CC Attribution-NonCommercial-NoDerivatives 4.0
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
Copyright (c) 2026 Annals of Medical Research https://creativecommons.org/licenses/by-nc-nd/4.0
Extensive involvement of multiple cranial nerves in relapsed multiple myeloma
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.
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.
Investigation of the anticancer effect of Ramelteon on different human cancers: An in vitro study
Aim: To describe the various methods used to treat cancer, one of the diseases with the highest mortality rates worldwide. Among these methods, the use of agents exhibiting antioxidant activity has increased significantly. Ramelteon, a melatonin receptor agonist, stands out for its antioxidant and anti-inflammatory properties. In this study, we investigated the cytotoxic and genotoxic effects of Ramelteon in different human cancer cell lines. Materials and Methods: In the study, Ramelteon was applied at concentrations of 5, 10, 25, 50, 100, and 500 µM to human ovarian (A2780), breast (MCF-7), colon (Caco-2), and prostate (LNCaP) cancer cell lines, which were exposed and incubated for 24 hours. The MTT assay was used to measure changes in viability. After obtaining data on dose-dependent effects, inhibitory concentration values were determined. Genotoxicity was examined using the Comet assay at the determined effective dose. Intergroup comparisons were performed using the Kruskal-Wallis H test. When statistically significant differences were found between groups, multiple comparisons were performed using the Bonferroni-corrected Mann-Whitney U tests (p<0.05). Results: Ramelteon significantly reduced cell viability (p<0.05) and exhibited genotoxic effects in the A2780, MCF-7, Caco-2, and LNCaP cell lines (p<0.05). Conclusion: Research findings indicate that Ramelteon exhibits anticancer potential in A2780, MCF-7, Caco-2, and LNCaP cell lines, suggesting that the drug may be considered a promising candidate for the development of new cancer treatment strategies.
Posterior tibial slope in adults with sequelae of Osgood-Schlatter disease: An MRI study
Aim: Magnetic resonance imaging (MRI) assisted evaluation of the lateral and medial posterior tibial slopes in patients with Osgood-Schlatter disease (OSD) sequelae who have reached skeletal maturity. Materials and Methods: The study population comprised 78 adults with OSD sequelae, while the control group consisted of 78 age-, sex-, and side-matched individuals without osseous, ligamentous, or tendinous pathology. A retrospective analysis of knee MRI scans was performed. The medial and lateral posterior tibial slope (PTS) angles were calculated from the sagittal T1-weighted images. Results: Demographic variables (age, sex, and side) were statistically similar among the two groups. The medial PTS was 4.01° (95% CI: 3.41–4.61) in the OSD group and 3.90° (95% CI: 3.33–4.47) in the control group (p = 0.784; Cohen's d = 0.04). The lateral PTS was 4.98° (95% CI: 4.46–5.51) and 4.85° (95% CI: 4.29–5.41) respectively (p = 0.732; Cohen's d = 0.05). Post-hoc power analysis indicated that, with the current sample size (n = 78 per group), the study had >80% power to detect a medium effect size (Cohen's d = 0.50) at α = 0.05; however, the observed differences corresponded to trivial effect sizes. Conclusion: Contrary to findings in adolescents, skeletally mature adults with OSD sequelae did not exhibit statistical variation in medial or lateral PTS compared to matched controls. These results imply that changes in slopes described during growth may be lost after maturity.
Belinostat in relapsed/refractory peripheral T-cell lymphoma: A real-world multicenter experience
Aim: Peripheral T-cell lymphoma (PTCL) is a rare and aggressive subtype of non-Hodgkin lymphoma with limited treatment options, particularly in relapsed/refractory (R/R) cases. Belinostat, a pan-histone deacetylase inhibitor, has emerged as a potential therapeutic agent in this setting. Materials and Methods: This retrospective study analyzed nine patients with relapsed/refractory PTCL treated with belinostat across three centers between 2018 and 2025. Clinical data and treatment outcomes were collected, and responses were evaluated using the Lugano criteria. Overall survival and progression-free survival were calculated with the Kaplan–Meier method. Results: Of the nine R/R PTCL patients treated with belinostat, two (22.2%) achieved complete remission (CR), one (11.1%) experienced stable disease, four (44.4%) developed progressive disease and two (22.2%) died from lymphoma progression before the second cycle could be administered. Notably, one patient maintained a prolonged CR through 14 belinostat cycles, while another continued to use belinostat as a bridge to allogeneic stem cell transplantation and as maintenance after allogeneic transplantation. Belinostat was generally well tolerated, and no treatment discontinuations or dose reductions were required due to adverse events. Conclusion: Although these real‐world findings suggest that belinostat may provide meaningful clinical benefit in a subset of heavily pretreated R/R PTCL patients, the high rate of early progression emphasizes the need for improved patient selection and prospective validation in larger studies.
Vortioxetine improves gastrointestinal motility and reduces intestinal inflammation in a cuprizone-induced multiple sclerosis model in mice
Aim: To investigate the effects of vortioxetine on gastrointestinal motility and intestinal inflammation in a cuprizone-induced demyelination model in mice by evaluating pro-inflammatory cytokine responses. Materials and Methods: Twenty-one C57Bl/6 mice (8 weeks old) were randomly allocated into three groups: Control, cuprizone, and cuprizone + vortioxetine (n = 7/group). Demyelination was induced by oral gavage of cuprizone (10 mg/kg) every other day for 5 weeks. Vortioxetine (10 mg/kg/day) was administered intraperitoneally for 5 weeks. Gastrointestinal motility was assessed by 24-hour fecal pellet count and wet fecal weight. At the end of the protocol, TNF-α and IL-1β levels in the stomach, intestine, and colon were measured by ELISA. Results: Cuprizone administration significantly reduced fecal pellet output and wet fecal weight compared with controls (p<0.0001). Vortioxetine treatment restored both parameters toward control levels (p<0.01). Intestinal TNF‑α and IL‑1β levels were markedly increased in the cuprizone group (p<0.0001) and were significantly decreased following vortioxetine treatment, reaching near-control values. Similar reductions were observed in colonic cytokine levels, whereas gastric cytokines were largely unaffected. Conclusion: Vortioxetine improves gastrointestinal motility and attenuates intestinal and colonic pro-inflammatory cytokine expression in a cuprizone-induced demyelination model in mice. These findings suggest that vortioxetine has the potential to exert beneficial effects on the gastrointestinal function and highlight its potential as an adjunctive therapy for gastrointestinal comorbidities in multiple sclerosis.
Assessment of potentially pathogenic bacteria isolated from mobile phones of preclinical and hospital-based medical students and healthcare workers
Aim: Healthcare-associated infections (HAIs) remain a major global problem, and contaminated personal devices may act as unnoticed vectors. This study aimed to evaluate the bacterial contamination of mobile phones among medical students and healthcare workers in hospital and non-hospital settings. Materials and Methods: A cross-sectional study was conducted between February and March 2024. A total of 203 mobile phones were sampled: 94 from hospital-exposed participants (clinical students and healthcare workers) and 109 from non-hospital-exposed preclinical students. Surface swabs were inoculated into Mueller-Hinton broth, cultured, and isolates were identified using standard microbiological techniques. Results: Among hospital-exposed participants, bacteria were cultivated from 62/94 phones (65.9%), with potentially pathogenic organisms detected in 13.8%. Among these bacteria were Staphylococcus aureus (n=4, none methicillin-resistant), Pseudomonas spp. (n=2), Acinetobacter baumannii (n=2), Enterococcus faecalis (n=1), Stenotrophomonas maltophilia (n=1), and Bacillus spp. (n=3). Commensals such as Staphylococcus epidermidis (n=36) and Staphylococcus haemolyticus (n=7) predominated. In contrast, only 28/109 samples (25.7%) from preclinical students showed growth, limited to skin flora without pathogenic isolates. The contamination rate was significantly higher in the hospital-exposed group (p<0.001). Conclusion: Mobile phones used in hospital settings are more frequently contaminated with potentially pathogenic bacteria compared to those of preclinical students, highlighting their role as overlooked reservoirs of HAIs. Incorporating mobile device hygiene into infection prevention strategies, alongside routine hand hygiene, and reinforcing structured training for students and healthcare professionals are critical measures to reduce cross-contamination risks.
Demographic characteristics of traumatic head injuries in pediatric patients: A single-center neuorsurgery clinic study
Aim: Traumatic brain injury (TBI) significantly contributes to mortality and disability in children aged 0-18 years. TBI is a potentially fatal health emergency, and when severe, children are at high risk of mortality and neurological morbidity. Our goal is to identify the various etiologies of head trauma in pediatric patients and provide examples of preventive measures to prevent further trauma. Our research also highlights the socioeconomic burden of patients with TBI. Materials and Methods: The institutional electronic health record (HBYS) was queried for all pediatric patients admitted to the Neurosurgery Clinic in Kayseri City Hospital, diagnosed with traumatic head injury by the neurosurgery service, and registered for discharge between January 2021 and June 2025. This study investigated 180 pediatric head trauma cases. Patient nationality (Republic of Turkey or Other) and length of hospital stay (HLOS) were also used as demographic data. Results: The mean age was 7.2±5.32 (min-max: 0-17) years. Of the 146 children, 146 were Turkish citizens. 15 of the children, 15 (8.3%) underwent cranial surgery, and 69 (38.3%) had a history of intensive care admission. The mean length of hospital stay was 2.73±3.03 (min-max: 1-18) days. The most common type of head trauma in children was linear fractures due to falls from heights and from the same level (p<0.05). Conclusion: Implementing primary prevention strategies, preventing secondary neurological injuries, and collaborating with organized emergency teams can facilitate early intervention in patients with head trauma. Thus, early diagnosis and treatment of high intracranial pressure can reduce the adverse effects of TBI. These preventive measures can reduce morbidity and mortality in children. This study comprehensively examines the etiology and demographic characteristics of pediatric head trauma in a single center in the Central Anatolia Region.
Morton’s neuroma or its mimics: Diagnostic yield of magnetic resonance imaging and radiographic markers in patients referred with a clinical suspicion
Aim: To determine the prevalence of Morton’s neuroma (MN) among patients referred with a clinical suspicion of MN, identify alternative diagnoses, and assess whether angular measurements and the Vulcan sign may help differentiate. Materials and Methods: This retrospective study included 265 feet from 244 patients (mean age, 50.7±13.0 years; 75% female) referred for magnetic resonance imaging with a presumptive diagnosis of MN between January 2020 and June 2025. All patients underwent radiography and magnetic resonance imaging. Morphometric parameters, including the hallux valgus angle, intermetatarsal angle, and interphalangeal angle (IPA), were measured according to the affected web space (2/3 or 3/4). The Vulcan sign was documented on radiographs. Statistical comparisons were performed using the Mann–Whitney U, chi-square, and Fisher’s exact tests. Results: MN was diagnosed in 167 feet (63.0%), while alternative diagnoses were in 98 (37.0%). Bursitis (32.8%), hallux valgus (30.9%), adventitial bursitis (24.5%), hallux rigidus (12.5%), and stress reaction (8.3%) were the most frequent mimics. The 3/4 IPA was significantly greater in MN than in non-MN feet (p<0.001).ROC analysis confirmed limited discriminatory performance, with the 3/4 IPA achieving an AUC of 0.60. Comparisons between bursitis and non-bursitis groups revealed no significant differences in any angular parameters. The Vulcan sign was significantly associated with MN in both the 2nd (p=0.006) and 3rd (p<0.001) web spaces, but no discriminatory value was found for bursitis. Its diagnostic performance was higher in the third web space (AUC 0.62) than in the second (AUC 0.51). Conclusion: This is the first study conducted exclusively in patients referred with a clinical suspicion of MN. The 3/4 IPA demonstrated a modest yet significant association with MN, while the Vulcan sign showed relative specificity for MN compared with bursitis. These results underscore the importance of detailed assessment in clinical practice to differentiate MN from its mimics.
Real-world efficacy of ramucirumab plus paclitaxel with or without nivolumab in advanced gastric and gastroesophageal junction cancers
Aim: This study primarily aimed to assess the efficacy of second-line ramucirumab (RAM) plus paclitaxel (PTX) in patients with advanced gastric and gastroesophageal junction (GEJ) cancers and to compare its outcomes with those of RAM+PTX plus immune checkpoint inhibitor (ICI) in real-world practice. The secondary objective was to assess the safety of RAM+PTX (±ICI) and to explore its efficacy in later-line settings. Materials and Methods: This single-center study retrospectively analyzed the clinicopathologic data of patients with advanced gastric/GEJ cancer treated with RAM+PTX, with or without an ICI, in second-line or later settings between January 2018 and September 2024. Efficacy was evaluated based on the objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and overall survival (OS). We analyzed efficacy outcomes by treatment line. Results: We identified 46 patients (female, 54.3%) who received RAM+PTX (±ICI). In the second-line setting, 27 patients (58.7%) received RAM+PTX, and 10 patients (21.7%) received RAM+PTX plus nivolumab. The ORRs were 18.5% and 30.0% (p = 0.66), and the DCRs were 55.6% and 80% (p = 0.26), respectively. The addition of nivolumab did not significantly improve survival outcomes (median PFS, 4.3 vs. 3.1 months; HR, 0.93; 95% CI, 0.44-1.98; p = 0.85; median OS, 7.8 vs. 9.6 months; HR, 0.82; 95% CI, 0.35-1.91; p = 0.64). Age ≥50 years (HR, 2.90; 95% CI, 1.24-6.78; p = 0.014) and the presence of ascites (HR, 2.86; 95% CI, 1.14-7.16; p = 0.025) were independently associated with poorer OS. Conclusion: The real-world efficacy of RAM+PTX as second-line therapy in advanced gastric/GEJ cancers is consistent with the results of randomized trials, though grade ≥3 adverse events were more frequent. While adding nivolumab did not confer a statistically significant benefit, a numerical improvement in ORR and DCR indicates potential value that warrants further prospective evaluation.