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Background: Age-related macular degeneration (ARMD) is a chronic, incurable, progressive, multifactorial, neurodegenerative disease, which is one of the leading causes of visual impairment, among individuals above 60 years of age in developed countries. Over the past decades, the role of inflammation and CRP in the pathogenesis of ARMD has been investigated.

Objective: The study aimed to investigate the association between inflammation or CRP levels in prediction the development or the progression of ARMD.

Methods: This retrospective-prospective, case-control study, was conducted at the Clinic for Eye Diseases, University Clinical Center Tuzla, from 2020. to 2024. Two group of participants were included in this study. The first group (n=100 patients) consisted of patients diagnosed with different stages of ARMD, and second, control group (n=100 patients) consisted of patients without ARMD. The study included subjects of both sexes, divided into three age categories (≤55; 56-66; ≥67 years). Detailed ocular and systemic evaluations were performed, including fundus examination and OCT angiography. A 5mL sample of venous blood was colected to determine serum CRP levels, for the both group of patients, using latex immunoassay method. Statistical analysis, including Student's t-test, Chi square test and posthoc (Turkey) tests, was conducted using SPSS 26 for Windows, with p<0,05 considered significant.

Results: Out of 100 patients, 34 were having early, 18 intermediate and 48 were having advanced stages of ARMD. The mean serum CRP levels in the ARMD group (8.39±27.22mg/L) were significantly higher compared to the control group, (2.52±5.35mg/L), p=0,000. Also, serum CRP values by age category, between ARMD subjects and the control group, showed statistically significant differences in all age groups: ≤55 p=0.032; 56-66 p=0.019; ≥67 p=0.000. The mean serum CRP levels was 6.6±6.9 mg/L, 10±13.3 mg/L and 16±22.7 mg/L, in early, intermediate and advanced ARMD, respectively. Comparing these CRP values and different stages of ARMD, there were found statistically significant differences between the three stages. Furthermore, these results showed that mean CRP values increase with disease severity.

Conclusion: Based on the obtained results serum CRP levels are significant risk factor in predicting the development and the progression of ARMD. Also, these results emphasize the role of systemic inflammation in the development and progression of ARMD.

Background: Sympathetic ophthalmia (SO) is a bilateral, diffuse granulomatous panuveitis that can occur after a penetrating trauma or intraocular surgery. The time from ocular injury to the onset of sympathetic ophthalmia varies greatly, ranging from several days to decades.

Objective: We report on the diagnostic dilemma and clinical outcome of patient with sympathetic ophthalmia within 2 weeks of cataract surgery.

Case presentation: A patient underwent left eye cataract surgery that was complicated by postoperative iris prolapse through the corneal wound. The wound was sutures with iris still entrapped, and he presented to our clinic 1 week later with bilateral vision loss and panuveitis. After workup for other inflammatory or infectious causes, sympathetic ophthalmia was diagnosed, and the patient was treated with topical and systemic corticosteroids. One month later, visual acuity improved markedly in both eyes, and inflammatory symptoms and findings resolved. Sympathetic ophthalmia may occur soon after cataract surgery and can be confused with infectious endophthalmitis, which must be considered.

Conclusion: Prompt diagnosis and institution of corticosteroid therapy is essential and may result in significant visual improvement in both eyes.

Background: Tuberculosis (TB), caused by Mycobacterium tuberculosis (MTB), remains a major global health problem, with one-third of the world's population infected.

Objective: This report presents five cases of tuberculous meningitis with a particular emphasis on the symptoms and signs of otitis media that, in various combinations, should raise suspicion for tuberculous meningitis.

Case presentation: These cases underscore the diagnostic challenges and clinical complexities associated with tuberculous otitis media, particularly when there is concurrent involvement of the central nervous system. It is crucial for physicians to maintain a high index of suspicion for tuberculosis in patients exhibiting chronic otorrhea that does not respond to conventional treatments, especially in endemic regions or in the presence of systemic symptoms. The use of advanced diagnostic tools and a multidisciplinary approach is essential for achieving timely diagnosis and effective management. Early initiation of antituberculous therapy, coupled with surgical interventions when warranted, can lead to favorable clinical outcomes. However, it is important to note that some patients may experience long-term sequelae, which highlights the necessity for prompt diagnosis and treatment to improve prognosis in those presenting with otitis media.

Conclusion: The findings of this case series contribute to a better understanding of the relationship between otitis media and tuberculous meningitis, advocating for increased awareness among healthcare providers to facilitate early recognition and intervention.

Background: Idiopathic omental infarction (IOI) is a rare cause of acute abdominal pain that can clinically mimic more common conditions, such as acute appendicitis. IOI occurs due to vascular compromise of the greater omentum, leading to ischemia, pain, and often necrosis. Preoperative diagnosis remains challenging due to nonspecific clinical and laboratory findings, as well as the fact that clinicians rarely include IOI as a "usual suspect" in the differential diagnosis. Therefore, the condition is commonly identified intraoperatively.

Objective: The aim of this article was to present a rare case of idipathic omental necrosis in young adult with description of appropriate diagnostic challanges and management.

Methods: We present the case of a 23-year-old previously healthy male who was admitted for suspected acute appendicitis based on right lower quadrant pain, nausea, vomiting, and elevated inflammatory markers. Exploratory laparoscopy revealed no signs of appendicitis but identified hemoperitoneum and a necrotic segment of the greater omentum in its right upper segment. Appendectomy and resection of the infarcted omental tissue were performed. Histopathological analysis confirmed the diagnosis of omental infarction as well as the absence of histopathological signs of acute appendicitis.

Conclusion: Idiopathic omental infarction, though rare, should be considered in the differential diagnosis of acute abdomen, particularly when clinical findings do not align with typical appendicitis. Advanced imaging modalities such as contrast-enhanced CT can facilitate preoperative diagnosis, potentially preventing unnecessary surgical interventions. However, in cases of diagnostic uncertainty, surgical exploration remains a mainstream approach. Awareness of this condition can improve diagnostic accuracy and optimize patient management.

Background: The upper mini sternotomy Bentall (mini-Bentall) procedure may result in less trauma and earlier recovery compared with the usual full sternotomy Bentall procedure (Usual Bentall-DeBono procedure).

Objective: This study evaluates the efficacy and safety of mini sternotomy aortic root surgery (MSARS), a minimally invasive technique designed to reduce surgical trauma, improve postoperative recovery, and lower healthcare costs.

Methods: The upper mini sternotomy (UMS) approach was performed in ten patients focusing on standardized surgical procedures, and rigorous postoperative care. Key findings indicate that MSARS markedly reduces postoperative complications, ICU stay, and overall hospital stay compared to traditional sternotomy.

Results: The median postoperative length of stay was seven days for MSARS versus 11 days for traditional sternotomy, with ICU stays of 27 hours and 105 hours, respectively. Our study also highlights the cost-effectiveness of MSARS, with decreased hospital costs per patient due to reduced ICU resource utilization and shorter hospital stays. These findings suggest that MSARS is a valuable and advantageous alternative to traditional sternotomy, offering substantial benefits in terms of patient outcomes and healthcare efficiency.

Conclusion: Mini sternotomy aortic root surgery via partial upper sternotomy could be a safe alternative to the full median sternotomy, marking a significant advancement in the field of cardiac surgery.

Background: Burn injuries are dangerous, difficult, and more likely to cause complications in children.

Objective: The purpose of the current study was to examine the knowledge and comprehension of emergency care for pediatric burns among Saudi and non-Saudi citizens.

Methods: An observational, cross-sectional study was carried out over a six-month period in various Saudi Arabian regions. A structured survey was utilized to collect information from adult participants recruited through social media. This survey was piloted to guarantee its clarity and relevance. The sample size was estimated to allow for a 95% confidence level and a 5% margin of error. SPSS software was used to conduct statistical analyses on awareness levels, first aid knowledge, and demographic relationships.

Results: Majority of participants was Saudi (94.7%), female (60.4%), single (54.9%) and less than 25 years old (51.9%). Only 124 (12.1%) participants had a high level of awareness. A total of 470 (45.9%), 338 (33%) and 216 (21.1%) participants had high, moderate and low knowledge scores, respectively. Also, 757 (73.9%), 231(22.6%) and 36 (3.5%) participants had positive, neutral and negative attitude, respectively. The majority of participants received their information through online resources (40.5%), social media (30%) and educational institutions (25%). Females' participants had significantly better knowledge score. Also, significantly better attitude scores were noticed with participants who had children and who age > 25 years old. Likewise, students and employees had better awareness and knowledge scores compared to other occupations. Meanwhile, participants with advanced level of education (Master/PhD) had better scores.

Conclusion: There is a lack of knowledge and practice of pediatric burn's first aid. Thus, courses and training in first aid for burns and awareness campaigns are essential in order to improve the knowledge of the general Saudi population.

Background: The Posterior Interosseous Artery Flap (PIA) is widely used in soft tissue reconstruction of the wrist and hand due to its consistent vascularity, long pedicle, and favorable donor site. However, anatomical variations in the vascular pedicle, perforator distribution, and flap dimensions remain limitations for clinical use.

Objective: This study aims to provide a detailed anatomical evaluation of the PIA flap in adult Vietnamese cadavers to support surgical planning.

Methods: A observational study was conducted on 30 forearm specimens from 15 adult Vietnamese cadavers. Methylene blue was injected into the PIA to evaluate its origin, perforator distribution, pedicle length, and perfused skin territory. Measurements were made using anatomical landmarks, and data were analyzed with SPSS 26.0.

Results: The PIA originated from the common interosseous artery in 93.3% (28/30) and from the ulnar artery in 6.7% (2/30). The reverse-flow pedicle length averaged 12.8 ± 1.6 cm. Perforators were concentrated in intervals 4-8, especially intervals 5 and 8. Pattern II was the most prevalent of the three identified perforator patterns, accounting for 70% of specimens. The methylene blue-stained skin territory measured 20.6 ± 2.0 cm in length, 8.4 ± 1.4 cm in width, and 175.9 ± 41.8 cm² in area. The stained area was located 1.9 ± 1.2 cm from the distal ulna (A1), 2.9 ± 1.2 cm from the anterior midline (A2), 0.8 ± 0.9 cm below the lateral epicondyle (A3), and 0.03 ± 0.18 cm from the posterior ulnar border (A4).

Conclusion: The PIA flap demonstrates a reliable vascular supply and a wide perfusion range. It should be designed > 2 cm distal to the ulna, ≥ 3 cm lateral to the anterior midline, ~1 cm below the lateral epicondyle, and not extend beyond the posterior ulnar border.

Background: Surgery is the preferred treatment for symptomatic intramedullary lesions. Intraoperative neurophysiological monitoring (IONM) has recently emerged as a crucial tool in spinal surgery, enhancing safety through real-time assessment of spinal cord function. Its use is particularly beneficial during intramedullary tumor resection, helping to reduce the risk of neurological impairment and improve postoperative outcomes.

Objective: Our study aims to evaluate the efficacy and outcomes of intraoperative neurophysiological monitoring for intramedullary tumor resection surgery in Vietnam and to identify some key predictive factors for tumor resectability.

Methods: A prospective study on 41 patients treated with neurosurgery using multimodal intraoperative neurophysiological monitoring between January 2022 and February 2024 at the Neurosurgery Center, Hanoi, Viet Nam.

Results: Gross total tumor resection was achieved in 26/41 patients (63.4%) with the mean tumor length was 49.9 mm. Among them, 21 cases (51.2%) were ependymoma, 15 cases (36.6%) were diffuse gliomas and 5 cases (12.2%) were other types (including hemangioblastoma, and metastases). Early outcomes assessed at 6 months using the modified McCormick Scale (MCS) revealed that 23.1 % showed no change, 76.9% patients demonstrated improvement. Univariate demonstrated intraoperative motor evoked potentials (MEPs) changes, tumor length and tumor transverse diameter were predictive factors for the resectability; preoperative McCormick Scale and somatosensory evoked potentials (SSEPs) changes were predictors for postoperative outcomes. Multivariate analysis revealed that tumor length was the only independent factor predicting tumor resectability.

Conclusion: Our study demonstrated the efficacy of IONM in improving surgical outcomes for patients undergoing intramedullary tumor resection. The outcomes of patients with intramedullary tumors post-surgery with IONM were significantly affected by the preoperative McCormick Scale and SSEPs changes during surgery. Predictive factors for resectability were tumor size in preoperative Magnetic Resonance Imaging (MRI) and intraoperative MEPs changes.

Background: Pediatric thyroid carcinoma, the most common endocrine malignancy among children, displays a notably higher incidence rate of 16% compared to 5% in adults. This disease often presents as advanced illness in pediatric cases, yet there's a paucity of data on its clinical features in this demographic. Our study, a first in North Sumatera, Indonesia, aims to fill this gap by examining the clinical characteristics of pediatric thyroid carcinoma.Objective: This research endeavors to provide comprehensive data on the demographic and clinical profiles of pediatric patients with thyroid nodules treated at our institution.

Methods: A retrospective descriptive study was conducted from 2018-2021, encompassing 35 pediatric patients (under 18 years) who underwent partial or total thyroidectomy for thyroid nodules. We reviewed and analyzed patient demographics and pathology results, presenting these as frequencies and percentages.

Results: Of the patients, 85.7% (30 patients) were female, and 14.3% (5 patients) were male, with an average age of 15.66 years (ranging from 10 to over 16 years). The age distribution showed 60% (21 patients) between 16-18 years, 22.9% (8 patients) between 6-11 years, and 17.1% (6 patients) between 12-15 years. Diagnoses included Colloid Goitres (42.9%), Follicular Adenoma (22.9%), Papillary Thyroid Carcinoma (20%), Hashimoto Thyroiditis and Graves' disease (5.7% each), and Follicular Neoplasm (2.9%).

Conclusion: The study period witnessed a steady prevalence of pediatric thyroid nodules necessitating thyroidectomy. This underscores the critical need for early detection of thyroid nodules in children for malignancy screening. Timely diagnosis is paramount for favorable outcomes and prognoses in pediatric thyroid conditions.

Background: Multinucleation, a deviation from typical embryonic development, is frequently observed during in vitro fertilization (IVF) cycles. The relationship between multinucleation at the two-cell stage (2MN), chromosomal status, and live birth remains poorly defined.

Objective: This study aimed to investigate whether 2MN is associated with chromosomal status, determined by preimplantation genetic testing for aneuploidy (PGT-A), and live birth outcomes following single embryo transfer.

Methods: This prospective study, conducted from January 2023 to December 2023, included 152 patients undergoing IVF. Oocytes were cultured and monitored in a time-lapse system, and blastocysts were analyzed by PGT-A.

Results: 23.3% of embryos exhibited 2MN. Euploidy rates were significantly lower in the 2MN group (36.0%) compared to the non-multinucleation group (46.3%) (p < 0.05), and mosaicism was significantly more frequent in the 2MN group (42.6% vs. 31.1%, p < 0.05). However, live birth rates following euploid embryo transfer did not differ significantly between the non-multinucleation group (61.8%) and the multinucleation group (62.3%) (p > 0.05).

Conclusions: While 2MN is associated with reduced euploidy rates and increased mosaicism, euploid embryos with early multinucleation have comparable live birth rates to non-multinucleated embryos. A limitation of the study was the relatively small sample size for the live birth outcome subgroup.