Ankyloblepharon flliforme adnatum (AFA) is a rare congenital abnormality of the eyelids. Upper and lower eyelids are joined by single or multiple bands. It is usually isolated but can be associated with ophtalmic and systemic diseases. AFA is potentially amblyopic condition. Treatment is quick, safe, and minimizes the risk of amblyopia. We report a case of newborn with isolated AFA at birth, treated by surgical excision of the band tissue.

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Background: The widespread use of digital devices causes adolescents to spend long periods of time in front of the screen. Aims: This study aimed to analyze the impacts of digital game addiction on the musculoskeletal system of secondary school children in Kayseri. Patients and Methods: A total of 1000 healthy children have been included. A questionnaire, which has been prepared by the researchers and questions children's socio-demographic knowledge, sport habits, durations of study, types of digital tools they use to play games, using positions and durations of use, has been applied to the children. A visual analog scale was used to assess pain intensity. Game addiction has been evaluated through Computer Game Addiction Scale for Children. Results: Between computer and phone use and neck pain, a significant correlation has been found (P < 0.05). Between game addiction and wrist, back and low back pain, a significant correlation has been detected. While males use more computer, tablet and are more addicted to games, the scores of head, wrist and back pain in females have been found out to be significantly high. Conclusions: As they cause musculoskeletal problems, the higher the time children consume in front of digital devices and the more they use it in wrong posture; the more the complaints about pain are.

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Background: Infective endocarditis (IE) is a disease endangering human lives. Therefore, several prophylactic measures are required to improve the protection of endocarditis-prone patients from bacteremia resulting from various dental actions. These measures range from developing the dental hygiene to trials of different antimicrobial agents. Objectives: To examine the knowledge and practices of dentists in Aseer Region, Saudi Arabia, regarding antibiotic prophylaxis against IE. Design: Cross-sectional study. Setting: Aseer Region, Saudi Arabia. Patients and Methods: The participants were interviewed at their workplaces and the data collection sheet was constructed based on the guidelines of the American Heart Association/American College of Cardiology (AHA/ACC, 2017). Main Outcome Measures: The examination of the data gathered was calculated using Statistical Package for Social Sciences (SPSS, version 25) such as to test the significance of variation in dentists' mean knowledge scores as per their personal characteristics. An output with P values <0.05 was statistically significant. Sample Size: 182 Dentists. Results: Dentists' mean knowledge score was 17.5 ± 3.7 (out of 24). The least correct responses regarding dental procedures that require prophylactic antibiotics were “root canal treatment” (30.8%). Regarding cardiac conditions that require prophylactic antibiotics, dentists' least correct responses were “heart failure” (50%). Dentists' mean knowledge scores differed significantly according to their age groups (P = 0.032), nationality (P = 0.002), education/qualification (P = 0.002). Mean knowledge scores differed significantly according to dentists' years of experience (P = 0.018) and sources of information (P < 0.001). Amoxicillin was the most regularly recommended antibiotic (90.7%), while 86.8% correctly stated 30--60 min. before the procedure as the time for prophylactic antibiotic administration. Conclusions: The knowledge of dentists in Aseer Region regarding the use of preventive drugs for the control and prevention of IE is suboptimal. The inclusion of the latest AHA guidelines into the dentistry curricula is highly recommended. Limitations: Outcome are simultaneously assessed.

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Background: Osteoporosis is a common public health problem in chronic kidney patients. The risk factors for osteoporosis in patients with nondialysis CKD have not been fully investigated. It is not known exactly whether the risk factors of osteoporosis in the general population are also valid for the nondialysis CKD patients. Aims: This study aims to determine the frequency of osteoporosis and the risk factors for osteoporosis in nondialysis CKD patients. Patients and Methods: Our study was performed with 283 nondialysis stage 3-5 CKD patients. According to the BMD results, the patients were classified into groups as normal, osteopenia and osteoporosis according to World Health Organization criteria. Monocyte/high-density lipoprotein-cholesterol ratio (MHR), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) were calculated individually for all cases. Results: According to our BMD results, 67 (24%) patients were found to have osteoporosis. In the osteoporosis patient group, compared to the normal BMD group, females were higher and the mean age was higher (P = 0.025, P = 0.028). Body mass index (BMI) and eGFR were lower in the osteoporosis group (P = 0.013). Parathyroid Hormone and Platelet-to-lymphocyte ratio in the patients in the osteoporosis group was higher than of those in the normal group (P = 0.026, P = 0.035). In the multivariate logistic regression analysis, advanced age, female gender, and low BMI were determined as independent risk factors for the development of osteoporosis in nondialysis CKD patients. Conclusion: Advanced age, female gender and low BMI are the risk factors for osteoporosis in nondialysis CKD patients. It may be a rational approach to measure BMD for the diagnosis of osteoporosis in nondialysis CKD patients who are elderly, female and have low BMI.

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Background: Oxidative stress triggered by hyperglycemia in diabetic patients leads to macrovascular and microvascular complications, resulting in deterioration in the quality of life. Aims: This study aimed to compare the oxidative stress status and quality of life in participants with type 2 diabetes mellitus according to treatment modality. Patients and Methods: Ninety type 2 diabetes mellitus participants aged between 40 and 60 years were included in the study. Forty-five participants were receiving oral antidiabetic drugs and 45 participants were receiving insulin therapy. Total antioxidant status, total oxidant status, and paraoxonase-1 were measured and oxidative stress indices were calculated. The SF-36 quality of life questionnaire was applied to the participants. Results: The total oxidant status and oxidative stress indices values were higher in the insulin-treated group than in the group treated with oral antidiabetic drugs. Paraoxonase-1 activities of the oral antidiabetic drugs-treated group were statistically significantly higher than the insulin-treated group. In the oral antidiabetic drugs-treated group, the physical function, social function, and pain subscale scores were higher than that of the insulin-treated group. In all participants, a negative correlation between total antioxidant status and fasting blood glucose and hemoglobin A1c, a positive correlation between total oxidant status and hemoglobin A1c and triglyceride, and a positive correlation was found between oxidative stress indices and fasting blood glucose and hemoglobin A1c. Conclusions: It was found that oxidative stress parameters were higher and quality of life was worse in the insulin-treated participants than participants treated with oral antidiabetic drugs. These results may be closely related to more severe chronic complications in insulin-dependent diabetes.

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Background: Percutaneous nephrolithotomy operation is a minimally invasive surgical procedure for the treatment of kidney stones. Aim: This study aimed to evaluate the effectiveness of ultrasound-guided erector spinae plane block (ESPB) on analgesic consumption in patients who underwent percutaneous nephrolithotomy. Subjects and Methods: The data of 60 cases who underwent percutaneous nephrolithotomy operation between 01.01.2020 January and 12.01.2020 were retrospectively analyzed. Hemodynamic parameters, verbal analogue scale adjectives, total morphine consumption, additional analgesic and antiemetic need, duration of hospitalization, and patient satisfaction score were compared in patients who had ESPB and did not have block. Results: Demographic data and hemodynamic parameters were similar between the two groups. Verbal rating scale values were lower for Group I at 2, 6, 12, and 24 h (P < 0.05). Patient satisfaction score was significantly higher in Group I over 24 h (P = 0.039). Total morphine consumption at postoperative 2^nd, 6^th, and 24^th h was less than that of Group II (P < 0.05). Analgesia consumption in postoperative 24 h of group I was less than that of Group II (P = 0.001). The amount of fentanyl given intraoperatively was significantly higher in Group II (P = 0.001). Nausea and vomiting rates were significantly lower for Group I (P = 0.002). Conclusion: Ultrasound-guided ESPB reduced postoperative morphine consumption and the rate of nausea and vomiting.

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Background: Many studies have investigated the association of the methylation of gene and tobacco use disorders (TUD), but results remain ambiguous. Aims: This study evaluated the relationship between methylation of Adenomatosis Polyposis Coli (APC), Nuclear Receptor subfamily 3 group C member 1 (NR3C1), Dopamine D2 receptor (DRD2) gene promoters, and its effect on TUD. Subjects and Methods: We recruited 154 active smokers and 111 healthy non-smoker controls. PCR based methods on genomic DNA characterized the methylation of APC2, NR3C1, and DRD2 gene promoters. Results: We have found a significant difference in methylation of APC2 for TUD compared to healthy controls (P < 0.001). The partial methylation ratio was about an eight-fold increase in smokers compared to healthy controls. NR3C1 methylation was slightly higher in TUD patients compared to the control group, but the difference was not significant between the two groups (%95.33 vs. 91.08, P = 0.269). DRD2 methylation ratio was not significant between TUD patients and healthy control groups (P = 0.894). Conclusion: We think that it is important to detect APC2 methylated cases earlier and to advise them to quit smoking.

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Background: Bronchiectasis is characterized by chronic symptoms and impaired physical activity. Anxiety and depression usually complicate chronic illness. Thus, underdiagnosis of psychological distress in bronchiectasis may lead to increased morbidity and mortality. Aims: The aim of this study is to evaluate the impact of physical illness on psychological distress and its association with health-related quality of life (HRQOL). Subjects and Methods: This is a cross-sectional study of adults with bronchiectasis. Patients completed a study questionnaire, the hospital anxiety and depression scale and the World Health Organization quality of life brief (WHOQOL-BREF) questionnaire. Physical examination was conducted on all participants. Results: 103 patients were recruited for this study: 54 males (52.4%) and 49 females (47.6%). The average age of the patients was 49.12 ± 14.37 years. The most common predisposing factor for bronchiectasis amongst the patients was previous pulmonary tuberculosis (51 patients, 49.5%). Chronic productive cough, which was reported by 98 of the subjects (95.15%), was the most common symptom. 89 subjects (86.41%) reported episodes of shortness of breath, 82 (79.61%) reported at least one episode of exacerbation, while 52 subjects (50.49%) were hospitalized for bronchiectasis in the previous 12 months. 23 subjects (22.3%) had anxiety and 32 (31.1%) had depression. Anxiety and depression were significantly associated with indicators of severe disease. The subjects recorded low HRQOL scores across all domains. Psychological distress displayed a significant negative association with all the quality-of-life domains except between anxiety and social interaction. Conclusion: Symptoms of depression and anxiety are common among patients with bronchiectasis and these symptoms have a negative impact on HRQOL.

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Background: The fetal cerebellum has been shown to be least affected by external pressures and molding during pregnancy and therefore might provide more accurate estimation of GA. Aims: To study the utility of transcerebellar diameter (TCD) measured by ultrasound for the detection of GA in normal and intrauterine growth-retarded (IUGR) fetuses. Subjects and Methods: This cross-sectional study comprised 500 antenatal patients with a GA between 14 and 39 weeks and who were certain of their last menstrual periods. The TCD was measured ultrasonographically and the corresponding GA was determined. The GA was also determined with other customarily used sonographic parameters such as biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL) and compared with TCD. Data of normal pregnancy patients was used to formulate nomograms by taking the 5^th, 50^th, and 95^th percentile measurements. TCD to AC ratio was also calculated in both normal (n = 424) and IUGR pregnancies (n = 76). Results: TCD showed significant correlation with gestational age (GA) measured by last menstrual period (LMP) as well as with GA calculated with other biometric fetal parameters. TCD also showed significant correlation with GA in normal (R² = 0.979) as well as with IUGR pregnancies (R² = 0.942). TCD to AC ratio remained fairly constant in normal pregnancies while it was increased in IUGR pregnancies. Conclusions: TCD and TCD/AC ratio can be employed as an objective parameter to establish the GA in normal as well as IUGR pregnancy cases.

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In patients with type 1 neurofibromatosis (NF1), there is an increased susceptibility to tumor development in the central nervous system due to the loss of neurofibromin, an inactivator of the protooncogene Ras. NF1 has a broad clinical spectrum,which includes spinal tumors. Although the most common intramedullary tumor of the spinal cord in adults is ependymoma, few patients with NF1 accompanied by spinal ependymoma have been reported to date, and the localization of the tumors is cervical and thoracic in these cases. In this study, we report the case of a patient with NF1 presenting to our clinic with low back pain and gait disturbance. The patient had an intradural extramedullary ependymoma at the L2-3 vertebra level. This report is the first case of NF1 with spinal ependymoma localized in the lumbar region.

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Marfan syndrome is an uncommon inheritable connective tissue disease which affects the cardiovascular system. This paper presents two cases of Marfan Syndrome with predominant aortic root disease that were seen at the Cardiology Clinic of University of Nigeria Teaching Hospital, Enugu, Nigeria. Their biography, clinical features and echocardiography parameters were captured using structured questionnaire. Both were young males in their 4^th decade of life, and had advanced aortic root diseases which were complicated by left ventricular failure in both, while one of them had aortic dissection and ischemic stroke. Young adult Nigerians with Marfan syndrome presented with advanced aortic root diseases, heart failure, aortic dissection and stroke.

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Background: Hepatocellular carcinoma (HCC) is one of the most common hepatic malignancies and the sixth most common cancer worldwide. Prognosis is affected by tumor stage, hepatic disfunction and patient performance. Albumin - bilirubin grade was developed to assess the hepatic function in patient with HCC. Aims: The purpose of this study was to examine the relationship between albumin–bilirubin (ALBI) grade and survival in HCC patients receiving sorafenib. We also planned to investigate whether ALBI scores in advanced stage patients are prognostic and predictive. Patients and Methods: Patients presenting to the Karadeniz Technical University Medical Faculty Medical Oncology Clinic and diagnosed with HCC in 2010–2018 were included in the study. Fifty-six patients using sorafenib with Eastern Cooperative Oncology Group (ECOG) performance scores of 0, 1, or 2, who had not previously received systemic therapy were enrolled. Results: Patients' median age was 64.8 years (range: 23–86), and 80.4% were men. The highest proportion of patients were infected with hepatitis B virus (46.4%), 37 patients were ECOG 1 (66.1%), and 40 were ALBI grade 2 (71.4%). The change occurring in ALBI scores after sorafenib therapy compared to pre-sorafenib values was found to affect progression-free survival. Prognosis was better in the group with decreasing ALBI scores than in the increasing score group (p: 0.028). Multivariate regression analysis revealed that the change occurring in ALBI scores after sorafenib therapy compared to pre-sorafenib values was predictive of progression-free survival independently of alpha-fetoprotein (AFP) levels. Conclusion: This study shows that ALBI grade affects survival independently of AFP, Hand–Foot Syndrome (HFS), and other prognostic factors. ALBI grading can be used as a prognostic parameter in patients using sorafenib.

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Background: Implant supported prosthesis is a common treatment modality. Nowadays, new manufacturing techniques are available to fabricate them. Aims: To evaluate the effect of different manufacturing techniques of implant supported frameworks (ISF) on the preload of abutment's screws. Materials and Methods: A mandibular edentulous acrylic model with four dental implants temporarily stabilized in the interforaminal area was used. One ISF was fabricated using the conventional technique; implants were removed from the model and reassembled into the framework; this framework served as the passively fitting framework (PF). Three additional frameworks were constructed: conventional cast framework (CF), milled framework (MF) and 3D-printed framework (3D-PF). The gap between the frameworks and the neck of the implants were recorded in microns using a digital microscope. A tightening torque (TT) of 35 N·cm was applied to all the four abutments' screws and the screw's preload was recorded using two methods, by strain gauges (SGs) that were attached to the neck of each implant and fed into a stain book in microstrain (μɛ) and by removal torque (RT) using a digital torque meter. Results: The frameworks' gap means from the lowest to the highest were PF, CF, 3D-PF, and MF. The RT was significantly lower than the TT in all frameworks (P ≤ 0.05). One-way analysis of variance (ANOVA) revealed that the PF had the lowest RT, while the CF and the 3DPF both had the highest RT, and those differences were found to be statistically significantly (P ≤ 0.05). When preload of the frameworks was recorded by SGs, one-way ANOVA revealed that PF had the highest preload value, while both 3D-PF and MF had the lowest preload values, those differences were also found to be statistically significant (P ≤ 0.05). Conclusion: The fabrication of implant-supported frameworks using milling or selective laser melting computer aided design/computer-aided manufacturing technologies did not necessarily enhance the screw's preload. This lack of enhancement could be attributed to the great amount of marginal gap in the frameworks fabricated by both techniques.

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One of the neurological complications associated with COVID-19 is Guillain Barre Syndrome (GBS). It is possible to be a complication of COVID19 due to the similarity of respiratory complication between both clinical entities. The aim of this case report is to present a case followed in the intensive care unit (ICU) with the coexistence of prolonged COVID-19 and GBS. The 68-year-old patient, whose COVID-19 symptoms had been going on for 5 weeks, was followed for 5 days in the ICU due to GBS diagnosis. During this period, the patient's symptoms regressed with IVIG treatment. ICU physicians should be careful that some neurological complications may accompany in some prolonged COVID-19 cases and that one of these may be GBS.

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Background: There are concerns that high cesarean section (CS) rates are driven by nonmedical indications and unmitigated maternal hypotension following spinal anesthesia (SA) has materno fetal effects. Aims: Our objective was to investigate CS rates using Robson classification, identify patient groups for focused intervention as well as assess the incidence and predictors of maternal hypotension following SA for cesarean delivery. Subjects and Methods: A cross sectional design was employed over 3 months (February–April, 2019). Data about total deliveries (vaginal and operative) were obtained from the hospital medical records. For parturients who had CS, variables which covered maternal characteristics, conduct of anesthesia, and the index pregnancy according to Robson classification system were entered into a proforma designed for the study. Results: The total deliveries were 3031, of which 556 were CSs, giving a CS rate of 18.3%. Twenty one nonconsenting parturients were excluded, so 535 responded. Robson groups 5, 10, and 1 combined contributed 75% [401/535] to the overall CS. Two or more previous CS, 29.7% [159/535], was the main indication for performing CS, followed by maternal request 12.9% [69/535]. The incidence of maternal hypotension was 62.6% (293/468); the independent predictors were elective CS and having comorbidities. Conclusion: We found a low CS rate and Robson groups 5, 10, and 1 were the major contributors – previous CS (≥2) and maternal request were the predominant indications for performing CS. The independent predictors of SA induced hypotension were presence of comorbidities and elective CS

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Cancer related thrombotic microangiopathies usually cause a diagnostic dilemma for hematologists and clinicians. In this case report, we presented a fifty-nine-year-old man who was admitted to our hospital with microangiopathic hemolytic anemia and thrombocytopenia due to the carcinoma metastasis to the bone marrow. As a result of rapid evaluations, it was revealed that the histological subtype of the cancer was signet ring cell carcinoma, and despite all the interventions, the patient died at a very short time after the initial presentation. Regardless of all the innovations in the diagnosis and treatment of thrombotic microangiopathies, cancer-associated thrombotic microangiopathy is still fatal and deadly today.

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