Background: This study aimed to compare optic nerve sheath diameter (ONSD) with SOFA score, mortality, and
length of stay in the intensive care unit (ICU) among patients with septic shock.
Methods: An interventional study was conducted on 70 patients with sepsis admitted to the Shariati Hospital ICU.Demographic data were first recorded. Bedside ultrasonography through the upper eyelid was then performed to measure ONSD on admission and repeated on days three and six of ICU stay. Simultaneously, C- eactive protein (CRP), serum lactate levels, and SOFA scores were documented. The presence of encephalopathy was also evaluated. Statistical analyses using paired t-test and Pearson correlation were applied to examine associations between ONSD and clinical/laboratory parameters.
Results: The mean age of patients was 60.42 ± 6.06 years, with 39 (54.2%) males. Encephalopathy was observed
in 40 patients (55.6%). The mean ICU stay was 7.64 ± 2.40 days, and 39 patients (54.2%) died. ONSD showed a
significant correlation with serum lactate, CRP, and SOFA score (p < 0.05). The maximum mean ONSD was 6.0 mm on days one and three, decreasing to 5.6 mm by day six.
Conclusions: ONSD, alongside CRP, lactate, and SOFA score, may serve as useful markers for monitoring
neurological status, systemic inflammation, hemodynamic improvement, and organ function in septic shock
patients. These findings highlight their potential role in guiding timely ICU management, despite limitations such as sample size and demographic variability.

Background: Intraoperative bleeding is a challenge in functional endoscopic sinus surgery (FESS). This study
aimed to compare the effects of Dexmedetomidine and Remifentanil on intraoperative bleeding, hemodynamic
stability, and postoperative pain in patients undergoing paranasal sinus surgery.
Methods: In this randomized controlled trial, 100 adult patients undergoing paranasal sinus surgery were randomly assigned to receive either Dexmedetomidine (0.2 μg/kg/h) or Remifentanil (0.25 μg/kg/min) by
continuous intravenous infusion during surgery. General anesthesia was administered in both groups. The
primary outcome was intraoperative blood loss, assessed both by volume (in milliliters) and bleeding severity
(on a 5-point Likert scale). Secondary outcomes included systolic and diastolic blood pressure, heart rate, Visual
Analog Scale (VAS) pain scores, and surgery duration.
Results: There was no significant difference in mean intraoperative blood loss between groups
(Dexmedetomidine:114.76 ± 1 26.65 mL vs. Remifentanil: 119.20 ± 47.28 mL; p = 0.81). However, bleeding
severity was significantly lower in the Dexmedetomidine group, with 76% experiencing mild bleeding compared to 56% in the Remifentanil group, and 16% in the latter experiencing severe bleeding (p = 0.008). Postoperative VAS pain scores were significantly lower in the Dexmedetomidine group (2.04 ± 0.53 vs. 3.12 ± 1.08; p < 0.001). Hemodynamic parameters decreased substantially over time in both groups, with no clinically significant
intergroup differences, except at isolated time points.
Conclusions: While both Dexmedetomidine and Remifentanil effectively maintained hemodynamic stability
during FESS, Dexmedetomidine resulted in milder bleeding severity and better postoperative analgesia,
supporting its use as a preferred agent for controlled hypotension in sino-nasal surgery.

Background: Traumatic brain injury (TBI) is one of the leading causes of emergency department admissions and neurological morbidity among children worldwide. Identifying epidemiological trends, mechanisms of injury, and outcome predictors is essential for guiding preventive strategies and improving clinical  anagement. This study aimed to evaluate the epidemiological characteristics, mechanisms, and outcomes of pediatric head trauma cases presenting to the emergency department of Khatam-Al-Anbia Hospital in Zahedan, Southeast Iran, during 2022–2023.
Methods: This descriptive, retrospective, cross-sectional study included 112 children under 16 years of age with
documented head trauma. Data were extracted from hospital records using a standardized checklist covering
demographic variables, mechanism of injury, trauma severity (based on the Glasgow Coma Scale; GCS), and
neurological outcome (discharge or death). Consecutive non-probability sampling was applied. Statistical analysis was performed using SPSS version 26.0, employing descriptive statistics and the Chi-square test to explore associations between clinical variables and outcomes.
Results: Of the 112 cases, males comprised 76.8%, and the 6–12-year age group accounted for the largest proportion (48.2%). Road traffic accidents were the predominant cause of trauma (54.5%), followed by falls. Regarding injury severity, 50.0% had mild, 26.8% moderate, and 23.2% severe injuries. The overall mortality rate was 4.5%. Although no significant association was found between age or gender and neurological outcomes, injury severity demonstrated a borderline significant relationship with mortality (p = 0.076).
Conclusions: Pediatric head trauma remains a major cause of morbidity and mortality in Southeast Iran, predominantly affecting school-aged boys and primarily resulting from road traffic accidents. Injury severity is a key determinant of outcome. These findings highlight the urgent need for enhanced parental education, implementation of school-based safety programs, and strengthening of prehospital and in-hospital trauma care
systems to reduce preventable deaths and improve outcomes.

Sepsis is known as a leading cause of morbidity, mortality, and healthcare burdened all around the globe, with  imited targeted therapies beyond standard supportive care. Currently, management strategies focus mostly on controlling the infection and hemodynamic stabilization but often fail to address to pathophysiological processes of inflammation, oxidative stress, and microvascular injury. Vitamin C (ascorbic acid) is a potential antioxidant and immunomodulator, and has gained attention as an adjunctive therapy due to its role in reducing oxidative damage, inflammatory responses regulation, and supporting catecholamine synthesis. In addition, the synergistic combination of vitamin C and thiamine has been proposed to enhance cellular metabolism and organ protection in patients who are critically ill. In this study, we investigated the effects of  itamin C, both alone and combination with thiamine, on clinical outcomes and biochemical markers in patients with sepsis. Our findings provide new insights into the potential role of vitamin supplementation in modulating disease progression and improving prognosis, highlighting its possible integration into sepsis management strategies.

Objective: The rapidly spreading and fatal infection caused by the virus called COVID-19, primarily damages to the upper and lower respiratory tract. Thoracic CT scans, which have become an important tool in the diagnosis of the disease, can reveal asymptomatic cases in various organs such as the lungs, the thoracic wall, the mediastinum and even the upper abdominal organs. On the other hand, rib tumors are quite rare; most are benign and are usually detected incidentally during radiological examinations performed for other reasons. In this article, we present for the first time in the literature six cases of rib tumors that were incidentally detected and operated on during the pandemic era.
Methods: A total of six patients, five female and one male, who underwent surgery with a diagnosis of rib tumor between March 2020 and October 2021 during the Covid-19 pandemic were included in the study.
Results: None of them had obvious complaints suggesting rib pathology. 5 of 6 patients underwent en bloc partial rib resection with sufficient margins. No patient required prosthetic reconstruction, no malignant pathology was reported, and all patients were discharged within an average of 2.5 days.
Conclusion: While the COVID-19 pandemic has cost humanity over two years, causing the deaths of approximately 7.5 million people and disability for many more, incidental findings during screening may have contributed to earlier diagnosis and treatment. While most rib tumors are benign, they should be considered potentially malignant until proven otherwise and should be operated on according to surgical principles.

Autologous fat grafting continues to face a persistent challenge: retention rates that fluctuate unpredictably
between 20% and 80%. The stromal vascular fraction (SVF)—a heterogeneous cell population containing
adipose-derived stem cells and other regenerative cell types—has emerged as a promising adjunct. By 
romoting angiogenesis and supporting tissue regeneration, SVF enhances graft survival [1,2].
This review examines current evidence on the mechanisms of SVF-enhanced fat grafting, the techniques used
for its isolation, and the clinical contexts in which it has been successfully applied [3]. Literature published
between 2015 and 2025 was analyzed, focusing on studies that investigated SVF-enriched fat grafting in
reconstructive surgery [4]. Evidence indicates that enrichment with SVF im proves graft retention, with rates
rising to 65–80% compared to 40–65% achieved with conventional methods. Enhanced neovascularization has
also been consistently reported [5,6]. Clinically, surgeons are applying SVF-assisted grafting in breastreconstruction, rehabilitation of radiation-damaged tissue, chronic wound management, and facial rejuvenation [7,8]. Both enzymatic digestion and mechanical separation techniques have proven effective for isolating SVF, offering flexibility depending on available resources and regulatory considerations [9,10]. Overall, SVF-enhanced fat grafting represents a significant advance in regenerative surgery. Multiple studies confirm its safety and therapeutic value, underscoring its potential to improve outcomes across a range of reconstructive and aesthetic applications [11,12].