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Background Tumor necrosis factor (TNF)-α inhibitors increase the risk of tuberculosis (TB). The objective of the present study was to determine the rate of active TB infection in inflammatory bowel disease (IBD) patients receiving anti-TNF therapy and to determine the results of their latent TB infection (LTBI) screening tests during the follow up. Methods This is a retrospective observational study of IBD patients receiving anti-TNF therapy. Tuberculin skin test (TST), interferon-γ release assay (IGRA), and chest radiography were used to determine LTBI. Active TB infection rate during anti-TNF treatment was determined. Results Seventy-six IBD patients (25 with ulcerative colitis, 51 with Crohn's disease; 53 male; mean age 42.0±12.4 years) were included. Forty-four (57.9%) patients received infliximab and 32 (42.1%) adalimumab. Their median duration of anti-TNF therapy was 15 months. Forty-five (59.2%) patients had LTBI and received isoniazid (INH) prophylaxis. During the follow-up period, active TB was identified in 3 (4.7%) patients who were not receiving INH prophylaxis. There was a moderate concordance between the TST and the IGRA (kappa coefficient 0.44, 95% CI 0.24-0.76). Patients with or without immunosuppressive therapy did not differ significantly with respect to TST (P=0.318) and IGRA (P=0.157). Conclusion IBD patients receiving anti-TNF therapy and prophylactic INH have a decreased risk of developing active TB infection. However, despite LTBI screening, the risk of developing active TB infection persists. [ABSTRACT FROM AUTHOR]

To analyze clinicopathologic characteristics of upper gastrointestinal leiomyomas and to determine the distribution and immunohistochemical features of interstitial cells of Cajal, in order to designate whether they can cause diagnostic challenges. Twenty-four upper gastrointestinal leiomyomas (14 esophagus, 10 stomach) were retrieved. CD117, DOG-1 and muscle markers were performed. The staining was analyzed based on the distribution and percentage. Interstitial cells of Cajal were distinguished based on their positivity for both CD117 and DOG-1 immunohistochemistry, along with their morphological features. Mean age of patients was 49 years, M/F ratio was 2.4. Patients with gastric leiomyomas were significantly younger than those with esophageal leiomyomas (41.5 vs. 54.3, p = 0.012). Histologically, leiomyomas were similar to their endometrial counterpart. Immunohistochemically, all tumors had strong/diffuse positivity for muscle markers. CD117 highlighted mast cells in all cases. Three cases had prominently increased mast cells. Both CD117 and DOG-1 also highlighted interstitial cells of Cajal in 24/24 (100%) of cases. Interstitial cells of Cajal were distributed in variable proportions, from focal to homogenous. In one case, they constituted 50% of tumor cells. In 16 cases, the distribution was homogenous. Superficial leiomyomas (n = 3) had only focal CD117 and DOG-1 positivity. Upper gastrointestinal leiomyomas harbor expression of CD117 and DOG-1 in entrapped/colonized interstitial cells of Cajal, which can cause a potential pitfall in the differential diagnosis, especially in cases that show prominent immunohistochemical positivity. Evaluation of the immunohistochemistry can be exceptionally challenging in small biopsy/cytology specimens. Careful histologic evaluation of the tumor as well as the recognition of interstitial cells of Cajal will help the pathologist render the accurate diagnosis. • Male predominance is striking in upper GI leiomyomas. • Gastric leiomyomas occur in younger patients than esophageal leiomyomas. • Interstitial cells of Cajal exist in variable proportions in all upper GI leiomyomas. • Cells of Cajal can cause potential pitfall in the diagnosis of upper GI leiomyomas. • The recognition of Cajal cells will help pathologists render the accurate diagnosis. [ABSTRACT FROM AUTHOR]

• There is no need to provide airless media in reactions of hexacholorocyclotriphosphazene with nucleophiles, except for organometallic compounds. • The reactions between hexacholorocyclotriphosphazene and nucleophiles should be monitored by 31P NMR spectroscopy and the reaction should be completed according to the results of this analysis. In this study, the reactions of hexachlorocyclotriphosphazene with 5-chloro-salicylaldehyde and 5-bromo-salicylaldehyde were separately performed in the presence of K 2 CO 3 and triethylamine as a base without using Ar or N 2 atmosphere for the preparation of the organocyclotriphosphazene derivatives bearing six formyl groups (2 and 3) again. These reactions were monitored by 31P NMR spectroscopy to determine the formation time of the compounds (2 and 3). The result of this analysis showed that the compounds (2 and 3) occurred within 3 h under the above reaction conditions after the reactions begun. The 31P NMR spectra of the mixtures clearly displayed only singlet signal in the range of 8–9 ppm corresponding to characteristic phosphorus signals of cyclotriphosphazenes. Moreover, these two compounds were obtained in high yields even under such mild reaction conditions. In addition, the compounds (2 and 3) were reacted with aniline and some aniline derivatives for the production of new organocyclotriphosphazene derivatives bearing poly Schiff bases (2a – 2k and 3a – 3k). Although all the primary amines in these reactions were used more than necessary, it was detected that the organocyclotriphosphazene derivative including both formyl and Schiff base moieties (2k and 3k) occurred from only 4-nitro-aniline. Most importantly of all, hydrolysis of hexachlorocyclotriphosphazene in THF solution was also studied. It was determined that hexachlorocyclotriphosphazene did not hydrolysis under these conditions. [ABSTRACT FROM AUTHOR]

Purpose: To determine the effect of capsulotomy size on intraocular lens (IOL) tilt and decentration in eyes undergoing Nd:YAG laser capsulotomy due to posterior capsular opacification (PCO) following femtosecond laser-assisted (FSL) cataract surgery. Materials and Methods: The study included 42 patients who underwent FSL-assisted standard 5.0-mm anterior capsulotomy followed by Nd:YAG laser capsulotomy at a mean of 16.2 (6-34) months after cataract surgery. The patients were divided based on Nd:YAG posterior capsulotomy size into the 3.5 mm group (22 eyes) and the 4.0 mm group (20 eyes). IOL tilt and decentration were measured with Scheimpflug camera before and at one month after Nd:YAG laser capsulotomy. Results: Before capsulotomy, there were no differences between the 3.5 mm and 4.0 mm groups in terms of angle of tilt or decentration at either meridian (p>0.05). After capsulotomy, both groups showed significant decreases in angle of tilt (mean vertical/horizontal values: 1.4/1.2 degrees in the 3.5 mm group; 0.9/0.8 degrees in the 4.0 mm group) and significant increases in decentration (mean vertical/horizontal values: 0.10/0.11 mm in the 3.5 mm group; 0.27/0.24 mm in the 4.0 mm group) at both meridians compared to precapsulotomy measurements (p<0.05). After capsulotomy, all tilt and decentration parameters differed significantly between the two groups at both meridians (p<0.05 for all). Conclusions: The diameter of Nd:YAG posterior capsulotomy performed after FSL-assisted cataract surgery affected the mechanical stability of the IOL, but the tilt and decentration values were very small and may not be clinically significant. [ABSTRACT FROM AUTHOR]

This document is a reply to a study titled "Influence of Nd:YAG laser capsulotomy on toric intraocular lens rotation and change in cylinder power." The reply is in the form of a comment on the original study and does not provide any new information or findings. The authors of the reply state that they have no financial or proprietary interests in the subject matter. The document is published in the Journal of Cataract & Refractive Surgery in August 2024. [Extracted from the article]

Objective: Peroral endoscopic myotomy (POEM) has proven to be a successful treatment method for achalasia in both adult and pediatric patients. Yet, there is a lack of evidence for anaesthetic management of pediatric patients who underwent POEM procedure. In this study, we aim to present perioperative and postoperative management strategies for pediatric patients with achalasia from in anaesthesia aspect. Methods: Medical records were reviewed for 16 pediatric patients at a single center who underwent POEM procedure for achalasia between 2017 and 2020. Patients' data regarding demographics, preoperative diet, body mass index, perioperative monitoring and vitals, airway management, anaesthesia maintenance, mechanical ventilation settings duration of recovery, length of stay, pain management and adverse events were evaluated. Results: The study cohort included 7 female and 9 male patients with a mean age of 5.5 years. Anaesthesia maintenance was provided with 0.8-1.2 minimum alveolar concentration sevoflurane in a 40-60% O2-air mixture, Remifentanil infusion and bolus doses of Rocuronium. The median age was 3 years for patients ventilated in pressure controlled ventilation mode and 10 years in volume controlled ventilation mode. Respiration rate and minute ventilation were adjusted to maintain end tidal carbon dioxide (ETCO2) below 45 mmHg. Needle decompression was applied for 14 patients (87.5%) for treatment of capnoperitoneum. The mean procedure duration and recovery room duration were 66 (±22.9) minutes and 62 (±21) minutes, respectively. Postoperative pain management is provided with paracetamol and tramadol in total 8 patients (50%). There was no adverse event during postoperative period and all patients discharged in a mean time of 3 days. Conclusion: POEM has demonstrated encouraging outcomes in terms of safety and effectiveness in pediatric patients. Due to challenging nature of the pediatric patients, it is important to acknowledge that the procedure requires specialized anaesthesia management. Management of perioperative complications of increased ETCO2 requires understanding the physiologic results of pneumo-mediastinum and pneumoperitoneum. Beside the known anaesthetic management strategies, a tailored approach should be adopted for each patient. Further investigations should be conducted to develop standardized management. [ABSTRACT FROM AUTHOR]

Objective Ostomy structure is an indispensable part of colorectal surgical procedures. With stoma, surgeons hope to get rid of the morbidity of the anastomosis they made. Ostomies are the source of morbidity both during construction and closure. Problem-free ostomies both reduce healthcare costs and support patients' quality of life. In this study, we aimed to reveal the relationship between the marking performed by the wound, ostomy and continence nurse (WOC nurse) before surgery and the quality of the stoma. Material and Method 150 patients who underwent surgery for malignant diagnosis in our oncology clinic and needed stoma construction were included in the study. The medical records and database of the patients kept by the WOC nurse were retrospectively reviewed. Demographic and clinicopathological data were recorded and grouped. Patients who underwent both emergency and elective procedures were included in the study. Statistical analyzes were performed within the 95% confidence interval. A p-value of less than 0.05 was considered statistically significant. Results A significant relationship was observed between the marking the stoma site and BMI with the complications (p=0.03, p=0,01). Patients with ileostomy were associated with significantly more peristomal skin complications (PSC) than patients with a colostomy (p=0.02). Again, in the different analyses performed, a significant difference was observed between stoma marking status and stoma diameters; large stoma diameters were associated with patients who were not consulted by the WOC nurse (p=0.001). Conclusion The findings showed that WOC nurse preoperative consultation was associated with fewer complications affecting stoma quality. [ABSTRACT FROM AUTHOR]

Purpose: To investigate changes in retinal vascular plexuses and choriocapillaris in patients with type 2 diabetes mellitus (DM) without diabetic retinopathy (DR) using optical coherence tomography angiography (OCTA). Methods: A total of 48 DM and 48 healthy control subjects were included. Mean superficial and deep vessel density (SVD, DVD) and flow in superficial and deep layers, choriocapillaris (CC) and FAZ area were measured by OCTA for analysis. Also, patients were categorized into two groups as high-risk (≥ 5 years) and low-risk (< 5 years) according to the duration of DM. Results: SVD did not change in eyes without DR, but DVD significantly decreased when compared to healthy controls (p< 0.05). Both superficial and deep layer's flow did not change in diabetic patients who had a significant enlargement in FAZ area. CC flow area and CC thickness did not change in DM patients (p> 0.05). The mean DVD and FAZ area were correlated with HbA1c levels and the duration of DM. Comparison between the high-risk (20 patients) and low-risk groups (28 patients) revealed significant difference in superficial and deep layer's fl ow, CC and FAZ area (p<0.05). Also, SVD and DVD measurements of the DM patients were significantly different between high-risk and low-risk groups for all macular regions (p<0.05 for all). Conclusions: OCTA can show the damage in patients without any clinically significant DR before the clinical manifestation in diabetic patients. Our results suggested that OCTA might be a promising tool for periodic screening of diabetic patients without DR. [ABSTRACT FROM AUTHOR]

To compare intraocular lens (IOL) tilt and decentration after Nd:YAG laser posterior capsulotomy in eyes that had femtosecond laser–assisted capsulotomy versus manual capsulorhexis. Ekol Eye Hospital, Izmir, Turkey. Retrospective case series. Intraocular lens decentration and angle of tilt were measured using a Scheimpflug camera before and 1 month after Nd:YAG capsulotomy. Eighteen eyes had a femtosecond laser–assisted capsulotomy and 25 eyes a manual capsulorhexis. The mean age was 58.2 years ± 10.2 (SD) (range 44 to 69 years) and 60.6 ± 8.3 years (range 45 to 70 years), respectively. Before capsulotomy, the angle of tilt and decentration at both meridians did not differ significantly between the 2 groups (P >.05). After capsulotomy, the angle of tilt was significantly decreased in both groups (femtosecond: vertical 1.5 degrees and horizontal 1.2 degrees; manual: vertical 1.1 degrees and horizontal) and decentration was significantly increased (femtosecond: vertical 0.085 mm and horizontal 0.096 mm; manual: vertical 0.2 mm and horizontal 0.2 mm) at both meridians (P <.05). After capsulotomy, all tilt and decentration parameters were significantly different between the 2 groups (P <.05) except decentration on the horizontal meridian (P =.669). Nd:YAG posterior capsulotomy performed after femtosecond laser–assisted capsulotomy resulted in better mechanical stability of the IOL. This suggests that a femtosecond laser–created capsulotomy better maintains a proper IOL position. Although the differences were statistically significant, the tilt and decentration values were small and might not be clinically significant. [ABSTRACT FROM AUTHOR]

Background: Cancer is a significant health problem for refugees and host countries. Breast cancer is the most common cancer among refugees. The subject of our study is to examine the clinical and pathological features of Syrian refugees with breast cancer and compare them with Turkish patients with breast cancer. Methods: Data of patients with breast cancer between January 2018 and December 2020 were retrospectively reviewed. The clinical and histological features, treatment modalities and overall survival were collected and analyzed. Results: A total number of 338 women with breast cancer were included in this study. Ninety-nine of the 338 (29.3%) patients were Syrian refugees and 239 patients (70.7%) were Turkish. The median follow-up time was significantly lower in Syrian patients (P < 0.001). Median OS was 146 months in Turkish and 116 months in Syrian group (P = 0.022). Independent risk factors associated with long survival were receiving adjuvant chemotherapy (HR 0.465; 95% CI 0.234-0.926; P = 0.029), adjuvant radiotherapy (HR 0.372 95% CI 0.182-0.758; P = 0.007), and adjuvant hormonotherapy (HR 0.367; 95% CI 0.201-0.669; P = 0.001). The rates of receiving adjuvant chemotherapy, adjuvant radiotherapy, and adjuvant hormonal therapy were significantly lower in the Syrian group (P = 0.023, P = 0.005, P = 0.002, respectively). Conclusion: Syrian refugees with breast cancer are more likely to receive suboptimal treatments. They have inferior survival compared to local patients. Our findings highlight the need for the provision of cancer therapy in such vulnerable populations. We suggest that more attention should be paid to breast cancer, as it is the most common cancer among refugees. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the outcomes of femtosecond laser-assisted arcuate keratotomy (FSAK) combined with cataract surgery in eyes with low-to-moderate corneal astigmatism. Materials and Methods: This study included patients who underwent combined femtosecond laser-assisted phacoemulsification and arcuate keratotomy between October 2016 and October 2018. Keratometric astigmatism and astigmatic changes were evaluated before and six months after the surgery by vector analysis based on Alpin's method. Results: In total, 69 eyes of 69 patients (35 female and 34 male; mean age, 60.3 ±10.5 years) were included. The mean preoperative target induced astigmatism (TIA) was 1.55±0.46 diopters (D) and postoperative astigmatism (difference vector [DV]) was 0.83±0.41 D (P<.001). The mean surgically induced astigmatism (SIA) was 1.09±0.56 D. The magnitude of error (difference between SIA and TIA) was -0.28±0.65 D and correction index (SIA/TIA ratio) was 0.71±0.34, indicating a slight undercorrection. The angle of error was near 0 (22±16 degrees), indicating no significant systematic error of misaligned treatment. The index of success (IOS), which is the ratio of DV to TIA, was 0.54±0.27, indicating a success rate of 46% in the correction of astigmatism. Conclusion: Combined phacoemulsification with FSAK appears to be a relatively easy and safe means for management of low-to-moderate corneal astigmatism in cataract surgery candidates. [ABSTRACT FROM AUTHOR]

Introduction: Socioeconomic factors play an important role in the prevalence of Helicobacter pylori (HP) infection. The aim of this study is to investigate HP prevalence among symptomatic patients in the upper socioeconomic segment of the population undergoing gastroscopy in an endemic urban region. Methodology: Over a 12-month period, data were collected from the first consecutive 1000 patients (500 from university hospital, 500 from community hospital) who had gastroscopy and HP evaluation. Results: Overall, 211/1000 patients (21.1%) were found to have HP in gastric biopsies. The specificity, sensitivity, positive predictive value, negative predictive value and diagnostic accuracy of rapid urease test were 87.5%, 99.7%, 99%, 96.5%, and 96.9% respectively. Atrophic gastritis, gastric and duodenal ulcers were significantly more common in HP positive patients. Age based distribution of HP prevalence: > 6 decades (15.5%), 3rd-5th decades (26.1%), < 3rd decades (10.4%). Conclusion: In an HP endemic country, the prevalence of HP infection among symptomatic patients belonging to the upper socioeconomic segment of the population appears to be markedly lower. The lowest prevalence in young patients is expected to result in future decrease in HP prevalence. [ABSTRACT FROM AUTHOR]

Objective Nonalcoholic fatty liver disease ( NAFLD), a hepatic manifestation of metabolic syndrome ( Met S) is closely associated with an increased risk of cardiovascular disease. Fetuin- A is associated with Met S and NAFLD. We investigated the relationship of circulating fetuin- A level with markers of endothelial dysfunction and presence of carotid atherosclerosis in subjects with NAFLD. Methods The consecutive 115 patients with NAFLD and age-matched 74 healthy subjects were enrolled. Plasma levels of fetuin- A and markers of endothelial dysfunction [asymmetric dimethyl arginine ( ADMA) and adiponectin] were measured by ELISA method. Insulin sensitivity was determined by homeostasis model assessment of insulin resistance ( HOMA- IR) index. Carotid artery intima-media thickness ( cIMT) was assessed by high-resolution ultrasonography. Results Fetuin- A and ADMA were higher and, adiponectin was lower in NAFLD group than the control group ( P = 0·004, P < 0·001 and P < 0·001, respectively). In addition, NAFLD group had greater c IMT measurements than the controls ( P < 0·001). However, no difference was found for fetuin- A, ADMA, adiponectin and c IMT between two groups when the findings were adjusted according to the glucose, lipids and HOMA- IR index. In correlation analysis, fetuin- A was found to be positively correlated with triglyceride ( r = 0·23, P = 0·001), HOMA- IR ( r = 0·29, P < 0·001), ADMA ( r = 0·24, P = 0·001), c IMT ( r = 0·3, P = 0·003) and, negatively correlated with HDL- C ( r = −0·17, P = 0·02) and adiponectin ( r = −0·19, P = 0·01) levels. Multiple linear regression analysis showed that fetuin- A was independently associated with ADMA and c IMT levels. Conclusion This study demonstrated for the first time that circulating fetuin- A in NAFLD is independently associated with endothelial dysfunction and subclinical atherosclerosis. [ABSTRACT FROM AUTHOR]

Abstract: Aims: Non-alcoholic fatty liver disease (NAFLD) is associated with cardiovascular disease. Asymmetric dimethylarginine (ADMA) is a novel marker of endothelial dysfunction and atherosclerosis. We aimed to investigate circulating ADMA concentrations in biopsy proven NAFLD and also to search its association with carotid atherosclerosis. Methods: Sixty-seven nondiabetic and normotensive patients with NAFLD and 35 healthy controls were enrolled. Plasma ADMA was measured along with glucose, lipids and insulin levels. Insulin resistance (IR) was assessed by homeostasis model assessment-estimated insulin resistance (HOMA-IR) method. Carotid atherosclerosis was evaluated by carotid artery intima-media thickness (CIMT) using carotid ultrasonography. Results: ADMA levels and CIMT measurements were significantly higher in NAFLD group than the controls. However, the difference regarding the CIMT disappeared when the findings were adjusted according to the metabolic parameters and insulin sensitivity. In contrast, the difference for ADMA remained significant between two groups. No significant association was found between ADMA, CIMT and histopathological findings. Conclusions: Plasma ADMA levels are increased in subjects with NAFLD. This increase seems to be independent from traditional cardiovascular risk factors, insulin resistance and liver histology. Circulating ADMA may be an earlier marker of vascular damage with respect to CIMT in subjects with NAFLD. [Copyright &y& Elsevier]

Abstract: Objectives : The data regarding circulating levels of markers of platelet activation and endothelial function in people with prediabetes are scant. The aim of the present study was to search blood levels of soluble CD40 ligand (sCD40L), soluble P-selectin (sP-sel) and von Willebrand Factor (vWF) in subjects with prediabetes, along with the effects of the metabolic syndrome (MetS) on these markers. Design and methods : A total of 77 prediabetic individuals and 81 age, sex and body mass index matched healthy subjects with normal glucose tolerance (NGT) were prospectively analyzed. Anthropometric parameters, fasting plasma glucose, blood d lipid profiles and insulin resistance indexes were determined. Plasma sCD40L, sP-sel and vWF levels were measured by ELISA. Results : sCD40L, sP-sel and vWF levels in the prediabetic group were similar to those in the controls. However, prediabetic subjects with the MetS had significantly higher level of sCD40L compared to those without MetS. Moreover, sCD40L level correlated significantly with waist circumference, systolic blood pressure and HDL-cholesterol level in the patient group. Conclusion : These data imply that MetS may contribute, at least in part, to the mechanism of platelet activation and endothelial dysfunction in people with prediabetes. [Copyright &y& Elsevier]