Objectives: This study aimed to compare the clinical and functional outcomes of geriatric patients (≥65 years) with proximal hu-merus fractures treated with locking plate fixation or nonoperative management and to identify factors associated with the development of complications. We hypothesized that fracture pattern, rather than treatment modality alone, would be more strongly associated with functional outcomes and complication risk in this population.
Methods: Patients aged 65 years and older who were treated for proximal humerus fractures were included in this retrospective cohort study. Patients were divided into two groups according to treatment modality: surgical treatment with locking plate fixation and nonoperative management. Clinical outcomes were evaluated using the Visual Analog Scale (VAS), Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and Oxford Shoulder Score (OSS). To explore factors associated with functional outcomes and complications, multivariable linear and logistic regression models were constructed.
Results: No significant differences were observed between the groups in demographic characteristics, fracture side, or mechanism of injury (p>0.05). There were no statistically significant differences between the surgical and nonoperative treatment groups in VAS or DASH scores (p>0.05). Although unadjusted Oxford Shoulder Scores did not differ significantly between the groups (28.4±10.1 vs. 24.7±11.1; p=0.09), multivariable analysis identified nonoperative management as independently associated with lower Oxford Shoulder Scores after adjustment for confounders, with the surgical group serving as the reference category (β=−6.85; 95% CI: −11.15 to −2.55; p=0.002). In multivariable analysis, Neer fracture classification was independently associated with worse DASH scores (β=6.33; p=0.008). Additionally, Neer classification was identified as an independent risk factor for complication development, with odds ratios increasing with fracture complexity: 3-part vs. 2-part (OR 5.95; 95% CI 1.02–34.78; p=0.048), 4-part vs. 2-part (OR 12.98; 95% CI 2.19–76.86; p=0.005), and displaced 4-part vs. 2-part (OR 33.28; 95% CI 3.47–318.97; p=0.002). Treatment modality was not independently associated with complication development.
Conclusion: In patients aged 65 years and older, no significant difference in functional outcomes between surgical and nonoperative treatment of proximal humerus fractures was observed in this cohort. Fracture pattern appeared to be more strongly associated with functional outcomes and complication risk than treatment modality. Neer classification should be considered when determining the appropriate treatment strategy. Treatment decisions should primarily be based on fracture characteristics together with the patient’s overall clinical condition.

Objectives: Medial opening-wedge high tibial osteotomy (MOWHTO) is a joint-preserving procedure designed to correct varus malalignment and reduce medial compartment overload in knee osteoarthritis (OA). Although historically reserved for early-stage disease, recent evidence suggests that patients with more advanced radiographic degeneration may still benefit from the procedure. However, the relationship between Kellgren–Lawrence (KL) grade and postoperative clinical outcomes remains controversial. This study aimed to evaluate early-term pain reduction and functional improvement following MOWHTO by comparing patients with low-grade OA (KL1–2) and moderate OA (KL3).
Methods: This retrospective observational study analyzed 73 consecutive adults who underwent standardized biplanar MOWHTO between May 2020 and May 2023 at a single tertiary center. Patients were stratified into KL1–2 (n=58) and KL3 (n=15) groups. Pain and function were assessed preoperatively and at 6, 12, and 24 months using the Visual Analog Scale (VAS), KOOS, and WOMAC index. Radiographic alignment parameters and complications were recorded.
Results: Preoperative VAS scores were high in both groups (KL1–2: 7.79±0.89; KL3: 8.27±0.70; p=0.066). At 24 months, VAS scores decreased significantly (KL1–2: 3.33±1.15; KL3: 1.87±0.74), with KL3 patients exhibiting greater pain reduction (ΔVAS: 6.40±1.06 vs. 4.47±1.52; p<0.001). KOOS scores improved substantially in both groups (KL1–2: 53.1±8.2 to 85.4±5.8; KL3: 43.9±7.6 to 76.7±6.3), with similar functional gains (ΔKOOS: 32.3±6.0 vs. 32.8±8.9; p=0.85). WOMAC scores improved significantly (KL1–2: 51.9±3.6 to 30.8±7.1; KL3: 61.4±4.3 to 34.9±5.6), with greater improvement in KL3 (ΔWOMAC: 26.5±8.2 vs. 21.2±7.4; p=0.034). The overall complication rate requiring surgery was 12.3%, and 24-month arthroplasty-free survival was 96.0%.
Conclusion: MOWHTO provides meaningful early-term improvements in pain and function across all KL grades. Despite worse baseline status, KL3 patients achieved comparable or greater symptomatic relief. These findings support MOWHTO as a viable op-tion for carefully selected patients with moderate OA seeking to delay arthroplasty.

Objectives: The Pneumatic Kerrison Rongeur (PKR) was introduced to overcome challenges associated with classical Kerrison Rongeurs (KRs), such as surgeon fatigue, limited dexterity, and potential tissue damage. This study aimed to evaluate the efficacy and advantages of the PKR in neurosurgical procedures compared with the classical KR.
Methods: Surgical outcomes, including operation time, blood loss, incision length, and postoperative pain scores, were assessed in groups using the PKR versus the classical KR.
Results: Surgeries performed using the PKR were associated with shorter operation times, reduced blood loss, and shorter incision lengths. No significant difference was found in preoperative or postoperative pain scores between the two groups. However, changes in Visual Analog Scale (VAS) scores on the first postoperative day were significant in both groups. Notably, the PKR provides enhanced dexterity, allowing surgeons to use both hands regardless of hand dominance. This increased flexibility may account for the shorter incision lengths observed. Despite its benefits, hesitancy to adopt the PKR in certain regions was observed, primarily due to concerns about uncontrolled biting and potential neural injury.
Conclusion: The Pneumatic Kerrison Rongeur offers distinct advantages over the classical KR, particularly in reducing operation time, blood loss, and incision size. These improvements may potentially reduce risks and complications, especially in elderly patients undergoing bilateral microdecompression for spinal canal stenosis.

Objectives: Nasal mucociliary clearance (MCC) is a physiological mechanism of the upper respiratory tract that removes locally produced deposits, excess secretions, and unwanted inhaled particles. Various pathologies, such as rhinitis, sinusitis, septal deviation, nasal polyposis, and inferior turbinate hypertrophy, are known to reduce the activity of the mucociliary mechanism by causing nasal obstruction. Increased mucus secretion accompanied by impaired ciliary movement prevents the clearance of nasal secretions and predisposes patients to recurrent infections. The aim of this study was to determine how commonly performed nasal surgeries affect mucociliary clearance.
Methods: The study included 43 patients who underwent septoplasty and 34 patients who underwent open-technique septorhinoplasty. The two groups were statistically compared in terms of age, sex, smoking status, and MCC scores.
Results: Both groups demonstrated a temporary prolongation of MCC in the early postoperative period (first week). At the third month, MCC values improved significantly in the septoplasty group (p<0.05). Improvement was slower in the open-technique septorhinoplasty group, and MCC values remained higher at the third month than in the septoplasty group (p<0.001).
Conclusion: Septoplasty has positive effects on the MCC mechanism. Our results suggest that elevation and prolonged operative time may have a negative effect on MCC that persists until the third postoperative month in open-technique septorhinoplasty.

Objectives: Patients who underwent either transurethral resection of the prostate (TURP) or bladder neck incision (BNI) for bladder outlet obstruction (BOO) were evaluated in this study. The aim was to compare the perioperative characteristics and postoperative outcomes of the two surgical approaches.
Methods: Data from 74 patients who underwent surgical treatment for bladder outlet obstruction (BOO) between January and December 2025 were assessed. The study population consisted of 33 patients treated with TURP and 41 patients treated with BNI. Demographic characteristics, prostate volume, and operative time were recorded for all participants. Uroflowmetry parameters, including maximum flow rate (Qmax), average flow rate (Qavg), and post-void residual urine volume (PVR), were evaluated preop-eratively and at 6 months postoperatively. Statistical analyses were performed using Student’s t-test or the Mann–Whitney U test.
Results: Patients in the TURP group were older and had significantly larger prostate volumes than those in the BNI group (both p<0.001). Procedure duration was also longer among patients who underwent TURP. Preoperative PVR values were higher in the TURP group, whereas preoperative Qmax, Qavg, and voided volume did not differ significantly between the groups. Patients treated with BNI demonstrated higher Qmax, Qavg, and voided volume values at 6 months postoperatively, while PVR was lower than that in the TURP group.
Conclusion: Postoperative voiding test results were more favorable in the BNI group than in the TURP group. This difference may be related to patient age and the underlying cause of bladder outlet obstruction. These factors should be considered when planning treatment and counseling patients.

Objectives: Tube thoracostomy is a frequently performed emergency procedure in pediatric patients; however, complication patterns and risk stratification in emergency settings remain incompletely defined. This study aimed to evaluate 30-day complication rates and identify independent predictors of adverse outcomes in pediatric patients undergoing tube thoracostomy in emergency settings.
Methods: This retrospective observational cohort study included 451 consecutive pediatric patients (0–18 years) who underwent tube thoracostomy between June 2020 and June 2025 at a tertiary referral center. Emergency settings included procedures performed in the Emergency Department (ED), Pediatric Intensive Care Unit (PICU), or urgent perioperative settings. The primary outcome was 30-day procedure-related complications. Variables with p<0.10 in univariate analysis were entered into a multivariate logistic regression model to determine independent predictors. Model calibration and discrimination were assessed using the Hosmer–Lemeshow test and the area under the receiver operating characteristic curve (AUC).
Results: The overall 30-day complication rate was 21.3% (96/451). More than half of the procedures were performed in the ED (53.9%). Complication rates were highest in children younger than 6 years (38.2%, p=0.001) and in those with traumatic presentations (36.0% vs. 19.5%, p=0.04). General anesthesia was associated with higher complication rates compared with local anesthesia with or without sedation (34.5% vs. 13.4%, p<0.001). Multivariate analysis identified age <6 years (adjusted OR: 2.42, 95% CI: 1.38–4.24), traumatic etiology (adjusted OR: 1.86, 95% CI: 1.02–3.39), and general anesthesia (adjusted OR: 2.18, 95% CI: 1.34–3.54) as independent predictors. Procedure location was not independently associated with complications. Model discrimination was acceptable (AUC: 0.71).
Conclusion: In pediatric emergency tube thoracostomy, younger age, traumatic presentation, and the use of general anesthesia are independently associated with 30-day complications. Comparable complication rates across the ED and other emergency settings support the safety of emergency department–based tube thoracostomy when performed by trained providers. These findings may guide risk stratification and clinical decision-making in pediatric emergency medicine.

Objectives: Percutaneous epididymal sperm aspiration (PESA) is a minimally invasive surgical sperm retrieval technique used in patients unable to provide ejaculated spermatozoa. This study aimed to evaluate fertilization, clinical pregnancy, and live birth outcomes following intracytoplasmic sperm injection (ICSI) using epididymal sperm obtained via PESA over an 11-year period at a single tertiary referral center.
Methods: This retrospective cohort study analyzed 63 PESA–ICSI cycles performed in 46 male patients between January 2015 and December 2025. Indications for PESA included obstructive azoospermia (n=13 cycles) and medically refractory ejaculatory dysfunction (n=50 cycles). Outcomes were evaluated both at the cycle level and independently per embryo transfer (ET) procedure. Comparative analyses were performed according to PESA indication, embryo developmental stage at transfer, and transfer type.
Results: Sperm retrieval was completely successful in all 63 cycles (100%). Of 498 mature (MII) oocytes injected, normal fertilization (2PN) was achieved in 268, yielding an oocyte-level fertilization rate of 53.8%. Total fertilization failure occurred in only one cycle (1.6%). Embryo transfer was performed in 57 cycles, resulting in 68 individual transfer procedures (42 fresh and 26 frozen–thawed). The overall clinical pregnancy rate was 39.7% (25/63) per initiated cycle and 36.8% (25/68) per ET procedure. The overall live birth rate was 33.3% (21/63) per initiated cycle and 30.9% (21/68) per ET procedure. No statistically significant differences were observed between cleavage-stage and blastocyst-stage transfers with respect to clinical pregnancy (p=0.615) or live birth outcomes (p=1.000). No major procedural complications were recorded.
Conclusion: PESA combined with ICSI provides favorable reproductive outcomes with a low rate of total fertilization failure. These results were achieved despite a cohort characterized by diminished ovarian reserve and diverse male infertility etiologies. The high sperm retrieval success rate and consistent clinical outcomes support PESA as a reliable and effective sperm retrieval technique in contemporary assisted reproductive practice.

Objectives: Ventral penile curvature often accompanies severe hypospadias and poses a risk of recurrence after repair. We postulated that altered myofibroblastic activity at the repair site contributes to recurrent curvature. To address this mechanism, we adopted a specific clinical strategy in 2017. We instructed patients to apply upward massage to the ventral side of the penis using a topical corticosteroid ointment between the two stages of Bracka repair. The aim of this study was to assess the impact of this intervention on the recurrence of curvature after surgery.
Methods: A retrospective review of the medical records of all patients who underwent Bracka repair for hypospadias between January 2009 and May 2023 by a single senior surgeon was conducted. Patients were divided into two groups according to whether they received steroid treatment, and complication rates were compared. In the steroid group, parents applied Betnovate® 0.1% (betamethasone valerate) ointment twice daily with upward massage to the ventral penile surface, beginning in the second post-operative week after Bracka stage 1 surgery and continuing for three months. The primary outcome was recurrence of curvature during the second stage and at long-term follow-up, while secondary outcomes included dehiscence and fistula formation.
Results: The review included 60 patients (median age: 14 months [5–171]) who underwent Bracka repair for hypospadias, with 40 in the steroid group and 20 in the control group. The mean degrees of curvature at presentation were similar (91 and 89 degrees, respectively; p>0.05). Compared with the control group, the steroid group had a significantly smaller mean degree of curvature both at the second-stage operation (17 vs. 26 degrees, p=0.04) and during long-term follow-up (15 vs. 25 degrees, p=0.03). There were no steroid-related complications, and no significant differences in the incidences of dehiscence and fistula formation were observed between the groups (p>0.05).
Conclusion: Our findings suggest that the application of a topical corticosteroid ointment with upward massage to the ventral graft site between stages 1 and 2 of Bracka hypospadias repair may reduce the recurrence of curvature both during the second stage of repair and at long-term follow-up.

Objectives: This study aimed to evaluate the presence of diabetes-related stigma and its relationship with disease control and family functioning among adults with type 2 diabetes mellitus (T2DM) living in rural Türkiye. A cross-sectional study was conducted between March and May 2025 at a Family Health Center (FHC). A total of 201 adults with physician-diagnosed T2DM participated in the study.
Methods: Data were collected through face-to-face interviews using a sociodemographic questionnaire, the Diabetes Stigma Assessment Scale-2 (DSAS-2), and the Family APGAR scale, which assesses family functioning. Statistical analyses included correlation tests, group comparisons, and logistic regression to identify independent predictors of stigma.
Results: The mean total DSAS-2 score was 39.4±9.2, indicating a moderate level of perceived stigma. Higher stigma scores were associated with very low income, polypharmacy, and the presence of comorbid chronic diseases (p<0.05). A positive correlation was found between the number of children and both the “Treated Differently” and “Self-Stigma” subdimensions of the DSAS-2 (r=0.202 and r=0.216, respectively). Family APGAR scores were generally high (mean=8.9±2.0), but no significant association was observed between family functioning and stigma levels. Logistic regression analysis showed that medication use was independently associated with higher stigma (OR: 2.48; 95% CI: 1.23–4.98; p=0.011), whereas moderate income was associated with lower stigma (OR: 0.165; 95% CI: 0.048–0.567; p=0.004).
Conclusion: Diabetes-related stigma remains a notable psychosocial challenge for adults with T2DM in rural settings. Socioeconomic disadvantage, comorbidity, and family burden contribute to the internalization of stigma, whereas family support alone may not mitigate its effects. Addressing stigma within primary care through culturally tailored psychoeducation and empower-ment programs may enhance both emotional well-being and disease management in rural populations.

Objectives: This study aimed to evaluate the efficacy and safety of fosaprepitant-containing antiemetic prophylaxis and associ-ated patient-related risk factors in patients receiving highly emetogenic chemotherapy (HEC) and moderately emetogenic chemotherapy (MEC).
Methods: Medical records of patients treated between July 2021 and March 2022 at two oncology centers were retrospectively reviewed. A total of 50 adult patients receiving chemotherapy were included in the study. The antiemetic regimen consisted of fosaprepitant, dexamethasone, granisetron, and olanzapine. Demographic data, emetogenic risk classification, Beck Anxiety Inventory (BAI) scores, timing and frequency of nausea and vomiting according to NCI-CTCAE v5.0, the need for rescue antiemetics, and adverse events were evaluated. The primary endpoint was defined as complete response (no vomiting) within 0–120 hours. Statistical analyses were performed using Fisher’s exact test.
Results: The majority of patients were female (80%) and younger than 65 years (84%). The most frequent diagnoses were breast cancer (38%) and pancreatic-biliary cancers (18%). All patients with comorbidities were in remission. A history of hyperemesis gravidarum was reported in 22% of patients, motion sickness in 18%, and alcohol use in 18%. Based on BAI scores, moderate and severe anxiety were detected in 16% and 2% of patients, respectively. According to the emetogenic risk classification, 82% of patients received HEC and 18% received MEC. Complete vomiting control was achieved in 80% of patients receiving fosaprepitant therapy, whereas 48% experienced no nausea. No statistically significant associations were found between emetogenic risk group, anxiety level, alcohol use, history of hyperemesis gravidarum, or motion sickness and treatment response (p>0.05). Complete response rates were 85.4% in the HEC group and 55.6% in the MEC group (p=0.118). Although the complete response rate was lower in patients with clinically significant anxiety (66.7%) than in those with low anxiety (82.4%), the difference was not statistically significant (p=0.475). Rescue antiemetics were required in 52% of patients. The most common adverse events were fatigue (10%) and dyspepsia (4%).
Conclusion: In this real-world study, high rates of vomiting control were observed with fosaprepitant-based antiemetic therapy. The treatment was generally well tolerated. Although not statistically significant, the lower response rates observed in patients receiving MEC regimens and those with high anxiety levels suggest the need for more vigilant monitoring in these patient subgroups.

Objectives: The pan-immune-inflammation value (PIV), calculated from neutrophil, platelet, monocyte, and lymphocyte counts, is a peripheral blood biomarker of systemic immune-inflammatory status. We evaluated the prognostic value of baseline PIV and its trajectory over the first six months of treatment for overall survival (OS) and progression-free survival (PFS) in patients receiving immune checkpoint inhibitors (ICIs) and benchmarked PIV against the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII).
Methods: We retrospectively analyzed 205 patients treated at a single tertiary center for non-small-cell lung cancer, renal cell carcinoma, melanoma, or other solid tumors who received an ICI (90.2% nivolumab). PIV was measured at baseline, month 3, and month 6. The outcome-independent median value (587.7) defined the PIV-low and PIV-high groups. Cox regression (per doubling of log2-transformed PIV), Kaplan–Meier analysis, 3- and 6-month landmark models, time-updated Cox models, and restricted cubic splines were used, with adjustment for age, sex, and tumor type. Discrimination was assessed using Harrell’s C-index, 1000-resample bootstrap internal validation, and time-dependent area under the curve (AUC).
Results: The median follow-up was 50.6 months; 168 deaths and 190 progression-or-death events occurred. Each doubling of baseline PIV was independently associated with worse OS (adjusted HR, 1.24; 95% confidence interval [CI], 1.14–1.36; p<0.001) and PFS (HR, 1.18; 95% CI, 1.09–1.28; p<0.001). Median OS was 11.96 vs. 5.62 months, and median PFS was 6.21 vs. 3.45 months, in the PIV-low vs. PIV-high groups (log-rank p<0.001 for both). Month-3 and month-6 absolute PIV values remained prognostic in landmark analyses, whereas the relative change in PIV from baseline to month 3 was not associated with either outcome. The association was approximately loglinear (nonlinearity p>0.05 for OS and PFS). PIV, NLR, PLR, and SII showed similar discrimination (adjusted C-index for OS: 0.650, 0.647, 0.633, and 0.652, respectively); PIV had the lowest Akaike information criterion (AIC) and Bayesian information criterion (BIC) values among the four indices.
Conclusion: Baseline and on-treatment absolute PIV values, but not early relative changes in PIV, are independently associated with survival outcomes in patients receiving ICIs, with prognostic performance comparable to that of established inflammatory indices. PIV may serve as a simple, repeatable biomarker to support risk stratification during ICI therapy.

Objectives: Acute kidney injury (AKI) is a frequent and clinically significant complication in critically ill neonates and is associated with increased morbidity and mortality. Although awareness of neonatal AKI has increased in recent years, data on mortality predictors and the trajectory of renal recovery remain limited, particularly in single-center cohorts. This study aimed to comprehensively evaluate the incidence, antenatal, perinatal, and postnatal risk factors, clinical characteristics, and short-term outcomes of neonates diagnosed with AKI in a neonatal intensive care unit, with a particular focus on deaths attributable to AKI during the neonatal intensive care unit (NICU) stay.
Methods: In this single-center retrospective cohort study, the medical records of neonates admitted to the NICU between Janu-ary 2019 and January 2024 were retrospectively reviewed. Neonates diagnosed with AKI according to the KDIGO criteria were included, and relevant demographic, clinical, laboratory, and outcome data were collected. Survivors and non-survivors were compared. Univariate and multivariable logistic regression analyses were performed to identify predictors of mortality, and model performance was assessed using receiver operating characteristic (ROC) curve analysis.
Results: Among 3,456 NICU admissions, 121 neonates (3.5%) were diagnosed with AKI. The mean gestational age was 31.0±5.5 weeks, and 78.5% of patients were preterm. The overall in-hospital mortality rate among neonates with AKI was 30.6%. Sepsis (54.5%) and perinatal asphyxia (40.5%) were common risk factors. Non-survivors had significantly lower gestational age and birth weight and higher serum creatinine levels on postnatal day 7 (p=0.04). In multivariable analysis, sepsis (adjusted OR: 2.64, 95% CI: 1.19–5.86) and serum creatinine on postnatal day 7 (adjusted OR: 7.98, 95% CI: 2.47–25.80) were independent predictors of mortality. The multivari-able model demonstrated good discrimination, with an AUC of 0.857.
Conclusion: Neonatal acute kidney injury-related mortality in the neonatal intensive care unit remains high. In this cohort, sepsis and persistently elevated serum creatinine levels on postnatal day 7 were identified as independent predictors of in-hospital mortality. The observed divergence in creatinine trajectories between survivors and non-survivors highlights the prognostic value of serial renal function assessment for risk stratification. These findings underscore the importance of early identification of high-risk neonates and support the need for future prospective studies to determine whether targeted monitoring and intervention strategies can improve clinical outcomes.

Objectives: Inborn errors of immunity (IEI) may manifest in neonates as severe or unusual infections and syndromic features, yet early recognition remains challenging, especially in settings without routine newborn screening. Early clinical warning signs—in-cluding recurrent or atypical infections, absent thymic shadow, unexplained hydrops fetalis, or treatment-resistant metabolic dis-turbances—can facilitate timely diagnosis. This study aimed to determine the prevalence and subtypes of IEI in a tertiary neonatal intensive care unit (NICU) and to characterize early diagnostic indicators that guide life-saving interventions.
Methods: We conducted a retrospective observational study of neonates diagnosed with IEI between August 2023 and August 2025 in a 61-bed, level 4 NICU. Seventeen infants meeting IUIS and ESID criteria were identified through the immunology–neonatology council registry. Demographic, clinical, laboratory, and outcome data were analyzed descriptively, with an emphasis on early warning signs.
Results: Among 11,276 live births and 2,942 NICU admissions, 17 neonates were diagnosed with IEI (1.51 per 1,000 live births). Combined immunodeficiencies were the most frequent subtype (58.8%). Diagnostic evaluation was primarily prompted by syndromic features or severe/unusual infections. Four infants (23.5%) died, while survivors remained clinically stable with immunoglobulin replacement therapy and antimicrobial prophylaxis. One infant underwent hematopoietic stem cell transplantation (HSCT). Early recognition facilitated the timely initiation of appropriate management strategies.
Conclusion: IEI should be suspected in neonates presenting with syndromic features or atypical infections. Awareness of subtle neonatal warning signs and prompt evaluation for appropriate interventions can improve outcomes, particularly in settings without routine newborn screening.

Objectives: Celiac disease (CD) is an immune-mediated disorder that may present with gastrointestinal or extraintestinal manifestations or remain asymptomatic. Although an increased prevalence has been reported in some autoimmune diseases, data regarding CD frequency in pediatric rheumatologic diseases are limited, and routine screening remains controversial. This study aimed to evaluate the frequency of CD among children with rheumatologic diseases and the necessity of routine serological screening.
Methods: This cross-sectional study included 94 children with rheumatologic diseases who underwent systematic CD screening between January 2020 and November 2023. Screening was performed using anti–tissue transglutaminase immunoglobulin A and endomysial antibody tests regardless of symptoms. Patients with positive serology underwent upper gastrointestinal endoscopy and intestinal biopsy. The prevalence of biopsy-confirmed celiac disease was calculated with 95% confidence intervals.
Results: The median age was 171 months (Q1–Q3: 124.25–192.25), and 55.3% were female. Juvenile idiopathic arthritis (JIA) was the most common diagnosis (88.3%). Serological positivity suggestive of CD was detected in two patients (2.1%), both of whom were diagnosed with JIA. Biopsy-confirmed CD was identified in one patient, corresponding to a prevalence of 1.06% (95% confidence interval: 0.03–5.79), which was not significantly different from the prevalence reported in Turkish school children (two-proportion z-test, p=0.553). Both patients who underwent endoscopy had normal growth parameters and no classical gastrointestinal symptoms.
Conclusion: The prevalence of CD in children with rheumatologic diseases was low and similar to that of the general pediatric population. Routine screening for CD in asymptomatic patients with rheumatologic diseases may not be necessary, and a more individualized, risk-based approach may be more appropriate.

Objectives: Pulmonary arterial hypertension (PAH) is a progressive disease characterized by increased pulmonary vascular resis-tance and reduced exercise capacity. Bosentan, an endothelin receptor antagonist, is commonly used in pediatric PAH, but standardized guidelines for its use are lacking. Macitentan, another endothelin receptor antagonist, offers advantages such as a longer duration of action, greater tissue penetration, and lower hepatotoxicity.
Methods: This retrospective study evaluated 21 pediatric patients (≥12 years) who transitioned from bosentan to macitentan due to worsening functional class and increased pulmonary artery pressure. Patients received 10 mg of macitentan daily after obtaining regulatory approval. Clinical assessments, including WHO functional class, NT-proBNP levels, transthoracic echocardiographic systolic pulmonary artery pressure (sPAP), and six-minute walk test (6MWT) distances, were conducted before and 6 months after the switch.
Results: At follow-up, the prevalence of WHO functional class III decreased from 66% to 19% (p=0.001). Median NT-proBNP levels significantly decreased from 1361.01 pg/mL to 906.06 pg/mL (p=0.009). Median sPAP also showed a statistically significant reduc-tion (p=0.001). Additionally, 6MWT distances improved significantly (p=0.002). No adverse events, hospitalizations, or significant changes in liver function tests were observed.
Conclusion: Macitentan demonstrated favorable efficacy and safety in pediatric patients with PAH, particularly those with idiopathic PAH. Its once-daily regimen may improve adherence and clinical outcomes. These findings are consistent with adult studies and highlight macitentan as a promising treatment option for pediatric PAH. Larger-scale studies are needed to establish its role in clinical guidelines.

Early diagnosis of biliary atresia (BA) remains challenging, although timely recognition is critical for achieving favorable surgical outcomes. We present two infants in whom gadoxetic acid–enhanced MRI demonstrated imaging findings that supported early suspicion of BA. Two neonates with persistent cholestasis underwent routine laboratory evaluation, targeted ultrasonography, and hepatocyte-specific magnetic resonance imaging using gadoxetic acid. This contrast agent is actively taken up by functioning hepatocytes and is normally excreted into the biliary system during the delayed hepatobiliary phase, allowing functional assessment of bile formation and excretion. MRI findings, particularly biliary excretion on delayed images, were evaluated and correlated with intraoperative cholangiography. In both infants, hepatic parenchymal enhancement after contrast administration was preserved, indicating intact hepatocellular uptake. However, no biliary excretion was observed on delayed hepatobiliary-phase images. Intraoperative cholangiography confirmed biliary atresia in both cases. Although the diagnosis of biliary atresia is traditionally based on clinical findings, laboratory parameters, and ultrasonography, these approaches may remain inconclusive in some patients. Our findings suggest that gadoxetic acid–enhanced MRI, by demonstrating preserved hepatocellular uptake with absent biliary excretion, may serve as a useful adjunctive diagnostic tool and contribute to earlier and more confident identification of biliary atresia.

Wilms tumor (WT) is the most common renal malignancy in children but can be challenging to diagnose in adults because its clinical and imaging features often mimic those of renal cell carcinoma (RCC). Most diagnoses are made incidentally following nephrectomy performed for suspected RCC. Due to the lack of established adult-specific treatment guidelines, management typically follows pediatric protocols. This report presents the case of a 26-year-old woman who presented with abdominal pain, weight loss, and fatigue. Imaging revealed a large, irregular mass in the left kidney, which was confirmed as WT after nephrectomy. She underwent radical nephrectomy followed by adjuvant chemotherapy, including doxorubicin, vincristine, and actinomycin D. After two years of follow-up, recurrence was detected, leading to a second surgery followed by radiotherapy. This case highlights the diagnostic and therapeutic challenges associated with adult WT and emphasizes the need for individualized treatment strategies tailored to each patient.

The ligamentum flavum is a structure that connects adjacent laminae and plays a role in maintaining upright posture. Hypopara-thyroidism can rarely cause ligamentum flavum ossification (LFO). LFO can cause symptoms due to spinal cord compression. A 48-year-old man was evaluated for complaints of widespread back pain, a burning sensation, and numbness in the lower extremities. Imaging revealed spinal stenosis at the T10-T11 level due to LFO. Following facet joint block and duloxetine treatment, the VAS score decreased from 8 to 3. Early diagnosis and appropriate treatment of LFO in patients with hypoparathyroidism are critical for symptom control and functional recovery.

Since the onset of the COVID-19 pandemic in 2019, various vaccines have been developed to control its spread. Initially, conventional inactivated virus vaccines, such as CoronaVac (Sinovac), were introduced, followed by more advanced mRNA-based vaccines, such as BNT162b2 (Pfizer-BioNTech). COVID-19 vaccines have been associated with several adverse effects, particularly dermatological manifestations. Morphea, also known as localized scleroderma, is an inflammatory and sclerosing skin disease that leads to sclerosis and loss of skin elasticity. Genetic and environmental factors, along with immune dysregulation, are thought to play a role in its pathogenesis. We report a case of morphea in a 72-year-old woman who developed localized skin lesions at the vaccination site following CoronaVac administration. To the best of our knowledge, this is the first reported case of morphea potentially triggered by CoronaVac.