Case report: Contraceptive implant migration.

Subdermal contraceptive implants are one of the effective and reversible methods of contraception available today. Implanon is a Saudi FDA-approved contraceptive that is commonly used by the Saudi population. Along with their hormonal side effects such as mood changes and acne, subdermal contraceptive implants can also lead to more life-threatening, albeit rare, mishaps, such as the deeper migration of them into the axillary and thoracic structures. Only a few cases exist in the literature regarding these rare complications. In this case report, we describe the case of a 31-year-old woman presenting with ulnar neuropathy due to deep proximal migration 3 years after the insertion of an Implanon. The foreign body was removed using intraoperative image-enhancing fluoroscopy, with neurological symptoms being resolved as a result.

Staged hip replacement for neglected bilateral Crowe's Grade 4 dysplasia.

Factors such as consanguinity, breech presentation, and family history have been attributed to the diagnosis of developmental dysplastic hip (DDH) in Saudi Arabia. The prevalence of DDH in Saudi Arabia is higher in females than in males, with 10.46 cases per 1000 live births. Cases with bilateral high hip dislocation rarely cause early symptoms and can easily be neglected; therefore, these cases present later in life with degenerative osteoarthritis requiring a challenging hip replacement. This report presents the case of a 54-year-old female with bilateral high dislocated dysplastic hip joints. A successful staged bilateral total hip replacement resulted in painless and stable hip joints. The surgery was conducted successfully by ensuring the availability of personnel with the necessary skills, equipment, and an experienced treatment team. Therefore, the results stress the need to utilize screening tests for the early diagnosis and treatment of developmental dysplastic hip.

An overview of pathophysiology and treatment options of osteonecrosis of femoral head in sickle cell disease.

Osteonecrosis of the femoral head (ONFH) is the most prevalent musculoskeletal pathologic manifestation of sickle cell disease (SCD) resulting in an osteonecrotic event. This review aimed to summarize mechanisms involved in pathophysiology of ONFH and treatment options available in Saudi Arabia to treat SCD patients with complication of osteonecrotic event. The pathophysiology of ONFH include genetic and micro particles involvement. The progression of osteonecrosis involves reduced levels of bioactive compounds in peripheral blood mononuclear cells and elevated CD4+T circulating levels to stimulate pro-inflammatory cytokines contributing to inflammation at target site. Initial treatment approach is pharmacological agents use to mitigate risk. Further, bone morphogenetic protein stimulation initiate bone formation and treatment can be improved with the use of bone morphogenetic protein, total hip arthroplasty and cell therapies. This review provides baseline information for future studies to be carried out in Saudi Arabia to improve treatment options in SCD patients with ONFH.

Cervical Joint Position Sense and Its Correlations with Postural Stability in Subjects with Fibromyalgia Syndrome.

Cervical joint position sense (JPS) and postural stability are vital to maintaining balance and preventing falls in fibromyalgia syndrome (FMS). Impaired cervical JPS may influence postural stability, and understanding the relationship between them can aid in formulating treatment strategies in individuals with FMS. This study aims to (1) assess cervical JPS and postural stability between FMS and control group and (2) determine the correlation between cervical JPS and postural stability in the FMS group. This cross-sectional study recruited 92 FMS patients (mean age: 51.52 ± 7.7 yrs.) and 92 healthy controls (mean age: 49.36 ± 6.9 yrs.). A cervical range of motion (CROM) unit was utilized to assess cervical JPS. The postural stability was assessed using an IsoFree force platform, and anterior-posterior (A/P) and medial-lateral (M/L) directions of sway and ellipse area were measured. Cervical JPS and postural stability tests were assessed and compared between FMS and control groups. Cervical JPS was significantly impaired in FMS compared to the control group (p < 0.001). The JPS errors in FMS group were larger in flexion (FMS = 5.5°, control = 2.4°), extension (FMS = 6.4°, control = 3.0°), and rotation in left (FMS = 5.4°, control = 2.2°) and right directions (FMS = 5.1°, control = 2.8°). FMS individuals demonstrated statistically significant impaired postural stability compared to control in both the dominant and non-dominant legs tested (p < 0.001). The cervical JPS test showed moderate to strong positive correlations with postural stability variables. Statistically significant correlations were observed in all the JPS directions tested with all the postural stability variables (A/P and M/L sway and ellipse area). The correlation coefficients ranged between r = 0.37 (moderate) to 0.75 (strong). Cervical JPS and postural stability are impaired in FMS individuals. A moderate to strong relationship existed between JPS and postural stability. Individuals with FMS who had a greater magnitude of cervical JPS errors exhibited more severe postural control deficits. Therefore, cervical JPS and postural stability tests should be incorporated into routine clinical practice when assessing or formulating treatment strategies for patients with FMS.

Targeting Hydrogen Sulfide Modulates Dexamethasone-Induced Muscle Atrophy and Microvascular Rarefaction, through Inhibition of NOX4 and Induction of MGF, M2 Macrophages and Endothelial Progenitors.

Long-term use of Glucocorticoids produces skeletal muscle atrophy and microvascular rarefaction. Hydrogen sulfide (H2S) has a potential role in skeletal muscle regeneration. However, the mechanisms still need to be elucidated. This is the first study to explore the effect of Sodium hydrosulfide (NaHS) H2S donor, against Dexamethasone (Dex)-induced soleus muscle atrophy and microvascular rarefaction and on muscle endothelial progenitors and M2 macrophages. Rats received either; saline, Dex (0.6 mg/Kg/day), Dex + NaHS (5 mg/Kg/day), or Dex + Aminooxyacetic acid (AOAA), a blocker of H2S (10 mg/Kg/day) for two weeks. The soleus muscle was examined for contractile properties. mRNA expression for Myostatin, Mechano-growth factor (MGF) and NADPH oxidase (NOX4), HE staining, and immunohistochemical staining for caspase-3, CD34 (Endothelial progenitor marker), vascular endothelial growth factor (VEGF), CD31 (endothelial marker), and CD163 (M2 macrophage marker) was performed. NaHS could improve the contractile properties and decrease oxidative stress, muscle atrophy, and the expression of NOX4, caspase-3, Myostatin, VEGF, and CD31 and could increase the capillary density and expression of MGF with a significant increase in expression of CD34 and CD163 as compared to Dex group. However, AOAA worsened the studied parameters. Therefore, H2S can be a promising target to attenuate muscle atrophy and microvascular rarefaction.

Total Hip Replacement in Sickle Cell Disease Patients with Avascular Necrosis of Head of Femur: A Retrospective Observational Study.

BACKGROUND: Femoral head avascular necrosis leads to osteoarthritis of the hip joint and affects its functional capacity in sickle cell disease patients. The functional outcomes of total hip replacement (THR) on patients with congruous joints who underwent hip replacement after having a failed joint preservation surgery are unknown. This study aimed to compare the functional outcomes of THR in patients with sickle cell disease having avascular necrosis with and without loss of hip joint congruency. METHODS: This retrospective study included 35 patients (age, 20-52 years; 18 males and 17 females) who underwent uncemented THR. Patients were divided into Group-A (n = 18, good hip joint congruency) and Group-B (n = 17, obliterated hip joint congruency). The Harris Hip Score (HHS) was used to assess functional outcomes. All patients were followed up at 6-weekly intervals then 6-monthly intervals. RESULTS: The mean follow-up period was 8.26 ± 3.01 years. The mean preoperative HHSs of Group-A and Group-B were 45.22 ± 3.021 and 25.94 ± 4.437, respectively. Postoperatively, a subsequent increase in HHS was found in both groups, and a significant difference between the groups was observed at 6 weeks (p < 0.0001*) and 1 year (p < 0.0006*). Interestingly, HHS was not significantly different (p = 0.0688) at 5-year follow-up between the groups. The differences in HHS within the group at each subsequent follow-up were also statistically significant (ANOVA, p < 0.0001*). CONCLUSION: A significant improvement was observed with THR in both groups. Nevertheless, the flattened hip joint congruency group showed significantly better HHS improvements than the normal congruency groups. These findings may aid in the decision-making capabilities of the surgeons.

Air Quality Over Major Cities of Saudi Arabia During Hajj Periods of 2019 and 2020.

Mecca and Madinah are two holy cities where millions of people in general, visit throughout the years, during Hajj (Muslim's pilgrimage) time number of people visit these holy cities from different parts of the world is very high. However, the Government of Saudi Arabia only allowed 1000 pilgrims during the 2020 Hajj especially when the world is suffering from COVID-19. In the present paper, a detailed analysis of air quality parameters available from ground measurements have been carried over major cities of Saudi Arabia, Mecca, Madinah, and Jeddah from June to September 2019 and 2020. At Mecca and Jeddah, PM10, NO2 and CO concentrations are found to be higher in comparison to stations located close to Madinah. In addition, meteorological parameters, temperature, relative humidity, and wind directions are also analysed to understand changes associated with the meteorological parameters. Our detailed analysis shows a reduction in concentrations of pollutants during the 2020 Hajj, when the lockdown was observed in Saudi Arabia due to COVID-19. During June-August 2020 lockdown period, no major changes in PM10 concentration was observed since there were frequent dust events were observed. In contrast, our results show 44% reduction in NO2 (8.77 ppbv in 2019 to 4.97 ppbv in 2020) and 16% reduction in CO (0.85 ppm in 2019 to 0.72 ppm in 2020) concentrations during COVID-19 restrictions. The concentrations of NO2 and CO do not cause any issue for the air quality as NO2 and CO Indices lie within the green band (Air quality index 0-50). In Mecca, Madinah and Jeddah, the air quality is generally affected during Hajj, but during 2020, the concentration of particulate matter was influenced by local weather conditions.

Total knee replacement at Southwestern Saudi Arabia: A single-center experience.

BACKGROUND: Knee replacement enables the surgical management of end-stage knee joint osteoarthritis. In Saudi Arabia, there has been a recent increase in total joint replacement surgery. However, there is insufficient literature regarding patient outcomes in this region. Here, we assessed characteristics of patients who underwent total knee arthroplasty and their improvements on knee society score, timed up and go test, and 2-min. walk test. METHODS: Patients who underwent primary total knee replacement at our tertiary care private hospital in Abha from January 2013 to January 2020 were included. The same orthopedic surgery performed primary cemented cruciate-substituting knee replacement. Knee function was evaluated using the knee society scoring system, timed up and go test, and 2-min. walk test. RESULTS: Out of 420 patients, 350 were females (83.33%) and 70 males (16.67%). The mean age was 69.50 ± 7.48 years (range, 48-90). Most patients had osteoarthritis (84.5%), either degenerative or secondary because of trauma. Knee society functional and knee scores were poor preoperatively (mean, 38.21 ± 9.65; SD, 36.89 ± 8.23) but improved postoperatively (mean, 81.42 ± 12.74; SD, 85.49 ± 11.69; P < 0.001). The timed up and go test significantly changed from 28.51 ± 3.29 s to 18.18 ± 3.17 s (P < 0.001) and 2-min. walk test from 51.83 ± 6.48 m to 85.72 ± 8.92 m (P < 0.001). CONCLUSION: Despite knee replacement's late acceptance in Saudi Arabia, there have been increased cases in recent years and excellent improvements in knee function. The resulting knee society functional and knee scores, timed up and go tests, and 2-min. walk tests were better or similar to results seen by other researchers worldwide.

Levels of public awareness regarding cervical spine injury and the suitable first aid response among adults in Saudi Arabia.

OBJECTIVES: To evaluate the level of public awareness regarding cervical spine injuries among adult residents of the Kingdom of Saudi Arabia (KSA). METHODS: This descriptive cross-sectional study was carried out between June and November 2020. It involved structured questionnaires, collecting information on participant socio-demographic characteristics, first responder training status, and the awareness of cervical spine trauma and suitable first aid response. RESULTS: A total of 4914 respondents (age, 31.6 ± 11.8 years) completed the survey. Most participants (75.2%) reported road traffic accidents as a risk factor for cervical spine injury. Moreover, 79.4% of the participants reported that cervical spine injury may be accompanied by damage to the spinal cord. Motor and sensory disability, and trouble breathing were recognized as complications associated with cervical spine injuries by 52.1%, 39%, and 28.8% of the participants, respectively. Fewer than one in 3 participants was aware of cervical spine trauma or the suitable first aid response. CONCLUSION: Public awareness regarding cervical spine trauma is poor among the KSA residents, although most study participants were aware trauma victims should be immobilized at the site of the accident until the arrival of an emergency response team.

Western-designed total knee implants mismatch Saudi patient knees. Anatomical bony measurements documented by computed tomography.

OBJECTIVES: To determine the anthropometric features of Saudi knees compared with knees of other ethnicities and reveal mismatches among different knee implant systems. METHODS: All knee computed tomography images obtained between January 2016 and September 2016 for varying medical reasons in a tertiary care hospital in Southwestern Saudi Arabia were retrospectively evaluated. Patients aged less than 18 years, with trauma or soft tissue or bone tumors were excluded.  Eleven parameters were measured for each knee joint. RESULTS: We evaluated 100 knees of 50 Saudi patients (25 men, 25 women) aged 28-85 (mean, 57.3) years. No statistically significant differences were found in age and Sasaki angle measurements between male and female patients. All other parameters were significantly larger in male than female knees. Our measurements were close to those published for Chinese, Thai, and Korean patients; however, published measurements were larger for Caucasian and Indian knees than our measurements. CONCLUSION: The Saudi population has morphological features of knee bone anatomy that do not match with the widely available prostheses designed for Caucasian knees. As several studies of different ethnicities have documented considerable prosthesis mismatch; our study further indicates the need for new implant designs that take these variations into account.

Burnout syndrome among southern region orthopedic surgeons, Saudi Arabia.

BACKGROUND: Burnout is known as result of long term exposing to stress. There are some factors that may cause stress in physicians: nature of work, their training, their public image, their families and themselves. The person who has burnout syndrome (BOS) seems like to have tiredness, low energy, nervousness, and mentally unstable. The aim of the study is to assess the pattern and magnitude of burnout among orthopedic surgeons in southern region, Saudi Arabia. METHODOLOGY: A descriptive cross-sectional survey was applied targeting all orthopedic surgeons in 12 hospitals all southern region, Saudi Arabia during the period from December 2018 to April 2019. Data were collected using self-administered questionnaire that was developed by the researchers. The questionnaire included personal data. Burnout was assessed using Maslach Burnout Inventory Scale. RESULTS: A total sample of 107 orthopedic surgeons were included with their ages ranged from 25 to 65 years old with mean age of 38.1 ± 8.9 years. About 94% of the surgeons were males and 43.9% were Saudi. Generally, the surgeons recorded mean score for emotional exhaustion of 18.9 points out of 54 with mean score% of 35.1%. Regarding depersonalization, the surgeons had mean score % of 30.7% and had a score of 39.6% for personal accomplishment. CONCLUSIONS: The study revealed that all included physicians had moderate levels of burnout. Personal accomplishment was the highest level of burnout recorded. Health education sessions and periodic training is required to improve surgeons coping strategies to overcome burnout.

Tumoral Calcinosis Presentation in Operated Developmental Dysplasia of the Hip: A Case Report and Review of Literature.

Tumoral calcinosis has long been a disputed clinical-pathological subject. It has been characterized by the deposition of calcium salt and hydroxyapatite in different periarticular soft tissue regions. It is most commonly seen in adults, and rarely seen in children. In this report, we present the case of a six-year-old girl referred to our institution for one year with a history of left hip pain and swelling. The patient underwent an open reduction of left hip and acetabuloplasty for developmental dysplasia of the hip (DDH) at the age of two years. Systematic investigations were performed and showed that the patient had abnormal calcifications and large, ill-defined lesions with an irregular margin on the left hip extended to the left gluteal area with skin ulceration suggestive of primary tumor calcinosis. Medical therapy has started, and a follow-up appointment was given to her in a pediatric metabolic clinic. In addition, we present a brief literature review of the effect of medical and surgical treatments on tumor calcinosis.

Bioremediation of Explosive TNT by Trichoderma viride.

Nitroaromatic and nitroamine compounds such as 2,4,6-trinitrotoluene (TNT) are teratogenic, cytotoxic, and may cause cellular mutations in humans, animals, plants, and microorganisms. Microbial-based bioremediation technologies have been shown to offer several advantages against the cellular toxicity of nitro-organic compounds. Thus, the current study was designed to evaluate the ability of Trichoderma viride to degrade nitrogenous explosives, such as TNT, by microbiological assay and Gas chromatography-mass spectrometry (GC-MS) analysis. In this study, T. viride fungus was shown to have the ability to decompose, and TNT explosives were used at doses of 50 and 100 ppm on the respective growth media as a nitrogenous source needed for normal growth. The GC/MS analysis confirmed the biodegradable efficiency of TNT, whereas the initial retention peak of the TNT compounds disappeared, and another two peaks appeared at the retention times of 9.31 and 13.14 min. Mass spectrum analysis identified 5-(hydroxymethyl)-2-furancarboxaldehyde with the molecular formula C6H6O3 and a molecular weight of 126 g·mol-1 as the major compound, and 4-propyl benzaldehyde with a formula of C10H12O and a molecular weight of 148 g mol-1 as the minor compound, both resulting from the biodegradation of TNT by T. viride. In conclusion, T. viride could be used in microbial-based bioremediation technologies as a biological agent to eradicate the toxicity of the TNT explosive. In addition, future molecular-based studies should be conducted to clearly identify the enzymes and the corresponding genes that give T. viride the ability to degrade and remediate TNT explosives. This could help in the eradication of soils contaminated with explosives or other toxic biohazards.

Characterization of Date Palm Fiber-Reinforced Different Polypropylene Matrices.

In this study, the effect of different polypropylene (PP) matrices (homopolymer (HPP), impact copolymer (ICP), and recycled polypropylene (rPP)) on the mechanical, morphological, and thermal properties of date palm fiber (DPF)-reinforced PP composites was investigated. The DPFs were treated with an alkali solution, and composites were fabricated with different DPF loadings (5, 10, and 15 wt %) and lengths (less than 2 mm and 8-12 mm). It was found that the tensile properties of the DPF/ICP and DPF/rPP composites were similar to those of the DPF/HPP composites. The addition of fiber to the matrix reduced its tensile strength but increased the modulus. The alkali treatment improved the compatibility between the fibers and the matrix by removing hemicellulose and other impurities. Fourier transform infrared spectroscopy confirmed hemicellulose removal. The morphology of the alkali-treated fractured tensile specimen revealed improved adhesion and less fiber pull out. Differential scanning calorimetry revealed that the alkali treatment enhanced the crystallinity index. Thermogravimetric analysis showed that the addition of DPFs into the PP matrix reduced the thermal stability of the composite. However, the thermal stability of the treated fiber-reinforced rPP and ICP composites was similar to that of the DPF/HPP composite. Hence, rPP can be used as an alternative to HPP with DPFs.

Future ophthalmology practice pattern: A survey of Saudi Board of Ophthalmology residents.

PURPOSE: The main purpose of the study was to examine and identify factors that influence the future practice pattern of Saudi Board of Ophthalmology residents as well as their academic goals. This study also aimed to compare the plans and career goals of the current Saudi ophthalmology residents with a former cohort of Saudi ophthalmology residents. METHODS: All current residents of Saudi Board of Ophthalmology were invited to complete an anonymous online survey in March 2017. Residents were contacted by email. The survey contained questions on demographics, plans and factors influencing career choice of the residents in their future. Data were categorized by gender. Chi-square was used to assess the effect of gender on outcomes where appropriate. RESULTS: Of 150 residents surveyed, 91 (61%) responded to the survey. Having the ability to combine medicine and surgery was the most motivating factor for pursuing an ophthalmology residency training program (81% of respondents). Most residents expressed an interest in providing refractive surgery (62%), being involved in research activities (85%) and working part-time in the private sector (73%). The majority (81%) expressed a desire to practice in an urban setting as well as pursuing fellowship training (81%). Anterior segment (31%) and surgical retina (15%) were the most popular choices for fellowship training. CONCLUSION: Increasing interest in joining fellowship training programs (mostly in surgical subspecialties) and being involved in research activities among current generation of ophthalmology residents have been observed compared to a previous cohort study in the same country.

Retinopathy of Prematurity Incidence and Risk Factors in a Tertiary Hospital in Riyadh, Saudi Arabia.

PURPOSE: The purpose of the study was to determine the incidence of retinopathy of prematurity (ROP) in preterm infants in the neonatal intensive care unit (NICU), to identify the risk factors that predispose to ROP, and to assess the outcome of these infants. MATERIALS AND METHODS: This was a retrospective cohort study on premature infants with a birth weight (BW) of <1501 g or gestational age (GA) of <32 weeks. These infants were admitted to the NICU at a tertiary hospital in Riyadh, Saudi Arabia, from January 2010 to December 2014. RESULTS: Five hundred and ninety-three infants were included; data were available for 581 infants. Of them, 224 infants (38.6%) had ROP. Of these, 22 infants (10.4%) had stage 3 ROP. The mean BW of infants with ROP was 938.4 ± 257.9 g, and the mean GA at birth was 27 ± 2.4 weeks. A significant relationship with a P < 0.05 was found between the occurrence of ROP and small GA at birth, low BW, low APGAR score at 1 min, and long duration of receiving oxygen (O2) therapy. Based on charts review, none of the infants had blindness. CONCLUSION: The incidence of ROP in our study falls in the range of incidence in developing countries. The low BW and small GA were the most significant risk factors. Furthermore, it is also recommended to control the amount and duration of O2 therapy to as little as needed.

Cardiac implantable electronic devices in adults with tetralogy of Fallot.

BACKGROUND: Tachyarrhythmias and bradyarrhythmias affect 20%-50% of adult patients with tetralogy of Fallot (TOF) and some of these patients will require cardiac implantable electronic devices (CIED) such as pacemaker and/or internal cardioverter defibrillator. METHODS: The Mayo Adult Congenital Heart Disease database was queried for patients with repaired TOF and history of CIED implantation, 1990-2017. The study objectives were: (1) determine the occurrence of device-related complications defined as lead failure, lead recall, device infection and lead thrombus; and (2) determine the occurrence and risk factors for defibrillator shock. RESULTS: There were 99 patients (age 46±14 years and 66 (66%) men) with CIED, and the CIEDs were 41 (41%) pacemakers and 73 (73%) defibrillators. Indication for defibrillator implantation was for primary prevention in 28 (38%) and secondary prevention in 45 (62%). Device-related complications occurred in 20 (20%) patients (lead failure 17, lead recall 4, device infection 12 and thrombus 3). Twenty-five per cent of all device infections occurred within 30 days from the time of device generator change. Annualised rates of appropriate and inappropriate shocks were 5.7% and 6.2%, respectively. The use of class III antiarrhythmic drug was protective against defibrillator shock. CONCLUSION: The current study provides useful outcome data to aid patient counselling and clinical decision-making. Further studies are required to explore ways to decrease the risk of postprocedural infection after device generator change, and to determine which patients will benefit from empirical antiarrhythmic therapy as a strategy to decrease incidence of inappropriate defibrillator shock.

Splenectomy vs. rituximab as a second-line therapy in immune thrombocytopenic purpura: a single center experience.

Immune thrombocytopenic purpura (ITP) is a common hematological disease treated primarily by corticosteroids. The aim of the present study was to compare response rate between patients, underwent splenectomy vs. rituximab as second-line therapy. Adult patients diagnosed with ITP who did not respond to corticosteroids or relapsed during the period 1990-2014 were included in a quasi-experimental study. Categorical variables were compared using Fisher exact test. Response to treatment was compared using logistic regression. Data were analyzed using SAS V9.2. One-hundred and forty-three patients with ITP were identified through medical records. Of 62 patients treated, 30 (48.38%) required second-line therapy. 19 (63%) patients received rituximab, and 11 (37%) underwent splenectomy. Platelets at diagnosis were not different between study groups (p = 0.062). Splenectomy group patients were younger (p = 0.011). Response to second-line therapy showed no significant difference between two groups (OR 2.03, 95% CI (0.21-22.09), p = 0.549). Results did not show a statistically significant difference in platelet counts over time between treatment groups (p = 0.101). When used exclusively as a second-line therapy for steroid-refractory ITP, the response rate was not statistically different between rituximab and splenectomy. However, further large studies are needed to assess the response rates for these treatment modalities as a second-line therapy.

Validity, Usefulness and Cost of RETeval System for Diabetic Retinopathy Screening.

PURPOSE: We studied the validity, usefulness, and relative cost to detect diabetic retinopathy (DR) and sight-threatening DR (STDR) by using a hand-held electrophysiologic tool compared to digital fundus photography. METHOD: Patients with diabetes attending the screening unit of King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia were evaluated by "RETeval", Amsler grid, and digital dilated fundus photography. Fundus images were evaluated by a retina specialist to determine grade of DR. The sensitivity and specificity of STDR and DR screening compared to photography were calculated, as well as "RETeval" combined with Amsler grid testing. The area under the curve (AUC) of "RETeval" screening outcome was calculated. RESULT: We analyzed data of 400 diabetic patients. The prevalence of DR of any grade was 48.8% (95% confidence interval [CI], 43.9-53.7) while the prevalence of STDR was 27% (95% CI, 22.6-31.4). The outcome of RETeval test was "fail" (based on 20 µV or more amplitude of electrophysiologic spikes) in 351 (87.8%; 95% CI, 84.5-91.0) eyes. The sensitivity of the device was 95.4% and the specificity was 17.5%. Thus, the sensitivity of sequential testing with RETeval and Amsler grid test was 30.1% and the specificity was 80.1%. The AUCs for STDR and DR in general were 76.6% and 50.6%, respectively. CONCLUSIONS: "RETeval" is a rapid screening device with excellent sensitivity for detecting STDR. It has potential as a first level screening tool to detect patients who require further evaluation. TRANSLATIONAL RELEVANCE: Retinal function, such as electrophysiology, can be used as a new concept for screening for DR.