Publications by authors named "Muhammet Ozer"

36 Publications

A Challenging Case of Carcinoid Crisis in a Patient With Neuroendocrine Tumor.

Cureus 2021 Jun 13;13(6):e15626. Epub 2021 Jun 13.

Critical Care Medicine, Capital Health System, Trenton, USA.

The critical state of circulatory collapse and hypoperfusion that results in end-organ damage has been called shock. Carcinoid crisis is a rare cause of shock, which is difficult to identify in the presence of infection. It occurs due to the release of vasoactive amines into the systemic circulation following an inciting event. In the presence of a neuroendocrine tumor, carcinoid crisis should be suspected in case of resistant shock. Herein, we report a rare case of carcinoid crisis, in which a quick response to the somatostatin analog therapy, octreotide, was helpful to confirm the diagnosis.
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http://dx.doi.org/10.7759/cureus.15626DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8275054PMC
June 2021

Acquired Gerbode Defect in a Patient With Infective Endocarditis of Bicuspid Aortic Valve.

Cureus 2021 May 31;13(5):e15352. Epub 2021 May 31.

Cardiovascular Disease, Mount Sinai Hospital, New York, USA.

Aortic valve abscess is a fatal complication of infective endocarditis. Transthoracic echocardiography is the initial imaging obtained in suspected infective endocarditis. However, its accuracy in detecting cardiac complications remains low, thus should be followed by transesophageal echocardiography if the clinical situation permits. Here, we present a case of a bicuspid aortic valve infective endocarditis caused by S and complicated with aortic valve abscess and acquired Gerbode defect, which appeared as a tricuspid valve vegetation on transthoracic echocardiography.
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http://dx.doi.org/10.7759/cureus.15352DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8244663PMC
May 2021

Assessment of abuse and related factors in older patients with cancer.

Support Care Cancer 2021 Jul 2. Epub 2021 Jul 2.

Department of Biostatistics, Erzincan Binali Yıldrıım University Medical School, 24000, Erzincan, Turkey.

Background: Older cancer patients are more likely to present with functional dependency, multiple comorbidities, polypharmacy, malnutrition, and cognitive dysfunction than their younger counterparts which increases the risk of elder abuse. Herein, in this single-institution observational study, we aimed to determine the frequency and risk factors of abuse in cancer patients aged 70 and above.

Methods: A total of 217 cancer patients aged ≥ 70 years who applied to the medical oncology outpatient clinic between June 2020 and January 2021 were included in this study. Informed consent was obtained before data collection. The Hwalek-Sengstock Elder Abuse Screening Test (H-S/EAST) was used to evaluate elder abuse. Sociodemographic characteristics and clinical measurements were collected.

Results: The mean age was 75.5, and 59.4% were male. The prevalence of abuse risk in older patients with cancer was 39.2%. In the multivariate logistic regression model, applying to the outpatient clinic for treatment (OR: 3.369, 95% CI: 1.455-7.802, p = 0.005), living in urban (OR: 5.787, 95% CI: 2.377-14.090, p < 0.001), history of falls (OR: 4.587, 95% CI: 1.789-11.762, p = 0.002), and being depressed according to the Geriatric Depression Scale-15 (GDS-15) score (OR: 10.788, 95% CI: 4.491-25.914, p < 0.001) were associated with an increased risk of elder abuse. Primary/junior education level and high school/university education level were protective against elder abuse risk compared to being illiterate (OR: 0.073, 95% CI: 0.025-0.210 and OR: 0.213, 95% CI: 0.056-0.806, respectively).

Conclusion: Cancer patients aged ≥ 70 years had a high risk of elder abuse. Elder abuse should be screened in patients with cancer, and the effects of this phenomenon on cancer care should be investigated in larger studies.
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http://dx.doi.org/10.1007/s00520-021-06391-7DOI Listing
July 2021

Characteristics and outcomes of cancer patients with covid-19 at a safety-net hospital.

Cancer Treat Res Commun 2021 Jun 10;28:100418. Epub 2021 Jun 10.

Department of Hematology and Oncology, Capital Health Regional Medical Center, Trenton, NJ, United States.

Patients with cancer are a vulnerable population during the COVID-19 pandemic due to underlying immunosuppression, pre-existing comorbidities, and poor nutrition. There is a lack of data describing the disease course of cancer patients with COVID-19 disease. Therefore, we analyzed data from cancer patients with COVID-19 who were admitted to our hospital. Cancer patients were categorized into two groups as survivors and non-survivors of COVID-19. Among 68 cancer patients with COVID-19, 27% of patients were admitted to ICU, and 37% of the patients died. The median age was 72, and non-survivors were older than survivors (p = 0.001). Non-survivors had higher comorbidity scores, late-stage cancer, and worse ECOG performance status than survivors (all p values<0.005). Non-survivors also had significantly lower lymphocyte count and albumin level but higher lactate dehydrogenase, C-reactive protein, fibrinogen, troponin, and ferritin levels than survivors. On multivariable analysis, increased age and mechanical ventilation were associated with increased odds of death. We report no association between anti-cancer treatments and mortality from COVID-19 disease. In summary, cancer patients have higher mortality of COVID-19 infection than the general population. In addition to generally known risk factors, the high mortality rate in cancer patients with COVID-19 is associated with several cancer-specific factors.
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http://dx.doi.org/10.1016/j.ctarc.2021.100418DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8189837PMC
June 2021

Evaluation of Successful and Failed Filtering Blebs after Trabeculectomy Using Anterior Segment Optical Coherence Tomography.

J Curr Ophthalmol 2021 Jan-Mar;33(1):1-5. Epub 2021 Mar 26.

Department of Ophthalmology, Beyoglu Eye Research and Training Hospital, Istanbul, Turkey.

Purpose: To evaluate filtering bleb characteristics using anterior segment optical coherence tomography (AS-OCT) and analyze correlations between these parameters and intraocular pressure (IOP).

Methods: The study included 54 eyes of 43 patients who underwent trabeculectomy with mitomycin-C. The patients were divided into two groups based on mean postoperative IOP. The criterion for surgical success was mean unmedicated postoperative IOP ≤18 mmHg. Patients with IOP values >18 mmHg were prescribed anti-glaucoma drops and classified as a surgical failure. All patients underwent AS-OCT, and maximum bleb height, maximum bleb wall thickness, and maximum fluid-filled cavity height were measured. AS-OCT bleb parameters were compared between the successful and failed groups.

Results: Of the 54 eyes, 37 (68.5%) were in the successful group, and 17 (31.5%) were in the failed group. Mean preoperative IOP values in the successful and failed groups were 26.9 ± 6.5 mmHg and 22.9 ± 4.9 mmHg, preoperatively, versus postoperative values of 13.3 ± 2.1 mmHg and 22.8 ± 2.8 mmHg, respectively. Mean postoperative follow-up time was 17.4 ± 9.5 months in the successful group and 19.1 ± 10.1 months in the failed group ( = 0.22). In the successful and failed groups, mean bleb height was 1473.7 ± 150.6 μm and 1165.4 ± 217 μm ( < 0.001), bleb wall thickness was 670.5 ± 119.9 μm and 538.8 ± 144.3 μm ( = 0.001), and fluid-filled cavity height was 736.5 ± 196.8 μm versus 532.5 ± 226.2 μm ( = 0.001), respectively.

Conclusions: The results of this study showed that higher AS-OCT values for bleb height, wall thickness, and fluid-filled cavity height were associated with greater functional success. These parameters may be helpful in determining bleb functionality.
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http://dx.doi.org/10.4103/JOCO.JOCO_112_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8102954PMC
March 2021

5-Fluorouracil associated neurovascular toxicities.

Curr Probl Cancer 2021 Apr 18:100746. Epub 2021 Apr 18.

Department of Hematology and Oncology, Boston University School of Medicine, Boston, Massachusetts.

Fluorouracil (5-FU) is a commonly used chemotherapeutic agent in many cancers. The widely reported adverse effects are infusion reactions, rash, fever, nausea, vomiting, peripheral neuropathy, and hepatic injury. However, there are limited data about its neurological side effects. Herein, we are reporting 3 cases of 5-FU induced neurovascular toxicities. Cerebral vasospasm with associated transient ischemia is a rare but significant adverse effect of the 5-FU. Stroke-like presentation makes timely recognition extraordinarily important. Differentiating stroke mimics is crucial as recombinant tissue plasminogen activator therapy should be given within a 4.5 hours window after an ischemic stroke. We suggest that 5-FU induced cerebral vasospasm can present with acute stroke-like symptoms. Physicians should be aware of stroke mimics as a differential diagnosis to spare their patients from unnecessary invasive and high-risk treatments.
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http://dx.doi.org/10.1016/j.currproblcancer.2021.100746DOI Listing
April 2021

Impact of coronaphobia on treatment and follow-up compliance of cancer patients.

Future Oncol 2021 Jul 21;17(20):2621-2629. Epub 2021 Apr 21.

Department of Pulmonology, Erzincan Binali Yıldrıım University Medical School, Erzincan, 24000, Turkey.

The aim of this study was to assess the impact of coronaphobia on treatment and follow-up compliance in cancer patients. The records of 230 cancer patients were reviewed. Coronaphobia was assessed via the validated COVID-19 Phobia Scale (C19P-S). A total of 64% of the patients had a high coronaphobia score. Among them, 59% were noncompliant. In multivariate logistic regression analysis, low educational status, treatment type, following COVID-19 news, having knowledge about COVID-19 transmission and higher C19P-S score were associated with noncompliance (p = 0.006, p < 0.001, p = 0.002, p = 0.002 and p = 0.001, respectively). Multivariate analysis revealed that having knowledge about COVID-19 transmission was related to a higher C19P-S score (p = 0.001). The cancer patients studied had significant coronaphobia. Moreover, greater coronaphobia was significantly associated with noncompliance with follow-up and treatment.
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http://dx.doi.org/10.2217/fon-2021-0020DOI Listing
July 2021

Unilateral Proptosis due to Orbital Metastasis of Paratesticular Leiomyosarcoma.

Eur J Case Rep Intern Med 2021 2;8(3):002315. Epub 2021 Mar 2.

Department of Hematology and Oncology, Capital Health Regional Medical Center, Trenton, NJ, USA.

Paratesticular leiomyosarcomas are uncommon malignant tumours that originate from smooth muscle and show aggressive tumour behaviour due to a high incidence of local recurrence and distant metastasis. Orbital metastasis is also rare and associated with a poor prognosis. Clinical suspicion plays an essential role in the diagnosis of orbital leiomyosarcoma because of its uncommon presentation. Comprehensive neuroimaging and histopathological work-up are warranted for definitive diagnosis and management. To date, surgical resection remains the best curative treatment. However, leiomyosarcomas are usually friable and unencapsulated, which makes surgery challenging. Also, whether adjunctive chemotherapy will alter the long-term prognosis remains to be determined. Herein, we report the case of a middle-aged man who presented with proptosis and decreased vision, who was subsequently diagnosed with metastatic orbital leiomyosarcoma from a primary paratesticular tumour. We performed orbital enucleation with negative margins. The patient is currently under systemic pazopanib chemotherapy.

Learning Points: Orbital metastasis from paratesticular leiomyosarcoma is rarely encountered and shows aggressive behaviour.Clinical suspicion plays an essential role in diagnosing orbital leiomyosarcoma as this is an uncommon and atypical cause of proptosis and can be easily misdiagnosed by physicians.Curative surgical treatment should be considered due to the high recurrence rate.
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http://dx.doi.org/10.12890/2021_002315DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046287PMC
March 2021

Intracranial Tuberculoma Mimicking Neurosarcoidosis: A Clinical Challenge.

Infect Dis Rep 2021 Mar 1;13(1):181-186. Epub 2021 Mar 1.

Division of Infectious Diseases, Capital Health Regional Medical Center, Trenton, NJ 08638, USA.

Central nervous system (CNS) tuberculosis is a rare manifestation of all tuberculosis presentations. The incidence of brain tuberculoma is increasing in developed countries due to HIV infection and immigration from tuberculosis-endemic countries. Symptoms and radiologic findings of CNS tuberculosis can be non-specific and lead to misdiagnosis or mistreatment. Intracranial tuberculoma can present with a seizure, intracranial hypertension, or focal neurologic symptoms. In our case, the diagnosis was challenging between neurosarcoidosis and intracranial tuberculoma due to inconclusive results of stereotactic brain biopsy and clinical presentation. The pathology result of the open brain biopsy revealed non-caseating granuloma. Finally, we were able to diagnose intracranial tuberculoma following acid-fast bacilli culture results of open brain biopsy. This report highlights the importance of including intracranial tuberculoma in the differential diagnosis of cerebral space-occupying lesions, even in patients with negative laboratory findings of tuberculosis.
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http://dx.doi.org/10.3390/idr13010020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7930965PMC
March 2021

Corneal and lens densitometry in patients with vernal keratoconjunctivitis.

Int Ophthalmol 2021 Aug 22;41(8):2667-2676. Epub 2021 Mar 22.

Ophthalmology Department, Faculty of Medicine, Van Yuzuncu Yil University, Tusba, Van, 65080, Turkey.

Aim: To evaluate corneal and crystalline lens densitometry in patients with vernal keratoconjunctivitis (VKC).

Methods: This is a case-control study. Patients with VKC and age-gender-matched healthy controls underwent a complete ophthalmologic examination with corneal and crystalline lens densitometry measurements. Additionally, the anterior chamber parameters comprise anterior and posterior K and astigmatism, anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (ACA), pachymeter, and corneal volume (CV). Patients who had clinically grade 0 or grade 1 VKC and with only tarsal conjunctiva involvement during the conductance of the study were included. The variables were compared statistically.

Results: One hundred and nine eyes were included in the study, in which fifty-one were in the VKC group. There were 25 males in the VKC group (26 female) and 22 males in the control group (36 female). A statistically significant difference was found between the groups in terms of posterior corneal astigmatism (p = 0.02). The mean corneal pachymeter, CV, ACD, ACA, and ACV were similar in both groups (p = 0.63, p = 0.26, p = 0.60, p = 0.41, and p = 0.32, respectively). The total mean corneal densitometry in the zones extending from 6 to 10 mm and 10 to 12 mm was increased in the VKC group compared to the control group (p = 0.04 and p = 0.012, respectively). The mean crystalline lens was found to be denser in the VKC group compared to the control group (8.96 ± 1.6 vs. 8.5 ± 0.57, respectively, p = 0.04).

Conclusion: Posterior corneal astigmatism is increased in VKC cases in comparison with age- and gender-matched controls. The peripheral anterior 6-12 mm annular corneal zone showed increased corneal densitometry in VKC cases compared to the healthy subjects. Additionally, the lens clarity is found to be decreased subclinically in VKC cases compared to control cases.
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http://dx.doi.org/10.1007/s10792-021-01822-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983973PMC
August 2021

Massive biventricular thrombi complicating new-onset heart failure in a patient with suspected COVID-19.

J Cardiol Cases 2021 Mar 14. Epub 2021 Mar 14.

Department of Cardiology, Capital Health Regional Medical Center, Trenton, NJ, United States.

The World Health Organization nominated SARS-CoV-2 as the cause of the Coronavirus Disease 2019 (COVID-19) and has been granted as a pandemic. COVID-19 is an emerging threat due to the risk of microvascular, venous, and arterial thrombosis, thereby exacerbating organ injury and mortality. Although the exact mechanism of extensive thromboembolism and myocardial injury caused by SARS-CoV-2 is not illuminated, it is clear that COVID-19 related hypercoagulation increasing the fatality of the disease. Herein, we reported a patient with extensive biventricular thrombi along with the new-onset severe systolic dysfunction as an unusual catastrophic presentation of COVID-19. In our patient, there was both a right atrial "clot in transit" from his DVT as well as extensive muralized biventricular thrombus from severe global hypokinesis. We believe that the hypercoagulable state of his COVID-19 infection, along with severe systolic dysfunction, caused this unusual presentation. Although the hypercoagulable state of COVID-19 is well recognized, there have not been any reported cases of extensive de-novo intracardiac thrombus as of yet. We urge awareness of severe and potentially fatal extensive thrombosis and cardiac failure as the initial clinical presentation of possible SARS-CoV-2.
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http://dx.doi.org/10.1016/j.jccase.2021.02.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7955911PMC
March 2021

Assessment of Prognostic Factors and Adjuvant Treatment Modalities in Adult Head and Neck Soft Tissue Sarcoma Patients Treated With Upfront Surgery.

Cureus 2021 Feb 13;13(2):e13324. Epub 2021 Feb 13.

Medical Oncology, Ankara Dr Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, TUR.

Objectives Head and neck soft tissue sarcomas (HNSTSs) are a heterogeneous group of rare tumors. Surgical resection with negative margins remains the standard primary treatment for patients with HNSTS. The role of chemotherapy (CT) and radiotherapy (RT) remains controversial. In this multicenter study, we aimed to demonstrate the real-world assessing prognostic factors and the effect of adjuvant treatment modalities in adult patients with HNSTS treated with upfront surgery. Methods We included a total of 47 patients who underwent curative-intent resection of a primary HNSTS between 2000 and 2019. Results The median follow-up was 29 months. The median age of patients was 51 years, and 66% of patients were male. The median relapse-free survival (RFS) of the study population was 31 months (range: 1.0-61.1 months), and the median overall survival (OS) was 115 months (range: 60.8-169.2 months). The univariable analysis revealed that treatment modalities showed a significant impact on RFS (p = 0.021); however, no difference was found in its impact on OS (p = 0.137). R0 resection did not showed impact on RFS (p = 0.130), but a significant association was found with OS (p = 0.004). In multivariable analysis, T stage of the tumor (hazard ratio [HR]: 3.834; 95% CI: 1.631-9.008; p = 0.002) and treatment with surgery and sequential RT and CT (HR: 0.115; 95% CI: 0.035-0.371; p < 0.001) were independent factors associated with RFS. R0 resection was independently associated with OS (HR: 4.902; 95% CI: 1.301-18.465; p = 0.019). Conclusion Our study revealed that R0 resection improved OS, and T3-4 stage of tumor was a negative independent factor for RFS in surgically resected HNSTS patients. The use of sequential CT and RT after resection was associated with a better RFS, which emphasizes the importance of multidisciplinary evaluation of the treatment of HNSTS. Randomized prospective studies are needed.
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http://dx.doi.org/10.7759/cureus.13324DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7958307PMC
February 2021

Effectiveness of Pulmonary Surfactant in the Treatment of Corneal Edema.

J Ocul Pharmacol Ther 2021 05 8;37(4):209-214. Epub 2021 Feb 8.

Department of Ophthalmology, Faculty of Medicine, Van Yüzüncü Yıl University, Van, Turkey.

To compare the effectiveness of topical surfactant and 3% sodium chloride (NaCl) in the treatment of corneal edema occurring after cataract surgery. Ninety eyes of 90 patients with no corneal disease who underwent cataract surgery were included in the study. Thirty eyes without corneal edema comprised group 1. Patients with corneal edema were divided into two groups: those treated with 3% NaCl (group 2, 30 eyes) and those treated with surfactant drop (group 3, 30 eyes). The mean age was 70.8 ± 6.6 years, with no significant age difference between the groups. Preoperatively, there was no significant difference in mean central corneal thickness (CCT) or mean endothelial cell count (ECC) among the groups ( = 0.999). On postoperative day 1, CCT was significantly lower in group 1 ( < 0.001) but did not differ between groups 2 and 3 ( = 0.999). There was no significant difference between groups in terms of ECC ( > 0.05). At postoperative day 7 and 14, CCT differed significantly between groups 1 and 2 ( < 0.001) and between groups 2 and 3 ( = 0.001), with no significant difference between groups 1 and 3 ( = 0.474). ECC was significantly higher in group 1 ( < 0.05), whereas there was no significant difference between groups 2 and 3 ( > 0.05). Topical pulmonary surfactant may be a more effective treatment option than 3% hypertonic NaCl for the treatment of corneal edema that develops after cataract surgery.
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http://dx.doi.org/10.1089/jop.2020.0121DOI Listing
May 2021

The Metabolic Equivalent BMI in Patients with Familial Partial Lipodystrophy (FPLD) Compared with Those with Severe Obesity.

Obesity (Silver Spring) 2021 02;29(2):274-278

Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, Michigan, USA.

Objective: This study aimed to investigate the shortcoming of BMI as a measurement of adiposity in patients with familial partial lipodystrophy (FPLD).

Methods: Two different matching procedures were used to compare 55 FPLD versus control patients with severe obesity (N = 548 patients) to study the relationship between body weight, fat distribution, and metabolic diseases, such as diabetes mellitus, hypertriglyceridemia, and nonalcoholic steatohepatitis. In MATCH1, the patients with FPLD were matched to controls with obesity (OCs) by truncal mass, and in MATCH2, the patients with FPLD were matched to OCs with respect to glucose control.

Results: With MATCH1, the FPLD group had worse glycemic control (hemoglobin A1c 8.2% ± 1.6% vs. 5.9% ± 0.9%), higher triglycerides (884 ± 1,190 mg/dL vs. 139 ± 79 mg/dL), and lower leptin (20.5 ± 15.8 ng/mL vs. 41.9 ± 29.4 ng/mL, P < 0.001 for all comparisons). In MATCH2, metabolic comorbidity-matched FPLD patients had significantly lower BMI compared with OCs (29.5 ± 5.7 kg/m vs. 38.6 ± 5.2 kg/m , P < 0.001).

Conclusions: Patients with FPLD with similar truncal mass have worse metabolic profiles than non-FPLD OCs. The differential BMI between the FPLD and OCs, when matched for their metabolic comorbidities, approximates 8.6 BMI units.
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http://dx.doi.org/10.1002/oby.23049DOI Listing
February 2021

Protective effects of taxifolin on pazopanib-induced liver toxicity: an experimental rat model.

Exp Anim 2021 May 26;70(2):169-176. Epub 2020 Nov 26.

Department of Pharmacology, Faculty of Medicine, Erzincan Binali Yildirim University, Fatih Street #124, 24030, Erzincan, Turkey.

Pazopanib is a tyrosine kinase inhibitor that is generally used for the treatment of metastatic renal cell cancer and advanced soft tissue sarcoma. It can cause various degrees of hepatotoxicity. Our study aimed to investigate the effect of taxifolin on pazopanib-induced liver toxicity. A total of 18 rats were divided into three groups: the pazopanib (PP), pazopanib plus taxifolin (TPP), and control (C) group. Taxifolin was administered to the TPP (n=6) group with a dose of 50 mg/kg. Distilled water was orally admnistered to the C (n=6) and PP (n=6) groups as a solvent. Subsequently, pazopanib 200 mg/kg was administered to the TPP and PP groups via the stomach. This procedure was repeated once a day for four weeks. Then, all rats were sacrificed, and their livers were removed. Malondialdehyde (MDA), total glutathione (tGSH), total oxidant status (TOS), and total antioxidant status (TAS) levels were evaluated. MDA and TOS levels were higher in the PP group compared with the levels of the other parameters (P<0.001). tGSH and TAS levels were lower in the PP group than in the TPP and C groups (P<0.001), and the aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) levels were higher. Furthermore, liver tissue damage, including hemorrhage, hydropic degeneration, and necrosis was observed in the PP group. Administration of taxifolin before pazopanib significantly improved degenerative changes. Our study demonstrated that the administration of taxifolin is significantly effective in preventing pazopanib-induced hepatotoxicity in rats.
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http://dx.doi.org/10.1538/expanim.20-0103DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8150244PMC
May 2021

Racial/Ethnic Disparities and Survival Characteristics in Non-Pancreatic Gastrointestinal Tract Neuroendocrine Tumors.

Cancers (Basel) 2020 Oct 15;12(10). Epub 2020 Oct 15.

Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX 75390, USA.

: We studied the effect of race and ethnicity on disease characteristics and survival in gastrointestinal neuroendocrine tumors. : The Surveillance, Epidemiology, and End Results database was used to select patients with non-pancreatic gastrointestinal neuroendocrine tumors diagnosed between 2004 and 2015. Trends in survival were evaluated among three groups: Hispanic, non-Hispanic White, and non-Hispanic Black. Kaplan-Meier and Cox regression methods were performed to calculate overall survival and cause-specific survival after adjusting for patient and tumor characteristics. A total of 26,399 patients were included in the study: 65.1% were non-Hispanic White, 19.9% were non-Hispanic Black, and 15% were Hispanic. Non-Hispanic White patients were more likely to be male (50.0%, < 0.001), older than 60 years (48.0%, < 0.001), and present with metastatic disease (17.7%, < 0.001). Non-Hispanic White patients had small intestine neuroendocrine tumors, while Hispanic and non-Hispanic Black patients had rectum neuroendocrine tumors as the most common primary site. Hispanic patients had better overall survival, while non-Hispanic Black patients had better cause-specific survival versus non-Hispanic White patients. This finding was confirmed on multivariable analysis where Hispanic patients had improved overall survival compared to non-Hispanic White patients (Hazard ratio (HR): 0.89 (0.81-0.97)), whereas non-Hispanic Black patients had better cause-specific survival compared to non-Hispanic White patients (HR: 0.89 (0.80-0.98)). : Race/ethnicity is an independent prognostic factor in patients with gastrointestinal neuroendocrine tumors.
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http://dx.doi.org/10.3390/cancers12102990DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7602558PMC
October 2020

Distinct Clinical Characteristics in Young-Onset Pancreatic Neuroendocrine Tumor.

Cancers (Basel) 2020 Sep 3;12(9). Epub 2020 Sep 3.

Division of Hematology and Oncology, UT Southwestern Medical Center, Dallas, TX 75390, USA.

Background: We aimed to study the effect of socioeconomic differences and molecular characteristics on survival in patients with young-onset pancreatic neuroendocrine tumors (YOPNET) and typical-onset PNET (TOPNET).

Methods: We identified the patients with YOPNET (<50 years) and TOPNET (≥50 years) who underwent definitive surgery diagnosed between 2004 and 2016 using the National Cancer Database. We evaluated overall survival (OS) using the Kaplan-Meier and Cox regression methods before and after propensity score matching. A publicly available genomic dataset was used to compare mutation frequencies among the two groups.

Results: A total of 6259 patients with PNET were included, of which 27% were YOPNET. Patients with YOPNET were more likely to be Black, Hispanic, female, and have private insurance versus patients with TOPNET (all < 0.001). Patients with YOPNET had a lower comorbidity score, but higher stage and tumor size (all < 0.001). YOPNET was associated with a greater improved OS than TOPNET before and after propensity score matching ( < 0.001). On multivariable analysis, this survival difference persisted for YOPNET as an independent prognostic factor (unmatched = 0.008; matched = 0.01). For genomic analysis, patients with YOPNET had a lower rate of multiple endocrine neoplasia type-1 (MEN-1) mutation than patients with TOPNET (26% vs. 56%, < 0.001).

Conclusions: YOPNET represents a disease with distinct clinical features. Patients with YOPNET who underwent definitive surgery had better OS than patients with TOPNET despite having higher stage and tumor size. YOPNET also had lower rate of MEN-1 mutation.
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http://dx.doi.org/10.3390/cancers12092501DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7563582PMC
September 2020

Hemicentral Retinal Artery Occlusion: A Rare Complication of Orbital Cellulitis.

J Pediatr Ophthalmol Strabismus 2020 Aug 19;57:e51-e55. Epub 2020 Aug 19.

A 14-year-old boy presented with acute vision loss and swelling of the right eye. An anterior segment examination revealed a relative afferent pupillary defect, severe proptosis, and ophthalmoplegia in his right eye. The fundus examination revealed inferior hemicentral retinal artery occlusion. Although the authors proceeded with systemic medical treatment, the findings did not improve. An endoscopic orbital decompression was performed. With both medical and surgical treatment, the orbital cellulitis resolved and the patient's visual acuity improved. [J Pediatr Ophthalmol Strabismus. 2020;57:e51-e55.].
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http://dx.doi.org/10.3928/01913913-20200602-01DOI Listing
August 2020

Racial Disparities in Time to Treatment Initiation and Outcomes for Early Stage Anal Squamous Cell Carcinoma.

Am J Clin Oncol 2020 11;43(11):762-769

Department of Radiation Oncology.

Objectives: Although cure rates for early stage anal squamous cell cancer (ASCC) are overall high, there may be racial disparities in receipt of treatment and outcome precluding favorable outcomes across all patient demographics. Therefore, the authors aimed to assess the time to treatment initiation and overall survival (OS) in Black and White patients receiving definitive chemoradiation for early stage ASCC.

Materials And Methods: The authors identified patients diagnosed with early stage (stage I-II) ASCC and treated with chemoradiation diagnosed between 2004 and 2016 in the National Cancer Database. Clinical and treatment variables were compared by race using the χ test, and OS assessed through Cox regression with 1:1 nearest neighbor propensity score matching.

Results: Among 9331 patients, 90.6% were White. Black patients had longer median time to treatment initiation as compared with White patients (47 vs. 36 d, P<0.001), and on multivariable analysis, the Black race was associated with higher odds of >6 weeks of time to treatment initiation (hazard ratio, 1.78; 95% confidence interval, 1.53-2.08; P<0.001). Furthermore, Black patients had worse OS (5-year survival 71% vs. 77%; P<0.001), which persisted after propensity score matching (P=0.007).

Conclusions: Black patients had a longer time to treatment initiation and worse OS as compared with White patients with early stage ASCC treated with chemoradiation. Further research is needed to better elucidate the etiologies of these disparities.
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http://dx.doi.org/10.1097/COC.0000000000000744DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7584763PMC
November 2020

The Surgical Outcomes of Limbal Allograft Transplantation in Eyes Having Limbal Stem Cell Deficiency.

J Curr Ophthalmol 2020 Apr-Jun;32(2):132-141. Epub 2020 Apr 30.

Private Practice, Istanbul, Turkey.

Purpose: To report the limbal allograft transplantation and penetrating keratoplasty (PK) results in limbal stem cell deficiency (LSCD)-developed eyes because of chemical or thermal injury.

Methods: Medical records of 18 eyes of 14 patients who had undergone keratolimbal allograft (KLAL) or living-related conjunctival limbal allograft (lr-CLAL) with or without PK and followed up at least 1 year postoperatively were evaluated retrospectively. The preoperative LSCD grade was noted in all patients. Rejection incidents, recurrence of LSCD, and corneal graft clarity along with a visual improvement during the follow-up were noted. The complications rate due to surgery or injury itself, for instance, glaucoma and cataract, were evaluated. The limbal allograft tissue survival analysis and corneal allograft survival analysis were done to reveal the differences in both the procedures. The existence of normal corneal epithelium and improvement in visual acuity were accepted as the surgical success criteria.

Results: In the limbal allograft transplantation group, the survival rates of the allograft tissue were 65 ± 10.7% at 1 year and 36.6 ± 11.4% at 3 years in lr-CLAL and 66.7 ± 15.7% at 12 months and 53.3 ± 17.3% at 18 months in KLAL-transplanted eyes. The survival rate of corneal allograft at the 5 postoperative year was lower in the simultaneous procedure compared to the staged procedure, but it was not statistically significant (25.7 ± 25.8% vs. 62.5 ± 17.1%, = 0.75). The ambulatory vision was achieved in 10 eyes (56%) after a mean follow-up time of 93.8 ± 37.8 months. The visual acuity level has increased in 12 eyes (67%) in which the limbal allograft transplantation was applied. The ambulatory visual acuity level was achieved (≤1.0 logMar [20/200]) in 10 eyes (56%). In addition, two or more Snellen lines' gain in the best corrected visual acuity was observed in 12 eyes of 18 (67%) at the last follow-up, and there was not any significant difference between the KLAL and lr-CLAL.

Conclusions: Ocular surface integrity was longer in KLAL than in lr-CLAL transplantation, but it was not statistically significant. The staged procedure was more convenient than the simultaneous procedure in terms of corneal allograft clarity maintenance in limbal allograft-employed eyes.
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http://dx.doi.org/10.4103/JOCO.JOCO_91_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7337021PMC
April 2020

Postpartum-Onset Moyamoya Disease: A Rare Cause of Stroke in Unexpected.

Case Rep Neurol Med 2020 15;2020:7689450. Epub 2020 Jul 15.

Division of Endovascular Neurosurgery, Capital Health Regional Medical Center, Trenton, NJ, USA.

Moyamoya disease (MMD) is a chronic cerebrovascular occlusive disease that is characterized by progressive bilateral stenosis of the terminal portion of the internal carotid artery and its main branches. Cerebrovascular events are the primary presenting symptoms and are related both to stenosis and occlusion of the ICAs and their main branches. Detection of bilateral stenosis by cerebral angiography is considered the gold standard, but computed tomography angiography (CTA) is also an acceptable method of diagnosis. In the current literature, there are no precise data on the incidence of moyamoya disease in Europe and the United States. Also, the pathogenesis of MMD remains obscure, and genetic factors and inflammation are the two most representative mechanisms. Here, we report the case of MMD in a 29-year-old African American female who presented with an ischemic stroke for the second time that manifested after pregnancy. This case is important to increase awareness of the probability of this rare disease in Western countries as well as to call attention to pregnancy's accelerating effects of MMD. Careful, long-term neurologic and radiologic follow-up is essential in adult patients with MMD to prevent additional stroke events and improve outcomes.
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http://dx.doi.org/10.1155/2020/7689450DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7378609PMC
July 2020

Evaluation of the Initial Optical Coherence Tomography Parameters in Anticipating the Final Visual Outcome of Central Retinal Vein Occlusion.

J Curr Ophthalmol 2020 Jan-Mar;32(1):46-52. Epub 2020 Mar 23.

Department of Ophthalmology, Faculty of Medicine, Van Yuzuncu Yil University, Tusba, Van, Turkey.

Purpose: To evaluate the predictive and associated factors in determining the visual outcome in patients having central retinal vein occlusion (CRVO)-related macular edema (ME).

Methods: The charts of the patients who were treated due to CRVO-related visual disturbance were reviewed. The optical coherence tomography (OCT) images of eyes were analyzed, and disorganization of retinal inner layers (DRILs), ellipsoid zone (EZ) and external limiting membrane (ELM) disruption length, hyper-reflectivity of retinal inner layer (HRIL) existence, baseline and final visual acuity (VA), subfoveal thickness (SFT), subretinal fluid (SRF), and injection numbers were noted. The regression and correlation analyses were applied.

Results: Thirty eyes of thirty patients were included in the study. The mean follow-up time was 17.5 ± 11 (8-47) months. The mean baseline VA was 1.4 ± 0.7 (0.2-3.1) logMAR. A total of 87 intravitreal injections were applied for the treatment of ME during the follow-up. The initial mean central subfield thickness was 795 ± 264 (1470-398) μm. HRIL and SRF were observed in 16 and 23 eyes at the initial visit, respectively. The final mean VA was 1.2 ± 0.9 (0.1-3.1) logMAR. At the final visit, additional OCT parameters were evaluated. The mean DRIL length was 463 ± 324 μm. The mean disruption length of EZ and ELM was 367 ± 247 μm and 414 ± 327 μm, respectively. The final mean SFT was 290 ± 91 μm. SRF presence at the initial visit was found to be associated with elongated EZ and ELM disruption length at the final visit ( = 0.03 and = 0.04, respectively). On linear regression analyses, none of the baseline features (SRF, SFT, and HRIL) except baseline poor best corrected visual acuity were found to be predictive in anticipating the final visual outcome ( = 0.04). On linear bivariate analysis, the final poor visual outcome was found to be affected by EZ disruption length of ≥500 μm at the last visit ( = 0.02).

Conclusion: Baseline VA was the only predictive factor in anticipating the final visual outcome. At the final visit, extensive disruption length of EZ in the subfoveal area was associated with a poor visual outcome.
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http://dx.doi.org/10.4103/JOCO.JOCO_47_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265274PMC
March 2020

Comparison of the efficacy of accelerated corneal cross-linking therapy in different pediatric age groups having progressive keratoconus.

Int Ophthalmol 2020 Oct 1;40(10):2651-2658. Epub 2020 Jun 1.

S.B.U, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.

Purpose: To report a comparison analysis of accelerated corneal cross-linking (A-CXL) treatment for progressive keratoconus patients in different pediatric age groups.

Study Design: Retrospective, cross-sectional.

Methods: Patients with progressive keratoconus aged ≤ 18 were retrospectively reviewed. Forty-one eyes of 41 patients were included in the study. Patients were divided into two groups according to their age (≤ 14 years and 15-18 years). All patients underwent epithelium-off A-CXL protocol. Acquired data were compared between the two groups.

Results: The mean age was 14.3 ± 1.8 (10-18) years. Twenty-five (61%) of the participants were male, and 16 (39%) were female. Twenty (49%) patients were separated into group 1 (≤ 14 years of age), and 21 (51%) were in group 2 (15-18 years). Age at presentation was found to be the only factor in anticipating the progression of keratoconus at the second postoperative year visit (p < 0.001). Progression in keratometric values was detected in seven (35%) of the 20 eyes in group 1, and one (4%) of the 21 patients in group 2 (Z = - 2.44, p = 0.014).

Conclusion: Even if proper treatment is applied, the progression of keratoconus is likely in patients younger than 14 years of age. Instead of evaluating pediatric patients as a whole, closer follow-up and early treatment may be useful in younger age groups (≤ 14 years).
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http://dx.doi.org/10.1007/s10792-020-01446-wDOI Listing
October 2020

In Vivo Analysis and Comparison of Anterior Segment Structures of Both Eyes in Unilateral Herpetic Anterior Uveitis.

Ocul Immunol Inflamm 2020 May 29:1-7. Epub 2020 May 29.

Faculty of Medicine, Ophthalmology Department, Van Yuzuncu Yil University, Van, Turkey.

: To compare the Schlemm's canal area (SCA) and to define iris features in patients with unilateral herpetic anterior uveitis (HAU) by using anterior segment spectral-domain optical coherence tomography (AS SD-OCT).: Unilateral HAU cases that had been in complete remission for ≥ 3 months were included. Two investigators analyzed the iris features of HAU. SCA in both healthy (N), and affected eyes (HAU) were compared.: The mean age of the participants (n = 22) was 36.3 ± 15 (17-70) years. The mean nasal and temporal (n-t) SCA was measured as 10,844 ± 4806 µm and 8,772 ± 3138 µm in HAU in comparison with 10,200 ± 4,824 µm and 10,045 ± 3,889 µm in N, respectively ( = .47 and = .12, respectively). The most common iris features were the sectoral iridoplegia (100%) on biomicroscopy and the disorganization of the iris layers (DIL) (77%) on AS SD-OCT images.: SCA found similar on both sides. DIL is the most common iris feature of affected eyes.
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http://dx.doi.org/10.1080/09273948.2020.1760311DOI Listing
May 2020

Prevalence of irritable bowel syndrome-like symptoms using Rome IV criteria in patients with inactive inflammatory bowel disease and relation with quality of life.

Medicine (Baltimore) 2020 May;99(19):e20067

Dokuz Eylul University, Division of Gastroenterology, Izmir, Turkey.

Irritable bowel syndrome (IBS)-like symptoms tend to be common in inflammatory bowel disease (IBD) patients even during the long-standing remission phase, and quality of life (QOL) seem to reduce in IBD patients with such symptoms. Thus, the aim of this study was to define the prevalence of IBS-like symptoms in inactive IBD patients using Rome IV criteria and evaluate the effect of IBS-like symptoms on QOL.Total 137 patients with IBD (56 with ulcerative colitis (UC) and 81 with Crohn disease (CD), who had been in long-standing remission according to the clinical scoring system and 123 control participants were included. These patients completed questionnaires to evaluate IBS-like symptoms according to Rome IV criteria, and the impact of these symptoms on the QOL of inactive IBD patients was compared with and without IBS-like symptoms according to disease-specific inflammatory bowel disease questionnaire (IBDQ).Depending on our research, IBS-like symptoms were found in 32% (18/56) of patients with inactive UC, 35% (29/81) of patients with inactive CD, and 13.8% (17/123) of control participants (P < .001). The QOL seemed to be significantly lower in both inactive UC and CD patients with IBS-like symptoms than in those without such symptoms (P < .001).In conclusion, we defined that the prevalence of IBS-like symptoms in IBD patients in remission is 2 to 3 times higher than that in healthy control participants, and significantly lower IBDQ scores showed QOL was reduced in inactive IBD patients with IBS-like symptoms as compared with patients without IBS-like symptoms.
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http://dx.doi.org/10.1097/MD.0000000000020067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7220554PMC
May 2020

-Induced Endocarditis and Associated Splenic Abscess.

Case Rep Infect Dis 2020 4;2020:1382709. Epub 2020 Apr 4.

Division of Interventional Cardiology, Capital Health Regional Medical Center, Trenton, NJ, USA.

is a rod-shaped, Gram-positive bacterium generally found in the normal flora of the oropharynx, gastrointestinal, and genitourinary tracts. It is commonly known as nonpathogen in the human body. Endocarditis due to is rarely encountered and associated with impaired immunity. Splenic abscess is also an uncommon infection that classically results from endocarditis or another source of hematogenous seeding. Here, we present the case of bioprosthetic aortic valve endocarditis and associated splenic abscess caused by . The source of the should be investigated because of the risk of life-threatening conditions. Most of the time, identifying species is challenging and can cause a delay in diagnosis and timely treatment. Especially in patients who have significant underlying clinical conditions, physicians should consider species as a causative microorganism.
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http://dx.doi.org/10.1155/2020/1382709DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7160721PMC
April 2020

The long-term surgical outcomes of conjunctival-limbal autograft procedure with or without penetrating keratoplasty in eyes with unilateral limbal stem cell deficiency.

Taiwan J Ophthalmol 2020 Jan-Mar;10(1):22-28. Epub 2020 Mar 4.

Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul 34000, Turkey.

Aim: The aim of the study is to report the results of conjunctival-limbal autograft (CLAU) transplantation and penetrating keratoplasty (PK) in eyes with limbal stem cell deficiency (LSCD) due to chemical or thermal injury.

Methods: Thirty-one eyes of the 31 patients, who had unilateral LSCD due to chemical or thermal injury, were included in the study. Bilaterally affected cases and LSCD due to Steven-Johnson syndrome and mucous membrane pemphigoid were excluded from the study. All patients underwent a complete ophthalmologic examination. The surgical procedures, postoperative complications, ocular surface status, and visual outcomes were noted.

Results: In the CLAU group, regular corneal epithelium and ambulatory vision (≤1.0 logarithm of the minimum angle of resolution [20/200]) were achieved in 81% of eyes, including 22 eyes (71%) that were assessed after a mean follow-up period of 58 months, respectively. The 5-year survival rate of corneal allograft was 33%, 4 ± 13.9 in the CLAU applied eyes. In addition, the corneal graft clarity maintenance rate was found to be higher in patients having ≥12 months duration between CLAU and PK, which is statistically significant (62% vs. 23%, = 0.046).

Conclusion: Waiting at least 1 year after CLAU transplantation to perform PK increases corneal clarity. Eyelid problems, even if the eyelids were reconstructed properly, remain a major risk factor for the development of the epithelial disorder in the early and late postoperative period in CLAU applied eyes.
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http://dx.doi.org/10.4103/tjo.tjo_55_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7158933PMC
March 2020

Choroid vascularity index as a parameter for chronicity of Fuchs' uveitis syndrome.

Int Ophthalmol 2020 Jun 15;40(6):1429-1437. Epub 2020 Feb 15.

Ophthalmology Department, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey.

Purpose: This study aimed to compare the choroidal vascularity index (CVI) of eyes having Fuchs' uveitis syndrome (FUS) with healthy fellow eyes (N).

Methods: This prospective, cross-sectional study included unilateral FUS cases and an age- and gender-matched healthy control group. Thirty-nine participants were included in the FUS group, and 24 age- and gender-matched individuals were randomly selected for the control group. Endothelial cell density (ECD) was measured using Tomey specular microscopy. Spectral-domain optical coherence tomography was used to acquire the choroidal images, and binarization was applied to the images. Two blinded investigators analyzed the CVI in both eyes of the FUS cases and the right eyes of the healthy control group.

Results: CVI was found to be significantly decreased in FUS (p < 0.001). Additionally, ECD had a strong positive correlation with CVI (r = 0.383, p = 0.008).

Conclusion: CVI may provide information about the chronicity of the disease.
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http://dx.doi.org/10.1007/s10792-020-01309-4DOI Listing
June 2020

Authors' reply to: Using anterior segment optical coherence tomography to compare the smoothness of anterior iris surface between two eyes in unilateral Fuchs' uveitis syndrome.

Graefes Arch Clin Exp Ophthalmol 2019 12 24;257(12):2801. Epub 2019 Oct 24.

Faculty of Medicine, Ophthalmology Department, Van Yuzuncu Yil University, Tusba, TR 65080, Van, Turkey.

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http://dx.doi.org/10.1007/s00417-019-04478-wDOI Listing
December 2019

Effect of Insulin Therapy on Ocular Biometric Parameters in Diabetic Patients.

J Ocul Pharmacol Ther 2020 03 23;36(2):102-108. Epub 2019 Oct 23.

Department of Ophthalmology, Beyoglu Eye and Research Hospital, Istanbul, Turkey.

To evaluate effects of insulin on ocular parameters in patients with type 2 diabetes mellitus who start insulin therapy. In this prospective study, ocular biometric parameters were obtained using optical biometer (Lenstar LS900; Haag-Streit AG) and refraction test (ARK-510A Auto refracto-keratometer; Nidek Co. Ltd, Aichi, Japan) before and at 3 months after initiating insulin therapy. In addition, patients' fasting blood glucose (FBG), glycosylated hemoglobin (HbA1C), and blood lipid levels were measured at the same time points. Pretreatment and post-treatment results were compared. In addition, associations between ocular parameters with initial dose and type of insulin treatment regimen, HbA1C, and FBG levels were evaluated. The patients' mean age was 51.2 ± 12.9 (18-73) years. Post-treatment HbA1C and FBG levels (8.5% ± 2.5% and 188.1 ± 111.2 mg/dL, respectively) were significantly lower than pretreatment values (12% ± 1.4% and 325.3 ± 95.7 mg/dL, respectively;  < 0.001 for both). There was a significant positive correlation between the change in HbA1C and the change in lens thickness ( = 0.03), and a significant negative correlation between the change in FBG and the change in the spherical equivalent refraction ( = 0.045). Insulin dose and treatment regimen type were not significantly correlated with ocular parameters ( > 0.05). HbA1C-lowering glycemic effect of insulin was correlated with a small decrease in lens thickness. Long-term, randomized controlled trials including larger patient numbers are needed to shed light on the long-term effects of insulin use and glycemic control on ocular parameters.
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http://dx.doi.org/10.1089/jop.2019.0070DOI Listing
March 2020