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Efficacy of virtual reality for pain management during central venous access device procedures in pediatric oncology: A systematic review and meta-analysis of randomized controlled trials
Aim: Procedures involving central venous access devices (CVADs) are painful and distressing for pediatric oncology patients. This systematic review and meta-analysis evaluated the efficacy of virtual reality (VR) interventions in reducing pain, fear, and anxiety during CVAD puncture among pediatric oncology patients. Materials and Methods: PubMed, EBSCO, Web of Science, and the Cochrane Library were systematically searched from inception to September 2025. Randomized controlled trials (RCTs) evaluating the use of VR for pain management during CVAD procedures in children and adolescents under 18 years of age were included. Two independent reviewers performed study selection and data extraction, and assessed risk of bias using RoB 2.0. Effect sizes were pooled as standardized mean differences using a DerSimonian–Laird random-effects model. Heterogeneity was quantified using the τ² and I² statistics. Results: Five RCTs were included (participants aged 6-18 years). VR reduced child-reported pain (SMD=-1.11; 95% CI: -1.82 to -0.40; I² =82.4%). Parent-reported pain likewise favored VR (SMD = -1.18; 95% CI: -1.89 to -0.47; I² =82.0%). VR reduced child-reported fear (SMD = -1.29; 95% CI: -2.33 to -0.25; I² = 87.2%) and parent-reported fear (SMD = -1.46; 95% CI: -2.00 to -0.91; I² = 36.1%). VR also lowered child-reported anxiety/distress (SMD =-1.18; 95% CI: -1.73 to -0.62; I² =61.4%). Parent-reported anxiety showed a statistically significant reduction (SMD = -1.12; 95% CI: -2.08 to -0.16; I² =85%). Risk of bias was generally low for randomization and outcome completeness, whereas some concerns were identified in the risk of bias assessment, mainly related to the lack of blinding. Conclusion: VR interventions during CVADS access appear to be effective in reducing pain and fear based on both child- and parent-reported outcomes, and they significantly reduce child-reported anxiety; however, they also reduce parent-reported anxiety. However, the certainty of the evidence is limited due to small sample sizes, heterogeneity, and methodological variability across the included studies.
Copyright (c) 2026 Annals of Medical Research https://creativecommons.org/licenses/by-nc-nd/4.0
Experiences of orthopaedic and traumatology surgeons with fasciotomy in the 2023 Kahramanmaras earthquake in Türkiye
Aim: February 6, 2023 Kahramanmaras earthquakes were among the most devastating disasters in Türkiye, causing numerous musculoskeletal injuries. This study evaluated orthopedic surgeons' experiences with fasciotomy in disaster zones, focusing on surgical practices, complication rates, challenges, and the adequacy of training. Materials and Methods: Between March–April 2023, an 18-item online survey was conducted among orthopedic surgeons serving in the earthquake-affected region. A total of 114 surgeons participated. The questionnaire covered demographics, surgical experience, fasciotomy techniques, complications, and training perceptions. Subgroup analyses were performed by experience level, surgical setting, incision preference, and prior fasciotomy exposure. Results: Fasciotomies were mainly performed in the operating room (74%; n=85), followed by the emergency department (12%; n=14), field hospitals (7%; n=8), intensive care units (4%; n=5), and temporary areas (3%; n=3). For leg fasciotomies, double incisions were preferred in 81% (n=92) and single incisions in 16% (n=18). For forearm fasciotomies, volar incisions were used in 74% (n=84), and combined volar+dorsal incisions were used in 26% (n=30). The overall complication rate was 43% (n=49); the most common complications were bleeding (16%; n=18) and wound problems (12%; n=14). Inadequately decompressed compartments were reported in 86% of cases (n=98). Complications were more frequent among surgeons with 1–5 years’ experience (58%; n=18) compared with those with >10 years’ experience (35%; n=17) (p=0.03), and were more frequent when procedures performed outside the operating room (55%; n=16) than within it (29%; n=25) (p=0.01). Surgeons with prior fasciotomy experience reported higher confidence (76%; n=73) than those without (41%; n=7) (p<0.01). Conclusion: The fasciotomy experiences of orthopedic surgeons during the Kahramanmaraş earthquake revealed deficiencies in standardization and competency in disaster surgery. Outcomes depended on the surgeon's experience and on the surgical conditions. Strengthening disaster preparedness requires structured training, simulation-based exercises, national and international guidelines.
In the article by Keser S, et al., entitled “An examination of the ocular surface parameters of patients with non-exophthalmic Graves disease” published in Ann Med Res. 2023;30(5):607–610, the authors informed us that the year “2022” had been inadvertently included in the description of the study period in the Abstract and Materials and Methods sections. Following editorial evaluation, it was deemed necessary to amend the study period to 2023 to ensure clarity and consistency throughout the manuscript. This correction does not affect the results, statistical analyses, or conclusions of the study. However, we believe that this minor revision improves the overall clarity and consistency of the manuscript. The relevant sections have been corrected accordingly. You can access the updated article PDF via the following link: https://annalsmedres.org/ index.php/aomr/article/view/ 4438
Extensive involvement of multiple cranial nerves in relapsed multiple myeloma
Clinical course and reaction profile of patients undergoing venom immunotherapy
Aim: Bee venom allergy is a major cause of anaphylaxis in adults. Venom Immunotherapy (VIT) is the only proven curative treatment, but the frequency and management of local and systemic reactions during therapy are essential considerations for safety. This study aimed to evaluate the demographic and clinical characteristics of patients undergoing VIT and to analyze reaction rates and management strategies. Materials and Methods: This retrospective single-center study included 31 patients (18 honeybee, 13 vespid)who received VIT at the Ankara Bilkent City Hospital Allergy and Clinical Immunology Clinic between October 2024 and September 2025. All patients received a standard premedication protocol. Demographic, clinical, and laboratory data were obtained from medical records. Systemic reactions were classified according to the Ring–Messmer grading system, and management strategies for VIT-related reactions were analyzed. Results: The mean age of the patients was 41.5 ± 15.3 years, and 61.3% were male. A history of beekeeping was significantly more common among honeybee-allergic patients (p = 0.009). Index sting reactions were often; Grade 3 reactions were observed in 58.1% of cases. Respiratory (77.4%) and cardiovascular (64.5%) involvement were the most common clinical manifestations; adrenaline was administered in 54.8% of index reactions. During VIT, 12 patients (38.7%) developed reactions, of which 7 (22.6%) were systemic. Systemic reactions occurred more frequently in the honeybee VIT group than in the vespid group, although this difference was not statistically significant (p = 0.101). Most systemic reactions were mild to moderate and occurred early during treatment. In selected cases, VIT was successfully continued with dose adjustment and adjunctive omalizumab therapy. Conclusion: Systemic reactions during VIT were more frequent among honeybee venom–allergic patients but were generally mild to moderate and manageable. With close monitoring, appropriate dose modifications, and biologic support when indicated, VIT can be safely continued in most patients.
Prognostic significance of PIK3CA immunoexpression and mutation status in triple-negative breast cancer
Aim: Triple-negative breast cancer (TNBC) is an aggressive subtype with limited targeted therapies. This study investigated PIK3CA protein expression in TNBC and, exploratorily, assessed PIK3CA mutations in a subset of tumors with high expression. Materials and Methods: Sixty-five TNBC cases were retrospectively analyzed. PIK3CA expression was assessed by H-score and grouped for survival analysis as negative versus moderate–high. Six high-expression cases underwent mutation analysis. Associations with clinicopathological parameters, overall and disease-free survival were evaluated using Kaplan–Meier and log-rank tests. Results: PIK3CA expression was negative in 80.0% (52/65) of cases, while moderate–high expression was observed in 20.0% (13/65). No significant associations were observed between PIK3CA immunohistochemical expression and clinicopathological features (p>0.05). PCR-based mutation analysis was performed on the moderate–high expression subgroup. 33.3% (2/6) of the tested high-expression cases harbored PIK3CA mutations. All deaths occurred in the negative-expression group; overall survival was significantly better in the moderate–high expression group (p = 0.043). However, no death events were observed in the moderate–high subgroup (n = 13), and this finding should be interpreted cautiously because of the low number of events. No significant difference in disease-free survival was found between groups (p = 0.588). Conclusion: PIK3CA protein expression was not associated with conventional clinicopathological prognostic parameters in TNBC. Nevertheless, moderate–high PIK3CA expression was associated with better overall survival, indicating a hypothesis-generating rather than an independent prognostic effect. Moreover, despite the absence of significant differences at the immunohistochemical level, PIK3CA mutations were detected by PCR in a limited subset of high-expression cases, highlighting a potential discordance between protein expression and molecular alterations. These findings warrant validation in larger, multicenter studies.
Antibacterial activity of Salvia officinalis (sage) against Streptococcus pyogenes isolates from throat culture
Aim: To investigate the antibacterial effects of methanolic extracts of Salvia officinalis (leaves and roots) against Streptococcus pyogenes isolates from throat cultures, based on the hypothesis that these extracts may exhibit inhibitory activity against clinical isolates, as suggested by previous reports of its antimicrobial potential. Materials and Methods: After the plant was collected, it was separated into leaf and root parts, dried at 70°C for 24 hours, and then powdered. Dried plant samples were extracted in methanol for 24 hours. The broth microdilution method was used to determine antibacterial activity. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) values of the extracts against the isolates were determined. Results: MIC values of leaf and root extracts against isolates ranged from 7.8-125 µg/ml and 7.8-500 µg/ml, respectively; MBC values ranged from 7.8-125 µg/ml and 7.8-500 µg/ml, respectively. In general, lower MIC and MBC valueswere observed in leaf extracts than in root extracts. Conclusion: Different methods are used in studies investigating the antibacterial effect of S. officinalis, and no standard method exists. If the safe use limits for sage are determined through cytotoxicity studies and a standard method is developed, S. officinalis can be used as a supplement for the treatment of infectious diseases caused by resistant strains.
Evaluating awareness of lysosomal storage diseases: A step toward early diagnosis
Aim: Lysosomal storage diseases (LSD) are a diverse group of rare inherited metabolic disorders that frequently go undiagnosed for extended periods because of their non-specific, overlapping clinical features. Raising awareness among healthcare professionals is crucial for facilitating early diagnosis and improving outcomes. This study aimed to evaluate physicians' awareness of and knowledge about five LSDs: Gaucher disease, Fabry disease, mucopolysaccharidoses, Pompe disease, and Niemann–Pick types A/B. Materials and Methods: A descriptive cross-sectional survey was conducted among 106 physicians, including 56 pediatricians and 50 internal medicine specialists. A 17-item online questionnaire assessed participants' knowledge of LSD symptoms, diagnosis, and treatment. Results: 81.9% of the physicians participating in the study reported limited knowledge of LSD. When the pediatric and internal medicine groups were compared, pediatric specialists generally exhibited higher levels of awareness than their internal medicine counterparts. This difference was statistically significant for MPS and Gaucher disease (p = 0.016 and p = 0.012, respectively). Among the participants, only 25.7% recognized that LSD can occur at any age. 86.7% of respondents identified genetic testing as accurate, while 38% and 58.1% indicated roles for bone marrow aspiration and liver biopsy, respectively, in diagnosis. The vast majority of physicians (99%) emphasized the need for increased training in this field. Conclusion: Our study demonstrates that physicians working at a tertiary training hospital lack sufficient awareness of LSD. Therefore, strengthening educational programs for physicians is essential to enhance awareness and improve early diagnosis of the disease.
The role of cognitive flexibility in the relationship between pregnancy risk perceptions and vaccine hesitancy in expectant mothers
Aim: Vaccine hesitancy has emerged as a significant public health problem in recent years. The aim of this study was to examine the moderating role of cognitive flexibility in the relationship between pregnant women's risk perceptions and vaccine hesitancy. Materials and Methods: The study employed a relational screening model. The study population consisted of pregnant women. The sample included 204 participants who were randomly selected and consented to participate. Data were collected using a Personal Information Form, the Vaccine Hesitancy Scale, the Pregnancy Risk Perception Scale, and the Cognitive Flexibility Scale. Data analysis was conducted using SPSS v26 and Hayes’ PROCESS Macro Model 1. Results: The sample’s mean age was 29.5 years; most participants had at least a university degree and reported middle-income status, while a majority lived in nuclear families. Participants with university or postgraduate education had higher cognitive flexibility scores than those with primary education. A marginal trend suggested greater cognitive flexibility among participants with higher incomes. Employment status significantly influenced vaccine hesitancy: self-employed women demonstrated higher hesitancy than those who were unemployed, and public-sector employees exhibited the highest levels of risk perception. A moderate positive correlation was observed between cognitive flexibility and vaccine hesitancy. A moderation analysis confirmed that cognitive flexibility did not significantly moderate the relationship between pregnancy risk perception and vaccine hesitancy. The overall model explained 7.8% of the variance in vaccine hesitancy, but was not statistically significant. Conclusion: The findings underscore the complexity of vaccine hesitancy, indicating that cognitive processes alone may be insufficient to predict vaccination attitudes during pregnancy. Expanding such research to a national scale and integrating qualitative insights could enrich interpretations of how personal and contextual variables jointly shape vaccine hesitancy during pregnancy, ultimately supporting targeted interventions to promote maternal and fetal health.
Association between serum chloride levels and 28-day mortality in geriatric septic ICU patients: A retrospective cohort study
Aim: This study aimed to examine whether serum chloride concentrations obtained within the first 24 hours after intensive care unit (ICU) admission are associated with 28-day all-cause mortality in elderly patients with sepsis, which was defined according to Sepsis-3 criteria (suspected infection plus ≥2-point increase in SOFA score) and to explore their potential prognostic value. Materials and Methods: This retrospective cohort study was conducted at a single center and involved 221 patients aged 65 years and older who were hospitalized in the ICU with sepsis between December 1, 2023 and May 31, 2024. Patient categorisation was based on serum chloride levels measured within the first 24 hours. Patients were categorised as hypochloremic (<95 mEq/L), normochloremic (95–110 mEq/L), or hyperchloremic (>110 mEq/L). Information on demographics, laboratory results, and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores was collected. Data analysis involved the Mann-Whitney U test, the Chi-square test, and logistic regression. Results: A total of 221 patients were evaluated, with a mean age of 80.87 ± 8.04 years. The 28-day all-cause mortality rate was found to be 67.4%.The prevalence of hyperchloremia (62.4%) was significantly higher than that of normochloremia (25.8%) and hypochloremia (11.8%). Multivariate logistic regression analysis showed that hyperchloremia was an independent predictor of 28-day mortality (OR = 4.95; 95% CI, 1.51–16.21; p = 0.008). A rise in the APACHE II score was found to be a highly significant predictor of mortality (p<0.001). Conclusion: An independent association between elevated chloride levels and 28-day mortality was observed in elderly septic patients requiring intensive care. Routine monitoring of serum chloride levels and careful management of chloride load may contribute to an improved prognosis in this vulnerable patient population.
A comparative analysis of large language models in digital content on painless labor: A systematic evaluation of readability, reliability, quality, and accuracy
Aim: Painless labor is an important concern in obstetric care, with both medical and psychosocial dimensions. With the increasing use of artificial intelligence (AI) in health communication, evaluating the quality of content generated by large language models (LLMs) is essential. This study aimed to compare AI-generated content on “painless labor” produced by three LLMs—ChatGPT (Chat Generative Pre-trained Transformer), Gemini, and DeepSeek—in terms of readability, reliability, content quality, and medical accuracy. Materials and Methods: A total of 270 texts were generated using 30 frequently searched keywords on three dates in May 2025 via the free versions of the three LLMs. Readability was assessed with six validated indices. Reliability and quality were evaluated using the Modified DISCERN tool, the JAMA (Journal of the American Medical Association) Benchmark Criteria, the Ensuring Quality Information for Patients (EQIP)-36, and the Global Quality Score. The medical accuracy of 90 texts was assessed by an obstetric anesthesia expert. Results: ChatGPT texts were the most readable and were written at lower grade levels, but scored lower in reliability and quality. Gemini ranked highest for both reliability and content quality, although it produced more complex language. DeepSeek showed variable performance. No significant differences were found in medical accuracy or content completeness. Gemini also demonstrated the most consistent performance across all time points. Conclusion: LLMs vary substantially in how they present medical content. ChatGPT achieved higher readability scores, indicating simpler language structures, whereas Gemini demonstrated higher reliability and content quality metrics. However, the absence of source citations across all models raises concerns about the verifiability of content, highlighting the need for critical oversight in healthcare applications.
Evaluation of swallowing and voice functions in children with different degrees of adenoid hypertrophy and after adenoidectomy
Aim: To evaluate self-reported swallowing difficulties and voice-related symptoms in children with varying degrees of adenoid hypertrophy and in those who had undergone adenoidectomy. Materials and Methods: Children aged 5–12 years diagnosed with adenoid hypertrophy were included in this prospective cohort study. Patients were categorized into three groups based on the degree of nasopharyngeal obstruction: no detectable adenoid hypertrophy (control), adenoid hypertrophy occupying less than ≤50% of the nasopharyngeal space, and adenoid hypertrophy occupying more than >50% of the nasopharyngeal space. Swallowing and voice functions were assessed using validated self-report screening questionnaires: the Children’s Voice Handicap Index-10 (CVHI-10) and the Pediatric Eating Assessment Tool-10 (PEDI-EAT-10). For patients who underwent adenoidectomy, both questionnaires were re-administered one month postoperatively and compared with preoperative results. Results: A total of 113 children (mean age 7.41 ± 2.00 years) were included. Group comparisons showed that PEDI-EAT-10 and CVHI-10 scores were significantly higher in Group 3 than in Group 1 (p < 0.001). Adenoidectomy significantly reduced both scores postoperatively (p <0.001). Self-reported dysphonia was observed in 15% of patients, and self-reported swallowing difficulties in 25.7% of patients, with the highest prevalence in Group 3. Conclusion: Severe adenoid hypertrophy was associated with greater patient-reported impairments in swallowing and voice function compared with controls. Adenoidectomy led to significant postoperative improvements in swallowing and voice symptoms, as assessed by screening tools.
Transcatheter arterial embolization for refractory non-variceal gastrointestinal bleeding: Outcomes and prognostic indicators
Aim: Transcatheter arterial embolization (TAE) is increasingly used as second-line therapy for non-variceal gastrointestinal bleeding (NVGIB) when endoscopic hemostasis fails. This study investigated factors influencing rebleeding, mortality, and length of hospital stay (LOS) following TAE. Materials and Methods: We retrospectively analyzed 50 patients (mean age 64.8 years; 72% male) who underwent TAE for acute NVGIB between April 2023 and April 2025. Demographic variables, comorbidities, laboratory values, endoscopic/angiographic findings, embolic materials, and outcomes were reviewed. Primary outcomes were rebleeding and in-hospital mortality; secondary outcomes were LOS and overall mortality. Results: Technical success was 97.9%. Rebleeding occurred in 30% (15/50) of cases, predominantly within the first week. Risk was higher with malignancy (45.5%), systemic disease or bleeding disorders (29.4%), multivessel embolization (66.7% vs. 21.1%), and negative endoscopic findings (75% vs. 25.6%) (all p < 0.05). In-hospital mortality was 32% (16/50) and was associated with higher Rockall scores (p = 0.001) and lower platelet counts (p = 0.037). Overall mortality reached 52% (26/50) at a median follow-up of 16 months and was significantly associated with elevated INR (p = 0.005) and Rockall score (p = 0.032). Among survivors, mean LOS was 15.5 days and was correlated with comorbidity burden, transfusion requirements, and delayed embolization; lower baseline hemoglobin predicted longer stays. Complications occurred in 6% of patients: two minor access-site hematomas and one ischemic event. Conclusion: TAE is a safe and effective treatment for NVGIB that is refractory to endoscopic therapy and is associated with high technical success and low complication rates. Mortality and rebleeding are primarily influenced by comorbidities, disease severity, and procedural complexity rather than by embolic technique, emphasizing the importance of individualized risk assessment and multidisciplinary management.
Baseline detrusor pressure and renal reserve as determinants of botulinum toxin a response in pediatric neurogenic bladder
Aim: Pediatric neurogenic bladder (NB) jeopardizes both lower and upper urinary tract integrity. This study evaluated the pressure-lowering efficacy of intradetrusor botulinum toxin A (BTX-A) in children with spinal-origin NB and identified clinical and urodynamic predictors of treatment response. Materials and Methods: In this retrospective cohort study, 38 pediatric patients with spinal-origin NB who received 100 IU of BTX-A between October 2023 and December 2024 were analyzed. BTX-A was injected cystoscopically at 20 detrusor sites, sparing the trigone. The primary outcome was the 6-month change in storage-phase detrusor pressure (Δp_det), calculated as p_det = p_ves − p_abd per ICCS standards. Secondary outcomes included an exploratory responder endpoint (≥10 cmH₂O reduction in storage pressure) and attainment of guideline-based safe storage thresholds (<30 and <35 cmH₂O). Associations with demographic, functional, and renal parameters were examined using correlation, multivariable regression, and ROC analyses. Results: Mean baseline storage-phase detrusor pressure was 59.9 ± 21.2 cmH₂O, decreasing to 52.5 ± 19.7 cmH₂O at six months (Δp_det = −7.4 ± 12.5 cmH₂O; P < 0.05). A ≥10 cmH₂O reduction in pressure was observed in 26.3% (10/38) of patients, and 10.5% and 13.2% achieved storage pressures <30 cmH₂O and <35 cmH₂O, respectively. In exploratory logistic regression, higher baseline p_det (OR = 1.05; P = 0.039) and preserved renal function (eGFR; OR = 1.04; P = 0.042) were associated with a ≥10 cmH₂O reduction, whereas etiology and age showed non-significant trends. Conclusion: Intradetrusor BTX-A produced a modest but statistically significant reduction in storage-phase detrusor pressure, with only a minority of patients reaching guideline-defined safe storage thresholds. These findings support BTX-A as a clinically relevant pressure-lowering option within a multimodal, pressure-guided strategy — particularly in children with high baseline pressures and preserved renal reserve — rather than as a uniformly transformative stand-alone therapy.
Pediatric atypical antipsychotic poisoning: A single-center cohort study
Aim: This study aimed to describe the clinical features, exposure characteristics, management, and outcomes of pediatric atypical antipsychotic poisonings treated in a single tertiary pediatric intensive care unit (PICU) and to contextualize findings using the Poisoning Severity Score (PSS). Materials and Methods: We conducted a retrospective, descriptive review of children and adolescents (1 month–18 years) managed for single-agent atypical antipsychotic ingestion at the PICU of Ağrı Training and Research Hospital between January 2018 and January 2023. De-identified electronic records were abstracted for demographics, implicated agent (amisulpride, aripiprazole, quetiapine, olanzapine, risperidone, ziprasidone), dose (mg and mg/kg), time from ingestion to presentation, decontamination (gastric lavage, activated charcoal), treatments (including biperiden), clinical/laboratory findings, and outcomes. Severity was classified according to PSS (0–4). Continuous data are reported as median (IQR); categorical data are reported as n (%). A two-sided p<0.05 was considered significant. Results: Forty-one pediatric cases were included. The most frequent agent was risperidone (46.3%). Decontamination included gastric lavage in 43.9% and activated charcoal in 46.3%. Tachycardia, hypokalemia, confusion, extrapyramidal symptoms (EPS), and drowsiness were common findings. The PSS distribution was none 14.6%, minor 43.9%, moderate 36.6%, and severe 4.9%; no deaths occurred (therefore, no PSS grade 4). In a risperidone subgroup analysis (n = 19), biperiden was administered to 6 patients for acute EPS; time to presentation tended to be longer in those given biperiden (median 9.0 vs 4.0 h; p = 0.08). Ordinal logistic modeling indicated higher PSS categories in the biperiden group (odds ratio [OR], 68.11; 95% confidence interval [CI], 3.59–1291.68; p = 0.005). Conclusion: In this cohort, pediatric atypical antipsychotic poisonings were predominantly mild to moderate with no fatalities. Risperidone exposures were the most common and frequently associated with EPS, which resolved with biperiden. These data support a generally favorable prognosis with timely supportive care and targeted symptomatic management.
Explainable deep learning for the automated classification of macular diseases in OCT images
Aim: Optical coherence tomography (OCT) is a widely used, noninvasive, rapid, and high-resolution imaging technique for diagnosing and monitoring macular diseases. Despite its clinical value, OCT image interpretation is time-consuming and requires expert knowledge, which may lead to inconsistencies in diagnosis. The objective of this study is to create an AI-based model that reliably and effectively categorizes macular diseases from OCT images, offering a workable solution in environments with restricted access to ophthalmology specialists. Materials and Methods: A convolutional neural network model based on ResNet50 architecture was developed to classify OCT images into seven categories: age-related macular degeneration (AMD), diabetic macular edema (DME), epiretinal membrane (ERM), retinal artery occlusion (RAO), retinal vein occlusion (RVO), vitreomacular interface disease (VID), and normal (NO) controls. Grad-CAM was employed to enhance the interpretability of the model and support clinical usability. Results: The model’s macro-averaged precision, recall, and F1-score were 0.943 (95% confidence interval [CI]: 0.941–0.960), 0.940 (95% CI: 0.941–0.960), and 0.940 (95% CI: 0.941–0.960), respectively, with an overall accuracy of 0.950 (95% CI: 0.941–0.960). Grad-CAM visualizations confirmed the model’s focus on relevant retinal regions, thus supporting diagnostic reliability and interpretability. Conclusion: The explainable model demonstrated strong diagnostic performance and potential as a clinical decision-support tool, especially in environments with limited resources. The integration of explainable AI techniques, such as Grad-CAM, enhances trust in automated decision-making and offers significant potential in supporting non-expert users and early detection strategies.
Primary cicatricial alopecia subtypes: Clinical and histopathological patterns in a large Turkish cohort
Aim: Primary cicatricial alopecias (PCAs) are a group of rare dermatological disorders characterized by irreversible destruction of hair follicles due to inflammatory processes, leading to permanent hair loss. The diagnostic process is often delayed because of nonspecific clinical presentation and overlapping histopathological features. This study aimed to analyze the clinical and histopathological characteristics of PCA subtypes diagnosed in a tertiary dermatology clinic in Türkiye over a 17-year period. Materials and Methods: A retrospective analysis was conducted on 116 cases of histopathologically confirmed PCA between January 2008 and January 2025. Clinical diagnoses included discoid lupus erythematosus (DLE), lichen planopilaris (LPP), frontal fibrosing alopecia (FFA), pseudopelade of Brocq (PPB), and folliculitis decalvans (FD). Histopathological features were systematically reviewed and statistically analyzed using the Statistical Package for the Social Sciences version 25.0. Results: The most frequent subtype was DLE (60.3%), followed by LPP (28.4%). DLE was associated with basal membrane thickening (82.9%) and dermal mucin deposition (71.4%), whereas LPP showed higher rates of sebaceous gland loss (51.5%) and interface dermatitis (54.5%). FFA exhibited overlapping features with LPP, including 100% basal cell degeneration. Statistically significant associations were found between specific histopathological patterns and clinical subtypes. Conclusion: This study provides one of the comprehensive PCA datasets in Türkiye, highlighting distinct histopathological patterns associated with specific clinical subtypes. These findings underscore the importance of clinicopathological correlation in PCA diagnosis and contribute valuable data for improving diagnostic accuracy and patient management.
One-year cardiovascular risk assessment after laparoscopic sleeve gastrectomy: A retrospective cohort study
Aim: Bariatric surgery effectively reduces cardiovascular risk, though the mechanisms remain incompletely understood. This study aimed to evaluate changes in Framingham cardiovascular risk scores and identify predictors of risk reduction following sleeve gastrectomy. Materials and Methods: This retrospective cohort study included 111 patients (73% female; median age, 33 years [range 18–63]; median BMI, 43 kg/m² [range 35–77]) who underwent laparoscopic sleeve gastrectomy between January 2021 and June 2024. Framingham 10-year cardiovascular disease risk scores were calculated at baseline and 12 months postoperatively. Multivariable linear regression identified independent predictors of absolute risk reduction. Results: The Framingham risk score decreased from 6 (-10–25) to 3 (-9–26) at 12 months (p < 0.001), representing a 50% relative risk reduction. BMI decreased from 43 (35–77) to 29 (21–55) kg/m² (p < 0.001). Notably, change in BMI was not correlated with cardiovascular risk reduction (r = 0.032, p = 0.735). HDL cholesterol demonstrated a biphasic trend—initially decreasing at 3 months, then exceeding baseline values at 12 months (p < 0.001). In multivariable analysis, age (β = -0.223, p < 0.001); baseline Framingham score (β = 0.532, p < 0.001); and HDL change (β = 0.279, p = 0.047) were independent predictors of the absolute risk reduction. Interestingly, an increase in HDL showed a negative association in univariable analysis but a positive association in multivariable analysis. Conclusion: Sleeve gastrectomy achieved a significant reduction in cardiovascular risk independent of the magnitude of weight loss. The HDL paradox and age-dependent response suggest that complex mechanisms beyond simple weight reduction are involved. These findings support incorporating cardiovascular risk assessment, not just BMI, when determining surgical indications.
Alpha-lipoic acid as a therapeutic agent in ibuprofen-induced liver fibrosis in a rat model
Aim: Ibuprofen (IBU), a commonly used nonsteroidal antiinflammatory drug, may cause hepatotoxicity and fibrosis with prolonged or high-dose use. Alpha-lipoic acid a natural antioxidant, has shown protective effects against oxidative stress and liver injury. The potential therapeutic role of ALA in IBU-induced liver fibrosis was evaluated. Materials and Methods: Thirty male Wistar Albino rats were divided into five groups (n = 6): control, sham (corn oil), IBU (200 mg/kg by oral gavage for 21 days), IBU + ALA (IBU for 21 days followed by ALA 100 mg/kg by oral gavage for 7 days), and ALA (100 mg/kg for 7 days). Liver tissue was analyzed histopathologically with hematoxylin-eosin and Masson’s trichrome staining and immunohistochemically for TLR4, TGF-β, and α-SMA expression. Data were analyzed using GraphPad Prism 10, with normality assessed by Shapiro-Wilk, group comparisons by analysis of variance or Kruskal-Wallis, and p < 0.05 considered significant. Results: IBU caused significant hydropic degeneration, sinusoidal dilatation, and perivascular collagen accumulation compared with controls (p<0.001). ALA treatment significantly reduced sinusoidal dilatation (p<0.01) and perivascular fibrosis (p<0.001) significantly but had no significant effect on hydropic degeneration. Immunohistochemistry showed increased TLR4, TGF-β, and α-SMA expression in the IBU group (p<0.001). ALA significantly decreased TLR4 (p<0.001) and α-SMA (p<0.001), while reduction in TGF-β was not statistically significant. Conclusion: Although ALA alleviates IBU-induced liver fibrosis by suppressing inflammatory signaling (TLR4) and hepatic stellate cell activation (α-SMA), its effect on TGF-β-mediated fibrogenesis is limited. These findings suggest that ALA may help prevent nonsteroidal anti-inflammatory drug-induced liver injury, but further studies with longer treatment durations are needed.
Analyses of human papillomavirus genotypes in cervical cancer patients using real-time PCR
Aim: The aim of this study was to identify the most prevalent Human Papillomavirus (HPV) genotypes associated with cervical cancer in Gaziantep and to determine the most appropriate HPV vaccine for individuals who have not yet been infected. Materials and Methods: This retrospective cross-sectional study included 74 patients diagnosed with cervical cancer at Gaziantep University Faculty of Medicine between December 2005 and June 2019. Formalin-fixed paraffin-embedded tissue samples were retrieved from the pathology archives. HPV DNA was extracted and genotyping of 14 high-risk HPV types was carried out by real-time PCR. Results: All patients were histopathologically diagnosed with squamous cell carcinoma. Single HPV type infection was detected in six patients (8.2%) (HPV 16 in five, HPV 56 in one), whereas multiple infections were observed in 68 patients (91.8%). Among these, HPV 16 was identified in 100% of cases, HPV 45 in 82%, HPV 18 in 45%, HPV 56 in 19%, and HPV 33 in 16%. Overall, HPV 16, 45, and 18 genotypes emerged as the most frequent types contributing to cervical cancer in this region. Conclusion: Given the genotypes identified in this study, the nonavalent HPV vaccine (9-valent; HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58) appears to be the most suitable option for our population. However, due to its limited availability in Turkey, the quadrivalent HPV vaccine (4-valent; HPV types 6, 11, 16, and 18), which may provide partial cross-protection against HPV 45, could serve as a reasonable alternative.
The relationship between empathy and cognition in patients with tension type headache
Aim: Tension-type headache (TTH) is the most common primary headache disorder, yet its impact on cognitive and empathic functions remains underexplored. This study investigates the relationship between cognitive domains and empathy in individuals with TTH, considering demographic influences. Materials and Methods: A total of 71 TTH patients (49 females, 22 males) underwent cognitive assessment using the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE), alongside the Empathy for Pain Scale (EPS) to evaluate cognitive and affective empathy. Statistical analyses included independent samples t-tests and Pearson correlation. Results: No significant differences found were in terms of gender, general cognitive performance (MMSE, MoCA). However, females exhibited significantly higher affective distress, visceral pain empathy, and empathic concern scores. Males showed slower cognitive processing speed on the Trail Making Test. Age negatively correlated with cognitive function but positively with affective distress and empathic concern. Education was positively associated with cognitive scores but not with empathy measures. Executive dysfunction correlated with increased emotional empathy. Conclusion: The findings reveal distinct gender-related differences in empathy among TTH patients, independent of global cognition, and highlight the complex interplay between executive function, age, education, and empathic processing. These insights underscore the need for integrative biopsychosocial approaches in TTH management.
HBV immunity gaps in older adults undergoing cataract surgery: Opportunistic screening and linkage to care
Aim: To assess whether routine preoperative testing in cataract surgery candidates can serve as a practical public health checkpoint for detecting waning hepatitis B immunity and initiating booster-based protection pathways. Materials and Methods: In this descriptive cross-sectional study, preoperative anti-HBs, HBsAg, anti-HCV, and anti-HIV serologies were evaluated in 430 patients (January 2023 – December 2024) who underwent cataract surgery. Anti-HBs levels were classified as non-protective (<10 mIU/mL), low-protective (10–<100 mIU/mL), or highly protective (≥100 mIU/mL). Chi-square tests and logistic regression were used to analyze immunity levels and associated risk factors. Results: Among 430 patients (mean age 67.4 ± 9.6 years; 47.4% women), anti-HBs titers were <10 mIU/mL in 47.0% (202/430), 10–<100 mIU/mL in 20.7% (89/430), and ≥100 mIU/mL in 32.3% (139/430). Women had higher odds of non-protective titers (<10 mIU/mL) than men (OR 1.52, 95% CI 1.04–2.23; P=0.031), which persisted after adjustment for age and comorbidity (aOR 1.49, 95% CI 1.04–2.13; P=0.028). HBsAg positivity was 4.4% (19/430); anti-HCV was 2.1% (9/430) and HIV was 0%. Across major comorbidity groups, anti-HBs distributions were broadly similar. Conclusion: A substantial proportion of patients undergoing cataract surgery lack adequate HBV immunity, emphasizing the need for routine preoperative serological screening and booster vaccination. This pioneering study from Türkiye provides valuable insights into infection control strategies for ophthalmic surgery.
The mediatory role of coping styles in the relationship between mindfulness in parenting and burnout in mothers of children with autism spectrum disorder
Aim: The purpose of this study was to examine the relationship between mindfulness in the mothers of children with autism spectrum disorder(ASD)and coping with stress styles and parental burnout, and to test the mediatory role of coping with stress styles. Materials and Methods: The research was performed using a cross-sectional design. Seventy-one mothers of children with ASD were included in the study. The participants were administered the Mindfulness in Parenting Questionnaire, Ways of Coping Questionnaire, and Maslach Burnout Inventory. Relationships were examined using correlation analysis, and mediating effects were examined using the bootstrap method. Results: Mindfulness in parenting exhibited a negative correlation with the burnout depersonalization subdimension (r = -0.337, p = .008) and a significant positive correlation with the personal accomplishment subdimension (r = 0.548, p ˂ .001). Mediation analysis showed that the helpless approach (b= -0.045, BootSE=0.029, 95% BCa CI [–0.117, –0.003]) and submissive approach (b= 0.031, BootSE=0.018, 95% BCa CI [0.002, 0.073]) coping styles played a mediating role in the protective effect of mindfulness on depersonalization. However, coping styles did not have a statistically significant mediating role in the effects of mindfulness on emotional exhaustion or personal accomplishment. Conclusion: The results suggest that mindfulness-based interventions may be effective in reducing burnout in mothers of children with ASD by targeting negative coping strategies. Therefore, integrating psychoeducational components into intervention programs to help mothers recognize nonfunctional coping styles is recommended.
Evaluation of first-trimester PAPP-A and β-hCG levels in isolated single umbilical artery pregnancies and their association with adverse perinatal outcomes
Aim: This study aimed to evaluate the association between first-trimester biochemical markers—pregnancy-associated plasma protein A (PAPP-A) and beta-human chorionic gonadotropin (β-hCG)—and adverse perinatal outcomes in pregnancies complicated by isolated single umbilical artery (SUA). Materials and Methods: This retrospective case-control study was conducted at a tertiary perinatology center between January 2023 and January 2025. The study group included 266 pregnant women diagnosed with isolated SUA, and the control group included 266 healthy singleton First-trimester serum PAPP-A and β-hCG MoM values were compared between groups. Composite adverse perinatal outcome (CAPO) was defined as the presence of at least one of the following: preterm birth, fetal growth restriction (FGR), oligohydramnios, polyhydramnios, intrauterine fetal demise (IUFD) or NICU admission. Results: Although PAPP-A MoM levels were not significantly different between the SUA and control groups, PAPP-A values were significantly lower in SUA cases that developed CAPO (p<0.001). ROC analysis revealed that a PAPP-A cut-off <0.65 predicted CAPO with 2% sensitivity and 72.2% specificity (AUC=0.704, p<0.001). Conclusion: Low first-trimester PAPP-A levels may serve as a moderate predictor of adverse perinatal outcomes in isolated SUA PAPP-A may help guide risk stratification and antenatal surveillance intensity in this β-hCG MoM levels were higher in SUA cases than controls (p<0.001), but no significant difference was found between SUA cases with and without CAPO (p>0.05).
Prognostic value of CA 19-9 elimination rate for mortality in metastatic pancreatic cancer
Aim: To evaluate the prognostic value of the CA 19-9 elimination rate on survival in patients with metastatic pancreatic cancer. Materials and Methods: This single-center retrospective cohort study included 103 adult patients with metastatic pancreatic ductal adenocarcinoma who received systemic therapy. The CA 19-9 elimination rate was calculated using baseline and 3-month values. The optimal cut-off value was determined using maximally selected rank statistics. Overall survival was analyzed using the Kaplan–Meier method and compared using the log-rank test. Results: The mean age of the patients was 64±10.1 years, and the overall mortality rate during follow-up was 87.4%. No significant differences were observed between mortality groups with respect to demographic, clinical, or pathological characteristics (all p>0.05). The optimal cut-off value for the elimination rate (ER) was 2.33 (ER ≥ 2.33: high elimination; < 2.33: low elimination). Median overall survival was 25 months (95% CI: 17–31) in the high-elimination group and 8 months (95% CI: 7–14) in the low-elimination group (p = 0.043). The 12-, 36-, and 60-month survival rates were 80.4%, 18.3%, and 11% in the high-elimination group, compared with 37.6%, 2.2%, and 0% in the low-elimination group. Conclusion: The CA 19-9 elimination rate is a significant prognostic biomarker for survival in patients with metastatic pancreatic cancer. A higher elimination rate is associated with improved short- and long-term survival outcomes, suggesting its potential utility for risk stratification and for assessing treatment response in clinical practice.
Effects of remote ischemic postconditioning treatment on ferroptosis and hexokinase II levels in a rat model of cerebral ischemia-reperfusion injury
Aim: Cerebral ischemia-reperfusion (I/R) injury is an unavoidable outcome of reperfusion therapy following a stroke, initiating intricate death mechanisms at both cellular and molecular levels. Comprehending the molecular pathways that result in neuronal death post-stroke is crucial for the development of effective neuroprotective strategies. Ferroptosis is a mechanism of cell death characterized by iron-dependent lipid peroxidation and is believed to contribute to the damage associated with cerebral I/R injury. Materials and Methods: Thirty male Sprague-Dawley rats were randomly assigned to three experimental groups: Control, IR, and IR+REPOSTC (n=10). Cerebral ischemia was induced using the intraluminal filament technique for 60 minutes, and the animals were euthanized after a 24-hour reperfusion period. The femoral artery of the right hind limb of the rat underwent RePostC consisting of three cycles of 5 minutes of ischemia followed by 5 minutes of reperfusion. Triphenyl tetrazolium chloride (TTC) staining was used to measure infarct size. Results: Compared to the control group, the I/R group showed a significant increase in glutathione peroxidase 4 (GPX4) levels, while RePostC treatment significantly decreased GPX4 levels. Compared to the control group, the I/R group showed a significant decrease in hexokinase II (HKII) levels. The RePostC group, however, exhibited a substantial increase in these levels compared with the I/R group. Levels of arachidonic acid 12-lipoxygenase (ALOX12) and lipocalin 2 (LCN2) were significantly increased in the I/R group compared with the control group. No statistically significant difference was observed between the RePostC treatment group and the I/R group. Conclusion: Ferroptotic cell death plays a role in the damage that occurs after cerebral I/R. GPX4, ALOX12, LCN2, and HKII levels may serve as potential targets for the management of cerebral ischemia-reperfusion injury. The RePostC application may help protect against I/R injury by activating the body's own tolerance mechanisms.
In vitro effects of sertraline and escitalopram on rat uterine smooth muscle
Aim: Depressive disorders affect around 10% of pregnant women. Antidepressant use during pregnancy is important for maternal and fetal health. Although studies link antidepressants to risks of spontaneous abortion, preterm labor, and postpartum hemorrhage, their direct effects on the myometrium remain unclear. This study investigated the effects of sertraline and escitalopram on spontaneous and oxytocin-induced contractions in rat myometrial tissue. Materials and Methods: 6 pregnant and 14 nonpregnant female Sprague-Dawley rats were used in the study. Myometrial strips measuring 1x0.2x0.2 centimeters were obtained from rats. Female rats were decapitated on day 18-20 of gestation. In oxytocin-induced and spontaneous contractions, sertraline and escitalopram were added cumulatively at concentrations of 1 μM, 3 μM and 10 μM in pregnant and nonpregnant rat groups and AUC (Area Under the Curve), frequency and amplitude values were recorded. Results: Regression analysis demonstrated a significant dose-dependent decrease in AUC (particularly under oxytocin). Holm-Bonferroni adjusted Wilcoxon tests confirmed that sertraline reduced AUC during oxytocin-induced contractions in both nonpregnant and pregnant strips, while escitalopram showed no significant effects on AUC, amplitude, or frequency. Conclusion: In vitro, AUC decreased dose-dependently—particularly with sertraline during oxytocin-induced contractions—while the effects of escitalopram were inconsistent. These results may support cautious use of the lowest effective dose in pregnancy and motivate further translational work.
Safe analgesic alternatives in patients with NSAID-exacerbated respiratory disease: The role of tramadol and celecoxib
Aim: This study aimed to determine which analgesic agents can be safely administered to patients with nonsteroidal anti-inflammatory drug–exacerbated respiratory disease (N-ERD) and to evaluate the safety of tramadol as a potential alternative. Materials and Methods: A total of 51 patients (34 females, 17 males; mean age 39.5 ± 14.2 years) with a history of NSAID hypersensitivity were retrospectively analyzed. All patients underwent oral drug provocation tests with celecoxib, paracetamol, nimesulide, meloxicam, and tramadol. In patients with a history of hypersensitivity to a single NSAID, negative skin test results were followed by an oral aspirin challenge to confirm N-ERD. Reaction rates among analgesics were compared using Cochran’s Q test, followed by Dunn–Bonferroni pairwise analysis. A p-value < 0.05 was considered statistically significant. Results: Eleven patients (21.6%) had hypersensitivity to a single NSAID; all demonstrated negative skin test results but positive aspirin challenge outcomes, indicating a non–IgE-mediated mechanism. Celecoxib and tramadol showed significantly lower reaction rates compared with nimesulide, paracetamol, and meloxicam (p<0.001). More than half of the cohort (52.9%) required moderate- or high-dose inhaled corticosteroids, while 25.5% of patients with severe asthma were receiving biologic therapy. Conclusion: Celecoxib and tramadol were well tolerated in all patients with N-ERD, suggesting that these agents are safe and effective analgesic alternatives. Individualized evaluation and supervised provocation testing remain essential to ensure safety before clinical use.
Age-related patterns of allergen sensitization and clinical phenotypes in adults with rhinitis
Aim: Allergic rhinitis (AR) is a common chronic condition that frequently coexists with asthma or urticaria. Allergen sensitization patterns vary by geography, environmental exposure, and age; however, data on adult and elderly populations remain limited. Understanding age-related sensitization trends is essential for optimizing diagnosis, prevention, and allergen immunotherapy (AIT) strategies. Materials and Methods: This retrospective study included 1,982 adults diagnosed with rhinitis, drawn from 7,000 patients who underwent skin-prick testing at a tertiary allergy clinic in Türkiye. Patients were categorized by age as young (18–39 years), middle-aged (40–64 years), or elderly (≥65 years), and further classified according to clinical presentation as rhinitis alone, rhinitis with asthma, rhinitis with urticaria, or rhinitis with both asthma and urticaria. Polysensitization was defined as sensitization to ≥2 allergens, and complex polysensitization as sensitization across distinct allergen groups. Results: Overall, 58.5% (n=1160) of patients demonstrated sensitization, with rates declining with age (62.0%, 52.7%, and 29.5%, respectively; p< .001). Among sensitized patients, 53.4% showed monosensitization and 46.6% showed polysensitization, of whom 63.3% exhibited complex patterns. Young adults, who most frequently presented with rhinitis alone (86.0%), were mainly sensitized to grass (29.5%), weed pollen (24.7%), and cat dander (13.0%); these rates were all significantly higher than those in middle-aged and elderly adults (p<0.01). Middle-aged and elderly adults, in contrast, showed significantly higher rates of mite sensitization than younger adults (up to 66.7%; p< .001 for both age groups). In these age groups, rhinitis was more frequently accompanied by asthma (10.3%) or urticaria (14.6%) (p< .01). Conclusion: Allergen sensitization among adults with rhinitis demonstrates a dynamic, age-dependent pattern. Sensitization to pollen and pets predominates in younger adults, whereas sensitization to mites persists and intensifies with advancing age and comorbidities. These findings highlight age as a key determinant, whose effects are shaped by both immunologic and behavioral and environmental factors, underscoring the need for personalized, age-adapted approaches in allergy management.
The role of autism symptoms on eating behavior in children diagnosed with attention deficit hyperactivity disorder: A preliminary study
Aim: The literature highlights the overlap between Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD), yet the impact of subclinical autistic traits on feeding behavior in ADHD populations remains underexplored. This study aims to investigate eating behaviors in children diagnosed with ADHD compared with those of typically developing peers, and to assess how elevated autistic traits influence eating behaviors within the ADHD group. Materials and Methods: A cross-sectional comparative design was employed, involving 67 children with ADHD and 75 healthy controls. Data were collected using the Children’s Eating Behavior Questionnaire (CEBQ) and the Social Responsiveness Scale (SRS). Within the ADHD group, participants were stratified by the presence of autistic traits. Group comparisons and correlational analyses were conducted to examine associations between autistic traits and feeding behaviors. Results: Compared with controls, children with ADHD exhibited significantly higher Desire to Drink scores and lower Emotional Under-Eating scores. Within the ADHD group, those with autistic traits had significantly higher Food Fussiness scores than those without autistic traits. Correlation analyses revealed significant associations between total SRS scores and multiple CEBQ subscales, including Emotional Overeating, Desire to Drink, Satiety Responsiveness, and Food Fussiness. Subscales, such as Pathognomonic Autistic Behaviors and Reciprocal Social Behavior, were especially predictive of disordered eating patterns. Conclusion: Findings suggest that autistic traits—even at subclinical levels—are significantly associated with maladaptive eating behaviors in children with ADHD. These results emphasize the importance of transdiagnostic approaches in clinical assessments, moving beyond categorical diagnoses. Understanding the dimensional interplay between ADHD symptoms and autistic traits may improve early nutritional interventions and individualized treatment strategies.