Publications by authors named "Hakan Demirci"

221 Publications

Vismodegib for Preservation of Visual Function in Patients with Advanced Periocular Basal Cell Carcinoma: The VISORB Trial.

Oncologist 2021 May 14. Epub 2021 May 14.

Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan, USA.

Background: Basal cell carcinoma (BCC) is a common skin cancer often curable by excision; however, for patients with BCC around the eye, excision places visual organs and function at risk. In this article, we test the hypothesis that use of the hedgehog inhibitor vismodegib will improve vision-related outcomes in patients with orbital and extensive periocular BCC (opBCC).

Materials And Methods: In this open-label, nonrandomized phase IV trial, we enrolled patients with globe- and lacrimal drainage system-threatening opBCC. To assess visual function in the context of invasive periorbital and lacrimal disease, we used a novel Visual Assessment Weighted Score (VAWS) in addition to standard ophthalmic exams. Primary endpoint was VAWS with a score of 21/50 (or greater) considered successful, signifying globe preservation. Tumor response was evaluated using RECIST v1.1. Surgical specimens were examined histologically by dermatopathologists.

Results: In 34 patients with opBCC, mean VAWS was 44/50 at baseline, 46/50 at 3 months, and 47/50 at 12 months or postsurgery. In total, 100% of patients maintained successful VAWS outcome at study endpoint. Compared with baseline, 3% (95% confidence interval [CI], 0.1-15.3) experienced major score decline (5+ points), 14.7% (95% CI, 5 to 31.1) experienced a minor decline (2-4 points), and 79.4% experienced a stable or improved score (95% CI, 62.1-91.3). A total of 56% (19) of patients demonstrated complete tumor regression by physical examination, and 47% (16) had complete regression by MRI/CT. A total of 79.4% (27) of patients underwent surgery, of which 67% (18) had no histologic evidence of disease, 22% (6) had residual disease with clear margins, and 11% (3) had residual disease extending to margins.

Conclusion: Vismodegib treatment, primary or neoadjuvant, preserves globe and visual function in patients with opBCC. Clinical trail identification number.NCT02436408.

Implications For Practice: Use of the antihedgehog inhibitor vismodegib resulted in preservation of end-organ function, specifically with regard to preservation of the eye and lacrimal apparatus when treating extensive periocular basal cell carcinoma. Vismodegib as a neoadjuvant also maximized clinical benefit while minimizing toxic side effects. This is the first prospective clinical trial to demonstrate efficacy of neoadjuvant antihedgehog therapy for locally advanced periocular basal cell carcinoma, and the first such trial to demonstrate end-organ preservation.
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http://dx.doi.org/10.1002/onco.13820DOI Listing
May 2021

The evolution of an active solitary idiopathic choroiditis (focal scleral nodule): a case report of the natural course and a review of the literature.

BMC Ophthalmol 2021 Mar 9;21(1):130. Epub 2021 Mar 9.

Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USA.

Background: To describe the clinical course of an active solitary idiopathic choroiditis (focal scleral nodule) that nearly resolved over six weeks without intervention.

Case Presentation: An 18-year-old man presented to the emergency department with headaches and new onset central scotoma in the right eye. Visual acuity was 20/20 in both eyes. Fundus examination revealed an amelanotic choroidal lesion with associated shallow subretinal fluid. It measured 6.1 × 6.3 × 1.4mm on A- and B-scan. Evaluation for systemic inflammatory and infectious diseases was negative. A week later, the lesion remained stable, and a month later, there was improvement of the lesion with a decrease in size on OCT and exam and resolution of the subretinal fluid suggesting that the lesion had become inactive.

Conclusions: Solitary idiopathic choroiditis (Focal scleral nodule) is a rare condition characterized by inflammatory granulomatous reaction. This case report sheds light on the unknown natural course of a solitary idiopathic choroiditis (focal scleral nodule).
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http://dx.doi.org/10.1186/s12886-021-01888-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7942170PMC
March 2021

Reasons for the relocation of contracted family physicians and job satisfaction.

Fam Pract 2021 Mar 18. Epub 2021 Mar 18.

Department of Family Medicine, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Yildirim, 16310 Bursa, Turkey.

Aim: The aim of this study was to determine the reasons for the relocation of contracted family physicians and the relationship of this situation with burnout and job satisfaction status.

Methods: This study was conducted with contracted family physicians in Bursa province between May 2019 and December 2019. The physicians were visited in the family health centres where they worked. The participants were asked to fill out a socio-demographic data form, Maslach Burnout Inventory Scale and Minnesota Job Satisfaction Questionnaire. In addition, physicians who had relocated were asked to fill out a questionnaire examining the reasons for this change.

Results: The most common reasons for the relocation of physicians were distance from home (65.30%), novelty seeking (25.60%) and burnout (24.80%). Being female (P = 0.004), duration of medical experience (P < 0.001), shorter time passed in family practice (P = 0.043) and job dissatisfaction (P = 0.006) were risk factors for relocation in a regression analysis model. Receiver operating characteristic analysis revealed a cut-off point value for the Minnesota overall score as ≤3.

Conclusions: In family practice, it is favourable to provide continuity of care to the patient with the same physician. However, migration of physicians within the province for social and cultural reasons to more prosperous regions, often to where they live, was observed. Young female family doctors will probably continue to migrate to better locations within the city regardless of payment advantages in poor settlements. The roles of female physicians in society (as mother, wife and daughter) may have an effect on this preference.
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http://dx.doi.org/10.1093/fampra/cmab015DOI Listing
March 2021

The spontaneous resolution of a vortex vein varix: case report.

BMC Ophthalmol 2021 Feb 24;21(1):101. Epub 2021 Feb 24.

WK Kellogg Eye Center, Department of Ophthalmology, University of Michigan, 1000 Wall Street, 40105, Ann Arbor, Michigan, USA.

Background: The natural course of a vortex vein varix, though not well understood, has been known to remain stable. However, here we report a novel case of a vortex vein varix that resolved after an extended period of monitoring.

Case Presentation: An asymptomatic 96-year-old Caucasian man was found to have a vortex vein varix. At his previous examination 13 months prior, his fundus was normal. At 13 months of observation, his vortex vein varix become clinically undetectable. Further follow-up confirmed continued absence of the varix.

Conclusion: This case demonstrates the development then clinical resolution of a vortex vein varix with no clear identifiable factors for its evolution. This case is novel and offers new insight into the natural history of some vortex vein varices, implicating venous congestion as an instigator and venous collateralization as its alleviator, suggesting that vortex vein varices are likely more common than previously reported since some may be temporary and under-identified.
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http://dx.doi.org/10.1186/s12886-021-01861-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7903696PMC
February 2021

Evaluation of Syrian refugees' emergency service admissions in the western region of Turkey.

Pathog Glob Health 2021 May 24;115(3):196-202. Epub 2021 Jan 24.

Deparment of Emergency Medicine, Health Sciences University Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey.

Immigration increases physical, mental, and social health problems. Emergency departments constitute resources that refugees can easily access and where they frequently present. Physicians from every specialty (chest diseases, thoracic surgery, internal diseases, etc.) may be consulted if needed. We aimed to compare demographic data and clinical characteristics of Syrian refugees and Turkish citizens in our emergency department. This study was an observational cross-sectional study. It included patients who presented to the Adult Emergency Department between April 1 and July 1, 2018. The patients were grouped into Syrian refugee and Turkish citizen groups. Patient age, gender, International Statistical Classification of Disease and Related Health Problems (ICD-10) diagnostic codes, and judicial case status were recorded from physician-patient outpatient clinic data records. Disease diagnoses and judicial cases were statistically compared between the two groups. A total of 30,749 patients presented to the emergency department during the study period. Of these, 999 were Syrian refugees. The mean ages of the Syrian refugees and Turkish citizens were significantly different. There were also differences between the two groups in the top five diagnostic codes (M79-Soft tissue disorders, J39-Other disorders of the upper respiratory tract; R51-Headache; R10-Abdominal and pelvic pain; M54-Dorsalgia). A comparison of the judicial cases also revealed a difference in mean age between the groups. Fewer specific disease diagnoses were identified among Syrian refugees. This may be explained by difficulties related to language barriers between the refugees and healthcare personnel.
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http://dx.doi.org/10.1080/20477724.2021.1878442DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8078921PMC
May 2021

Long-term follow up of systemic rituximab therapy as first-line and salvage therapy for idiopathic orbital inflammation and review of the literature.

Orbit 2021 Jan 21:1-8. Epub 2021 Jan 21.

Department of Ophthalmology and Visual Science, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA.

: To report long-term outcomes of systemic rituximab therapy for idiopathic orbital inflammation (IOI) as both primary and salvage therapy and to review the English literature.: A retrospective review of four consecutive biopsy-proven IOI cases managed with systemic rituximab including demographics, management, and outcomes, and review of English literature, were performed. Primary outcome measures included resolution of symptoms, recurrence, and length of follow up.: Of four cases, systemic rituximab was the first-line therapy in two cases and salvage therapy in two cases. The mean age of the patients was 62 years (range, 50-68 years). The orbit was involved in three cases and extraocular muscle in one case. Systemic rituximab (1 g weekly for 4 weeks) was given for one session in three patients and for 12 sessions in 1 patient. All four patients responded with the resolution of all symptoms without recurrence after at least 5 years of follow up. Review of the literature showed systemic rituximab had provided clinical improvement at shorter follow up in 14 of 15 cases when used as a salvage therapy.: Systemic rituximab therapy seems to be an effective therapy for IOI as salvage or first-line therapy with long-term clinical durability.
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http://dx.doi.org/10.1080/01676830.2021.1874424DOI Listing
January 2021

Sleep quality and obstructive sleep apnoea and triple screen test results in pregnancy.

J Obstet Gynaecol 2021 Jan 16:1-4. Epub 2021 Jan 16.

Department of Family Medicine, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey.

In this study, we aimed to examine the relationship between sleep quality, sleep apnoea and triple screen test results. This was an observational descriptive research study. The STOP questionnaire and the STOP-BANG questionnaire were performed to assess obstructive sleep apnoea risk and Pittsburgh Sleep Quality Index was used to evaluate sleep quality. The average Pittsburgh Sleep Quality Index score of the participants was 5.92 ± 3.26. According to the STOP test, 11.40% (87) of the pregnant women had a high risk of OSAS, and, according to the STOP-BANG test, 32 participants were under high risk of OSAS. An increased risk was detected in 1.30% of the participants in terms of Trisomy18 and in 1.60% in terms of neural tube defects. A direct and significant relationship was detected between Trisomy 21 risk and STOP-BANG score. This is the first study to show this relationship. Sufficient evidence needs to be collected on this issue. Testing in earlier weeks of pregnancy and in the conception period may allow more meaningful assessment of the relationship of OSAS with chromosomal abnormalities.IMPACT STATEMENT There is a link between OSAS and epigenetic changes. Components of the triple screen test, levels of serum total β-hCG and unconjugated oestriol are increased in OSAS. An increase in Trisomy 21 risk is correlated with increased OSAS risk. Alpha Fetoprotein levels were higher in the low OSAS risk group. This is the first study to show this relationship. Sufficient evidence needs to be collected on this issue. Treatment of OSAS may be necessary during pregnancy.
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http://dx.doi.org/10.1080/01443615.2020.1845629DOI Listing
January 2021

A novel OCT signature in leukemic papillopathy masquerading as autoimmune or infectious uveitis.

Graefes Arch Clin Exp Ophthalmol 2021 May 4;259(5):1315-1322. Epub 2021 Jan 4.

Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA.

Purpose: With therapeutic advances, central nervous system (CNS) involvement in leukemia has become more common. Leukemic optic disc infiltration, often a clinical diagnosis, can present as an isolated finding in primary or relapsed CNS disease and therefore requires early recognition. Not previously well appreciated, we report here signs of intraocular inflammation accompanying leukemic optic disc infiltration, suggesting infectious or non-infectious uveitis as an alternative diagnosis. We describe a novel optical coherence tomography (OCT) sign favoring leukemic infiltration.

Methods: Retrospective consecutive case series of all leukemic patients with disc edema (5 patients, 6 eyes) presenting to the University of Michigan's Ocular Oncology Clinic between October 2019 and March 2020.

Results: We report five leukemic patients (6 eyes) who were evaluated for disc edema and vitritis and eventually diagnosed with leukemic papillopathy. All five patients initially had a bland lumbar puncture (LP), and all four patients who underwent magnetic resonance imaging (MRI) had no retrobulbar nerve involvement. Clinical findings included preserved visual acuity (n = 5 eyes, 83%), anterior chamber (AC) cell (n = 3 eyes, 50%), vitreous cell (n = 6 eyes, 100%), and retinal whitening (n = 4 eyes, 66%). In five eyes (83%), a diagnosis of infectious or non-infectious uveitis was initially considered. The OCT finding of inner retinal thickening and loss of inner retinal lamination with largely preserved outer retinal architecture helped point towards a leukemic infiltrative process emanating from the disc and spreading retrograde through the nerve fiber layer.

Conclusions: These cases highlight the difficulty of distinguishing intraocular inflammation associated with leukemic papillopathy from infectious or non-infectious uveitis, especially considering bland LP and negative retrobulbar MRI signal in all our patients. We propose juxtapapillary inner retinal infiltration with the loss of inner retinal lamination and relative preservation of outer retinal architecture on OCT imaging as a finding that supports the diagnosis of leukemic papillopathy.
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http://dx.doi.org/10.1007/s00417-020-05055-2DOI Listing
May 2021

Relationship between health literacy and quality of colonoscopy bowel preparation.

Turk J Gastroenterol 2020 11;31(11):799-804

Department of Gastroenterology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey.

Background/aims: There are a variety of factors that affect the quality of colonoscopy bowel preparations, although the relationship between the level of health literacy (HL) and the quality of bowel preparations has yet to be clarified. The present study evaluated the effect of HL on the quality of bowel preparation prior to a colonoscopy.

Materials And Methods: The data of 150 patients who underwent a colonoscopy for colorectal cancer screening and in whom the quality of bowel preparation was scored during the colonoscopy were recorded prospectively. The European Health Literacy Survey Questionnaire (HLS-EU-Q47) was used to evaluate HL prior to the colonoscopy, and the Boston bowel preparation scale was used to evaluate the quality of the bowel preparation during the colonoscopy. The demographic characteristics of the patients, the presence of comorbidities, socioeconomic characteristics (marital status, income level, and educational level), HLS-EU-Q47 questionnaire, and Boston bowel preparation scale scores were recorded and evaluated.

Results: A significant linear relationship was identified between the general HL index score, the cleanliness of the colonic segments (right, transverse, and left colon) and the total Boston bowel preparation scale score (p=0.013, p=0.010, p=0.008, p=0.001, respectively). In a HL subgroup analysis, a significant linear relationship was noted between disease prevention and health promotion index, the cleanliness of the colonic segments (right, transverse, and left colon), and the total Boston bowel preparation scale score. It was observed that an increase in the health care index resulted in an increase in the cleanliness of the relevant colonic segments and the total Boston bowel preparation scale score. No relationship was found between the right, transverse, and left colon and the total Boston bowel preparation scale scores and gender, age, Body Mass Index (BMI), comorbidity, marital status, level of income, or educational level.

Conclusion: The level of HL affects the quality of colonoscopy bowel preparations.
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http://dx.doi.org/10.5152/tjg.2020.19529DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759226PMC
November 2020

Change in Postoperative Opioid Prescribing Patterns for Oculoplastic and Orbital Procedures Associated With State Opioid Legislation.

JAMA Ophthalmol 2021 02;139(2):157-162

Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor.

Importance: Understanding whether statewide legislation, such as the Michigan Opioid Laws, is associated with reduction in postoperative opioid prescriptions is informative in guiding future legislation.

Objective: To identify changes in opioid prescribing patterns for oculoplastic and orbital procedures associated with the enactment of the Michigan Opioid Laws in 2017 and 2018.

Design, Setting, And Participants: This cross-sectional study included 3781 patients who underwent any of 10 common oculoplastic and orbital procedures between June 1, 2016, and November 30, 2019, at a tertiary care institution.

Exposures: From 2017 to 2018, Michigan enacted a series of laws to address the state's worsening opioid epidemic. Two major components of this legislation enacted on June 1, 2018, required prescribers to review a report of patients' opioid use history and obtain signed consent after educating patients on the use and disposal of opioids prior to prescribing.

Main Outcomes And Measures: Demographic information, type of surgery, type and amount of opioid prescriptions, and morphine milligram equivalent (MME) were analyzed. MME was calculated as the product of dose, quantity, and opioid-specific conversion factor for each prescription. Linear interpolation spline regression was used to evaluate the association of prescription MME with time.

Results: Of 3781 patients, 1614 (42.7%) were male. The mean (SD) age at the time of surgery was 63.3 (16.6) years. Of 2026 patients undergoing surgery before June 1, 2018, 1782 (88.0%) were prescribed postoperative opioids; of 1755 patients undergoing surgery after June 1, 2018, 878 (50.0%) were prescribed postoperative opioids (P < .001). There was no difference in age, sex, race/ethnicity, surgery type, or opioids prescribed between these 2 cohorts. Linear interpolation spline regression showed a decrease of 26.025 MMEs (equivalent to a 36.2% reduction of mean MME) between June 1, 2017, and September 30, 2018 (β, -1.735; 95% CI, -0.088 to -0.024; P < .001), stabilizing at a persistently reduced rate of MME prescribed through the end of the study period (October 1, 2018, to November 30, 2019; β, -0.005; 95% CI, -0.039 to 0.016; P = .42). Changes in MME in the 12 months before or 12 months after the period of legislation enactment were not identified.

Conclusions And Relevance: In this cross-sectional study, reduction in opioid prescriptions for oculoplastic and orbital procedures was observed during the enactment period of the Michigan Opioid Laws and appeared to be sustained through the end of the study period. Similar statewide or national legislations aimed at increasing prescriber awareness and patient education on opioid use may help curtail the prescription opioid epidemic.
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http://dx.doi.org/10.1001/jamaophthalmol.2020.5446DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7729578PMC
February 2021

Penetration of Carbon Nanotubes into the Retinoblastoma Tumor after Intravitreal Injection in LH T Transgenic Mice Reti-noblastoma Model.

J Ophthalmic Vis Res 2020 Oct-Dec;15(4):446-452. Epub 2020 Oct 25.

Electrical Engineering and Computer Science, University of Michigan Ann Arbor, MI, USA.

Purpose: To evaluate the penetration of carbon nanotubes (CNTs) throughout retinoblastoma in a transgenic mice model.

Methods: CNTs functionalized with fluorescein isothiocyanate and targeting ligands biotin (CTN-FITC-Bio, 0.5mg/ml), or folic acid (CNT-FITC-FA, 0.5mg/ml) were injected into the vitreous of one eye of LH T transgenic mice. Other eye did not receive any injection and was used as control. Three mice were sacrificed at days 1, 2, and 3. Eyes were enucleated and stained with 4,6-diamidino-2-phenylindole. The sections were imaged by fluorescent microscope. The images were transformed into grey-scale in MATLAB for intensity analysis. Background intensity was normalized by marking squares outside the eyeball and using the mean intensity of these squares. Fluorescent intensity (FI) for each image was measured by calculating the intensity of a same-sized square within retinoblastoma.

Results: Nine eyes of nine mice were included in each CNT-FITC-Bio and CNT-FITC-FA groups. The mean FI in CNT-FITC-Bio was 52.08 6.33, 53.62 9.00, and 65.54 5.14 in days 1, 2, and 3, respectively. The mean FI in CNT-FITC-FA was 50.28 7.37, 59.21 6.43, and 58.38 2.32 on days 1, 2, and 3, respectively. FI was significantly higher in eyes injected with CNT-FITC-Bio and CNT-FITC-FA compared to the control eyes ( = 0.02). There was no difference in FI between eyes with CNT-FITC-Bio and CNT-FITC-FA, and FI remained stable on days 1-3 in CNT-FITC-Bio, CNT-FITC-FA, and control eyes ( 0.05).

Conclusion: We observed higher FI in eyes with CNT-FITC-Bio and CNT-FITC-FA compared to control eyes, showing penetration of CNTs throughout retinoblastoma. CNTs can be a carrier candidate for imaging or therapeutic purposes in retinoblastoma.
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http://dx.doi.org/10.18502/jovr.v15i4.7778DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7591833PMC
October 2020

Immunotherapy for Conjunctival Squamous Cell Carcinoma with Orbital Extension.

Ophthalmology 2021 May 25;128(5):801-804. Epub 2020 Sep 25.

Roger Cancer Center, University of Michigan, Ann Arbor, Michigan.

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http://dx.doi.org/10.1016/j.ophtha.2020.09.027DOI Listing
May 2021

Effect of health literacy on help-seeking behavior: A comparison of patients accepting surgery and refusing surgery for urinary incontinence.

J Gynecol Obstet Hum Reprod 2021 Apr 11;50(4):101908. Epub 2020 Sep 11.

University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Department of Family Medicine, Turkey. Electronic address:

Objective(s): To compare the health literacy (HL) of the adult females with SUI complaints in terms of their acceptance or non-acceptance of surgery.

Methods: In this cohort study, the European Health Literacy Survey Questionnaire (HLS-EU- Q47) scores as a measure of health literacy were compared among the two groups of patients who accepted to undergo surgery for SUI and the ones who did not. Demographic features, weight and BMI values, comorbidity, menopausal status, duration and type of UI, socioeconomic characteristics (marital status, educational level, level of income) and HLS-EU- Q47 survey results of the two groups were compared. We also investigated the reasons regarding the acceptance or refusal of SUI surgery.

Results: Among the patients who were offered surgery 474% accepted to undergo operation. Total HLS-EU-Q47 score was 30.04 in the group of patients who accepted surgery and 23.46 in the group who refused surgery. The patients that refused surgery had more often insufficient health literacy level (p=0.001). An excellent health literacy level was higher for patients who agreed to anti-incontinence surgery (p=0.021).

Conclusions: Health literacy score of patients with urinary incontinence (UI) who refused surgery was lower than those who accepted surgery. Acceptance of surgery may be increased by providing more understandable and clear information, especially for women with lower HL levels.
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http://dx.doi.org/10.1016/j.jogoh.2020.101908DOI Listing
April 2021

Comparison of the effects of trospium and solifenacin on intraocular pressure and tear secretion in patients with overactive bladder.

Int Urogynecol J 2021 Jan 4;32(1):173-178. Epub 2020 Aug 4.

University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Family Medicine, Bursa, Turkey.

Introduction And Hypothesis: Comparison of the effects of trospium and solifenacin used for the treatment of overactive bladder (OAB) on intraocular pressure (IOP) and tear secretion.

Methods: This study was planned as a prospective study and was conducted at a single center between October 2014 and April 2016. OAB patients were included in the study following an ophthalmic examination, IOP measurement with an applanation tonometer, and tear secretion measurement with the Schirmer I test in the ophthalmology outpatient department. The patients were started with trospium 30 mg oral bid or solifenacin 5 mg oral qd. They were then followed up at the 4th and 12th weeks.

Results: A total of 225 OAB patients with a mean age of 47.80 (18-75) years were evaluated. The mean age was 47.41 ± 12.65 years in the trospium group (n = 104) and 48.14 ± 11.82 years in the solifenacin group (n = 121) with no statistically significant difference. When the two medications were compared, no statistically significant difference was observed at the 4th and 12th weeks in terms of IOP (p = 0.988, p = 0.822) and dry eye (p = 0.764, p = 0.581).

Conclusions: No statistically significant difference was observed between trospium and solifenacin in terms of their effects on IOP and tear secretion in OAB patients. We therefore concluded that the effects of trospium and solifenacin on IOP and tear secretion changes were similar in OAB patients without comorbidities.
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http://dx.doi.org/10.1007/s00192-020-04473-4DOI Listing
January 2021

Retinal Whitening After Lung Transplant for Cystic Fibrosis.

JAMA Ophthalmol 2020 09;138(9):994-995

Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor.

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http://dx.doi.org/10.1001/jamaophthalmol.2020.1306DOI Listing
September 2020

An adolescent with uveal melanoma and tumor predisposition syndrome.

JAAD Case Rep 2020 Jun 25;6(6):563-566. Epub 2020 Apr 25.

Department of Dermatology, Michigan Medicine, Ann Arbor, Michigan.

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http://dx.doi.org/10.1016/j.jdcr.2020.04.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265053PMC
June 2020

Geriatric giants in women over 65 years living in a rural area in Turkey.

J Women Aging 2020 Jun 6:1-7. Epub 2020 Jun 6.

Urology, Bursa Yuksek Ihtisas Trainig and Research Hospital, Bursa, Turkey.

The aim of this study was to determine the prevalence of fall tendency, urinary incontinence, and dementia in women over 65 years of age living in rural areas of Turkey. The research was a descriptive study. Mini-Mental tests, The International Consultation of Incontinence Questionnaire (ICIQ) short forms, and Falls Behavioral Scales for the elderly were used. Urinary incontinence prevalence in women over 65 years of age living in rural areas of Bursa was 51%. Dementia frequency was calculated as 56%. A reverse and significant relationship was detected between Mini-Mental Scale and ICIQ scale scores ( = -0.12; = .017). The Falls Behavioral Scale score was higher in the group with incontinence. The conclusion reached was that urinary incontinence and dementia are frequent among older women living in rural areas in Turkey. As diseases known as geriatric giants are associated with each other, treatment of one of them may bring protection from another negative situation.
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http://dx.doi.org/10.1080/08952841.2020.1763890DOI Listing
June 2020

Invasive squamous cell carcinomas and precursor lesions on UV-exposed epithelia demonstrate concordant genomic complexity in driver genes.

Mod Pathol 2020 11 27;33(11):2280-2294. Epub 2020 May 27.

Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA.

Although squamous cell carcinomas (SCC) are the most frequent human solid tumor at many anatomic sites, the driving molecular alterations underlying their progression from precursor lesions are poorly understood, especially in the context of photodamage. Therefore, we used high-depth, targeted next-generation sequencing (NGS) of RNA and DNA from routine tissue samples to characterize the progression of both well- (cutaneous) and poorly (ocular) studied SCCs. We assessed 56 formalin-fixed paraffin-embedded (FFPE) cutaneous lesions (n = 8 actinic keratosis, n = 30 carcinoma in situ [CIS], n = 18 invasive) and 43 FFPE ocular surface lesions (n = 2 conjunctival/corneal intraepithelial neoplasia, n = 20 CIS, n = 21 invasive), from institutions in the US and Brazil. An additional seven cases of advanced cutaneous SCC were profiled by hybrid capture-based NGS of >1500 genes. The cutaneous and ocular squamous neoplasms displayed a predominance of UV-signature mutations. Precursor lesions had highly similar somatic genomic landscapes to SCCs, including chromosomal gains of 3q involving SOX2, and highly recurrent mutations and/or loss of heterozygosity events affecting tumor suppressors TP53 and CDKN2A. Additionally, we identify a novel molecular subclass of CIS with RB1 mutations. Among TP53 wild-type tumors, human papillomavirus transcript was detected in one matched pair of cutaneous CIS and SCC. Amplicon-based whole-transcriptome sequencing of select 20 cutaneous lesions demonstrated significant upregulation of pro-invasion genes in cutaneous SCCs relative to precursors, including MMP1, MMP3, MMP9, LAMC2, LGALS1, and TNFRSF12A. Together, ocular and cutaneous squamous neoplasms demonstrate similar alterations, supporting a common model for neoplasia in UV-exposed epithelia. Treatment modalities useful for cutaneous SCC may also be effective in ocular SCC given the genetic similarity between these tumor types. Importantly, in both systems, precursor lesions possess the full complement of major genetic changes seen in SCC, supporting non-genetic drivers of invasiveness.
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http://dx.doi.org/10.1038/s41379-020-0571-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7934000PMC
November 2020

High-dose dual therapy is effective as first-line treatment for Helicobacter pylori infection.

Turk J Gastroenterol 2020 03;31(3):234-238

Department of Gastroenterology, Gulhane School of Medicine, Ankara, Turkey.

Background/aims: Although many regimens, including quadruple, sequential, and concomitant treatment, are used and recommended as first-line or rescue therapies for Helicobacter pylori infection, eradication rates are still below 90% in intention-to-treat analyses. Treatment protocols with substantially high eradication rates and low antibiotic resistance are needed. In this study, we investigated the efficacy of high-dose dual therapy as first-line treatment in a Turkish population.

Materials And Methods: All patients underwent upper gastrointestinal endoscopy for the initial H. pylori status because of dyspeptic symptoms. All patients received a 14-day, high-dose dual therapy comprising rabeprazole (20 mg t.i.d.) and amoxicillin (1 g t.i.d.) for H. pylori eradication. H. pylori stool antigen tests of eradication were administered to all participants at least 4 weeks after the completion of the treatment.

Results: The high-dose dual therapy demonstrated a 91.3% rate of successful eradication of H. pylori infection. Per-protocol success was 94.4% among female patients (n=51) and 89.6% among male patients (n=86); in terms of gender, the differences were not significant (p=0.310). No side effects were observed during the study in any patient. Six other patients did not take adequate doses of the treatment protocol.

Conclusion: High-dose dual therapy with rabeprazole and amoxicillin was highly effective and well tolerated as a first-line therapy for H. pylori eradication.
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http://dx.doi.org/10.5152/tjg.2020.18974DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7197926PMC
March 2020

Intralesional Rituximab Injection for Low-Grade Conjunctival Lymphoma Management.

Ophthalmology 2020 09 18;127(9):1270-1273. Epub 2020 Mar 18.

Department of Ophthalmology and Visual Science, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan.

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http://dx.doi.org/10.1016/j.ophtha.2020.03.014DOI Listing
September 2020

Evaluation of Eating Attitudes, Anger and Impulsivity in Atypical and Non-Atypical Depression and Assessment of Comorbidity of Binge Eating.

Psychiatr Danub 2020 ;32(1):105-114

Department of Psychiatry, Istanbul Bakırköy Mental Health Training and Research Hospital, Psychiatry Department, Istanbul, Turkey,

Background: Although there have been studies investigating emotional eating, impulsivity and anger, the relationship between differentiated eating attitudes, impulsivity and anger in atypical depression has not yet been studied. Therefore, the aim of this study was to evaluate eating attitudes, impulsivity and anger in participants with atypical and non-atypical depression and to compare their behaviours with those of the control group. Binge eating comorbidity was also investigated. The relationship between eating attitudes, impulsivity and anger was explored and the factors contributing to disordered eating attitudes were analysed.

Subjects And Methods: The participants were divided into three groups; 56 with atypical depression, 36 with non-atypical depression and 32 healthy controls for comparison. Clinical assessment was carried out using the Structured Clinical Interview for DSM-IV Axis I Disorders, Barratt Impulsiveness Scale, Multidimensional Anger Scale, Eating Attitude Test, and Hamilton Depression Scale.

Results: Deteriorated eating attitudes, increased anger symptoms and motor impulsivity were observed more in participants with atypical depression compared with participants with non-atypical depression. The frequency of binge eating was statistically significantly higher in participants with atypical depression (50%) than in participants with non-atypical depression (8%). A positive relationship was identified between deteriorated eating attitude, anger, and impulsivity. Behaving anxiously as a reaction to anger was found to be the significant predictor of disordered eating attitudes in participants with depression. The percentage of the variance explained by anxious behavior in disordered eating attitudes was 7%.

Conclusion: Participants in the atypical and non-atypical depression groups can be differentiated from each other based on their eating attitudes, anger symptoms, motor impulsivity and binge eating frequency.
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http://dx.doi.org/10.24869/psyd.2020.105DOI Listing
April 2020

Amyloid Goiter in a Patient with Rheumatoid Arthritis and End-Stage Renal Disease.

Indian J Nephrol 2020 Mar-Apr;30(2):125-128. Epub 2020 Feb 19.

Department of Family Medicine, Yuksek Ihtisas Educational and Research Hospital, Bursa, Turkey.

The association between amyloidosis and collagen vascular diseases, such as rheumatoid arthritis (RA) is well-documented. Amyloid goiter is an extremely rare pathologic condition caused by a massive amyloid infiltration of the thyroid tissue. Our patient had been diagnosed with RA 20 years ago and was on hemodialysis for 7 years. He was assessed for decreased appetite, dysphagia, and nausea during the hemodialysis. On physical examination, the thyroid was diffusely enlarged with multiple nodules. He was biochemically euthyroid. Ultrasound of the thyroid gland showed multinodular goiter. A total thyroidectomy was performed. Histopathological examination showed dilated follicles surrounded by abundant homogeneous substance that stained positive with Congo red. The patient was reported as amyloid goiter. Complaints of the patient improved after the surgery. In the literature, amyloid goiter with RA in a hemodialysis patient is very rare. Amyloid goiter should be considered if there is a rapid thyromegaly causing pressure symptoms in the background of any disease with chronic inflammation.
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http://dx.doi.org/10.4103/ijn.IJN_271_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7132848PMC
February 2020

What is the emergency application differences concerning diseases pertinent to the chest between Turkish citizens and Syrian refugees: A cross-sectional study.

Clin Respir J 2020 Mar 23. Epub 2020 Mar 23.

Deparment of Emergency Medicine, Health Sciences University Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey.

Aim: Millions of Syrians were displaced after the Syrian civil war broke in 2011. Turkey hosts the largest number of refugees. This study aimed to describe the disease patterns of Syrian refugees applying to an emergency department.

Material And Methods: The study included patients who presented to an emergency department between 2017 and 2018. Study data were retrieved from the hospital's electronic medical records registry. The main study outcome was the ICD-10 codes pertinent to "chest diseases." Additionally, analyzed data were nationality, age, sex, triage status on admission, hospitalization status, and examination date.

Results: The number of emergency department admissions included in the study period was 378 487 persons, of which 14 262 (3.8%) were Syrian refugees. A total of 62 345 diagnoses (16.5%) were related to the respiratory system. Turkish patients had a significantly higher median age than Syrian refugees. Also, there were significantly more women among Syrian applicants, and acute bronchitis and asthma were more common among Syrian patients. However, the hospitalization rates were similar between the two groups. Moreover, Syrian patients had more applications during the summer seasons and had higher "Yellow" labels in the emergency triage.

Conclusion: There are differences in the disease patterns of Syrian refugees and Turkish citizens applying to the emergency department. This may be explained by the difficulty in communication which, to our opinion, may be reversed as language barriers are overcome and adaptation to the society is completed over time.
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http://dx.doi.org/10.1111/crj.13189DOI Listing
March 2020

Atypical Presentation of Conjunctival Vascular Malformation.

JAMA Ophthalmol 2020 03 12;138(3):e190895. Epub 2020 Mar 12.

Department of Ophthalmology and Visual Science, Kellogg Eye Center, University of Michigan, Ann Arbor.

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http://dx.doi.org/10.1001/jamaophthalmol.2019.0895DOI Listing
March 2020

Global Retinoblastoma Presentation and Analysis by National Income Level.

JAMA Oncol 2020 05;6(5):685-695

Imam Hussein Cancer Center, Karbala, Iraq.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale.

Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis.

Design, Setting, And Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017.

Main Outcomes And Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis.

Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]).

Conclusions And Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs.
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http://dx.doi.org/10.1001/jamaoncol.2019.6716DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7047856PMC
May 2020

Diagnostic accuracy of fine needle aspiration cytology of thyroid nodules.

Diagnosis (Berl) 2020 01;7(1):61-66

Department of Family Medicine, University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Yildirim, 16310 Bursa, Turkey.

Background Routine application of fine needle aspiration cytology (FNAC) has decreased unnecessary referral of thyroid nodules for surgical treatment and has also increased the cancer rates found in surgery materials. Success of thyroid FNAC depends on skilled aspiration, skilled cytological interpretation and rational analysis of cytological and clinical data. The aim of this study was to determine the diagnostic accuracy rates of thyroid FNAC results obtained in our institution. Methods The data from FNAC and thyroidectomy reports of patients presenting with goiter and who had been evaluated from 1st January 2014 to 1st March 2018 were used. There were 149 patients in total who had undergone thyroidectomy following FNAC. The Bethesda System for Reporting Thyroid Cytology was used in all cytological diagnoses. Results The sensitivity of thyroid FNAC for malignant cases was 57.89%, specificity was 88.10%, false-positive rate was 11.90%, false-negative rate was 42.11%, positive predictive value was 52.38%, negative predictive value was 90.24% and accuracy rate was 82.52%. "Focus number" variable was detected as the factor that affected the accurate prediction of FNAC and thyroidectomy results by the pathologist. Conclusions This study showed that there was a moderate conformity between thyroid FNAC and thyroidectomy cyto-histopathological diagnosis in malignant cases. As two or more nodules have a negative effect on the physician's diagnosis of malignant nodules, we think that a more sensitive approach is needed in the determination of these cases. Sampling defects may affect this non-matching.
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http://dx.doi.org/10.1515/dx-2019-0039DOI Listing
January 2020

Ciliary Body Mass as a Feature of Ocular Sarcoidosis.

JAMA Ophthalmol 2020 03;138(3):300-304

Department of Ophthalmology and Visual Science, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor.

Importance: Ocular sarcoidosis may be the primary and only clinical manifestation of sarcoidosis, and irreversible loss of visual acuity may occur from delayed treatment. Thus, early diagnosis is imperative to preserve visual acuity. Establishing the diagnosis of sarcoidosis in cases manifesting only in the eye may require a diagnostic biopsy, which may prove challenging in the absence of available ocular surface, lacrimal gland, and systemic tissue for biopsy.

Objective: To describe diffuse or segmental ciliary body mass as a clinical sign and tissue source for biopsy in the diagnosis of ocular sarcoidosis.

Design, Setting, And Participants: This case series captures 3 cases from a university-based ocular oncology and uveitis practice. All 3 patients presented with uveitis and a diffuse or segmental ciliary body mass, which was identified via ultrasonographic biomicroscopy.

Main Outcomes And Measures: Clinical, ancillary, and histopathological ocular findings in the 3 patients.

Results: The patients were a 52-year-old white woman, a 42-year-old African American man, and an 81-year-old white man. Two individuals had unilateral involvement, and 1 had bilateral involvement. All 3 individuals presented with uveitis. Diffuse, circumferential ciliary body masses were observed in 2 patients. A localized, nodular ciliary body mass on the temporal quadrant with superior and inferior extensions was observed in 1 patient. Moderate to high internal reflectivity was observed on ultrasonographic biomicroscopy in all 3 individuals. Biopsies of the ciliary body masses were diagnosed as sarcoidosis in all 3 patients.

Conclusions And Relevance: These findings support that diffuse or segmental ciliary body mass may serve as a clinical sign and tissue source for biopsy in the diagnosis of ocular sarcoidosis, although the frequency of this cannot be determined from 3 cases. To our knowledge, such cases all demonstrate a uveitic component; whether a ciliary body mass caused by sarcoidosis can occur in the absence of uveitis remains unknown.
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http://dx.doi.org/10.1001/jamaophthalmol.2019.5704DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7042929PMC
March 2020

Fluorescein angiography findings in both eyes of a unilateral retinoblastoma case during intra-arterial chemotherapy with melphalan.

Int J Ophthalmol 2019 18;12(12):1987-1989. Epub 2019 Dec 18.

Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, MI 48105, USA.

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http://dx.doi.org/10.18240/ijo.2019.12.24DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6901897PMC
December 2019

Sebaceous carcinoma: evidence-based clinical practice guidelines.

Lancet Oncol 2019 12;20(12):e699-e714

Department of Dermatology, University of Minnesota, Minneapolis, MN, USA.

Sebaceous carcinoma usually occurs in adults older than 60 years, on the eyelid, head and neck, and trunk. In this Review, we present clinical care recommendations for sebaceous carcinoma, which were developed as a result of an expert panel evaluation of the findings of a systematic review. Key conclusions were drawn and recommendations made for diagnosis, first-line treatment, radiotherapy, and post-treatment care. For diagnosis, we concluded that deep biopsy is often required; furthermore, differential diagnoses that mimic the condition can be excluded with special histological stains. For treatment, the recommended first-line therapy is surgical removal, followed by margin assessment of the peripheral and deep tissue edges; conjunctival mapping biopsies can facilitate surgical planning. Radiotherapy can be considered for cases with nerve or lymph node involvement, and as the primary treatment in patients who are ineligible for surgery. Post-treatment clinical examination should occur every 6 months for at least 3 years. No specific systemic therapies for advanced disease can be recommended, but targeted therapies and immunotherapies are being developed.
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http://dx.doi.org/10.1016/S1470-2045(19)30673-4DOI Listing
December 2019

Melanocytoma of the optic disk: A review.

Indian J Ophthalmol 2019 12;67(12):1949-1958

Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.

Melanocytoma is a deeply pigmented variant of melanocytic nevus that classically occurs in the optic disk, sometimes with contiguous involvement of the adjacent retina or choroid. Historically, this tumor was often confused with malignant melanoma both clinically and histopathologically. Today, however, it is generally recognized by its typical clinical features that differ from most melanomas and erroneous enucleation is rarely done. Histopathologically, melanocytoma is composed of intensely pigmented round to oval nevus cells with benign features. Although traditionally believed to be a relatively stationary lesion, it is now known to exhibit minor enlargement in 10--15% of cases and can cause minor visual loss by a variety of mechanisms. In rare instance, it can induce severe visual loss due to spontaneous necrosis of the lesion or compressive optic neuropathy. More importantly, it can exhibit malignant transformation into melanoma in 1--2% of cases. Ophthalmologists should be familiar with melanocytoma of the optic disk and affected patients should be followed periodically.
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http://dx.doi.org/10.4103/ijo.IJO_2039_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6896535PMC
December 2019