Irreversible Complications Research Articles

Wernicke encephalopathy after chronic pancreatitis exacerbation. Case report

Wernicke encephalopathy (WE), is an emergency acute neuropsychiatric condition, which develops secondary to thiamine deficiency. According to data of multiple investigations, this disorder is greatly underdiagnosed. WE classically connected to chronic alcohol abuse, but also diagnosed in non‑alcoholic patients with different risk factors including severe vomiting, chronic malnutrition, systemic infections, malignancies, chemotherapy, HIV/AIDS, gastrointestinal surgeries or disease, and renal problems.
 We present a case of a 33‑year‑old woman with history of chronic pancreatitis exacerbation with prolonged vomiting, present to the neurological department with neurological symptoms consistent with WE. WE was suspected according to triad of symptoms, such as altered mental state, oculomotor disturbances and ataxia. Brain magnetic resonance imaging (MRI) and thiamine blood level aid us to confirm WE diagnosis. The patient was given thiamine, at the dosage of 200 mg 3 times per day intravenously for seven days, followed by oral thiamine. Gaze paresis disappeared at day 10, truncal ataxia noticeably improved after two weeks. The patient was left with some signs of anterograde amnesia, gaze‑provoked nystagmus at the two month follow‑up.
 Physicians should be familiar with clinical presentation of WE in non‑alcoholic patients with appropriate history and risk factors, like prolonged emesis, unbalanced diet, malignancies, etc. Presence of classic triad of clinical symptoms and pathological findings on brain MRI are the most important diagnostic tool, while the blood thiamine level may be within the normal range. Early diagnosis and therapy onset are crucial for patients to prevent further irreversible complications or death.

Microbial profile with their antimicrobial susceptibility pattern in ear discharge of Chronic suppurative otitis media patients at a tertiary care hospital in Durgapur

Background: Chronic suppurative otitis media (CSOM) is a persistent middle ear disease with high risk of irreversible complications in absence of timely management. It is a massive health problem in India having the highest prevalence rate (>4%) requiring urgent attention. Aims and Objectives: The aim of the study was to find out risk factors, microbiological profile, with their susceptibility pattern, and of ear discharge in CSOM patients to provide guidelines for the empirical treatment. Materials and Methods: Ear discharge samples from 135 clinically diagnosed CSOM patients were collected and processed. Microbial isolates were identified and drug susceptibility testing was conducted using Kirby-Bauer disc diffusion method. Results: Pseudomonas species (59/135, 43.70%) was the predominant isolate followed by Staphylococcus species (37/135, 27.40%) while Aspergillus species (10/12, 83.33%) was the predominant fungus isolated. No anaerobic bacteria were isolated on culture. Gram-negative bacilli were most susceptible to Meropenem (100%) and Amikacin (100%) while Pseudomonas species was to Imipenem (98.35%). Gram-positive cocci showed 100% susceptibility to Vancomycin, Linezolid, and Doxycycline. Conclusion: A continuous and periodic evaluation of microbiological pattern of CSOM and antimicrobial sensitivity of isolates is necessary for forming the basis of empirical treatment which shall aid in decreasing the potential risk of complications. Further, accurate and timely identification, knowledge of the pathogens, and judicious use of antibiotics are the need of the hour.

Etiological Evaluation of Patients with Hepatomegaly, Splenomegaly and Hepatosplenomegaly Referred to a Pediatric Metabolism Unit

Purpose: Hepatomegaly, splenomegaly and hepatosplenomegaly in children can be due to infections, genetic liver diseases, hematological diseases or malignancies, autoimmune disorders, and also inborn errors of metabolism (IEM). Some IEM’s have specific treatments which should be started before irreversible complications occur. The aim of this study is to evaluate the etiological causes of visceromegaly in pediatric patients and assess the clinical findings of patients having an IEM.
 Materials and Methods: In this study, medical records of 93 patients who were referred to Pediatric Metabolism Unit in a tertiary care hospital with the suspicion of IEM-related hepatomegaly, splenomegaly or hepatosplenomegaly were reviewed retrospectively. 
 Results: 45 patients had hepatomegaly, 18 had splenomegaly and 30 had hepatosplenomegaly. A total of 52 patients were diagnosed as having an IEM. 32 patients were lost to follow-up. The eventual diagnoses of 9 patients were not IEM. 
 Conclusion: IEMs present from prenatal period to adulthood. Awareness of clinicians and diagnostic algorithms can prevent delayed diagnosis and enable early treatment for treatable IEMs or provide genetic counseling for the patient’s family.

Survival in patients with multiple myeloma: a real-life single-center study

Introduction: The development of novel drugs with a different mechanism of action has led to considerable progress in multiple myeloma (MM) treatment. However, the exact associations between overall survival (OS) and different treatment types, response to treatment, as well as clinical and laboratory parameters, have not been fully elucidated. We aimed to determine the effect of clinical and laboratory parameters, type of induction therapy, and high-dose chemotherapy with autologous hematopoietic stem-cell transplant (auto-HSCT) on OS in patients with MM. Material and methods: This retrospective study included 413 patients with MM treated between 2006 to 2017. Correlations between selected clinical and laboratory parameters and OS were assessed. The severity of MM was evaluated using the Durie-Salmon classification. Results : The median OS was 4.08 years. The overall response rate to chemotherapy was 76%. The complete remission (CR) rates were higher in patients receiving bortezomib-based therapy than in those receiving thalidomide-based therapy or standard chemotherapy ( p < 0.001). The CR rate was positively correlated with OS. The use of auto-HSCT with bortezomib-based therapy was associated with longer OS. Renal failure and elevated urinary protein levels were inversely correlated with OS. The severity of MM at diagnosis was also associated with OS. The percentage of bone marrow plasma cell infiltration did not correlate with OS. Conclusions: MM is still diagnosed too late, by which time patients have developed almost irreversible complications. However, we confirmed that novel treatments improve OS in these patients, especially when used in addition to auto-HSCT. These findings may facilitate clinical therapeutic decision making.

Umbilical Discharge

An umbilical discharge is itself not a disease, but it is a symptom of many diseases. In children, it may be found to be associated with an underlying congenital abnormality like persistent OMD (Omphalo-mesenteric Duct) or Vitelline cysts or sinuses or umbilical granuloma or a diverticulum like the Meckel’s diverticulum which may possess ectopic gastric or pancreatic or even colonic mucosa, or the persistent allantois or a urachal cyst or an infected urachus etc. Umbilical discharge though rare in adults, it may be caused by diverse congenital or acquired conditions. The most common causes of umbilical discharge in adults are such acquired conditions as pilonidal sinus disease, infection of hair tufts and foreign bodies4, and specific and non-specific acute and chronic inflammation and abscess of the umbilicus, infected omphalolith etc. Very rarely the discharge may be due to endometriosis or metastatic carcinoma, umbilical hernia ulceration etc. Discharging umbilical abscess may be caused by bacteria that can enter as a result of penetrating trauma, rupture of the bowel, or abdominal surgery. Irrespective of aetiology, umbilical discharge is a distressing condition for the patient and the family members. Appropriate diagnostic aids and successful management strategies are now available. If not associated with malignant diseases or irreversible complications, the prognosis is excellent. KYAMC Journal Vol. 13, No. 01, April 2022: 50-55

Breaking the Bad News in Cancer: An In-Depth Analysis of Varying Shades of Ethical Issues

AbstractOncology has a range of ethical issues that are difficult to address and breaking the bad news is probably the most important and common across the world. Conventionally, breaking the bad news has been exclusively used in the situation where definitive diagnosis of cancer is to be conveyed to the patient. On a practical note, for the treating doctor, breaking the bad news is not restricted only to the confirmation of cancer and its prognosis at the initial diagnosis but also includes conveying futility of curative treatment, changing from curative to palliative treatment, recurrence/metastasis posttreatment, end of life care, and finally informing death of the patient to the family members. In addition to this, informing pregnant women that she has been diagnosed with cancer, about surgery-induced body disfigurement, loss of fertility due to chemotherapy/ radiotherapy, and of treatment-induced irreversible health complications are also challenging for the treating oncologist. On the basis of an in-depth analysis, the current review presents the various situations, complexities, and the related ethical issues in breaking the bad news in various situations from the perspective of an oncologist in detail in Indian context.

An evaluation of clinical and ultrasound results of Pavlik harness treatment for developmental dysplasia of the hip.

Developmental dysplasia of the hip (DDH) is the instability or dislocation of the hip joint at birth that may occur in utero, during infancy, and childhood. This condition was identified as an important challenge. This study aimed to determine the clinical and ultrasound results of Pavlik harness treatment for DDH in patients referred to the pediatric clinic of Imam Khomeini Hospital in Ahvaz. This is a descriptive cross-sectional study in which 100 newborns aged 15 to 30 days were included by the census method after obtaining parental consent. Follow-up of the infants was performed at 3 and 6 months after treatment. All analyzes were performed using SPSS version 22 at a significance level of 0.05. The results showed that the mean age of the infants was 23.46±2.12 days, of which 33 infants were boys and 67 girls. The involvement on the right and left sides was 39% and 50%, respectively, and 11% of the infants had bilateral involvement. The mean value of acetabular index before placement was 25.48±6.509 and 26.38±3.866 on the right and left sides, which after 3 months of placement, was reduced to 21.62±2.578 and 21.57±2.839, respectively. Pavlik harness treatment was associated with acceptable radiological results in infants. This technique seems to be a suitable and applicable attempt to treat this problem and prevent serious and irreversible complications of late diagnosis.

ISCHEMIC PRIAPISM: A STARTLING THROMBOEMBOLIC COMPLICATION OF COVID-19

TYPE: Case Report TOPIC: Chest Infections INTRODUCTION: The coronavirus disease-2019 (COVID-19) is known to cause severe systemic inflammation leading to thrombotic complications. Deep vein venous thrombosis, pulmonary embolism and stroke are some of the most commonly reported. However, ischemic priapism has been rarely documented as a thromboembolic consequence. CASE PRESENTATION: A 39-year-old man with a history of hypertension and type 2 diabetes mellitus presented with a painful irreducible erection of six-hour duration. Physical exam revealed tachycardia and a tender, rigid penile shaft, with an engorged glans and corpus spongiosum. He denied prior episodes or penile trauma. Laboratory-work revealed an elevated D-Dimer and inflammatory markers, as well as a positive COVID PCR test. Further investigations showed no previous hematological diseases or medications with an elevated thromboembolic risk. He received epinephrine irrigation and cavernosal blood aspiration which resolved the priapism. Nonetheless, the erection recurred a few hours later and a heparin infusion was started. Despite being on heparin for 24 hours, the erection persisted, requiring surgical intervention via a corpora cavernosa - penis glans fistula. The erection resolved and he was discharged home. DISCUSSION: Priapism is a prolonged penile erection of more than four hours without sexual stimulation. Interestingly, COVID-19 induces thrombosis by the hypercoagulability, hyperviscosity, and endothelial dysfunction after the massive inflammatory response and free radical damage. Ischemic priapism is a medical emergency that prompts treatment with a-agonists and corporal blood aspiration if needed. Detumescence can be achieved surgically if the initial measures fail. CONCLUSIONS: This case highlights a rare complication of COVID-19. Early recognition and medical treatment can prevent irreversible complications. DISCLOSURE: Nothing to declare. KEYWORD: COVID-19 Ischemic Priapism

Neuromyopathy due to mitochondrial trifunctional protein deficiency caused by novel HADHA mutation

Mitochondrial trifunctional protein deficiency (MTP deficiency or MTPD) is a rare autosomal recessive disorder of oxidation of long-chain fatty acids. It is characterized by severe neonatal manifestations such as cardiomyopathy, hypoglycemia, metabolic acidosis, skeletal myopathy, neuropathy, liver disease, and death. It can also present with mild symptoms such as peripheral polyneuropathy, episodic rhabdomyolysis, and pigmentary retinopathy. Peripheral neuropathy is a known and long-term irreversible complication of MTPD. We report a rare case of a 5-year-old male child with slowly progressive limb weakness; genetic analysis was suggestive of MTPD with novel HADHA gene mutation. The present study comprehensively analyzed the cases, including exome sequencing, to the best of our knowledge, describing the first observation of homozygous novel mutation in the HADHA gene underlying this disorder in India.

Случай успешного хирургического лечения трофической язвы роговицы

Purpose. To present the results of clinical outcomes of modern high-tech surgical treatment of a patient with unilateral neurotrophic keratitis using layered keratoplasty, which helps to prevent the development of further irreversible complications. Material and methods. A 45-year-old patient, after a course of radiation therapy for a brain tumor with the development of numbness on the upper left-side of her face, conjunctiva and cornea underwent six months later cataract phacoemulsification with IOL implantation in the left eye. After 2 months the patient’s vision decreased significantly, the examination showed that she developed neurotrophic keratitis on the operated eye, followed by progression and transformation into a trophic corneal ulcer with descemetocele. Results. In order to prevent further complications in the form of corneal perforation, anterior deep layered keratoplasty with a small diameter graft was performed. Extremely slow epithelialization was noted, and therefore a successful and effective biopsy of the cornea with an amniotic membrane was carried out. Conclusion. Cataract extraction in patients after radiation therapy with further loss of corneal sensation is extremely risky and can lead to serious consequences, in particular, the development of neurotrophic keratitis and corneal trophic ulcers. The use of the surgical technique of anterior deep layered corneal transplantation is an effective method of treating trophic ulcers, and the technique of performing the operation has certain features compared to the classical technology and requires extensive experience of the surgeon. However, the use of this method of surgical treatment for corneal trophic ulcers with descemetocele due to neurotrophic keratitis developed on the basis of radiation therapy does not always lead to success. In this case, the additional use of the amniotic membr ane for therapeutic purposes contributed to the r elief of the pathological process, paving the way for subsequent surgical interventions to restore high visual acuity i n the future. Key words: radiation therapy, neurotrophic keratitis, trophic ulcer, anterior deep layered keratoplasty, amniotic membrane

Impact of COVID-19 Pandemic on Emergency Department Referrals with Urologic Complaints; a Retrospective Cross-Sectional Study

Introduction:Medical and surgical priorities were dramatically changed during the COVID-19 pandemic. This study aimed to evaluate the impact of this pandemic on presentation to emergency department (ED) with urologic complaint. Method:This cross-sectional study was conducted at a tertiary urology referral center in Tehran, Iran. The data of all ED admissions were collected and the frequency of admissions with urologic complain and their outcomes were compared between two 90-day periods (before and during COVID-19 era).Results:480 ED admissions were studied. The number of patients visiting the ED with urologic complaint during COVID-19 era was significantly lower than the same period in the pre-COVID-19 period (125 vs. 355 admissions; p = 0.01). The mean hospitalization days for patients in the pre-COVID-19 period were significantly higher (5.6 ± 4.4 vs. 3.2 ± 4.2 days; p <0.001). The most common patient complaints before and during COVID-19 period were flank pain (32.7%) and gross hematuria (32.8%), respectively. The number of patients discharged against medical advice in the COVID-19 period was significantly higher than before (22 (17.6%) vs. 10(2.8%); p < 0.001). The number of patients who developed severe complications was significantly higher in the COVID-19 period than in the pre-COVID-19 period (p = 0.001).Conclusion:During the COVID-19 pandemic we were faced with decreasing frequency of admission with urologic complaint, change in the pattern of referrals, decrease in the duration of hospitalization, increase in the number of patients discharged against medical advice, and increase in the number of cases with irreversible urologic complications or complications requiring surgery due to deferred treatment.

Management of femoral head fracture by Ganz surgical dislocation of the hip

IntroductionPosterior hip dislocation is the commonest type of hip dislocation. It is associated with femoral head fracture in 7% of cases. Urgent and congruent hip reduction is mandatory to improve clinical outcomes and avoid irreversible complications. The purpose of this study is to assess the safety and functional and radiological outcomes of surgical hip dislocation by Ganz technique for treatment of femoral head fracture.Patients and methodsIn this retrospective study, 18 cases of femoral head fracture were included. Six cases had Pipkin type I and 12 had Pipkin type II fracture. They were treated through surgical hip dislocation. All cases were followed up for at least 24 months. Matta’s criteria were used for radiological evaluation (plain radiographs). Functional evaluation was done using Harris Hip Score and modified Merle d’Aubigne and Postel score at final follow-up.ResultsNo patients were lost during the follow-up period. No signs of infection or wound dehiscence were noted in this study. There was one case of osteonecrosis. All cases had labral injury, which was debrided. None of our cases needed suture anchor repair of the labrum. Radiographical evaluation according to Matta’s criteria yielded anatomic fracture reduction in 17 patients but imperfect in 1 patient. According to Harris Hip Score, four Pipkin type I cases were rated as excellent and two as good. Among cases of Pipkin type II fracture, six were rated as excellent, four as good, one as fair, and one as poor. According to modified Merle d’Aubigne and Postel score, 11 cases had excellent results, 5 cases were rated as good, one as fair, while one case had poor results.ConclusionOpen reduction and internal fixation of femoral head fracture using surgical hip dislocation through Ganz approach is a viable treatment option and provides satisfactory results with low complication rate.

WATER vs WATER II 3-Year Update: Comparing Aquablation Therapy for Benign Prostatic Hyperplasia in 30-80 cc and 80-150 cc Prostates

To compare the outcomes of Aquablation for small-to-moderate (30-80cc) prostates with the outcomes for large (80-150 cc) prostates at 3-year follow up. WATER is a prospective, double-blind, multicenter, international clinical trial comparing the safety and efficacy of Aquablation and TURP in the treatment of LUTS/BPH in men 45-80 year with a prostate of 30cc-80cc. WATER II is a prospective, multicenter, single-arm international clinical trial of Aquablation in men with a prostate of 80cc-150cc. We compare 36-mo outcomes amongst 116 WATER and 101 WATER II study subjects undergoing Aquablation. International Prostate Symptom Score (IPSS) scores improved from 22.9 and 23.2 at baseline in WATER and WATER II, respectively, to 8.0 and 6.5 at 36-month, with 36-mo reductions of 14.4 and 16.3 points, respectively (P=.247). At baseline, urinary flow rate (Qmax) was 9.4 and 8.7 cc/sec in WATER and WATER II, improving to 20.6 and 18.5 cc/sec, respectively (P=.552) at 36-mo. Improvements in both IPSS and Qmax were immediate and sustained throughout follow-up. At 3 year, 98% and 94% of treated patients were BPH medication-free in WATER and WATER II, respectively (P=.038). At 3yr, 96% and 97% of treated patients were free from surgical retreatment in WATER and WATER II, respectively (P=.613). Three-year follow-up demonstrates that Aquablation therapy leads to sustained outcomes, few irreversible complications, and low retreatment rates for the treatment of LUTS/BPH independently of prostate volume.

No-Fault Compensation and Anti-COVID-19 Compulsory Vaccination: The Italian Context in a Broad View.

Italy, like other European countries, has produced a series of regulations during the COVID-19 pandemic. Compulsory vaccination has been introduced for the Italian population. Meanwhile, the Decree-Law 27 January 2022 n. 4 provided for the compensation mechanism for those who have received damage of the psycho-physical integrity due to the anti-SARS-CoV-2 vaccination recommended by the Italian Health Authority. Law 1992 no. 210 already provided for the indemnity system for persons damaged by irreversible complications due to compulsory vaccinations, transfusions, and the administration of blood products. The legislator intended to attribute the right to an indemnity that is not compensatory in order to repair a wrong connected to some hypothesis of liability, but it rather has a welfare character in the broad sense, being attributable to Constitutional fundamentals. In the Italian panorama, although the vaccination damages have been fully included in the already existing law no. 210/1992, to date, no precise indications have been provided regarding the ascertainment of the causal link and the extent of the compensable damage. In the near future, the interest of the scientific community will focus on the evaluation of applications for access to the benefit.

Etiology and Pathophysiological Pathways of Ocular Complications Associated with Local Dental Anesthesia and Odontogenic Infections: A Systematic Review.

Ocular complications during or after dental extraction have been reported in the literature. These complications were either due to infiltration of local anesthetic solution or due to spread of odontogenic infection extending to the ocular region. The purpose of the present study is to outline the pathophysiological pathway of such ocular complications pertaining to dental procedures due to infiltration/local anesthesia block or spread of odontogenic infection. An exhaustive literature search was conducted in October 2020 on various online research databases to identify various etiological factors causing ocular complications during dental procedures or followed by odontogenic infections. The findings of all the articles recruited for the review were recorded and analyzed. The search protocol revealed a total of 897 articles related to the study where only 208 relevant articles were recruited for detailed evaluation, which led to the exclusion of 123 articles and a total of 85 articles were included in the study. Out of the total 113 cases in 85 articles, 92 cases (81.42%) showed complications associated with the use of local anesthetic agent and 21 cases (18.58%) exhibited ocular complications due to spread of infections. Most common ocular complications reported were diplopia, followed by ptosis and ophthalmoplegia. Dental anesthesia can cause a reversible or irreversible ophthalmic complication, while the infectious afflictions of the orbit still remain a challenge to the practicing maxillofacial surgeon.

A Descriptive Case Series Study from 2009 to 2019 and a Brief Review on Takayasu’s Arteritis Patients in Arak

Background: Takayasu is a form of large vessel vasculitis that mainly affects the aorta and its branches. It is a chronic disease, and the long-term prognosis depends on arterial complications and its progressive stage. Objectives: This project is a single-center descriptive study of Takayasu’s arteritis patients in Arak city aimed to determine these demographic patterns, which can help physicians in early diagnosis. Methods: All Takayasu’s arteritis patients referred to the rheumatology center of Amir Al-Momenin subspecialty clinic were studied from 2009 to 2019. Imaging methods were used for diagnosis, and SPSS version 23 was used for statistical analysis. Results: Out of 17 registered patients, information of nine patients was available from the beginning of diagnosis. Constitutional signs and symptoms indicated an inflammatory process in 77.78% of the patients. All patients in this study received a steroid-sparing drug as a part of the treatment, and the most commonly used drug was methotrexate, which was used in all patients at the onset. Conclusions: This study reports the details and the characteristics of patients with Takayasu’s Arteritis in Arak, Iran. Although the number of patients was small, these results can inform the physicians about the signs, symptoms, and complications of delayed diagnosis of this disease. One of the most important points in the diagnosis of Takayasu is the delay between the onset of symptoms and the diagnosis of the disease. This delay may lead to irreversible complications and increased morbidity.

Retinal Findings of Hospitalized Neonates Recovered from COVID-19 Infection: A Prospective, Observational, Descriptive Study.

ABSTRACTPurposeCoronavirus disease 2019 (COVID-19) that is caused by severe acute respiratory syndrome coronavirus 2 can cause microvascular alterations that can lead to irreversible complications in multiple tissues and organs. Detrimental effects of COVID-19 on retinal structure have recently been reported in adult population. However, literature data about neonatal population is very scarce. Thus, we aimed to assess possible retinal changes of neonates recovered from COVID-19 infection in this prospective, observational, descriptive study.MethodsThe neonates recovered from COVID-19 infection were included to the study between 01 September 2020 and 30 April 2021. Their initial ophthalmological examination was made after a negative real-time reverse transcription-polymerase chain reaction obtained and all patients were re-examined 1 month later. All examinations were performed by same retina specialist using a binocular indirect ophthalmoscopy.ResultsA total of 15 neonates [9 (60%) male, 6 (40%) female, mean gestational age of 38.9 ± 0.9 weeks (ranging from 37 to 40 week)] were evaluated in the study. The mean age at the time of hospitalization was 17.5 ± 8.7 days (ranging from 2 to 29 days), and the mean duration of hospitalization was 12.5 ± 6.2 days (ranging from 4 to 27 days). Except for one patient with bilateral avascular area in Zone-III, no further retinal manifestation related to COVID-19 was found in the study.ConclusionCOVID-19 infection can cause retinal damage in neonates. Therefore, these patients should be closely monitored for signs of ocular involvement.

Gut microbial dysbiosis in rheumatoid arthritis: a systematic review protocol of case-control studies

IntroductionRheumatoid arthritis (RA) has a huge societal impact due to the high prevalence, irreversible joint damage and systemic complications. Gut microbiota plays an important role in the pathogenesis and progression...

Diagnosing, Managing, and Controlling COVID-19 using Clinical Decision Support Systems: A Study to Introduce CDSS Applications

Coronavirus disease (COVID-19) as an emerging disease decreases security among people from different countries. Sense of security can be raised via quick diagnosis of COVID-19, and its management and control using clinical decision support systems (CDSS) to prevent further spread of the disease. So, the aim of this study is to identify and introduce the applications of a CDSS in the diagnosis, management, and control of COVID-19. This cross-sectional study was conducted to identify and introduce the applications of CDSS in the diagnosis, management, and control of COVID-19. Based on the results of some meetings with infectious disease specialists and a general practitioner as well as reviewing the related literature, information about COVID-19 and CDSS was obtained. Then based on the information obtained, a questionnaire was designed electronically and distributed in a two-round Delphi method among 19 experts in the three fields of medical informatics, health information management, and infectious disease specialists. According to the literature and expert opinions, 35 applications of CDSS applications were identified in the four main groups of “diagnosis”, “medication”, “monitoring”, and “health services”. Eventually, a collective agreement was reached on 30 applications in the first and second rounds of Delphi. Among all the applications, the highest means were assigned to “monitoring the vital signs” and “helping diagnose infections and damaged lung tissue through CT scan”. Introducing these applications can provide general, basic knowledge of the design and implementation of clinical decision support systems in the real world to prevent irreversible complications and even many people’s death.

Optical cohorence tomography angiography findings in carotid artery stenosis.

To investigate vascular density (VD) changes in the superficial (SCP) and deep capillary plexus (DCP), radial peripapillar capillary plexus (RPCP), Foveal avascular zone (FAZ) and thickness changes of peripapillary retinal nerve fiber layer (ppRNFL) and choroid (CT) using optical coherence tomography angiography (OCTA) ipsilateral eyes of patient with internal carotid artery stenosis (ICAS) and to compare the obtained values with kontralateral eyes of patients with İCAS and healthy individuals. This prospective cross-sectional case-control study was conducted in 43 patients with a diagnosis of unilateral ICAS and 47 age- and sex-matched healthy subjects. The patients were divided into three groups. Group 1 consisted of ipsilateral eyes of patients with ICAS, group 2 consisted of contralateral eyes of patients with CAS and group 3 comprised healthy individuals without ICAS, All participants underwent a comprehensive ophthalmologic examination including OCTA. FAZ, Superficial parafoveal and superficial superior VD were significantly lower in group 1 compared to group 2 (p = < 0.001, p = 0.018 and 0.021, respectively). Group 1 also had lower superficial superior (p = 0.038), superficial inferior (p = 0.034), deep superior (p = 0.034), and deep inferior (p = 0.012) VD compared to group 3. There was no significant difference between the groups in terms of ppRNFLT, whereas CT and RPC mean, superior, and inside-disc VD values were significantly lower in group 1 compared to both group 2 and 3 (p < 0.05). OCTA measurements may be useful in preventing irreversible ocular complications by detecting early structural changes in patients with ICAS before the development of symptomatic ocular ischemic syndrome.