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In this paper, a new 5-level inverter is developed by inserting a switched-capacitor (SC) unit into the traditional 3-level neutral-point-clamped (NPC) inverter phase-leg. The SC unit consists of two capacitors and one bidirectional switch, all of which withstand a quarter of the dc input voltage. Whilst increasing the output levels, the performance is also improved in terms of power loss, common-mode voltage, switching stress dv/dt and output filter. Compared to other 5-level inverters like the conventional NPC and active NPC 5-level topologies, the new solution not only reduces the number of components and simplifies the design, but also has the advantage of self-balanced capacitor voltages. The analysis, simulation and experiment indicate that the proposed inverter is suitable for a wide range of applications like renewable source grid-connected interfaces and motor drivers. Simulation and experimental results of grid-connected operation verify that the new inverter is capable of providing both active and reactive power to the grid. Its excellent performance is also experimentally evaluated by a 1.2 kW prototype and the measured efficiency is above 97% for a wide range of load.

Extractive fermentation is a technology used to combat product inhibition. However, there has been comparatively low adoption of this technique in industry and this can be attributed to, among other reasons, a need for novel and optimised bioreactor configurations to facilitate this unit operation. Recent research has proposed a novel Semi-Partition Bioreactor (SPB) which combines the fermentation (mixer section) and extraction (settler section) steps in one reactor thus simplifying the operation of extractive fermentation. However, while the bioreactor was shown to be feasible, an improved understanding of the reactor’s hydrodynamics is required to allow for optimised designs. This study thus focuses on the use of validated Computational Fluid Dynamics (CFD) simulations to investigate the hydrodynamics of the SPB. Key findings illustrate that, unsurprisingly, normal stirred tank reactors’ hydrodynamics are significantly changed by the introduction of a settler. Consequently, the modified hydrodynamics influence the volumetric flux between the fermentation and extraction sections. Accurate modelling of this flux gives insights into various operational choices and physical systems (for instance modifying the settler insert). Key then is accurately matching the CFD model with experimental work. For example, it has been shown that mixing time (in the settler) can be predicted to within 14.8% accuracy if the transient nature of the volumetric flux is considered as opposed to a 57% accuracy if a constant flux is assumed. Finally, a design approach for the in silico prediction of possible volumetric removal rates of top phase from the settler has been proposed. This approach would be of interest to a bioreactor engineer seeking to, for example, estimate an optimal removal rate that prevents over-accumulation of a toxic species and subsequent product inhibition.

Background: This study aimed to evaluate the clinical characteristics and changes in the number of patients receiving intravitreal injections (IVIs) at a tertiary hospital during the coronavirus disease 2019 (COVID-19) pandemic as compared to the pre-pandemic period. Methods: This retrospective, cross-sectional study included 3,211 patients with retinal disease, who received IVIs of anti-vascular endothelial growth factor (anti-VEGF) between January and May 2020. This 5-month period was divided into a pre-pandemic and a pandemic period. Clinical and demographic data were collected and were compared between the patients in each period. All COVID-19 infection precautions were implemented to minimize the potential transmission of COVID-19 to both healthcare workers and patients. Results: A total of 3,211 IVIs were administered to patients with diabetic retinopathy, age-related macular degeneration, retinal vein occlusion, and other retinal conditions. Diabetic retinopathy was the most common indication for treatment in the pre-pandemic as well as pandemic periods. Bevacizumab (Avastin, Roche) was the most common IVI type, followed by aflibercept (Eylea, Bayer). Of 3,211 IVIs, 2,943 (91.7%) were administered during the pre-pandemic period and 268 (8.3%) during the pandemic period. There was a statistically significant decrease in injections between the pre-pandemic and pandemic periods, with an overall reduction of 90.8% in IVIs (P < 0.05). No cases of confirmed transmission of COVID-19 orcomplications associated with IVIs were recorded. Conclusions: This study showed that the number of IVIs and patient visits decreased significantly, by more than 10-fold, during the lockdown period. These findings show that COVID-19 has turned the management of sight-threatening eye diseases into a challenging process and must be addressed if future healthcarerestrictions are imposed.

A preterm infant who underwent bilateral laser photocoagulation for the treatment of stage 3 retinopathy of prematurity (ROP) is presented because she was incidentally diagnosed with grade 3 lipemia retinalis by dilated fundoscopy at post-laser 2 weeks. Meticulous ophthalmologic examination is imperative in premature newborns for not only ROP screening but also detecting any concomitant ocular abnormalities, which can be sight-threatening or even life-threatening. © 2021 by Turkish Ophthalmological Association.

Purpose: To define the characteristics of vitreoretinal surgeries amid coronavirus disease 2019 (COVID-19) pandemic restrictions in Turkey. Methods: This descriptive, cross-sectional study was conducted for vitreoretinal surgeries during the 10-week period (during this period, all elective surgeries were postponed across the country by the order of the Republic of Turkey Ministry of Health) in a single tertiary referral hospital in Ankara, Turkey. The number of surgeries, surgical indications, risk factors, etiological factors, and associated conditions were investigated and compared with the clinical features of the patients who underwent vitreoretinal surgery in the same period of the recent year. Results: During this period, vitreoretinal surgery was performed more commonly for the male population (P < 0.001). The number of vitreoretinal surgeries was statistically significantly correlated with the number of COVID-19 cases (P = 0.006 and r = −0.791 for weekly numbers of new surgeries and cases, and P < 0.001 and r = 0.929 for cumulative numbers of surgeries and cases). Diabetes mellitus in 26 patients (32.9%) was the most common systemic comorbidity. The most common indication for vitreoretinal surgery was rhegmatogenous retinal detachment in 44 patients (55.7%) followed by diabetic retinopathy complications in 21 patients (26.6%). No one was operated on for vitreoretinal interface disorders during this period, and the rate of rhegmatogenous retinal detachment was higher than the same period of the recent year (P = 0.003). Conclusions: Amid COVID-19 pandemic restrictions in Turkey, the number of vitreoretinal surgeries was inversely associated with the number of confirmed COVID-19 cases. The male population needed more vitreoretinal surgery, and rhegmatogenous retinal detachment was the most common indication for all patients.

Aim:It is known that muscle mass decreases with age. Sometimes it may be possible to adversely affect this reduction. It was aimed to investigate the contribution of claudin-5 and E-cadherin to this process.Methods:Samples were taken from the psoas muscle of 55 cases autopsied for different reasons between 2018-2019. Age, gender, weight, height, chronic disease, and addiction were recorded. Histopathological degeneration parameters were evaluated. In addition, samples were prepared for immunohistochemical study. Evaluation for E-cadherin and claudin-5; no staining, weak staining, moderate staining and severe staining. Fibrosis was evaluated with Masson trichrome.Results:There was a very strong and statistically significant inverse relationship between acidophilic sarcoplasma and staining with claudin-5 (p0.05).Conclusion:Claudin-5 can be a target protein that can be used in the detection and prophylaxis of degeneration and atrophy in striated muscles.

Hyperferritinemia may develop due to various reasons such as inflammation, infection, or malignancy. The purpose of the study to explore the prevalence and to figure out the causes of general hyperferritinemia and extreme hyperferritinemia as detected through the ferritin measurements requested by the rheumatology department. Adult patients at the age of 18 years and older with at least one serum ferritin level measurement at or above 500 ng/mL as requested by the rheumatology department between January 2010 and December 2019 were evaluated retrospectively. Hyperferritinemia was detected in 4.7% of 11,498 serum ferritin tests. The mean age of 242 patients found to have hyperferritinemia was 53.7 ± 17.1 years; of the patients, 63.2% were female, and the mean serum ferritin value was 2820 ± 5080 ng/mL. The most common cause of hyperferritinemia was rheumatological diseases with a ratio of 59.1%, which was followed by infections, iron overload, and solid malignancy. Among the rheumatologic diseases, adult-onset Still’s disease (AOSD), rheumatoid arthritis, and vasculitis were the cause accounting for hyperferritinemia. Ferritin levels were significantly higher in the AOSD group compared to the other rheumatologic disease groups (p

Objective: To investigate neutrophil/lymphocyte (NLR), lymphocyte/monocyte (LMR), platelet/lymphocyte (PLR) ratios, and the value of these parameters in determining disease severity and progression in hospitalized COVID-19 patients. Materials and Methods: Study was conducted retrospectively with 182 in-patients and 91 controls due to COVID-19 between April-September 2020 in the chest diseases clinic. Hematological parameters and rates were compared with controls’ parameters. Correlations and differences between hematological parameters and other parameters were investigated. Results: Lymphocyte, monocyte, eosinophil, basophil, hemoglobin, thrombocyte, and LMR were significantly lower. NLR and PLR were higher. There were significant increases in hematological parameters and PLR on discharge. A positive correlation existed between radiological pneumonia severity score, and NLR (r=0.234, p=0.001) and PLR (r=0.128, p=0.042), and significant inverse correlation with LMR (r=-0.206, p=0.003). Positive correlations were detected between NLR (r=0.140, p=0.030) and PLR (r=0.125, p=0.046), and symptom-discharge time, and inverse correlation between LMR, and both symptom-discharge (r=-0.137, p=0.032) and hospital stay time (r=-0.135, p=0.034). A positive correlation existed between CRP, and NLR and PLR on admission and discharge. Conclusion: NLR, LMR and PLR were found as hematological predictors to be used with CRP in following-up COVID-19, showing a significant correlation with disease severity, monitoring responses to treatment and predicting prognosis.

Acyclovir may cause acute kidney injury (AKI) due to the accumulation of relatively insoluble acyclovir crystals in renal tubules. The aim of this study was to evaluate risk factors associated with acyclovir-related AKI in children. Between January 2010 and December 2019, pediatric recipients of intravenous (IV) acyclovir were evaluated retrospectively. There were a total of 472 patients [249 (52.7%) boys] of which 32 (6.8%) had AKI [15 (46.8%) boys]. Patients with AKI had greater mean age, baseline creatinine level, and duration of treatment compared to patients without AKI (p 100.5 months, 1500 mg/m2/day dosage, concomitant use of nephrotoxic drugs). Acyclovir dosing should be evaluated in prospective, multicenter studies in order to identify the lowest possible therapeutic doses that do not increase AKI risk. What is Known: • Although acyclovir is mostly well tolerated, nephrotoxicity may be seen due to the accumulation of acyclovir crystals in renal tubules. • Older age, obesity, and concomitant use of other nephrotoxic drugs are reported to be risk factors for acyclovir-induced AKI in children. What is New: • In this study, pediatric patients with acyclovir-induced AKI were older, received treatment longer, received concomitant nephrotoxic drugs more commonly, and had higher acyclovir dosage and baseline creatinine levels compared to those without AKI. • Being older than 100.5 months of age, use of 1500 mg/m2/day dosage and use of nephrotoxic drugs concomitantly appear to be the prominent risk factors for AKI development in children treated with acyclovir.

Background/Aim: The aim of this study was to assess long-term clinical efficacy of temporary bulbar urethral stent (BUS) used for treatment of recurrent bulbar urethral stricture (US). Materials and Methods: A total of 168 patients with recurrent bulbar US who underwent BUS placement after internal urethrotomy between 2009 and 2019 were enrolled. An indwelling time of 12 months was planned for the stents. After stent removal, the criteria for success of BUS treatment were defined as follows: no evidence of stricture on urethrogram or endoscopy, more than 15 mL/s of urinary peak flow, and no recurrent urinary tract infections. Patients were divided into 2 groups based on clinical success and compared. Results: The mean age, US length, and indwelling time were 46.7 (±8.3) years, 2.32 (±0.4) cm, and 9.7 (±2.3) months, respectively. Median (range) follow-up was 71 (8–86) months. Clinical success was achieved in 77.9% patients. Longer indwelling time (8–18 [81.88%] vs. 3–7 [60%] months) and US length p < 0.05). Conclusion: This study is both the largest patient series and the longest follow-up for BUS in bulbar US. Our results suggest that BUS can be a safe and minimally invasive treatment alternative among bulbar US treatment options.

BACKGROUND: Coronavirus disease 2019 (COVID-19) continues to cause major mortality and morbidity worldwide even after a year of its emergence. In its early days, hypertension, diabetes, and cardiovascular diseases were noted as poor prognostic factors, while obesity gained attention at a later stage. In the present study, unfavorable clinical outcomes (transfer to the intensive care unit, invasive mechanical ventilation, and mortality) were investigated in obese patients with COVID-19. MATERIALS AND METHODS: In this retrospective study we analyzed patients with positive polymerase chain reaction test in tertiary care hospital between March-May 2020. They were divided into 3 groups according to body mass index (BMI) as normal, overweight, and obese (BMI: 18.5 - 24.99 kg/m², 25 - 29.99 kg/m², and ≥ 30 kg/m², respectively). We compared clinical features and laboratory findings of these groups and recorded adverse clinical outcomes. Multivariate logistic analysis was performed for unfavorable outcomes. RESULTS: There were 99 patients (35%), 116 (41%), and 69 patients (24%) in the normal-weight, overweight, and obese group, respectively. Among all patients, 52 (18%) patients were transferred to the intensive care unit (ICU), 30 (11%) patients received invasive mechanical ventilation (IMV), and 22 patients (8%) died. Obese patients had minimum 1 more comorbidity than normal BMI patients (73% vs. 50%, P = 0.002), and a longer median (interquartile range [IQR]) duration of hospitalization (8 [5 - 12] vs. 6 [5 - 9]) days, P = 0.006). Obese participants had higher concentrations of serum C-reactive protein, procalcitonin, ferritin than non-obese patients (P

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Background The purpose of this study was to assess the long-term clinical efficacy of temporary, Allium round posterior stent (RPS) used for treatment of recurrent bladder neck contracture (BNC). Methods Records of 42 patients with recurrent BNC who underwent Allium RPS placement after bladder neck incision, between 2009 and 2019, were analyzed. After stent removal, the success criteria for Allium RPS treatment were defined as: no evidence of stricture on urethrogram or endoscopy; more than 12 ml/sec of urinary peak flow; and no recurrent urinary tract infections. Based on clinical success, patients were divided into two groups and compared. Clinical success was evaluated with particular regard to stent indwelling time and contracture etiology. Results The mean ± standard deviation age, stricture length, and indwelling time were 66.7 ± 9 years, 2.4 ± 1.4 cm, and 7.7 ± 2.2 months, respectively. Median (range) follow-up was 59 (8–73) months. The etiologies of BNC in this cohort were 57.1% retropubic radical prostatectomy; and 42.9% transurethral resection of prostate. Overall clinical success was achieved in 64.3% and the success rates did not differ by etiology. The success rates were 54.2% and 77.8% (P = 0.118) for retropubic radical prostatectomy and transurethral resection of prostate, respectively. Longer indwelling time (8–14 vs 3–7, months) was significantly associated with clinical success (78.3% vs 47.4%, P = 0.040). Conclusion Our data suggest that better clinical success was associated with longer indwelling time for stent in BNC treatment. In BNC management, Allium RPS treatment may be considered since its clinical efficacy is acceptable and tolerable.

Objective:Paragangliomas are rare tumors arising from extra-adrenal chromaffin tissue, which are widely distributed near or within the autonomic nervous system in the retroperitoneal sites and in the sympathetic ganglia of various viscera. We present a review of our 18-year institutional experience with resected abdominal paragangliomas.Methods:The data collected from 12 patients who underwent surgery due to abdominal paraganglioma in our clinic between 2002 and 2020 were analyzed retrospectively.Results:There were 12 patients in our study. The median age was 44 years (range: 21-81 years). The patients had one or more of the symptoms of headache (n=2, 16,6%), palpitations, abdominal pain (n=5, 41.6%), sweating (n=2, 16.6%) and hypertension (n=5, 41.6%), which are the classic clinical symptoms. One of the cases (1/12; 8,3%) was detected incidentally. The mass location was in the retroperitoneal region in 10 cases (83.3%) and in the pelvic region in 2 cases (16.6%). Five of the patients applied to our clinic with episodes of paroxysmal hypertension, and vanillylmandelic acid and metanephrine levels were found to be high in the blood and 24-h urinary tests. After a median follow-up period of 60 months, only 1 patient (8.3%) had metastasis and required reoperation 2 years after the first operation. One patient (8.3%) died on postoperative 36th month due to cardiac problems.Conclusion:Abdominal paragangliomas are rare tumors whose optimal management requires the surgeon to be highly attentive to the disease course, from diagnosis of functioning or nonfunctioning lesions, through operative treatment that may require adjacent organ resection, to lifelong follow-up for recurrences.

Cerebrotendinous xanthomatosis (CTX) is a lipid storage disease caused by deficiency of sterol 27-hydroxylase enzyme encoded by CYP27A1 gene. This multicenter, cross-sectional descriptive study aimed to document clinical characteristics of CTX patients of different ages, clinical presentations of early-diagnosed patients, and responses to short-term chenodeoxycholic acid (CDCA) treatment. Seven of 11 CTX patients were diagnosed in childhood. Three patients (27%) had neonatal cholestasis, seven (63%) patients had a history of frequent watery defecation started in infantile period, and eight (72.7%) patients had juvenile cataract. Four patients in the adult age group had pyramidal signs and parkinsonism symptoms. The mean Mignarri score at diagnosis was significantly lower in the pediatric patients (267.8 +/- 51.4) than in the adult patients (450.0 +/- 64.0, p = 0.001). No significant difference was determined between pediatric patients and adult patients regarding plasma cholestanol concentration at diagnosis (p = 0.482). The frequency of defecation decreased with treatment in six children, who had diarrhea at admission. Compared to pretreatment values, patients' body weight and standardized body mass index significantly increased at the 12th month of treatment. In conclusion, Mignarri scores are lower in the pediatric patients than in adult patients since the most determinative signs of the CTX disease are not apparent yet in the childhood. The disease is frequently overlooked in routine practice as the disease presents itself with different clinical combinations both in adults and in children. CTX is potentially a treatable disease; thereby, enhanced awareness is critically important for early diagnosis particularly in children.

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.

Lidiya Gutema Lemu,1 Biruktawit Fekade Woldu,2 Natnael Eshetu Teke,3 Nardos Delelegn Bogale,1 Ermias Ayalew Wondimenew4 1Department of Midwifery, College of Health Science, Mizan Tepi University, Mizan-Aman, Ethiopia; 2Department of Midwifery, College of Medicine and Health Science, Wachemo University, Hossana, Ethiopia; 3Department of Midwifery, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia; 4Department of Nursing, College of Health Science, Mizan Tepi University, Mizan-Aman, EthiopiaCorrespondence: Lidiya Gutema LemuMizan Tepi University, Mizan-Aman, EthiopiaEmail lidyagutemal@gmail.comBackground: Despite being one of the few cancers that can be prevented with simple testing, cervical cancer is the fourth most common cancer in women. HIV-positive women showed a median three-fold higher incidence of cervical lesions.Aim: This study aims to assess the prevalence and factors associated with precancerous cervical lesions among HIV-infected women attending care and treatment clinic in selected hospitals of Southwestern Ethiopia.Methods: Institution-based cross-sectional study was conducted from February 1 to July 30, 2018. A systematic random sampling technique was employed to select 454 HIV-infected women. Pretested interviewer-administered questionnaire and medical record review were used for data collection. Visual inspection with Acetic acid was done for participants to detect precancerous cervical lesions. Data were analyzed by SPSS version 20. Binary and multiple logistic regression analyses were done. The presence and strength of association were determined using AOR with its 95% CI. Variables with a P value of less than 0.05 were considered as statistically significant.Results: The prevalence of precancerous cervical lesion was 18.7% [95% CI; (15.1– 22.4%)]. Currently, not being on highly active antiretroviral treatment [AOR= 2.31, 95% CI: 1.23– 4.39], age (20– 29 years) [AOR= 0.185, 95% CI: 0.036,0.939], has no history of sexually transmitted infection [AOR=0.026, 95% CI: 0.006– 0.116], has no history of genital wart [AOR= 0.261, 95% CI: 0.073– 0.934] and having one lifetime sexual partner [AOR=0.133, 95% CI: 0.024– 0.726] were found to be significantly associated with precancerous cervical lesion.Conclusion: The prevalence of Precancerous Cervical lesion was found to be high in this study. Expansion of screening services and undertaking preventive measures against sexually transmitted infection need to be emphasized.Keywords: precancerous cervical lesion, HIV positive, prevalence, factors, Ethiopia

Ochronotic arthropathy (OcA) refers to excessive homogentisic acid (HGA) deposition in the musculoskeletal system. Our current understanding of OcA is limited, as there are less than a thousand alkaptonuria (AKU) cases reported in the literature. Herein, we investigated the rheumatological manifestations of OcA in a group of adult AKU patients.Adult AKU patients with symptoms suggestive of OcA were included. Patients underwent a detailed rheumatological assessment. Laboratory testing, including autoantibodies and radiological investigations such as conventional X-rays, andEight out of 12 (66%) patients had symptoms consistent with OcA. The median age at OcA symptoms was 36 (27-48) years, and the presenting symptom was back pain in 87.5% of the patients. All patients had chronic back pain, and three (37.5%) had an inflammatory type of pain character. Radiographic sacroiliitis based on X-rays was present in 2 (25%) cases. MRI of the sacroiliac joints documented bone marrow edema in five (62.5%), and spinal MRI identified corner inflammatory lesions in three patients (37.5%). One patient (12.5%) had rheumatoid arthritis. Extra-articular involvement, including enthesitis (The frequent occurrence of OcA-related inflammatory manifestations in our patients contradicts the conventional concept of OcA as a non-inflammatory disorder. The activation of inflammatory pathways, possibly by the HGA products, may responsible for this condition.Significance and innovationsAbout three-fourths of adult ochronotic arthropathy (OcA) patients in our group had associated inflammatory disease.OcA associated inflammatory diseases were showing a severe phenotypeNearly half of the OcA patients required early prosthesis operations compared to their healthy counterparts.

Background: The aim of this study was to examine the clinical course and outcomes of patients with diabetes mellitus (DM) with coronavirus disease-2019 (COVID-19).Methods: This retrospective, single-center study included 185 adult patients diagnosed with COVID-19. All patients were separated into 4 groups. Group 1(n=79): patients with no accompanying disease, Group 2 (n=14): patients with only DM, Group 3 (n=31): patients with comorbid disease(s) including DM, Group 4 (n=61): patients with comorbid disease(s) without DM. Data about COVID-19 management and outcome were obtained from the medical records of the patients. COVID-19 was confirmed by real-time polymerase chain reaction (RT-PCR) from throat swab samples. All patients underwent chest x-rays or chest computed tomography.Results: 185 patients diagnosed with COVID-19 were evaluated. The COVID-19 prognoses of the patients were classified as good, moderate and poor. No statistically significant difference was determined between the groups in terms of COVID-19 prognosis (p>0.05). While the rate of DM patients with a good prognosis was 20.4%, the DM patient rate increased up to 40% among moderate or poor prognosis patients. A statistically significant difference was observed between blood glucose levels and mortality (p: 0.008). Mortality due to COVID-19 pneumonia developed in 15 (8.1%) patients. Mortality increase was mostly encountered in the group with DM and accompanying comorbidities. It was observed that ACEI / ARB use had no effect on mortality.Conclusions: Although the study results do not show a statistically significant effect of DM on the prognosis of COVID-19 patients, the higher rate of DM patients in the group with poor prognosis suggests that it may affect the severity of COVID-19. These results may be useful for clinicians in the management of DM patients with COVID-19.

By using a single dc voltage source to feed a 4-level switched-capacitor (SC) unit and a 3-level NPP/NPC unit simultaneously, a new 9-level inverter is developed in this work. The 4-level unit is implemented by cascading an inverting half-bridge with a double- or half-mode SC circuit. It involves four transistors, two diodes and two capacitors with self-balanced voltage. Inrush charging current variation di/dt of capacitors at switching instants is successfully suppressed by inserting a small inductor into the SC unit. Compared with the existing solutions for 9-level inverters, the proposed circuit has the advantages of simpler structure and lower cost per level. These make the proposed inverter very suitable for low voltage applications such as PV and fuel cells. Circuit configuration, operation, system characteristics under POD-PWM modulation are analyzed in detail. Feasibility and dynamic performance are also demonstrated experimentally.

In this study, an optimal reactive power (Volt/VAr) control of smart inverters for photovoltaic (PV) and battery energy storage systems (BESSs) to improve the PV hosting capacity (PVHC) of distribution networks is proposed. The primary objective of the proposed method is to improve the PVHC of a distribution network by determining the optimal oversize, dispatch, and control setting of the Volt/VAr functions of the smart inverters for both PVs and BESSs. Concurrently, the optimal locations of the PVs and BESSs are determined. The problem is formulated as a multi-objective mixed-integer nonlinear optimization to maximize the PVHC and minimize the voltage deviation simultaneously. A bio-inspired metaheuristic optimization method, i.e., the slime mould algorithm (SMA), is employed to solve the optimization problem. To assess the efficacy of the proposed PVHC improvement method, extensive simulations are conducted on an IEEE 33-node system using MATLAB software. The simulation results verify that the proposed method improves the PVHC of the distribution network compared to different cases and the default Volt/VAr control settings of the smart inverters. Furthermore, the SMA optimization method provides superior performance in finding the optimal PVHC of a distribution network compared to the conventional metaheuristic optimization methods.

Faecaloma is a mass of inspissated faeces, typically found in the rectosigmoid colon. Furthermore, faecalomas may cause intestinal obstruction, stercoral ulcer development and colon perforation, which may be due to the pressure effect of large faecal mass. We herein present a case of massive megacolon due to giant faecaloma in a 72-year-old man with symptoms of mechanical ileus. During surgery, there was a giant faecaloma, 10 cm in diameter, within the sigmoid colon, and a Hartmann left colon resection was performed. The purpose of this article is to provide a brief overview of this condition and discuss treatment options.

Temporal artery biopsy (TAB) is one of the diagnostic criteria of giant cell arteritis (GCA) according to 1990 ACR criteria and remains a tool for diagnosis. Although clinicians perform TAB with an intent to confirm suspected GCA, some biopsies result in negative and some lead to non-GCA diagnoses. We aim to review the diagnoses after TAB biopsy performed for suspected GCA and also wanted to evaluate the diagnostic changes and concomitant diseases that develop over time. The patients who had undergone TAB for suspected GCA were identified using the record entry code for TAB. Patients meeting the classification criteria for GCA were designated as the GCA group and not meeting criteria were designated as a non-GCA group. Other classification criteria were implemented for the non-GCA group diseases. A total of 51 patients (Female: 62.7%, median age: 72.1 ± 7.4 years) who had undergone TAB for suspected GCA were evaluated. TAB was positive in 23 (69.6%) of the 33 patients who met the GCA classification criteria. No significant difference was found between TAB-positive and TAB-negative GCA patients in terms of clinical and laboratory parameters. In the non-GCA group, 12 patients had isolated polymyalgia rheumatica (PMR), and the diagnoses of the remaining six patients were as follows: four large vessel vasculitis (LVV) not satisfying GCA diagnostic criteria, one chronic myelomonocytic leukemia (CMML), and one amyloidosis. TAB was negative in all patients with isolated PMR. TAB showed primary amyloidosis in one patient. Out of 33 GCA patients, 21 had "isolated" GCA, four had GCA + Rheumatoid arthritis (RA), seven had GCA + PMR, and one had GCA + polymyositis. RA was diagnosed antecedent to GCA in two patients, and after GCA in the other two patients. One of the patients had developed GCA 20 years after polymyositis had been diagnosed. TAB was found to be positive in two-thirds of patients with suspected GCA. Late-onset RA and rarely other inflammatory rheumatic diseases may develop in the course of GCA.

Anemia is a common complication of chronic kidney disease (CKD). The most common cause of anemia in CKD is erythropoietin deficiency; and the most important cause of mortality in CKD patients is atherosclerotic vascular complications which are associated with endothelial damage. One of the methods evaluating vascular integrity is the cytometric measurement of circulating endothelial cells and endothelial progenitor cells in peripheral blood. The study aimed to investigate the effects of erythropoietin therapy on endothelial dysfunction by evaluating circulating endothelial cells and endothelial progenitor cells in peripheral blood using the technique of flow cytometry. Methods. A total of 55 hemodialysis patients were evaluated in three groups; those having erythropoietin therapy for at least last 3 months (n = 20) / not having erythropoietin for at least the last 3 months (n = 20) and the patients who started erythropoietin treatment during the study (n = 5). The control group consisted of 20 people. Blood values of the 3rd Group were investigated three times as baseline, 2nd week and 8th week CD34 +, CD105 + cells were evaluated as activated circulating endothelial cells; CD133 +, CD146 + cells were evaluated as activated endothelial progenitor cells. Results. There was no difference between the patients and healthy individuals in terms of circulating endothelial cells and endothelial progenitor cells. In the third group, no differences were observed in circulating endothelial cells / endothelial progenitor cell levels at baseline / 2nd and 8th weeks. There was no correlation between erythropoietin and circulating endothelial cells / endothelial progenitor cells. Conclusion. A correlation is not available between the therapeutic doses of erythropoietin used in hemodialysis patients and circulating endothelial cells / endothelial progenitor cell levels; supratherapeutic doses could change the results.

Amyloidosis is described by the deposition of misfolded proteins in the tissues. Amyloidoses are classified into two as systemic and localized. Out of the systemic forms, AL (light chain) amyloidosis is the most prevalent type; however, amyloid A (AA) amyloidosis is more frequently encountered in the rheumatology practice. AA amyloidosis stands out as a major complication of familial Mediterranean fever (FMF). Splenic and renal involvement is more likely in FMF-associated systemic amyloidosis. The involvement of thyroid and adrenal glands has also been described, although infrequently. Amyloidoses have a heterogeneous plethora of clinical manifestations, with certain phenotypes associated with specific amyloid forms. Gynecological amyloidosis is a rare condition. Uterine involvement may occur in a localized fashion or may also arise as a part of systemic involvement, albeit at a lesser ratio. Several cases of uterine AL amyloidosis have been documented so far as an organ involvement in systemic AL amyloidosis. On the other hand, uterine amyloidosis associated with AA amyloidosis has been described merely in one case with rheumatoid arthritis (RA). Here, we presented a 40-year-old female patient with FMF known for 38 years who underwent splenectomy and hysterectomy due to massive splenomegaly, deep anemia, and persistent menometrorrhagia. Histological examinations of materials revealed uterine and splenic AA amyloidosis. This case report is first-of-its-kind to describe FMF-associated uterine AA amyloidosis and also provides a discussion of possible mechanisms of amyloidosis-induced uterine bleeding.

Meckel’s diverticulum is a prevalent congenital anomaly of the digestive system, with an incidence of approximately 1-3% in the population. Intestinal obstruction is a widespread complication in adults. Patients are often operated on with a preliminary diagnosis of acute abdomen, and Meckel's diverticulum are usually diagnosed during the operation The surgical technique should be planned according to the condition of the patient. In this article, we aimed to present a case of 68-year-old female with mechanical bowel obstruction caused by internal herniation of small intestine as a complication of Meckel’s diverticulum. Statement: Oral presentation at V. International Congress on Natural and Health Sciences (ICNHS-2019), Adana, Turkey, December 13 to December 15, 2019.

Background: Internalised Stigma is considered to be the main barrier to people receiving effective treatment for mental health problems (Knaak et al, 2017). As healthcare students become more professionalised, they learn how to provide optimal quality care to all patients. Experiential models of learning complemented with feedback and debriefing are said to be one of the approaches to preparing healthcare professionals who are work ready (Tavares et al, 2019). Method: We collected feedback data from people living with mental health experiences following an experiential learning activity via interactive learning sessions (ILS) and focus group discussions (FGDs). We manually analysed the data for themes; after which, we used the data as a guide for a series of semi-structured in-depth interviews with MPharm students. Results: Main themes emerged from the FDGs were that people living mental health experiences want to be seen as a person, not a prescription. They also appreciated that there is no “magic bullet” to solve all of the challenges. MPharm students felt that the environment for learning was enriching; however, they felt they needed more time to apply their knowledge and skills. When prompted that people with experiences of mental health would want to be looked at as a person and not a prescription; MPharm students appreciated the feedback. However, they felt they needed to also ensure that they are applying their pharmacotherapy knowledge. Conclusion: ILS with content-based learning improved students’ perceptions of mental health issues. Moreover, the feedback-driven, real-world experiences and experiential learning in the education of pharmacy students, was well-received by MPharm students. Not only does this benefit students’ education, it has also allowed for those with mental health experiences to communicate their concerns in education of future healthcare professionals, as well as enhance their abilities to ‘tell their story’ more effectively, without fear of stigma or judgement.

Subdural empyema (SDE) is a rare condition which can appear secondary to meningitis in childhood, especially in infants. This study was planned to evaluate and compare clinical and laboratory features, treatment, and outcome of children with SDE to those with acute bacterial meningitis (ABM) without SDE. The electronic medical files of 266 patients diagnosed with ABM between January 2009 and December 2019 were evaluated. Patients' demographic and clinical features, laboratory results, cranial imaging findings, treatment, and outcomes were recorded. SDE was identified in 10 patients, 3.7% of all diagnosed with meningitis. The etiology of SDE was identified in eight (80%). The most common responsible pathogen was Streptococcus pneumoniae. Cranial imaging was performed between the 2nd and 13th days of admission, and the most common reason of performing cranial imaging was persistence of fever. Two patients were healed with 4-6 weeks of antibiotic treatment without surgery, eight (80%) needed surgical intervention.Conclusion: The clinical signs and symptoms of SDE may be subtle. If the fever persists or focal neurological findings are seen during the treatment of bacterial meningitis, SDE should be suspected. Furthermore, patients with ABM who are determined to have a protein-to-glucose ratio in the cerebrospinal fluid above 4.65 should be carefully monitored for SDE development. What is known: • Subdural empyema may develop subsequently to meningitis, especially in the infant age group in whom very little is known in terms of disease characteristics. • Delay in diagnosis and treatment can cause long-term neurologic sequelae and mortality. What is new: • Persistence or relapse of fever during the treatment of acute meningitis is an important warning sign for SDE even if there are no other symptoms. • Children with subdural empyema secondary to bacterial meningitis have higher protein-to-glucose ratio in the CSF, and a threshold of ˃ 4.65 was determined to demonstrate 100% sensitivity and 50.7% specificity.

Objective:Circumcision is one of the most performed surgical procedures in the world. This study is a retrospective study on the short-term postoperative complications after a thermocautery-assisted circumcision on a series of patients according to the Clavien-Dindo classification system (CDCS).Materials and Methods:A total of 2.356 male thermocautery-assisted circumcision cases, performed by two urologists in a hospital, were examined retrospectively. The mean age, type of anesthesia, peri- and postoperative complications, durations of the procedures, mean number of sutures, cohesive bandage requirements, and mean recovery times were evaluated.Results:The age of the patients ranged from 1 to 32 years with the mean age being 8.33 years. While 1.943 patients (82.47%) were only locally anesthetized, the remaining 413 (17.53%) were sedated in addition to local anesthesia. The mean values of the operative time, suture count, total requirement of cohesive bandages, and recovery time were 5.19±1.38 min (range of 4-20), 5.71 (range of 4-12), 69 (2.92%), and 6 days (range of 4-25), respectively. The short-term postoperative complications of 1.573 patients who returned to the hospital for a physical examination after being discharged were edema (mild, moderate, and severe), bleeding (simple and hematoma-causing), and infection (mild, moderate, and serious). The postoperative complications were adapted to the CDCS as grade 1 (638 patients, 40.55%), grade 2 (12 patients, 0.76%), grade 3 (6 patients, 0.38%), grade 4 (0 patients, 0%), and grade 5 (0 patients, 0%). There was no statistically significant difference between the patients in terms of complications adapted to the CDCS who received local anesthesia and those who received sedation + local anesthesia (p>0.05). Additionally, there was no significant difference in the development of penile edema between the patients who were sutured with Vicryl Rapide and normal Vicryl (p>0.05).Conclusion:Our retrospective results indicate that thermocautery-assisted circumcision has a short operative time and is tolerable despite its short-term complications. Thermocautery-assisted circumcision may be a useful method in regions where circumcision is common.

The optimal chemotherapy regimen for concurrent chemoradiation in locally advanced non-small cell lung cancer (NSCLC) remains unclear. Cisplatin-etoposide regimen related toxicity is high, weekly regimens have been investigating. We aimed to compare the efficacy and safety of different concurrent chemotherapy regimens in the context. A total of 225 patients with locally advanced, unresectable stage III NSCLC were included. Patients who were treated with weekly docetaxel-platin (DP), paclitaxel-platin (PP) and standard dose etoposide-platin (EP) chemotherapy regimens were selected and divided into groups for the comparison of toxicity, response rate, progression free survival (PFS), and overall survival (OS) times. There was a statistically significant difference between overall response rate of each treatment groups (DP: 96.1%, PP: 94% and EP: 76.7%, p

We aimed to assess an “Immunological Profile (IP)” including CD8+ and FoxP3+ T lymphocytes for renal cell carcinoma (RCC) to evaluate its effects on tumor pathological characteristics, disease progression, and survival. Adjacent normal and intratumoral specimens from 42 patients who had undergone radical nephrectomy for RCC were analyzed for counts of CD8+ and FoxP3+ T lymphocytes by immunohistochemistry. Tissue from both sites were evaluated and scored separately according to low (0) or high (1) expression of CD8 and FoxP3. A total score (min: 0, max: 4) was assigned to each patient. Thereafter, patients were divided into two groups for clinicopathologic and survival stratification based on score (IPWeak 0–2; and IPStrong 3–4). Survival curves were constructed using the Kaplan–Meier method, and a multivariable Cox regression model was used for overall survival (OS) and progression-free survival (PFS). The mean follow-up was 54.73 ± 21.34 months. Poor RCC characteristics including pT3–T4, tumor necrosis, lymphovascular invasion, lymph node involvement, and larger tumor size were significantly more common in the IPWeak patients compared to IPStrong (p

Purpose: To investigate the long-term results and efficacy of the treatment modalities for preretinal hemorrhage due to valsalva retinopathy. Methods: Retrospective review was conducted on 24 eyes of 24 patients with valsalva retinopathy who were treated between 2004 and 2019. These patients were treated with Nd:YAG laser, argon laser and vitrectomy or were only observed. Nd:YAG laser hyaloidotomy was performed in 10 eyes, argon laser was applied to two of those following failed Nd:YAG laser, and vitrectomy was performed in one eye. A conservative approach was adopted in 13 eyes. Results: There were 15 females and nine males with mean age of 41.08 ± 12.72 (21–65) years. Mean follow-up period was 42.83 ± 23.78 (range: 12–116) months. Patients with hemorrhage size smaller than or equal to 4-disc diameter were observed for spontaneous resorption and achieved 20/20 visual acuity within 6 months. Visual acuity of all patients treated with Nd:YAG and/or argon laser, increased within the first week after the treatment. Vitrectomy was performed in only one patient with hemorrhage located away from macula. The good visual outcomes were achieved in all treatment modalities. Conclusions: Observation, Nd:YAG laser and argon laser seem to be safe and effective approaches for eyes with valsalva retinopathy. The size, volume and duration of hemorrhage are the most crucial factors for treatment choice, success and complications.

Septo-optic dysplasia (SOD) is characterized by optic nerve hypoplasia, pituitary gland hypoplasia, and midline abnormalities of the brain. The phenotype of SOD is highly heterogeneous, and the existence of at least two features is considered sufficient for diagnosis. Fovea plana is the absence of a foveal pit in the central fovea, and despite being a developmental abnormality of the fovea, good visual acuity may be retained in some individuals. In this case, a 12-year-old female presented to the ophthalmology clinic with the complaint of blurred vision in her right eye. In dilated fundus examination, optic disc hypoplasia and no foveal light reflex were seen. Magnetic resonance imaging and optical coherence tomography revealed optic nerve, brain midline, and foveal abnormalities. The patient was diagnosed as having SOD with optic nerve hypoplasia and septum pellucidum agenesis, and fovea plana. Both SOD and fovea plana are rare conditions, and there are several reports in the literature that separately describe their clinical features. The most important aspect of this case report is to reveal the unusual co-existence of SOD and fovea plana in a young patient.

Purpose Ventricular tachycardia (VT) is a rapid, abnormal heart rhythm that can lead to sudden cardiac death. Current treatment options include antiarrhythmic drug therapy and catheter ablation, both of which have only modest efficacy and have potential complications. Cardiac radiosurgery has the potential to be a noninvasive and efficient treatment option for VT. Cardiac motion, however, must be accounted for to ensure accurate dose delivery to the target region. Cardiac synchronized volumetric modulated arc therapy (CSVMAT) aims to minimize the dose delivered to normal tissues by synchronizing beam delivery with a cardiac signal, irradiating only during the quiescent intervals of the cardiac cycle (when heart motion is minimal) and adjusting the beam delivery speed in response to heart rate changes. Methods A CSVMAT plan was adapted from a conventional VMAT plan and delivered on a Varian TrueBeam linear accelerator. The original VMAT plan was divided into three interleaved CSVMAT phases, each consisting of alternating beam-on and beam-off segments synchronized to a sample heart rate. Trajectory log files were collected for the original VMAT and CSVMAT deliveries and the dose distributions were measured with Gafchromic EBT-XD film. Results Analysis of the trajectory log files showed successful synchronization with the sample cardiac signal. Film analysis comparing the original VMAT and CSVMAT dose distributions returned a gamma passing rate of 99.14% (2%/2 mm tolerance). Conclusions The film results indicated excellent agreement between the dose distributions of the original and cardiac synchronized beam deliveries. This study demonstrates a proof of principle cardiac synchronization strategy for precise radiation treatment plan delivery and adjustment to a variable heart rate. The cardiac synchronized technique may be advantageous in radioablation for VT.

Purpose Since the treatment strategy for benign and malignant pancreatic lesions differ, we aimed to evaluate the clinical value of PET/CT in the diagnosis and management of pancreatic lesions. Methods Ninety patients who had a histologically confirmed pancreatic lesion were studied. Receiver operating characteristic (ROC) curve analysis was used to investigate the ability of PET/CT to differentiate malignant lesions from benign tumors. Results The malignant and benign groups comprised 64 and 26 patients, respectively. Despite the similarity in the size of primary tumors (P = 0.588), the mean maximum standardized uptake values (SUVmax) obtained from PET/CT imaging were significantly higher in malignant lesions (9.36 ± 5.9) than those of benign tumors (1.04 ± 2.6, P < 0.001). ROC analysis showed that the optimal SUVmax cutoff value for differentiating malignant lesions (to an accuracy of 91%; 95% confidence interval, 83%-98%) from benign tumors was 3.9 (sensitivity, 92.2%; specificity, 84.6%). Conclusion PET/CT evaluation of pancreatic lesions confers advantages including fine assessment of malignant potential with high sensitivity and accuracy using a threshold SUVmax value of 3.9.

Objective To evaluate the effects of solifenacin, darifenacin, and propiverine on nasal-, subfoveal-, temporal choroidal thicknesses (NCT, SFCT, TCT), intraocular pressure (IOP) and pupil diameter (PD). Materials and Methods Patients with overactive bladder (OAB) diagnosed according to The International Continence Society were administered with solifenacin, darifenacin or propiverine on a daily basis between November 2017 and May 2018. NCT, SFCT, TCT, IOP, and PD of these patients were measured and compared as initial, fourth and twelfth weeks. Results A total of 165 patients (330 eyes) with OAB were evaluated. Solifenacin (n=140) significantly reduced IOP from 17.30±2.72 mmHg to 16.67±2.56 mmHg (p=0.006) and 16.57±2.41 mmHg (p=0.002), at the fourth and twelfth weeks, respectively. Darifenacin (n=110) significantly reduced NCT from 258.70±23.96 μm to 257.51±22.66 μm (p=0.002) and 255.36±19.69 μm (p=0.038), at the fourth and twelfth weeks, respectively. Propiverine (n=80) significantly increased PD from 4.04±0.48 mm to 4.08±0.44 mm (p=0.009) and 4.09±0.45 mm (p=0.001), at the fourth and twelfth weeks, respectively. Conclusion These findings can help to decide appropriate anticholinergic drug choice in OAB patients. We finally suggest further well-designed randomized prospective studies with a larger population to evaluate the anticholinergic-related complications in eyes.

Tuberculosis-related pleural effusion (TPE) is reported in 12 to 38% of thoracic tuberculosis (TB) cases in the pediatric population. In TPE, the pleural fluid bacilli load is very low, generally resulting in negative acid-fast bacill (AFB) staining and Mycobacterium culture. In the pleural fluid, AFB stain positivity is reported in

Typhoid fever is an infectious disease that has been a public health concern for millennia. The use of herbal preparations is getting popularity, with an estimated 80% of the world’s population still depending on it for the management of various diseases including typhoid fever. However, data concerning their quality, safety and efficacy is not readily available. Our aim was to determine the in vitro efficacy of some commercially available herbal preparations used in the treatment of typhoid fever in Bamenda Municipality. Five herbal preparations indicated for the treatment of typhoid fever (coded P1 to P5) were bought from various outlets of the herbal producers and serial dilutions made and screened for their activities against clinical isolates of Salmonella Typhi and Salmonella Paratyphi using the agar well diffusion and dilution methods. The bacterial growth inhibition zone diameters of the herbal preparations were measured with a transparent ruler and compared with those of some standard antibiotics (ciprofloxacin and ceftriaxone). Two of the herbal preparations (P1 & P2) showed inhibition zone diameters against S. Typhi (20 and 14 mm respectively) while the rest (P3, P4 & P5) were inactive. P1 showed minimal activity on S. Paratyphi while the rest of the herbal preparations (P2, P3, P4 and P5) were inactive at all tested concentrations. The difference between the value of the inhibition zone diameters of the herbal preparations and that of the standard antibiotics on both S. Typhi and S. Paratyphi was statistically significant (p

Item does not contain fulltext PURPOSE: To describe the clinical and multimodal imaging findings of a series of cases of serous macular detachment (SMD) caused by Best disease (BD) masquerading as neovascular age-related macular degeneration or central serous chorioretinopathy that were inappropriately treated with intravitreal anti-vascular endothelial growth factor or laser therapy. This study will also present data to support age-related progressive choroidal thickening in BD patients, which may play a role in the development of SMD in this population. METHODS: Clinical examination and multimodal imaging findings, including color fundus photography, spectral-domain optical coherence tomography, fundus autofluorescence, fluorescein angiography, and optical coherence tomography-angiography, were reviewed and analyzed. Subfoveal choroidal thickness was also formally measured, and an age-related choroidal thickness analysis was performed and compared with a normal population. RESULTS: Twenty-six eyes of 13 patients (5 women) were included. Median age was 44 years. Nine patients presented with a history of SMD and subretinal fluid recalcitrant to various therapies, including intravitreal anti-vascular endothelial growth factor injections and photodynamic therapy. Best disease was subsequently diagnosed genetically in six patients and by detailed family history in seven. Mean logarithm of the minimum angle of resolution best-corrected visual acuity for all 26 eyes at last follow-up was +0.36 (Snellen equivalent of 20/46). Subfoveal choroidal thickness positively correlated with age for our cohort, increasing linearly at a rate of 25.6 µm per decade (R = 0.64; P < 0.001). Choroidal neovascularization was identified in four eyes on optical coherence tomography angiography, but these eyes did not respond to anti-vascular endothelial growth factor treatment. CONCLUSION: The diagnosis of BD should be considered in patients presenting with SMD and recalcitrant subretinal fluid masquerading as neovascular age-related macular degeneration or chronic central serous chorioretinopathy to avoid unnecessary treatment procedures. The positive correlation of subfoveal choroidal thickness with age in BD patients may be a factor in the pathogenesis and development of SMD in this population. Recognizing the multimodal imaging features of SMD associated with BD, described in detail in this study, will guide practitioners to the accurate diagnosis of BD and reduce the risk of unnecessary intraocular procedures with potential complications.

“This book was borne out of an idea that I had during the period in which I spent time with several young people who had approached me to assist them in different ways, including personal development, career advancement and growth, as well as growing their businesses and entrepreneurial acumen and skills. I took the challenge but felt that more could be achieved, hence this book. The chapters in this book are written by each one of these young people. They chose the topics, guided by me, and the plan was to simply convey a message from each one of them about leadership. They did not do this for fame or to sell this book to make money, but to share their ideas. The topics covered in this book will appeal to different readers, and some readers might find more lessons in one chapter or in more chapters than one. I urge each one of you who read this book to pick one or a few lessons and share it with those you wish to make a difference to. Mentorship of young people is critical, but this does not mean that the mentors will provide handouts in the form of money. People who wish to grow, are not interested in money, they are interested in a piece of your generous heart.” - Mike Teke