Istanbul Eye Hospital

This study aimed to establish the normal range of kidney stiffness (KS) in individuals with normal appearing kidneys (INK) using 3 Tesla (T) magnetic resonance elastography (MRE) while also exploring the potential influence of demographic and anatomical parameters on KS. This retrospective study included cases from March 2021 to October 2024, in May 2025, where abdominal magnetic resonance imaging (MRI) was performed, capturing both kidneys in the cross-sectional area. Only cases with normal kidney signal characteristics and morphology on conventional MRI sequences were included. All relevant data and radiological images were obtained from the hospital computerized database. The study included patient age, sex, comorbidity status, body mass index (BMI), and specific MRI and MRE parameters, including kidney stiffness (KS in Pascal), cranio-caudal (CC) diameter, anteroposterior (AP) diameter, lateral diameter, and kidney volume. The study included 31 males (51.70%) and 29 females (48.30%), with a mean age of 36.30 ± 9.05 years. No significant correlation was found between the stiffness of the right and left kidneys and age, sex, or BMI. The mean stiffness of the right kidneys was 2360.57 ± 93.62 Pa, while that of the left kidneys was 2360.35 ± 144.13 Pa. No significant correlations were observed between the CC diameter, AP diameter, lateral diameter, kidney volume of either kidney, and stiffness. KS values were similar in both kidneys and showed no correlation with demographic or anatomical factors, indicating their consistency for future studies.

Drainage is used to prevent complications such as hematoma and seroma formation during liposuction. This study aims to place the drain into the desired area in patients undergoing liposuction with the liposuction canulae. This technique enables the procedure to be completed without the need for instruments or additional incisions. In this technique, we used a thick, long liposuction cannula with a wide hole at its tip. The cannula was advanced along the desired tract through the liposuction trocar incision. Once the cannula reached the most distal point where the drain was intended to be placed, a 2/0 Vicryl suture was sequentially passed through the skin, between the holes of the cannula, and then through the skin again, exiting externally. The end of the suture emerging from the trocar site was tied to the distal end of the drain that was intended to remain within the tissue. Then, by gently pulling the externalized end of the suture at the skin, the drain was advanced through the tissue. No additional scars were created during the drain placement in any of the patients. Furthermore, no complications, such as hematoma or seroma, were observed in the liposuction area. No additional incisions are made, thereby preventing the formation of extra scars. The drainage tube can be placed precisely within the desired area or tract. Only instruments already utilized during the surgical procedure are employed, resulting in reduced overall cost. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Lower abdominal surgeries in children are associated with significant postoperative pain. While caudal block (CB) is widely used, ultrasound-guided truncal blocks such as retrolaminar block (RLB) may provide more targeted and prolonged analgesia. In this double-blind, randomized controlled trial conducted at two tertiary hospitals (March 1-September 1, 2025), children aged 1-7 years (ASA I-II) scheduled for unilateral orchidopexy were randomized to RLB or CB. CB received 0.125% bupivacaine 1 mL/kg (max 20 mL); RLB received 0.25% bupivacaine 0.1 mL/kg, both under standardized general anesthesia with intraoperative IV paracetamol (10 mg/kg). FLACC scores were recorded at 30 min and 1, 2, 4, 6, 12, and 24 h. Rescue analgesia was IV paracetamol for FLACC 2-4 and IV tramadol for FLACC >4. Primary outcome was analgesic efficacy (FLACC at 12th hour). Secondary outcomes were time to first analgesic and total consumption within 24 h. Sixty-two patients were analyzed (N.=31 per group); baseline demographics did not differ. RLB yielded lower FLACC scores at 6 h (P=0.002), 12 h (P=0.007), and 24 h (P=0.018), with no difference at 30 min or 1 h (P>0.05). Time to first analgesic was longer with RLB (P<0.001), and total 24-h consumption was lower (P=0.001). Fewer patients required rescue analgesia with RLB (3/31) than CB (14/31). No major block-related complications occurred. In pediatric orchidopexy, RLB provided superior and more durable analgesia than CB, reduced 24-h analgesic requirements, and delayed first rescue dosing without major complications, supporting its role within opioid-sparing pediatric ERAS pathways.

Background and Objectives: Predictive performance of the modified myocardial performance index (Mod-MPI) for emergency cesarean delivery secondary to intrapartum fetal compromise (IFC) was examined in late-onset fetal growth restriction (FGR) or small-for-gestational-age (SGA) pregnancies. Materials and Methods: This prospective observational cohort comprised 120 singleton term pregnancies affected by late-onset FGR or SGA, classified in line with the Delphi consensus criteria, for whom a trial of vaginal delivery was planned. The primary endpoint was emergency cesarean delivery indicated by IFC, while the secondary endpoint was the development of composite adverse perinatal outcomes (CAPO). Measurements of Mod-MPI, the umbilical artery, the middle cerebral artery, and the cerebroplacental ratio (CPR) were performed within the final 72 h before delivery and were blinded to the clinicians managing the intrapartum period. Results: IFC constituted 28.3% (n = 34) of the study cohort. The IFC group exhibited significantly higher Mod-MPI values and lower CPR values (p < 0.001). In multivariable analysis, elevated Mod-MPI (≥0.61) and reduced CPR (<5th percentile) were identified as independent predictors of IFC. On receiver operating characteristic analysis, Mod-MPI demonstrated superior discriminative performance compared with CPR for predicting IFC (area under the curve [AUC]: 0.835 vs. 0.759). In contrast, CPR showed the highest diagnostic performance for predicting CAPO (AUC: 0.779). Conclusions: Mod-MPI reflects subclinical cardiac dysfunction in fetuses with late-onset FGR and SGA and represents a valuable parameter for predicting tolerance to acute intrapartum stress. Rather than routine implementation, it appears most appropriate as a complementary tool contributing to intrapartum risk assessment in selected high-risk cases.

No-reflow phenomenon (NRP) after primary PCI in STEMI is strongly linked to early mortality and adverse events. Conventional indices such as the systemic immune-inflammation index (SII), the CRP to albumin ratio (CAR), and the SYNTAX 1 score (SXscore) appear to provide only moderate discrimination for NRP. The endothelial activation and stress index (EASIX), calculated as LDH × creatinine / platelet count, reflects endothelial dysfunction and microvascular stress and may add to risk stratification. This two-center retrospective cohort study included 983 consecutive STEMI patients undergoing primary PCI. NRP was defined as the failure to achieve distal TIMI 3 flow despite a fully patent epicardial artery, or the need for pharmacological therapy to reverse NRP. We evaluated the relationships of EASIX, SII, CAR and SXscore with NRP; key exclusion criteria were non-ticagrelor P2Y12 loading, advanced renal/hepatic failure, active infection/inflammatory–hematologic disease or malignancy, shock/arrest (Killip ≥ 2), door-to-balloon time > 60 min, prior CABG/PCI, and pre-PCI fibrinolytic therapy. NRP occurred in 267 patients (27.2%). EASIX, SII, CAR and SXscore were significantly higher in the NRP (+) group (all p < 0.001). In multivariable models, EASIX (OR 18.97, 95% CI 11.83–30.43; p < 0.001), CAR (OR 2.45, 95% CI 1.90–3.16; p < 0.001), SII (OR 1.000, 95% CI 1.000–1.000; p = 0.003), and SXscore (OR 1.04, 95% CI 1.03–1.06; p < 0.001) were independently associated with NRP. In ROC analysis, EASIX demonstrated the highest discriminative ability for predicting NRP (AUC = 0.835). The optimal cut-off value of 1.248 provided 62.2% sensitivity and 93.6% specificity. In comparison, CAR, SII, and SXscore showed lower discrimination (AUC = 0.687, 0.562, and 0.583, respectively). EASIX demonstrated a stronger association with NRP than CAR, SII, and the SXscore. Easily derived from routine laboratory tests, EASIX may represent a practical and readily applicable index for early NRP risk stratification in STEMI.

Introduction & Objective: Graft-versus-host disease (GVHD) is a major complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT), with limited treatment options for steroid-resistant cases. Ruxolitinib, a JAK1/2 inhibitor, has shown promise in treating steroid-resistant acute (aGVHD), chronic (cGVHD), and overlap GVHD (oGVHD), but real-world data remain limited. This study evaluated the real-world efficacy and safety of ruxolitinib in allo-HSCT patients with steroid-resistant GVHD. Materials & Methods: This retrospective, multicenter study included adult patients treated with ruxolitinib for Grade II or higher aGVHD or moderate-to-severe cGVHD at nine centers in Turkey (2017-2024). Clinical characteristics, treatment responses, and adverse events were recorded. Primary outcomes were overall response rate (ORR) and overall survival (OS). Results: Among 80 patients (mean age: 39.3 ± 13.3 years; 60 males), 39 had aGVHD, 68 cGVHD, and 15 oGVHD. The ORR was 72 of 80 patients (90.0%) (complete response: 37 of 80 [46.3%], partial response: 35 of 80 [43.8%]). The 1-year and 2-year OS rates were 91.3% and 82.5%. Severe cGVHD (p < 0.001) and lack of response to ruxolitinib (p = 0.018) were associated with reduced OS. Adverse events included infections in 40 of 80 patients (50.0%), cytopenias in 23 of 80 (28.7%), and cytomegalovirus reactivation in 20 of 80 (25.0%). Conclusion: In this retrospective multicenter cohort, ruxolitinib was associated with high response rates in steroid-refractory GVHD, while disease severity remained a key determinant of survival, and findings should be interpreted as exploratory.

Intoeing is a common reason for pediatric orthopedic consultations. Families increasingly use YouTube for medical information, but the reliability and quality of this content are unclear, and no previous study has evaluated videos on intoeing. This study assessed the reliability, educational quality, and popularity of YouTube videos on intoeing using validated scoring systems and a novel disease-specific tool. YouTube was searched using the terms 'intoeing', 'pigeon toe', and 'toeing in'. After applying inclusion and exclusion criteria, 48 videos were analyzed. Video characteristics were recorded, and reliability and quality were evaluated using the Journal of the American Medical Association score, Global Quality Score, DISCERN instrument, and the Intoeing Specific Score (ISS) developed for this study. Popularity was measured using the Video Power Index. Interobserver and intraobserver reliability were calculated, and statistical analyses examined associations between scores, video sources, and content. Overall quality was low: 76.4% of videos scored less than or equal to 2 on the Journal of the American Medical Association score, and 54% were rated poor or very poor by DISCERN. According to the ISS, 43.8% were very poor. Academic and physician-generated videos had higher educational quality but lower popularity than nonprofessional sources. Videos from YouTube-verified uploaders scored significantly higher in all quality measures, yet popularity did not correlate with educational quality. YouTube videos on intoeing are generally low quality, revealing a gap between popularity and reliability. Although academic and physician-generated content is more accurate, it is less represented among popular videos. The ISS showed strong reliability and may be useful for future evaluations of disease-specific online content.

Purpose: To identify and report such rare entity and keep special concern to manage such case. Method: It is a prospective study. We hereby reviewed six cases of this rare entity selected from pediatric outpatient department of Ispahani Islamia Eye Institute &amp; hospital since January ’2019- December’2019. Selected patients underwent detailed history taking, cyclo refraction, slit lamp examination, orthoptic evaluation, fundoscopy and nystagmus evaluation. Result: Average age of presentation was 8+/-2 years. Aided visual acuity of two patients was (3/60-6/60), three (6/60-6/24), one (6/24-6/12). Four patients had positive family history of high myopia. On slit lamp examination revealed deep anterior chamber. One case showed normal fundus where remaining fives had characteristic myopic fundus. Four were associated with jerky nystagmus. Three of them had right beating and one left beating nystagmus. Head tilt was present in one patient. Ocular motility was free for two cases whereas restricted in variable degree in four cases may be due to herniation of progressive enlarging myopic globe supero temporally and retro equatorially through muscle cone. Conclusion: Understanding the different spectrum of presentation of high myopic patient facilitates early diagnosis, rehabilitation and management of such patient. J.Natl.Inst.Ophthalmol.2024;7(2): 71-75