surgical residents regarding stoma creation was also assessed. METHODS: Patients who had undergone gastrointestinal surgery between January 2012 and December 2013 were assessed. A total of 116 of those patients who had a stoma created during the initial operation were followed by a stoma therapy nurse in the postoperative period and were enrolled in the current study. In addition, a survey of the residents was conducted to evaluate their knowledge about stoma creation and stoma care. RESULTS: A total of 67 (58%) of the 116 patients included were male. The median age was 57±16 years (range: 17-87 years). A body mass index above 30 kg/m2 was detected in 16 patients (14%). The reason for surgery was malignant disease in 93 (80%) patients, and 97 cases (84%) were elective operations. Preoperative stoma marking was performed in 72 patients (62%). The stoma type was an ileostomy in 87 patients (75%). Stoma-related complications were observed in 40 patients (35%). Emergency surgery (p=0.020), preoperative stoma marking (p=0.000), adjuvant therapy (p=0.004), and the stoma caretaker (patient or relatives) (p=0.05) were associated with stoma-related complications. Logistic regression analysis revealed that only the type of surgery (emergency or elective), preoperative stoma marking, and the stoma caretaker increased the rate of stoma-related complications. CONCLUSION: Marking the stoma location before surgery reduces the risk of stoma-related complications and has a positive effect on the patient's quality of life. Multivariable analysis indicated that marking the stoma site before the operation was the only factor that affected the rate of stoma-related complications, regardless of emergency or elective surgical conditions. Since surgeons will encounter the need for a stoma procedure during their professional career and they will not always have the opportunity to work with stoma therapy nurse, stoma care education should be provided during their residency (internship) education, and ascertaining a stoma localization before surgery for all potential stoma cases should be encouraged in emergency shifts.

Trend in Antibiotic Resistance of Extended-Spectrum Beta-Lactamase-Producing Escherichia Coli and Klebsiella Pneumoniae Bloodstream Infections.

OBJECTIVES: Extended-spectrum beta-lactamases (ESBLs) have been detected more frequently in members of the Enterobacteriaceae family, particularly Escherichia coli and Klebsiella pneumoniae. Infections caused by ESBL-producing bacteria are often resistant to treatment with various antibiotic classes and accompanied by increased complication risks, mortality, and costs. In this study, blood culture results were analyzed to determine the change in the ESBL production rate and antibiotic susceptibilities in E. coli and K. pneumoniae isolates over a period of 3 years. METHODS: The results of blood cultures sent to our laboratory between February 2014 and August 2016 were examined retrospectively. Repeat isolates from the same patient were not included when antibiotic susceptibility rates and clinical distributions were calculated. BD Bactec FX automated blood culture system (Becton Dickinson, Sparks, MD, USA) was used to examine the blood cultures. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (Bruker Daltonics, Bremen, Germany) was used to identify microorganisms. For antibiotic susceptibility tests (AST) and ESBL detection Kirby Bauer disk diffusion method or Phoenix automated system (Becton Dickinson, Sparks, MA, USA) was used. When the AST results were evaluated, Clinical and Laboratory Standards Institute breakpoints were used for 2014 and 2015, and European Committee on Antimicrobial Susceptibility Testing breakpoints were used for 2016. RESULTS: During the 3-year period, 224 (35%) of 632 E. coli and 137 (31%) of 439 K. pneumoniae isolates were determined to be ES BL-producers. The ESBL-positive isolate percentage for E. coli and K. pneumoniae for 2014, 2015, and 2016 was 23%, 36%, 48% and 23%, 32%, 37%, respectively. The increase in ESBL was statistically significant for both E. coli (p<0.001) and K. pneumoniae (p=0.011). ESBL-positive E. coli and K. pneumoniae strains were most sensitive to carbapenem-class antibiotics, amikacin, and colistin. While there was no meropenem-resistant strain, 5 (3.3%) ertapenem-resistant and 1 (0.7%) imipenem-resistant ESBL E. coli strains were detected. The ESBL K. pneumoniae strain resistance rate to ertapenem, imipenem, and meropenem was 12%, 11.2%, and 11.1%, respectively. The resistance rates of K. pneumonia strains to ertapenem, imipenem, meropenem, and piperacillin-tazobactam increased significantly over the study period (p<0.001). CONCLUSION: Monitoring ESBL rates and the antibiotic susceptibility of E. coli and K. pneumoniae strains of bloodstream infections is of the utmost importance in guiding empiric antibiotic therapies and patient management.

Optical coherence tomography angiography for screening of hydroxychloroquine-induced retinal alterations.

BACKGROUND/AIMS: The purpose of the study was to evaluate the retinal and choroidal changes via optical coherence tomography angiography (OCTA) in patients who received hydroxychloroquine (HCQ). METHODS: Sixty eyes of 60 female patients who received HCQ were included in the study. Patients were categorized into two groups as high-risk (≥ 5 years) and low-risk (< 5 years) in terms of HCQ-induced retinal toxicity. Spectral domain-OCT, OCTA, and visual field tests were performed. Retinal thickness, vascular density, flow rates, choroidal thickness (CT), and visual field parameters were compared between the groups, and the correlation between total HCQ cumulative dose, duration of use, and these parameters was assessed. RESULTS: Compared to low-risk group, patients in the high-risk group had vascular density loss (p < 0.05). In this group, foveal avascular zone (FAZ) was found to be wider (p < 0.05). Retinal and choroidal flow rates were found to be decreased markedly in the high-risk group (p < 0.05). CT was found to be thinner in the high-risk group (p < 0.05). HCQ cumulative dose and duration of use had a negative significant correlation with all vascular density, flow rate, CT parameters, and positive significant correlation with FAZ parameters (p < 0.05). In visual field tests, mean defect (MD) was found to be increased in the high-risk group (p < 0.05). Moreover, MD had a positive correlation with HCQ cumulative dose and duration of use (p < 0.05). CONCLUSIONS: Evaluation of microvascular changes via OCTA may contribute to the early detection of HCQ-induced retinal toxicity, which cannot be detected through other imaging devices, at the stage when it is reversible.