Infantile hypertrophic pyloric stenosis in Bosnia and Herzegovina: A retrospective cohort study from the largest tertiary care facility.

BACKGROUND: Infantile hypertrophic pyloric stenosis (IHPS) is the most common condition requiring surgery in infancy, but the etiology of IHPS is still unclear. The study aimed to analyze the epidemiological and clinical features of the infants with IHPS in our setting and determine the yearly trends in IHPS incidence in the Sarajevo Canton between 2007 and 2016. METHODS: We retrospectively analyzed epidemiologic, clinical, and operative data of all infants undergoing pyloromyotomy for IHPS over ten years in the largest tertiary care facility in Bosnia and Herzegovina. RESULTS: Fifty-three IHPS patients were diagnosed, yielding an overall incidence of 1.17 per 1000 live births (1.25 and 1.09 cases in 2007-2011 and 2012-2016, respectively). IHPS was more prevalent among male infants (ratio 6.6:1, p < 0.001). The mean age at onset of symptoms was 39.6 days (range, 17-107 days). The estimated median time from symptoms onset to hospitalization was 11 days (range, 1-17 days). The mean age at diagnosis was significantly longer in premature infants compared with term infants (p = 0.003). Both first-born rank and bottle-feeding were significantly associated with IHPS (p = 0.001 and p = 0.04, respectively). No seasonal variation associated with IHPS was detected (p = 0.25). No evidence was found of differences in the incidence of IHPS related to maternal age (p = 0.24) and smoking (p = 0.59). CONCLUSION: Our data indicate a declining trend and provide insights into the clinical characteristics of IHPS in Bosnia and Herzegovina. Most of the obtained results are in line with the published data and could improve the quality of local pediatric services.

Assessment of Perfused Peripapillary Capillaries and Peripapillary Capillary Density Maps in Glaucoma Patients.

INTRODUCTION: Monitoring and diagnosing glaucoma until 2017 included funduscopy, IOP measurements, gonioscopy, pachymetry, as well as visual field tests, optical coherence tomography (OCT) and optical coherence tomography angiography (OCT-A). Radial peripapillary capillaries (RPC) can be observed by fluorescein angiography, as well as histologically - superficial and deep capillary layer. AIM: To correlate density of radial peripapillary capillary network (RPC) and retinal nerve fiber layer (RNFL) thickness in eight peripapillary segments in patients with a primary open angle glaucoma (POAG) which have the disease under 10 years of duration, over 10 years of duration and in a group of healthy patients. METHODS: This is a cross-sectional review which included three groups of patients: POAG patients under 10 years of disease duration, over 10 years of disease duration and control group of patients. The study is performed on the commercial optical coherence tomography angiography system (AngioVue, Avanti RTVue-XR, Optovue, CA). Sectoral RPC density values, RPC maps and RNFL thickness were analyzed in three groups of patients, data was compared and correlation between parameters was examined. RESULTS: Mean RPC Density values in both superior segments (S1, S2) were significantly lower in patients with glaucoma over 10 years of disease duration compared to patients with glaucoma under 10 years of disease duration (p<0.05). Statistically significant positive correlation was established between RNFL thickness and RPC density in all eight peripapillary segments. CONCLUSION: Analysis of radial peripapillary capillary network density on optical coherence tomography angiography may provide an earliest functional sign of progressive optic nerve disease and new insights into the pathophysiology of glaucomatous damage.

Assessment of Retinal Microangiopathy in Chronic Kidney Disease Patients.

INTRODUCTION: Optical coherence tomography angiography (OCT-A) is a useful diagnostic tool for assessing eyes' health in patients with chronic diseases, such as diabetes, hypertension, Parkinson's disease and chronic kidney disease (CKD). AIM: To detect changes in macular structure and retinal vascular meshwork in the macular area and peripapillary in patients with chronic kidney disease (CKD). METHODS: This cross-sectional study included 80 eyes of patients with CKD in stages 2, 3 or 4, who were followed-up in the Nephrology Clinic of University Clinical Center Sarajevo. All patients were categorized according to the stage of CKD. All patients were scanned by a high-speed 840-nm-wavelength spectral-domain optical coherence tomography instrument (RTVue XR Avanti; Optovue, Inc, Fremont, California, USA). Blood flow was detected using a split-spectrum amplitude-decorrelation angiography algorithm. A fully automated microstructural analysis of the foveal avascular zone (FAZ), FAZ perimeter, foveal vessel density in a 300-µm area around the FAZ (FD), nonflow area, flow index in superficial and deep vascular plexus, choriocapillary flow, vascular density, radial peripapillary capillary density was performed. RESULTS: When comparing patients with CKD stage 2 and stage 3 there were no statistically significant changes in microvascular parameters on OCT angiography, as well as when comparing patients with CKD stage 3 and stage 4. But in the comparison between patients with less developed CKD (stage 2) and terminal CKD (stage 4) there was a significant difference between some microvascular parameters such as FAZ area, FAZ perimeter, choriocapillary flow. CONCLUSION: Many studies demonstrated that evaluation of the microvascular changes in different retinal layers using SS-OCTA may be considered as a key to assessing the systemic perfusion status. Evaluation of retinal microvasculature may ease the management and approach of patients with CKD, having in mind that the retinal and the kidney vascular network are, concerning structure, development and the function, very similar.

Optical Coherence Tomography Angiography Contributions in Classification of Nonproliferative Diabetic Retinopathy.

INTRODUCTION: To show the importance of optical coherence tomography (OCT) angiography imaging of superficial and deep capillary network in patients with non-proliferative diabetic retinopathy (NPDR), and to show the correlation between blood glucose level and changes in the foveal microvasculature. METHODS: A cross-sectional study was performed on eyes with NPDR and healthy subjects using a highspeed 840-nm-wavelength spectral-domain optical coherence tomography instrument (RTVue XR Avanti; Optovue, Inc, Fremont, California, USA). Blood flow was detected using the split-spectrum amplitude-decorrelation angiography algorithm. A fully automated microstructural analysis of the foveal avascular zone (FAZ) and avascular surfaces was performed. Quantitative values from diabetic patients were compared with those of healthy subjects. Data about blood status in diabetic patients and healthy subjects were taken from patients' medical history. RESULTS: Size of both, FAZ and vascular dropout are significantly different between healthy patients and patients with NPDR. OCT angiography detected enlargement and distortion of the foveal avascular zone, retinal capillary dropout, and a higher number of vascular loops and microaneurysms. Sizes of FAZ and vascular dropout increase with the duration of disease. Central macular thickness (CMT) is not significantly different between healthy patients and patients with NPDR. A study has proven a positive correlation between the size of FAZ and the size of vascular dropout in superficial vascular plexus in patients that have DM over 10 years. CONCLUSION: A qualitative and quantitative OCT angiography approach to retinal vascular status can offer objective data on monitoring patients with non-proliferative diabetic retinopathy as well as indicate the progression of the disease.