An assessment of "neuroendocrine differentiation" in malignant melanomas of the sinonasal and oral region.

Mucosal melanomas often require a detailed differential diagnosis and immunochemical study due to their different morphology and pattern characteristics. The tumors may also show fibroblastic, schwannian, smooth muscle, rhabdomyosarcomatous, gangliocytic, epithelial, and neuroendocrine differentiation. All these features can lead to serious diagnostic difficulties. The study aimed to determine the frequency of neuroendocrine differentiation in melanomas of the sinonasal and oral regions and to assess whether there is any relationship between neuroendocrine differentiation and clinical, histopathological, and other immunophenotypic features of this neoplasm. The study included 18 cases diagnosed with oral or sinonasal malignant melanoma. Neuroendocrine differentiation was determined by immunohistochemistry using synaptophysin, chromogranin, CD56, and INSM-1. A cut-off defining neuroendocrine differentiation in malignant melanomas has not been established in the literature. Because of this, any degree of neuroendocrine marker expression was considered as indicative of "neuroendocrine differentiation" without setting any cut-off. Neuroendocrine differentiation was observed in 13 of 18 cases (72.2 %) when a single positive neuroendocrine marker was considered sufficient. The number of cases with at least two positive neuroendocrine markers was 8/18 (44.4 %). Synaptophysin, chromogranin A, CD56, and INSM1 were positive in 33.3 %, 13.3 %, 56.2 %, and 47.1 % of cases, respectively. The results of our study suggest that neuroendocrine differentiation is not uncommon in oral and sinonasal melanomas. Knowing that malignant melanomas can show neuroendocrine differentiation will prevent diagnostic pitfalls.

The Impact of Different Telerehabilitation Methods on Peripheral Muscle Strength and Aerobic Capacity in COPD Patients: A Randomized Controlled Trial.

Lung diseases have profound effects on the aging population. We aimed to hypothesize and investigate the effect of remote pulmonary telerehabilitation and motor imagery (MI) and action observation (AO) methods on the clinical status of elderly chronic obstructive pulmonary disease (COPD) patients. Twenty-six patients were randomly assigned to pulmonary telerehabilitation (PtR) or cognitive telerehabilitation (CtR) groups. The programs were carried out 3 days a week for 8 weeks. The 6-min walk test (6MWT), modified Medical Research Council dyspnea score, blood lactate level (BLL), measurement of peripheral muscle strength (PMS), and electromyography activation levels of accessory respiratory muscles were the main outcomes. There was a statistically significant improvement (p < 0.05) in both groups in the 6MWT distance and in secondary results, except for BLL. Generally, in the mean muscle activity obtained from the electromyography measurement after the program, there were statistically significant increases in the PtR group and decreases in the CtR group (p < 0.05). There was a statistically significant increase in PMS in both groups. An active muscle-strengthening program has the same benefits as applying the muscle-strengthening program to the patient as MI and AO. CtR can be a powerful alternative rehabilitation method in respiratory patients who cannot tolerate active exercise programs.

Chatbots talk Strabismus: Can AI become the new patient Educator?

BACKGROUND: Strabismus is a common eye condition affecting both children and adults. Effective patient education is crucial for informed decision-making, but traditional methods often lack accessibility and engagement. Chatbots powered by AI have emerged as a promising solution. AIM: This study aims to evaluate and compare the performance of three chatbots (ChatGPT, Bard, and Copilot) and a reliable website (AAPOS) in answering real patient questions about strabismus. METHOD: Three chatbots (ChatGPT, Bard, and Copilot) were compared to a reliable website (AAPOS) using real patient questions. Metrics included accuracy (SOLO taxonomy), understandability/actionability (PEMAT), and readability (Flesch-Kincaid). We also performed a sentiment analysis to capture the emotional tone and impact of the responses. RESULTS: The AAPOS achieved the highest mean SOLO score (4.14 ± 0.47), followed by Bard, Copilot, and ChatGPT. Bard scored highest on both PEMAT-U (74.8 ± 13.3) and PEMAT-A (66.2 ± 13.6) measures. Flesch-Kincaid Ease Scores revealed the AAPOS as the easiest to read (mean score: 55.8 ± 14.11), closely followed by Copilot. ChatGPT, and Bard had lower scores on readability. The sentiment analysis revealed exciting differences. CONCLUSION: Chatbots, particularly Bard and Copilot, show promise in patient education for strabismus with strengths in understandability and actionability. However, the AAPOS website outperformed in accuracy and readability.

Factors associated with substance use among preclinical medical students in Turkey: a cross-sectional study.

Introduction: Medical students experience high levels of stress due to their rigorous training, which can negatively affect their mental health. This study aimed to investigate substance use habits of medical students at Istanbul University-Cerrahpasa and the association on their mental health and demographic factors. Methods: This cross-sectional survey study was conducted in March-April 2022 among preclinical medical students (years 1-3 of a 6-year program). A confidential, anonymous online survey consisting of four sections on sociodemographic and educational characteristics, nicotine use and dependence [Fagerström Test for Nicotine Dependence (FTND)], alcohol use [Alcohol Use Disorders Identification Test (AUDIT)], mental health status [12-item General Health Questionnaire (GHQ-12)], was distributed to 1131 students via WhatsApp and Telegram text messages. Mann-Whitney U and Kruskal Wallis tests compared variables' distribution in the questionnaire categories. Spearman's correlation assessed associations between scales. Significance was p < 0.05. Results: The study included 190 medical students. A total of 26.3% of the participants were smokers, with 8.4% showing moderate to high levels of nicotine dependence. An estimated 45.8% and 8.4%reported low-risk consumption and risky usage of alcohol, respectively. There were statistically significant associations between substance use and demographic factors such as sex, GPA, and religious belief. The study found a statistically significant correlation between FTND scores and GHQ-12 scores, and, between FTND scores and AUDIT scores. Conclusion: The findings of this study will inform the development of interventions to improve the mental health and academic performance of medical students at Istanbul University-Cerrahpasa. Furthermore, it will raise awareness about the importance of addressing substance use among medical students in Turkey.

Introduction: Les étudiants en médecine sont assujettis à des niveaux élevés de stress en raison de leur formation rigoureuse, ce qui peut avoir un impact négatif sur leur santé mentale. Cette étude avait pour but d'étudier les habitudes de consommation de substances des étudiants en médecine de l'Université d'Istanbul-Cerrahpasa et l'association avec leur santé mentale et les facteurs démographiques. Méthodes: Cette étude transversale a été menée en mars-avril 2022 parmi les étudiants en médecine au pré-clinique (années 1 à 3 d'un programme de 6 ans). Un questionnaire en ligne confidentiel et anonyme comprenant quatre sections sur les caractéristiques sociodémographiques et éducatives, l'usage et la dépendance à la nicotine [Test de Fagerström pour la dépendance à la nicotine (FTND)], la consommation d'alcool [Test d'identification des troubles liés à la consommation d'alcool (AUDIT)], l'état de santé mentale [Questionnaire général sur la santé en 12 points (GHQ-12)], a été distribué à 1131 étudiants au moyen de messages texte WhatsApp et Telegram. Les tests de Mann-Whitney U et de Kruskal Wallis ont comparé la distribution des variables dans les catégories du questionnaire. La corrélation de Spearman a évalué les associations entre les échelles. Le niveau de signification statistique était p<0,05. Résultats: L'étude a porté sur 190 étudiants en médecine. Au total, 26,3 % des participants étaient des fumeurs, dont 8,4 % présentaient des niveaux modérés à élevés de dépendance à la nicotine. On estime que 45,8 % et 8,4 % des participants ont déclaré une consommation d'alcool à faible risque et une consommation d'alcool à risque, respectivement. Des associations statistiquement significatives ont été observées entre la consommation de substances et des facteurs démographiques tels que le sexe, la moyenne générale et les croyances religieuses. L'étude a mis en évidence une corrélation statistiquement significative entre les scores FTND et les scores GHQ-12, ainsi qu'entre les scores FTND et les scores AUDIT. Conclusion: Les résultats de cette étude permettront d'élaborer des interventions visant à améliorer la santé mentale et les résultats universitaires des étudiants en médecine de l'université d'Istanbul-Cerrahpasa. En outre, elle sensibilisera à l'importance de la prise en charge de l'utilisation de substances chez les étudiants en médecine en Turquie.

Investigation of Inspiratory Muscle Training Efficiency Before Bronchoscopic Lung Volume Reduction: A Randomized Controlled Trial.

INTRODUCTION: Pulmonary rehabilitation (PR) is recommended prior to bronchoscopic lung volume reduction (BLVR) procedures to optimize patient outcomes. However, there's a lack of clear guidance on PR content. The aim of our study is to examine the effect of adding inspiratory muscle training (IMT) to standard PR before BLVR on exercise capacity, dyspnea, fatigue level and quality of life. METHODS: Sixty-four patients were randomly assigned to either the PR Group (PRGr) or the PR with IMT group (IMTGr). Both groups underwent an 8-week standard PR program, including breathing exercises, muscle strengthening, and walking. Additionally, IMTGr received IMT sessions. Outcome measures comprised six-minute walking distance (6MWD), maximal inspiratory and expiratory pressures (MIP, MEP), peripheral muscle strength, modified Medical Research Council dyspnea score, fatigue symptom scale, spirometric parameters, Saint George Quality of Life Questionnaire (SGRQ), International Physical Activity Questionnaire Short Form (IPAQ-SF), and Hospital Anxiety and Depression Scale. RESULTS: Our study found no significant difference in exercise capacity improvement between IMTGr and PRGr. However, IMTGr showed significant improvement in MIP compared to PRGr. Both groups experienced improvements in dyspnea, fatigue, and depression scores, as well as enhancements in 6MWD, MEP, peripheral muscle strength, IPAQ-SF and SGRQ scores. CONCLUSION: Adding IMT to PR did not show a significant difference between groups among BLVR-eligible patients. However, improved respiratory muscle strength may have positive clinical implications. Further research is needed to explore short and long-term effects.

Is temporary clamping of the bilateral common iliac artery beneficial in reducing intraoperative blood loss in patients with segmental resected anterior placenta percreta?: A prospective observational study.

OBJECTIVE: The aim of our study was to investigate whether temporary clamping of the bilateral common iliac artery (BCIA) has a role in reducing intraoperative blood loss in patients with segmentally resected anterior placenta percreta or not. METHODS: This prospective observational study included patients with anterior placenta percreta who underwent cesarean segmental resection either with BCIA temporary clamping or without clamping between October 2022 and September 2023. RESULTS: A comparison of demographic, obstetric, and surgical parameters and the need for transfusion (except for postoperative erythrocyte suspension transfusion) between the two groups revealed no significant difference (P > 0.05). In contrast, the amount of intraoperative blood loss (P = 0.001) (1974 ± 749 mL vs 2702 ± 615 mL) and postoperative erythrocyte suspension transfusion (P = 0.046) in patients who underwent BCIA temporary clamping were significantly lower than in those who did not undergo BCIA temporary clamping. CONCLUSION: Temporary clamping of BCIA plays a significant favorable role both in reducing blood loss and the need for postoperative transfusion in patients with placenta percreta who underwent segmental uterine resection.

Investigation of respiratory muscle strength and its influence on exercise capacity and quality of life in patients with idiopathic pulmonary fibrosis.

BACKGROUND: Adequate respiratory muscle strength is required to meet the increased ventilatory demand during physical activities. However, it is not well known whether respiratory muscle strength is impaired in patients with idiopathic pulmonary fibrosis (IPF). OBJECTIVES: This study aimed to investigate the relationship between respiratory muscle strength and exercise capacity, quality of life, physical activity level, and fatigue in IPF patients. METHODS: The study comprised 30 individuals with idiopathic pulmonary fibrosis (IPF) and 30 healthy controls. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured to assess respiratory muscle strength. The International Physical Activity Questionnaire-Short Form, 6-minute walk test distance (6MWD), St George Respiratory Questionnaire (SGRQ), and Fatigue Severity Scale (FSS) were employed to evaluate physical activity level, exercise capacity, quality of life, and fatigue severity, respectively. RESULTS: MIP (81±29 vs.73±20 cmH2O) and MEP (93±31 vs. 93±34 cmH2O) did not differ significantly between IPF patients and controls (p>0.05). In patients with IPF, MIP was significantly correlated with 6MWD (r=0.533), SGRQ (r=-0.428), and FSS (r=-0.433). Multivariate models including MIP, MEP, FEV1, FVC, and PA level explained 74% of the variance in the 6MWD (p<0.001), and MIP, FEV1, and PA level were independent predictors of the 6MWD, with FEV1 being the strongest predictor (ß=0.659). Multivariate models predicting SGRQ revealed none of MIP, FEV1 or PA level was directly influencing the SGRQ score. CONCLUSIONS: This study suggests that patients with IPF do not have respiratory muscle weakness. Inspiratory muscle strength has a direct influence on exercise capacity but an indirect effect on quality of life, probably by influencing exercise capacity.

Vinorelbine-loaded multifunctional magnetic nanoparticles as anticancer drug delivery systems: synthesis, characterization, and in vitro release study.

In this study, a multifunctional therapeutic agent combining chemotherapy and photothermal therapy on a single platform has been developed in the form of vinorelbine-loaded polydopamine-coated iron oxide nanoparticles. Vinorelbine (VNB) is loaded on the surface of iron oxide nanoparticles produced by a solvothermal technique after coating with polydopamine (PDA) with varying weight ratios as a result of dopamine polymerisation and covalent bonding of thiol-polyethylene glycol (SH-PEG). The VNB/PDA/Fe3O4 nanoparticles have a saturation magnetisation value of 60.40 emu/g in vibrating sample magnetometry, which proves their magnetisation. Vinorelbine, which is used as an effective cancer therapy agent, is included in the nanocomposite structure, and in vitro drug release studies under different pH conditions (pH 5.5 and 7.4) and photothermal activity at 808 nm NIR laser irradiation are investigated. The comprehensive integration of precise multifunctional nanoparticles design, magnetic response, and controlled drug release with photothermal effect brings a different perspective to advanced cancer treatment research.

Concomitant Tricuspid Valve Surgery Is Not Associated With Increased Operative Risk During Robotic Mitral Valve Surgery.

OBJECTIVE: The aim of this study was to investigate the outcomes of robotic mitral valve surgery with and without concomitant tricuspid valve surgery. METHODS: Patients who underwent robotic mitral surgery between March 2010 and September 2022 were included. Patients were grouped according to the presence of concomitant tricuspid interventions. The groups were compared for baseline factors, operative parameters, and early postoperative outcomes. Age- and gender-matched groups were also compared for outcomes. RESULTS: The study included 285 robotic mitral surgery patients. There were 59 patients who underwent concomitant tricuspid interventions. In the concomitant tricuspid surgery group, cardiopulmonary bypass time (150.1 vs 128.4 min, P < 0.001) and cross-clamp time (99.2 vs 82.4 min, P < 0.001) were longer. Prolonged intubation was more frequent in the concomitant tricuspid intervention group (5.2% vs 0.5%, P = 0.029). The groups did not differ in terms of mortality, permanent pacemaker (PPM) requirement, or other morbidities. Perioperative outcomes were similar after matched group analysis. CONCLUSIONS: Operative mortality and early adverse outcomes did not increase with the addition of tricuspid intervention in our cohort of robotic mitral surgery patients. The robotic approach for mitral disease and coexisting tricuspid disease may offer safe results without an increased risk of postoperative PPM requirement.

Robotic-assisted minimally invasive multivessel coronary bypass surgery.

Robotic-assisted minimally invasive multiple vessel coronary bypass surgery is safe and can be performed with excellent results. In this video tutorial, we present our technique for robotic-assisted minimally invasive multivessel coronary artery bypass grafting, with complete coronary revascularization via a left anterior thoracotomy and guided by preoperative computed tomography.

Robot-Assisted Minimally Invasive Multivessel Coronary Bypass Guided by Computerized Tomography.

OBJECTIVE: Robot-assisted minimally invasive coronary bypass surgery is one of the least invasive approaches that offers multivessel revascularization and accelerated recovery. We investigated the benefits of computed tomography angiography (CTA) guidance in robotic coronary bypass (RCAB) by analyzing perioperative outcomes. METHODS: Between April 2022 and April 2023, 60 consecutive patients who underwent RCAB under preoperative CTA guidance were included. The intercostal space of the minithoractomy incision was determined based on the distance from the thoracotomy site to the midsection of the left anterior descending artery (LAD) on preoperative CTA. Peripheral vascular findings on preoperative CTA guided the decision for the cannulation site. Perioperative parameters and early outcomes were evaluated. RESULTS: The mean age of the patients was 62.3 ± 10.5 years, and 51 patients were male (85.0%). The mean number of revascularized vessels was 2.9 ± 1.1. Left thoracotomy guided by CTA measurements was performed in the fourth intercostal space in 37 patients (61.7%) and in the third intercostal space in the remaining patients. Axillary cannulation was performed in 28 (46.7%) patients because of prohibitive findings in the iliac vessels and aorta. All target coronary arteries with an indication for bypass were revascularized with CTA-guided RCAB. The left internal mammary artery (LIMA) was anastomosed to the LAD in all patients, and the LIMA was anastomosed sequentially to the diagonal artery in 17 patients (28.3%). No operative mortality or cerebrovascular event was observed. One patient underwent reoperation due to bleeding. CONCLUSIONS: Robot-assisted minimally invasive multiple-vessel coronary bypass under preoperative CTA guidance is safe and can be performed with excellent results.

Case Report: Neo-ostium creation with saphenous vein in a patient with anomalous origin of the right coronary artery.

Anomalous origin of the right coronary artery from the left sinus of Valsalva is a rare congenital anomaly. Most patients may be asymptomatic, but some may experience major cardiac events such as syncope, arrhythmias, and sudden cardiac death. We present a 16-year-old patient, who had several syncopes, with anomalous origin of the right coronary artery from the left coronary sinus, with an intramural and interarterial course between the pulmonary artery and the aorta. We describe a new surgical procedure of neo-ostium creation with a saphenous vein.

Adaptive Peer Tutoring and Insights From a Neurooncology Course.

Peer teaching in medicine is a valuable educational approach that benefits students and tutors alike. The COVID-19 pandemic has significantly impacted the advancement of remote education in the medical field. In response, the Cerrahpasa Neuroscience Society organized a web-based, volunteer-based peer tutoring program to introduce students to central nervous system tumors. This viewpoint examines our peer mentoring experience in medical education. We discussed how we shaped the course, its positive effects, and the flexible nature of the course, which brought medical students from different regions together. In addition to evaluating academic results, we examined the social relations made possible by this unique teaching method by analyzing student feedback and test scores. Finally, we discussed the promise of global web-based mentoring, highlighting its significance in the dynamic and global context of medicine.

Decreased choroidal vascularity index and subfoveal choroidal thickness in vitamin D insufficiency.

BACKGROUND: To present the effects of vitamin D insufficiency on the choroidal vascularity index, central choroid and central macula. METHODS: 42 eyes of 42 patients with vitamin D insufficiency and 51 eyes of 51 age- and sex-matched healthy subjects were included in this retrospective, cross-sectional, and comparative study. The macular layer was examined using the retinal mapping mode of the spectral domain Optical coherence tomography (Optovue RTVue XR, Optovue Inc., Fremont, CA). Optical coherence tomography (OCT) images were taken in Enhanced Deep Imaging mode and transferred to Image J program. choroidal vascularity index (CVI) and subfoveal choroidal thickness (SFCT) measurements were evaluated. RESULTS: The mean age of volunteers was 35.4 ± 7.2 years. There was a significant difference in CVI values 67.75±2.4 in the patients with vitamin D insufficiency and 69.22±1.75 in the control group. The SCFT of patients with vitamin D insufficiency and control group were 295.25±42.3 and 335.71±11.6 (p = 0.001, p<0.001 respectively). CONCLUSION: OCT examination of patients with vitamin D insufficiency showed a decrease in CVI and SCFT values. These results are important in demonstrating the retinochoroidal effects of vitamin D insufficiency.

Simple Tool for Bleeding Control During Minimally Invasive and Robotic Cardiac Surgery.

Achievement of complete hemostasis is a key element to success in cardiac surgery. Bleeding control is of utmost importance in minimally invasive and robotic cardiac surgery to avoid conversion, as major bleeding is one of the most common indications for conversion to sternotomy. Bleeding control with surgical techniques can be technically more difficult in robotic and minimally invasive cardiac surgery as access to the bleeding area is limited and it is harder to intervene compared with open cardiac surgery with sternotomy. We present in this case the achievement of hemostasis in a minimally invasive robotic mitral repair, without the employment of surgical techniques and with the aid of a surgical sealant.

The effect of baseline intraocular pressure and anterior segment parameters on intraocular pressure after intravitreal bevacizumab injection.

PURPOSE: We aimed to compare the predictive effect of pre-injection intraocular pressure (IOP) and anterior segment parameters on post-injection IOP values after intravitreal bevacizumab injection for neovascular age-related macular degeneration (NVAMD) in phakic and pseudophakic patient groups. MATERIAL AND METHODS: This retrospective cross-sectional study included 65 eyes of 65 treatment-naive NVAMD patients. Patients were divided into two groups according to their lens status (35 phakic and 30 pseudophakic patients). Pre-injection IOP, anterior segment parameters measured with PENTACAM, and post-injection IOP values measured at the 5th minute were recorded. Univariate and multivariate regression analyses were used to recognise the predictive effect of pre-injection IOP and anterior segment parameters on post-injection IOP for each group. RESULTS: Multivariate regression analyses showed that the decrease in anterior chamber depth (ACD), and the increase in pre-injection IOP were significantly correlated with higher post-injection IOP in the phakic patient group (p = 0.019 and 0.031; respectively). No correlation was found in the pseudophakic patient group. CONCLUSION: Pre-injection ACD and IOP values may be predictive of higher post-injection IOP in phakic patients. Preoperative assessment of these parameters could be beneficial in patients at risk of glaucoma.

The activity levels and quality of life of physically disabled children who continued or did not continue rehabilitation during the COVID-19 pandemic.

BACKGROUND: Social isolation during the COVID-19 pandemic had a harmful impact on the psychological and physical health of children and teenagers. It is known that interruptions in rehabilitation can cause soft tissue contractures, bone deformities and a decline in motor functions among other complications. OBJECTIVE: The aim of this study was to compare the quality of life and physical activity levels of physically disabled children who continued and did not continue rehabilitation during the COVID-19 pandemic. METHOD: The gross motor levels of 18 children who continued special education and rehabilitation during the COVID-19 pandemic and 18 children who did not continue were determined with the Gross Motor Function Classification System (GMFCS). The International Physical Activity Questionnaire Short Form (IPAQ) and Children's Quality of Life Scale (PedsQL) questionnaires were administered. RESULTS: The study participants comprised 54.1% females and 45.9% males with a mean age of 9.02 years. No significant differences were detected between the two groups in respect of demographic, clinical and functional characteristics (p > 0.05). The walking parameters of PedsQL (p = 0.02) and IPAQ-SF scores (p = 0.03) were determined to be statistically significantly better in the group that continued rehabilitation. CONCLUSION: The results of this study demonstrated that the quality of life and walking capacity of children who continued rehabilitation during the COVID-19 pandemic were better. Methods should be developed to ensure that rehabilitation is not interrupted during isolation periods of any future pandemic.

Robotic-assisted mitral valve surgery without aortic cross-clamping: a safe and feasible technique.

Background: The primary objective of this study was to evaluate the safety and feasibility of robotic-assisted mitral valve surgery without aortic cross-clamping. Methods: From January 2010 to September 2022, 28 patients underwent robotic-assisted mitral valve surgery without aortic cross-clamping in our center using DaVinci Robotic Systems. Clinical data during the perioperative period and early outcomes of the patients were recorded. Results: Most patients were in New York Heart Association (NYHA) class II and III. Mean age and EuroScore II of the patients were 71.5 ± 13.5 and 8.4 ± 3.7 respectively. The patients underwent either mitral valve replacement (n = 16, 57.1%) or mitral valve repair (n = 12, 42.9%). Concomitant procedures were performed including tricuspid valve repair, tricuspid valve replacement, PFO closure, left atrial appendage ligation, left atrial appendage thrombectomy and cryoablation for atrial fibrillation. Mean CPB times were 140.9 ± 44.6 and mean fibrillatory arrest duration was 76.6 ± 18.4. Mean duration of ICU stay was 32.5 ± 28.8 h and mean duration of hospital stay 9.8 ± 8.3 days. One patient (3.6%) underwent revision due to bleeding. New onset renal failure was observed in one (3.6%) patient and postoperative stroke in one (3.6%) patient. Postoperative early mortality was observed in two (7.1%) patients. Conclusions: Robotic-assisted mitral valve surgery without cross-clamping is a safe and feasible technique in high-risk patients undergoing redo mitral surgery with severe adhesions as well as in primary mitral valve cases that are complicated with ascending aortic calcification.

Impact of Valsalva manuever on choroidal vascularity index, central choroid and central macula.

BACKGROUND: Evaluation of the effects of the Valsalva maneuver on choroidal vascularity index, central choroid and the central macula. METHODS: Eighty-four eyes of 42 healthy volunteers were evaluated in this prospective study. The central macular layer was assesed using the retinal map mode of the spectral domain OCT (Optovue RTVue XR, Optovue Inc., Fremont, CA), OCT images taken in the Enhanced Deep Imaging mode were transferred to the Image J program and the choroidal vascularity index and subfoveal choroidal thickness measurements were calculated. RESULTS: The mean age of volunteers was 35.4±7.2 years. Choroidal vascularity index, subfoveal choroidal thickness, central macular thickness and intraocular pressure measurements in the resting position were 67.99±2.1%, 337.73±12.8 µm, 232.04± 8.4 µm, 14.04±2.5 mmHg respectively, during Valsalva maneuver were 69.44±2.1%, 351.15±12.2 µm, 238.84±8.1 µm, 19.4±5.4 mmHg respectively. There was a statistically significant increase during Valsalva maneuver. CONCLUSION: The Valsalva maneuver may cause temporary changes in choroidal vascularity index, subfoveal choroidal thickness, central macular thickness and intraocular pressure. These measurements may be misinterpreted in situations where patients breath-hold inadvertantly causing the Valsalva maneuver.