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Evaluation of conventional histopathological scoring in breast carcinoma using artificial intelligence technologies
Aim: Breast cancer is the most commonly diagnosed malignancy in women, and early detection plays a critical role in the success of treatment. The Ki-67 proliferation index is widely used to evaluate tumor cell proliferation; however, its manual scoring process is observer-dependent, time-consuming, and inherently subjective. This study aims to assess Ki-67 immunohistochemical staining using deep learning algorithms in an objective, rapid, and reproducible manner, and to compare the model’s performance with conventional scoring methods. Materials and Methods: In the first phase of the study, a dataset was created using digital images of Ki-67-stained histological sections obtained from patients diagnosed with breast cancer. These images were used to train a machine learning algorithm. In the second phase, 50 new Ki-67-stained tissue sections previously unseen by the model were digitized, and the model’s predictions were compared with Ki-67 index values calculated by conventional manual assessment. Results: The developed model achieved a mean absolute error (MAE) of 8.69%, a root mean square error (RMSE) of 13.00%, and a coefficient of determination (R²) of 0.540 in overall prediction performance. For cases with low proliferation (Ki-67<20%), the model demonstrated high accuracy (MAE: 5.31%). Binary classification based on a 20% threshold yielded 80% accuracy, 80% sensitivity, 90% precision, and an F1 score of 0.84. Conclusion: The use of artificial intelligence algorithms in Ki-67 assessment demonstrated successful performance, with an MAE of 8.69%, and has the potential to reduce pathologists' workload during the preliminary evaluation phase. The findings suggest that, with further refinement, the proposed model could contribute to more objective, consistent, and reproducible assessments in breast cancer diagnostics.
Copyright (c) 2026 Annals of Medical Research https://creativecommons.org/licenses/by-nc-nd/4.0
Effect of adding bone marrow aspirate injection to core decompression on clinical outcomes in the treatment of femoral head avascular necrosis
Aim: Avascular necrosis of the femoral head (ANFH) is a progressive condition that often affects young individuals and may ultimately require total hip arthroplasty (THA). Core decompression (CD) is a widely used joint-preserving surgical technique, and bone marrow aspirate concentrate (BMAC) injection has been proposed as an adjunct to enhance outcomes by promoting vascularization and cartilage repair. To compare the clinical and radiological outcomes of patients treated with CD alone versus CD combined with BMAC injection for ANFH. Materials and Methods: Patients diagnosed with ANFH who underwent CD with or without BMAC injection were retrospectively analyzed. Demographic characteristics, preoperative and 1-year Harris Hip Score (HHS), Visual Analog Scale (VAS) score, Steinberg stage, and the need for THA during follow-up were recorded. All diagnoses were confirmed by MRI and radiography. Results: A total of 42 hips (30 males, 12 females; mean age 41.8 years, range 14–66) were analyzed. BMAC injection was performed in 28 hips (66.7%) and not performed in 14 hips (33.3%). At 1-year follow-up, Steinberg stage progression was observed in 73.8% of hips, while 26.2% showed regression. THA was required in 14.3% of patients overall—7% in the BMAC group versus 28% in the CD-only group (p = 0.1). VAS scores decreased in 32% of BMAC-treated hips versus 21% in CD-only hips (p>0.05). Improvement in HHS was seen in 60% of the BMAC group versus 50% of the CD-only group (p>0.05). Conclusion: Although statistical significance was not reached, the addition of BMAC to core decompression showed a trend toward reduced THA conversion and improved hip function. These findings suggest a potential benefit that warrants further investigation in larger, prospective studies before routine use can be recommended.
Low dose cytarabine-induced posterior reversible encepalopathy syndrome with atypical features
Copyright (c) 2025 Annals of Medical Research https://creativecommons.org/licenses/by-nc-nd/4.0
Prevalence of asthma and allergic diseases and associated risk factors among primary school children in the Malatya region
Aim: In recent years, a significant increase has been observed in the prevalence of allergic diseases during childhood. This study aims to determine the prevalence of asthma, allergic rhinitis, and atopic dermatitis among children aged 6–7 living in the city center of Malatya, as well as to analyze potential environmental and familial risk factors associated with these conditions. Materials and Methods: The study was conducted between December 2023 and January 2024 in primary schools located in central Malatya, using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire protocol. A total of 431 children were included. Participants were evaluated based on demographic characteristics, environmental exposures, family history, and symptoms related to asthma, allergic rhinitis, and atopic dermatitis. The collected data were analyzed statistically. Results: Lifetime wheezing was reported in 20% of the children, while 18.6% reported wheezing within the past 12 months. The prevalence of physician-diagnosed asthma was 4.2%. Allergic rhinitis symptoms were reported in 32.7% of the children throughout their lifetime and in 29.9% during the last year, while the rate of physician-diagnosed allergic rhinitis was 6.7%. The lifetime prevalence of atopic dermatitis was 8.8%, and the physician-diagnosed rate was 2.6%. Family history of asthma, allergic rhinitis, atopic dermatitis, and premature birth were identified as significant risk factors (p<0.05). No statistically significant association was found with gender, exposure to tobacco smoke, pet ownership, mode of delivery, parental consanguinity, or the presence of mold in the home. Conclusion: These findings confirm that allergic diseases represent a significant public health burden among children in Malatya. The results specifically highlight family history and perinatal factors as major determinants of disease prevalence in this population.
Evaluation of clinical and neonatal outcomes of cancer in pregnancy and patients in remission
Aim: To retrospectively examine patients diagnosed with cancer during pregnancy and compare the maternal and natal outcomes of these patients with those in cancer remission and healthy pregnant women. Materials and Methods: This study was designed at a single tertiary care center. A total of 99 patients were included, of whom 18 were diagnosed with cancer during pregnancy, 21 had a pregestational history of cancer and were in remission, and 60 were healthy controls. Results: Breast cancer was the most frequently detected malignancy during pregnancy. The average cancer during pregnancy was seen at the 21st week. Diagnostic methods included various biopsy methods and magnetic resonance imaging. Some patients underwent cancer-related surgery and chemotherapy during pregnancy. Two patients diagnosed with cancer during pregnancy died. Neonatal and maternal intensive care requirements were found to be higher in patients diagnosed with cancer during pregnancy compared to the other two groups. Additionally, neonatal birth weight was lower than that observed in healthy pregnancies. Conclusion: We consider the monitoring and management of patients diagnosed with cancer during pregnancy to be a critical issue for ensuring optimal maternal and fetal health outcomes, and we emphasize the need for further research in this field.
Comparison of neuroendocrine responses between caudal block and local infiltration techniques in pediatric inguinal hernia surgery: A prospective comparative clinical study
Aim: This study aimed to compare the effects of caudal anesthesia and local wound infiltration on postoperative stress hormone responses (cortisol and prolactin) and pain scores in pediatric patients undergoing inguinal hernia repair. Materials and Methods: A total of 64 children aged 1–4 years, classified as ASA I, scheduled for elective unilateral inguinal hernia surgery were randomized into two groups: caudal anesthesia (Group C) and local infiltration (Group I). All patients received general anesthesia. Group C received 1 mL/kg of 0.25% bupivacaine via the caudal route, while Group I received 0.25 mL/kg of 5 mg/mL bupivacaine via 23-gauge needle infiltration. Postoperative pain was assessed using the CHEOPS scale at 1st, 2nd, 3rd, and 4th hours by a blinded anesthesiologist. Blood samples for cortisol and prolactin levels were collected before induction and 40 minutes after surgery and analyzed by ECLIA. Results: No significant differences were found between groups in postoperative cortisol and prolactin levels. Pain scores were also similar at all time points (p>0.05). A significant positive correlation was observed between preoperative and postoperative prolactin levels (p<0.05). Anesthesia and surgical durations were longer in the caudal group (p<0.05), while fentanyl requirements were similar. Conclusion: Both caudal block and wound infiltration provide comparable postoperative analgesia and hormonal stress response control in pediatric inguinal hernia surgeries. Given its shorter application time, local infiltration may offer a practical alternative in suitable clinical settings.
Eating behaviors in individuals over the age of 18 years who applied to a family health center and the associated factors
Aim: This study aimed to determine the eating behaviors of individuals over the age of 18 years who applied to a family health center as well as the associated factors. Materials and Methods: This cross-sectional study included 1,684 adults aged 18 years who attended two Family Health Centers in Elazığ, Turkey. Participants voluntarily completed a questionnaire, including sociodemographic items and the AEBQ, through face-to-face interviews. Ethical approval was obtained from the Ethics Committee of the Non-Interventional Clinical Trials. Statistical analyses, including t-tests, analysis of variance, Pearson correlation, and multiple linear regression, were used to examine associations between eating behaviors and sociodemographic and health-related factors. Results: The participants’ emotional eating (EE) scores were high, whereas the other AEBQ subscale and total scores were moderate. Higher AEBQ scores were observed in individuals aged ≥55 years, married, childless, with higher income, with chronic diseases, or with physical disabilities. Positive correlations were found between age, number of children, chronic disease duration, physical disability duration, BMI, and AEBQ scores. Conclusion: The study demonstrates significant associations between sociodemographic and health-related factors and EEBs. These findings support the need for further research using the AEBQ and may guide interventions to promote healthier eating habits and improve the health of the population.
In silico characterization of missense mutations in PI3K/AKT/mTOR signaling genes in breast cancer and their role in therapeutic resistance
Aim: This study aimed to investigate the most frequent missense mutations in key genes of the PI3K/AKT/mTOR signaling pathway to evaluate their potential role in the progression of breast cancer and the development of therapy resistance using computational analyses. Materials and Methods: Nine genes involved in the PI3K/AKT/mTOR pathway were systematically analyzed by screening mutation databases and applying a range of computational prediction tools to assess the possible deleterious effects of missense variants on protein function and pathway regulation. Results: Several mutations with predicted deleterious effects were identified, including PTEN (D92H, D92N, R130G, R130Q, C136R, and C136Y), AKT1 (L52R), and AKT2 (R170W). These variants were predicted to contribute to aberrant PI3K/AKT/mTOR pathway activation, enhanced cancer cell survival, and therapeutic resistance in breast cancer. Conclusion: The findings provided insights into the mutational landscape of breast cancer, proposing potential biomarkers for risk stratification and novel therapeutic targets. Further experimental validation and functional studies are recommended to clarify the clinical significance of these mutations and to guide the development of personalized interventions for breast cancer.
Intraventricular migration of intraocular silicone oil: A rare case with computed tomography and magnetic resonance imaging findings
Intraocular silicone oil (SiO) is widely used as a long-term internal tamponade agent in the surgical treatment of various vitreoretinal disorders. A rare but diagnostically critical complication of SiO is its migration into the brain ventricles. Although few such cases have been reported, this condition may mimic serious pathologies, such as intraventricular hemorrhage. In this case report, intraventricular migration of SiO was identified in an 81-year-old woman with a history of vitreoretinal surgery for diabetic retinopathy–related retinal detachment. The patient presented with dizziness, imbalance, and nausea, and neuroimaging revealed hyperdense layering within the bilateral frontal horns on noncontrast brain computed tomography. These findings may mimic acute intraventricular hemorrhage, highlighting the importance of clinical and radiological correlation for accurate differential diagnosis. Additionally, the patient was concurrently diagnosed with a cerebellar infarction. Awareness of this rare complication may help prevent unnecessary interventions and potential treatment errors in patients presenting with stroke-like symptoms.
The effect of tartrazine and thymoquinone on the antioxidant system and lipid peroxidation in brain tissue
Aim: To investigate the possible effects of harmful Tartrazine and protective Thymoquinone on brain tissue in Wistar albino rats. Materials and Methods: Thirty-two rats were divided into 4 groups: Control (n=8), Tartrazine (n=8), Thymoquinone (n=8), and a combination of Tartrazine and Thymoquinone (n=8). Tartrazine and Thymoquinone were administered orally via gavage for 3 weeks, and the brain tissues were collected after the 3-week period. Oxidant-antioxidant parameters such as malondialdehyde (MDA), glutathione (GSH), glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), catalase (CAT) were examined. Results: There were differences between the Tartrazine and all other groups. Tartrazine administration led to a significant increase in MDA and SOD enzymes activity levels in brain tissue. It also caused a significant decrease in reduced GSH, GSH-Px and CAT activities. Thymoquinone administration caused an increase in GSH, GSH-Px enzymes activity, and CAT enzymes activity levels compared to all other groups. Conclusion: This study examined the effects of tartrazine and thymoquinone on brain tissue found that tartrazine has neurotoxic effects. We believe that the neurotoxicity caused by tartrazine results from oxidative stress, increased oxidant capacity, and decreased antioxidant capacity. Thymoquinone may serve as a neuroprotective agent because it significantly increased antioxidant capacity.
Association of hOGG1 and APE1 gene polymorphisms with disease severity in ulcerative colitis: A case-control study
Aim: Ulcerative colitis (UC) is a chronic inflammatory disease of the colon characterized by excessive oxidative stress and impaired DNA repair mechanisms. This study aimed to investigate the relationship between two key base excision repair gene polymorphisms—APE1 (Asp148Glu) and hOGG1 (Ser326Cys)—and clinical features of UC, particularly disease activity. Materials and Methods: Ninety-nine UC patients, 50 colorectal cancer (CRC) patients, and 50 age- and gender-matched healthy controls were enrolled. Peripheral blood samples were collected for DNA extraction, and genotyping was performed using real-time PCR and melting curve analysis. Clinical data, including disease duration, location, and activity based on the Truelove-Witts index, were analyzed about genetic variants. Results: No significant differences were found in the genotype or allele frequencies of APE1 and hOGG1 between UC, CRC, and control groups. However, the hOGG1 Ser326Cys polymorphism was significantly more frequent in UC patients with severe disease activity (p = 0.034), suggesting a possible role in disease progression. Conclusion: The hOGG1 Ser326Cys polymorphism may be associated with increased disease severity in UC and could serve as a potential prognostic biomarker. Further studies are needed to validate this finding in larger cohorts.
Metabolic imaging of head and neck lesions: Differentiating dental and maxillofacial conditions using positron emission tomography/computed tomography
Aim: Fluorine-18-labeled fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) is an essential oncologic imaging modality, but its uptake patterns may also be seen in benign inflammatory or structural oral conditions, leading to diagnostic confusion. This study aims to compare metabolic activity with maximum standardized uptake value (SUVmax) among common dento-maxillofacial conditions—dental artifacts, periodontal infections, maxillary sinus pathologies, and temporomandibular joint (TMJ) disorders—against confirmed malignant lesions, to guide differential diagnosis and improve clinical interpretation. Materials and Methods: A total of 100 FDG-PET/CT scans were retrospectively analyzed. Inclusion criteria comprised pre-treatment scans with available CT or magnetic resonance imaging (MRI) acquired within four weeks. Patients were categorized into five groups: Dental Artifacts (n=19), Periodontal Infections (n=23), Maxillary Sinus Pathologies (n=21), TMJ Pathologies (n=19), and Malignant Dento-maxillofacial Lesions (n=18; control group). All scans were reviewed by an oral and maxillofacial radiologist and a radiologist. SUVmax were calculated using a 42% threshold. Statistical analyses were conducted using Kruskal-Wallis and Mann-Whitney U tests with Bonferroni correction. Results: Significant differences in SUVmax were observed across all groups (χ² = 77.4, p < 0.000001). The malignant lesion group demonstrated the highest metabolic activity (mean SUVmax = 12.5 ± 3.0), significantly greater than all other groups (p<0.000001). Among non-malignant conditions, maxillary sinus pathologies showed the highest SUVmax (4.2 ± 1.0), followed by periodontal infections (3.5 ± 0.8). TMJ pathologies and dental artifacts exhibited the lowest FDG uptake (2.0 ± 0.6 and 2.5 ± 0.7, respectively), suggesting minimal metabolic activity. Conclusion: This study confirms that malignant dento-maxillofacial lesions exhibit significantly higher FDG uptake compared to inflammatory and mechanical conditions. Understanding these uptake patterns is crucial to avoiding false-positive interpretations, especially in oncologic patients. Multimodal imaging and interdisciplinary evaluation are recommended for accurate differentiation of dental and maxillofacial pathologies in FDG-PET/CT interpretation.
Pan-immune inflammation value in systemic lupus erythematosus: Is it associated with organ involvement?
Aim: This study aimed to investigate the association between pan-immune inflammation value (PIIV) and both disease activity and organ involvement in patients with systemic lupus erythematosus (SLE). Materials and Methods: A total of 50 adult SLE patients, meeting the 2019 EULAR/ACR classification criteria, and 35 healthy volunteers were included in the study. PIIV was determined using the formula: [neutrophil × platelet × monocyte] / lymphocyte. Disease activity was evaluated with the SLEDAI-2K index. The relationship between PIIV and clinical findings, organ involvement, laboratory results, and disease activity was assessed. Results: PIIV levels were markedly higher in SLE patients compared to the control group (p < 0.001). Patients with cardiac involvement had elevated PIIV values compared to those without heart involvement (p < 0.05). On the other hand, individuals receiving hydroxychloroquine therapy showed lower PIIV than those not using the drug (p = 0.019). No clear correlation was observed between PIIV and SLEDAI-2K scores (p = 0.532). Conclusion: The findings indicate that PIIV levels are increased in SLE patients compared with healthy controls, suggesting its potential role as a supportive diagnostic marker. Additionally, higher PIIV in patients with cardiovascular involvement and lower values in those treated with hydroxychloroquine imply that PIIV could be considered a useful biomarker for evaluating and tracking cardiovascular risk in SLE.
Examination of thoracic deformities in patients with different clinical types of cerebral palsy
Aim: Cerebral Palsy is a clinical condition that causes permanent but non-progressive damage to the developing brain and can affect multiple systems. This study aimed to evaluate functional levels by assessing thoracic deformities across different clinical types of cerebral palsy (CP) and by gender, while also comparing anthropometric measurements between individuals with CP and a healthy control group. Materials and Methods: Between the ages of 6 and 12 years, a total of 154 patients diagnosed with cerebral palsy (91 males, 63 females) and 40 healthy individuals (20 males, 20 females) were included in the study. Demographic characteristics, clinical type of CP, secondary findings, thoracic deformity, anthropometric measurements, and functionality levels were obtained from the patients. A tape measure and caliper were used for anthropometric measurements. Results: The results indicated that the spastic type was the most prevalent clinical presentation of CP, with intellectual disability being the most common secondary problem. Among thoracic deformities, pectus excavatum was the most frequent anterior chest wall deformity, observed in 9.52% of females and 16.48% of males. Scoliosis was the most common spinal deformity, affecting 26.98% of females and 21.98% of males. Functionally, most patients were classified at GMFCS level II and Ambulation Group 1, although thoracic deformities were more prevalent in Group 2 patients. Furthermore, anthropometric measurements of patients with CP were significantly lower than those of healthy individuals, with statistically significant differences observed between Group 1, Group 2, and the healthy control group (p<0.05). Conclusion: Cerebral palsy has a substantial impact on anthropometric measurements, musculoskeletal integrity, and the functional performance of the patients. Consequently, regular monitoring of the thoracic area is essential. The inclusion of thoracic evaluations in routine follow-up and treatment plans will likely have a positive impact on the disease's progression.
Evaluation of clinical, radiological characteristics, and treatment outcomes of pediatric pseudotumor cerebri syndrome cases
Aim: This study aims to evaluate the clinical, radiological, and treatment outcomes of pediatric patients diagnosed with Pseudotumor Cerebri Syndrome. Materials and Methods: This retrospective study included 21 children diagnosed with definite or possible Pseudotumor Cerebri Syndrome according to the revised Friedman diagnostic criteria, out of 115 patients evaluated between 2017 and 2019 at a pediatric neurology clinic. Clinical findings, radiological features, treatment responses, and prognosis were analyzed. Results: The study cohort was predominantly female (85.7%), with a mean age of 12.8 years. The most common presenting symptoms were headache, visual disturbances, and vomiting. A key diagnostic finding was elevated cerebrospinal fluid (CSF) opening pressure (>280 mmH₂O), observed in 67% of patients. Two-thirds of the cases (66.6%) were classified as Primary Pseudotumor Cerebri Syndrome, while the remaining third (33.4%) were secondary, most frequently attributed to drug exposure or vitamin imbalances. The majority of patients showed significant clinical improvement following medical treatment with high-dose acetazolamide. Only a few required adjunctive therapies such as topiramate or corticosteroids, and recurrence was documented in only a single case. Additionally, MRI findings supportive of the diagnosis were present in a subset of patients. Conclusion: Early diagnosis and treatment of Pseudotumor Cerebri Syndrome in children can prevent permanent visual complications. A multidisciplinary approach, including ophthalmology and pediatric neurology, is essential for accurate diagnosis, effective treatment, and favorable outcomes.
A comparative study of nerve-sparing techniques in open radical prostatectomy: Antegrade versus retrograde
Aim: To compare perioperative, oncological, and functional outcomes between antegrade and retrograde nerve-sparing techniques in open radical prostatectomy (ORP). Materials and Methods: This retrospective study included 278 patients who underwent open radical prostatectomy (ORP) performed by a single surgeon between 2016 and 2025. Patients were divided based on the nerve-sparing approach: antegrade (n=90) or retrograde (n=188). Demographic characteristics, perioperative variables, pathological outcomes, biochemical recurrence (BCR), urinary continence, and erectile function were evaluated. Multivariable logistic regression analysis was used to determine independent predictors of BCR. Results: Retrograde ORP demonstrated a shorter operative time compared with the antegrade technique (151.1 vs. 166.5 minutes, p<0.001), whereas the antegrade group was associated with lower intraoperative blood loss (437 vs. 517 mL, p=0.047). Biochemical recurrence was significantly higher in the antegrade group (33.3% vs. 18.8%, p=0.008). Postoperative functional outcomes, including urinary continence (p=0.524) and erectile function (p=0.230), were comparable between the groups. In multivariable logistic regression, the retrograde approach independently reduced the risk of biochemical recurrence (OR 0.38; 95% CI: 0.19–0.76; p=0.0058). Conclusion: It is evident that both techniques are safe and effective in ORP. The retrograde approach was associated with more favourable oncological outcomes, whereas the antegrade technique provided better intraoperative hemostasis. The choice of surgical approach should be individualized based on tumor characteristics and surgeon expertise.
Evaluation of postoperative complications and mortality predictors in adult patients undergoing ventriculoperitoneal shunt surgery: A retrospective single-center study
Aim: The aim of our study is to retrospectively analyze the incidence of postoperative complications in adult patients who underwent ventriculoperitoneal shunt (VPS) surgery for hydrocephalus and to identify clinical, demographic, and surgical predictors of mortality. Materials and Methods: This is a single-center retrospective analysis including 44 patients aged 18 years and older who underwent primary or revision VPS surgery between September 2021 and January 2025. Data including demographic characteristics, comorbidities, hydrocephalus etiology, type of shunt (programmable vs. standard), clinical presentation, early and late complications, and mortality were collected and analyzed. Statistical analysis involved independent t-tests and chi-square or Fisher’s exact tests as appropriate. Results: The mean patient age was 68.8 ± 10.8 years, with a mortality rate of 29.5% observed during follow-up. Early and late complication rates were each 13.6%. Over-drainage (9.1%) was the most common early complication, while shunt infection (6.8%) predominated among late complications. Mortality was significantly higher in patients with standard valves (61.5%) compared to those with programmable valves (38.5%, p<0.001). Hydrocephalus secondary to intracranial hemorrhage was associated the highest rate and it was slightly above the significance level (30.8%, p=0.053). Conclusion: The type of shunt system and hydrocephalus etiology, particularly intracranial hemorrhage, were identified as the most significant predictors of mortality. The use of programmable valve systems and close monitoring of high-risk patients may improve outcomes.
Risk of hepatitis B reactivation in rheumatic patients receiving tocilizumab treatment
Aim: This study aimed to investigate the relationship between tocilizumab, a biological agent widely used for treating rheumatic diseases, and hepatitis B virus reactivation (HBVr). Materials and Methods: The electronic records of all patients who received tocilizumab in our rheumatology outpatient clinic between July 2018 and August 2024 were retrospectively reviewed. Demographic data, baseline and followup HBV serological markers, liver biochemistry, and antiviral prophylaxis details were extracted and analyzed. Results: A total of 54 patients were included (76.2 % female; mean age 57.5 ± 14.3 years). While HBsAg, anti-HBc IgGG and anti-HBs were requested for all patients before treatment, HBsAg was positive in 1 of 54 patients (1.9%) and anti-HBc IgG was positive in 26 (48.1%). While antiviral treatment was initiated in 10 (18.5%) of the patients, 9 were HBsAg negative, 1 was HBsAg positive, and 1 was anti-HBc Ig G positive. No patient experienced HBV reactivation during treatment; however, one HBsAg-positive patient achieved HBsAg seroclearance. The mean follow-up period was 50.5 ± 22.9 months. Conclusion: No patient experienced HBV reactivation during tocilizumab therapy, and a single HBsAgpositive participant on prophylactic tenofovir achieved HBsAg seroclearance. These realworld data suggest that HBsAgnegative/antiHBcpositive individuals may be managed with vigilant biochemical and serological monitoring rather than routine antiviral prophylaxis during tocilizumab treatment. Nevertheless, the retrospective singlecentre design and modest sample size limit the strength and generalizability of these findings; larger prospective studies are required for definitive guidance.
Efficacy of combined screening tests used in the first trimester in predicting adverse pregnancy outcomes
Aim: This study aims to evaluate the predictive efficacy of first-trimester screening test parameters, including free β-human chorionic gonadotropin (β-hCG), pregnancy-associated plasma protein-A (PAPP-A), and nuchal translucency (NT), in identifying adverse pregnancy outcomes such as gestational diabetes mellitus (GDM), fetal growth restriction (FGR), preeclampsia, preterm birth, and placenta accreta spectrum (PAS) or placenta previa (PP). Materials and Methods: A retrospective cohort analysis involved 776 pregnant women who underwent first-trimester screening tests between January 2023 and August 2024. Patients were categorized into two groups based on the presence or absence of pregnancy complications. Results: Pregnancy complications were identified in 36.6% of participants, with GDM, FGR, and preterm birth being the most common. PAPP-A levels were significantly reduced in pregnancies complicated by GDM (p=0.033), FGR (p=0.048), and preeclampsia (p=0.001). NT values were notably elevated in GDM cases (p=0.016). Free β-hCG levels were significantly higher in preterm birth (p=0.040) and PAS/PP cases (p=0.016). ROC analysis revealed notable predictive thresholds: PAPP-A <0.64 for preeclampsia (AUC=0.760, p=0.001) and β-hCG >1.01 for PAS/PP (AUC=0.814, p=0.016). Conclusion: First-trimester screening test parameters, particularly PAPP-A, NT, and β-hCG, exhibit potential in predicting adverse pregnancy outcomes. Reduced PAPP-A levels correlate with GDM, FGR, and preeclampsia, while elevated NT and β-hCG levels are associated with GDM and PAS/PP, respectively. Although these markers demonstrate promise, larger-scale prospective studies are needed to confirm their clinical utility and reliability in predicting pregnancy complications.
A resveratrol-loaded scaffold enhances tendon healing: Histological and biomechanical analysis in a rat Achilles tendon repair model
Aim: This study aims to evaluate the effects of Dermalix® (Dx), a resveratrol-loaded, bioabsorbable scaffold composed of collagen, laminin, and hyaluronic acid, on tendon healing and peritendinous adhesion formation following primary Achilles tendon repair in a rat model. Materials and Methods: A total of 28 female Wistar Albino rats underwent bilateral Achilles tendon injury and repair using the modified Kessler technique. The right legs were treated with local Dx application over the repair site, while the left legs served as untreated controls. Animals were randomly assigned to one of four groups (n = 7 per group). The groups were defined by the evaluation time point (3 or 6 weeks) and the type of analysis (histological or biomechanical). Assessments included macroscopic adhesion scoring, histological quantification (counts of fibroblasts, fibrocytes, and vessels), and biomechanical testing (maximum load to failure and elongation at rupture). Statistical comparisons were made using t-test, Mann-Whitney U, chi-square , ANOVA, or the Friedman test, as appropriate for the data. Results: Dx application significantly reduced severity of adhesion at both 3 and 6 weeks (p<0.01). Histological analyses revealed significantly lower fibroblast and fibrocyte counts with more organised collagen alignment in Dx-treated groups (p<0.05). Biomechanically, rupture force was significantly higher in Dx groups at both time points (p<0.01 and p=0.029), while no significant difference was found in elongation distance. The scaffold was resorbed by week 3, without inducing any foreign body reaction or systemic side effects. Conclusion: The local application of Dx enhanced tendon healing significantly and reduced peritendinous adhesions without compromising biomechanical strength. Its bioabsorbable composition and local antioxidant properties make Dx a promising supportive local treatment option in tendon repair surgery. This is particularly valid in cases with high adhesion risk.
Time-dependent exposure to venetoclax induces ferroptosis in human neuroblastoma cells via upregulated transferrin gene expression and lipid peroxidation
Aim: Neuroblastoma is one of the most widely diagnosed extracranial tumors in pediatric patients with poor survival rates. Despite the available treatment options, alternative treatment strategies are required, especially for high-risk patients. Venetoclax (VTX) is a small-molecule inhibitor of the anti-apoptotic protein Bcl-2, originally approved for the treatment of acute myeloid and chronic lymphocytic leukemia. Mounting evidence indicates that VTX may also be a promising agent against other types of cancer. However, data on the alternative mechanisms of VTX toxicity are limited. The present study aimed to unveil the potential of the agent against neuroblastoma. The effect of VTX on iron metabolism and ferroptotic cell death in neuroblastoma cells was investigated for the first time. Materials and Methods: Cell viability was determined using the MTT assay. Oxidative stress, intracellular iron content, and lysosomal integrity were visualized using confocal microscopy. The MDA assay was performed to detect lipid peroxidation. The expression of TFR, FPN1, and GPX4 was determined by RT-qPCR. Results: VTX significantly reduced cell viability in a time- and concentration-dependent manner, which was reversed by the addition of ferroptosis inhibitors. Further experiments revealed that VTX induces ROS generation, leads to lysosomal degradation and iron accumulation followed by lipid peroxidation, all of which are ferroptosis markers. RT-qPCR analyses indicated that VTX upregulates TFR gene expression while downregulating GPX4 and FPN1. Conclusion: The present study demonstrated for the first time that VTX activates ferroptotic pathways in neuroblastoma cells and may be considered as a promising agent for add-on therapies.
Should videolaryngoscopy enter routine use? Unanticipated difficult airway: A five-year experience in a tertiary care hospital
Aim: An unanticipated difficult airway (UDA) can be very challenging for anesthesiologists in airway management and, if not managed appropriately, may lead to increased morbidity and even mortality in patients. Because patients with normal physical examination findings may also have a difficult airway, meticulous preparations are essential for every patient. Our study investigated the five-year outcomes of a tertiary care hospital in patients with UDA. Materials and Methods: We retrospectively reviewed the records of 143 patients with UDA who underwent surgery under general anesthesia between January 2020 and March 2025. We evaluated their airway management: preoperative physical examination findings, demographics, comorbidities, mask ventilation, laryngoscopic visualization, and tracheal intubation success. Results: We found that videolaryngoscopy (VL) improved glottic visualization compared to direct laryngoscopy (DL) in patients with UDA (p<0.001). VL reduced the risk of complications and accidental esophageal intubation compared to DL (p<0.001, p<0.001, respectively). We also found that 129 out of 133 patients (97%) who could not be intubated with DL were successfully intubated endotracheally using VL. Conclusion: VL improves glottic visualization, reduces the risk of complications, and increases the rate of successful intubation compared to DL in patients with UDA.
Diagnostic and prognostic utility of systemic inflammation indices in cervical dysplasia
Aim: This study investigated the diagnostic and prognostic potential of the Systemic Immune Inflammation Index (SII), Neutrophil Lymphocyte Ratio (NLR), and Platelet Lymphocyte Ratio (PLR) in cervical dysplasia, evaluating their correlation with disease presence and severity for potential clinical applications in risk assessment and patient management. Materials and Methods: In this retrospective study, the SII, NLR, and PLR values were analyzed using parameters obtained from the routine complete blood count of 215 patients whose cervical dysplasia grades were evaluated through colposcopic biopsy. Results: HPV DNA types 16 and 18 were detected in 114 (53.0%) of 215 patients, while 101 (47.0%) tested positive for non-16/18 hr-HPV DNA types. No statistically significant differences were observed in WBC, neutrophil, platelet, lymphocyte, SII, NLR, and PLR values across the chronic cervicitis, LSIL (low-grade squamous intraepithelial lesion), and HSIL (high-grade squamous intraepithelial lesion) groups (p < 0.05). However, logistic regression analysis for HSIL risk identified lymphocyte count (OR = 0.998) and PLR (OR = 0.975) as significant predictors, where a one-unit increase in each was associated with a 0.2% and 2.5% decrease in the odds of HSIL, respectively. Conclusion: SII, NLR, and PLR values in diagnosing or grading the presence or severity of cervical dysplasia, indicating that these systemic inflammatory markers alone may have limited value as diagnostic or prognostic tools. Further validation through larger prospective studies is warranted to more comprehensively elucidate the role of these markers.
Functional and radiological comparison of lateral pinning versus cross pinning in displaced pediatric supracondylar humerus fractures
Aim: The aim of this study is to compare the commonly used cross pinning and lateral pinning techniques in the surgical treatment of pediatric supracondylar humerus fractures by evaluating clinical and radiological outcomes. Materials and Methods: Between 2018 and 2024, patients who had surgical treatment for Gartland type 3 supracondylar humerus fractures were included in the study. Patients were divided into two groups based on the surgical technique: lateral pinning (Group 1) and cross pinning (Group 2). Patients with a minimum folloe-up of 6 months were included in the study. Demographic data inlcuidng age, sex, side, mechanism of trauma were recorded. Clinical evaluation was performed using Flynn’s criteria. Radiological evaluation included assessment of fracture union, Baumann’s angle and its change from 0 to 6 months, carrying angle, lateral humerocapitellar angle (LHCA), and its 0 to 6-month change. Complications and additional procedures were also recorded. Results: Group 1 consisted of 32 patients, while Group 2 included 28 patients. The demographic data showed no statistically significant differences between the two groups. Based on Flynn’s criteria, outcomes in Group 1 were classified as excellent in 24 (75%) patients, good in 5 (15.6%), fair in 3 (9.4%), and none were considered poor. In Group 2, 20 (71.4%) patients achieved excellent results, 7 (25%) were rated as good, 1 as fair (3.6%), and no poor outcomes were observed. Functional outcomes were similar in both groups (p: 0.488). The groups showed comparable results in terms of both the Baumann’s angle and its change, carrying angle, LHCA and its change. Ulnar nerve injury developed in 2 patients in Group 2 and resolved with conservative follow-up. Conclusion: In the management of pediatric supracondylar humerus fractures, lateral and cross pinning techniques yield comparable clinical and radiological results. To prevent ulnar nerve palsy in the cross-pinning technique, a mini medial incision can be used to protect the ulnar nerve.
Effect of methylphenidate treatment on macula and optic disc microvascularity in children with attention-deficit/hyperactivity disorder: A retrospective study
Aim: This study aimed to investigate macular and optic nerve head (ONH) microvascularization in children diagnosed with attention deficit hyperactivity disorder (ADHD) before and 6 months after the initiation of methylphenidate (MPH) treatment, and to compare these findings with a healthy control group. Materials and Methods: This retrospective study included 66 eyes of 66 patients with ADHD and 74 eyes of 74 healthy controls, all aged 6–17 years. Participants were grouped as follows: newly diagnosed treatment-naive ADHD patients, the same patients after 6 months of MPH treatment, and healthy controls. Specular microscopy findings, pupil size (PS), anterior chamber depth (ACD), and lens thickness (LT) values of participants were recorded. Additionally, retinal nerve fiber layer (RNFL) thickness, central macular thickness (CMT), and optic nerve head (ONH) radial peripapillary capillary plexus (RPCP), superficial capillary plexus (SCP), and deep capillary plexus (DCP) vessel density (VD) parameters were measured. Results: Statistically significant increases in whole-image VD values for SCP and DCP were observed following MPH treatment (both p < 0.001). Additionally, SCP VD values were significantly lower in treatment-naive children with ADHD compared to healthy controls, while RPCP VD values were higher (p = 0.006 and p = 0.010, respectively). No statistically significant differences in CMT, RNFL thickness, or anterior segment parameters (PS, ACD, LT) were observed either after MPH treatment within the ADHD group or between the control group and treatment-naive ADHD patients. Conclusion: In children diagnosed with ADHD, significant increases in SCP and DCP values were observed following MPH treatment. These findings indicate the need for further studies to evaluate the effects and clinical significance of MPH treatment on retinal microvasculature.
Attention deficit hyperactivity disorder
Optical coherence tomography angiography
Evaluation of risk factors for morbidity and mortality in intensive care unit readmissions
Aim: Unplanned readmissions to the intensive care unit (ICU) are associated with poor clinical outcomes, prolonged hospital stays, and increased healthcare costs. Identifying the clinical and laboratory predictors of ICU readmission and its impact on in-hospital mortality remains critical for improving patient safety and optimizing utilization of the resources. This study aimed to investigate the factors associated with ICU readmission and evaluate its relationship with mortality in a tertiary-care hospital setting. Materials and Methods: In this retrospective cohort study, data of 1347 patients followed in Pulmonary ICU between 2016 and 2024 were retrospectively evaluated. Data of 153 patients (75 patients readmitted and 78 control cases selected randomly who were not readmitted during the same hospitalization) were analyzed. The two groups -those with and without ICU readmission- were compared in terms of demographic characteristics, clinical parameters, comorbidities, nutritional status, and laboratory findings. Logistic regression analysis was used to identify predictors of mortality. Results: Readmitted patients were older (p=0.001), had lower Glasgow Coma Scores (p <0.001), higher APACHE II scores (p <0.001), and longer ICU and hospital stays (p=0.002, p=0.006 respectively). They also required more vasopressors (p=0.004), mechanical ventilation (p=0.001), and sedation (p<0.001). Nosocomial infections were more frequent in this group (p <0.001). Univariate regression analysis revealed that ICU readmission, low serum albumin, nosocomial infections, use of vasopressors, and comorbidities such as dementia and cerebrovascular disease were significantly associated with mortality (p<0.05). In the Backward Wald model, albumin during hospitalization, nosocomial infection and APACHE II scores were independent risk factors for mortality (p<0.05). Conclusion: ICU readmission is strongly associated with adverse clinical outcomes and increased in-hospital mortality. Identifying high-risk patients based on clinical and laboratory parameters—such as low serum albumin levels, presence of nosocomial infections, use of vasopressors, and comorbidities like dementia/Alzhiemer’s disease—may facilitate early interventions and improve patient prognosis.
Role of loneliness in the relationship between chronic pain and analgesic use in the elderly
Aim: Loneliness is more frequently observed in older adults than in other age groups and is associated with adverse health outcomes. This study aimed to examine the relationship between loneliness, chronic pain, and analgesic use in the geriatric population. Materials and Methods: This cross-sectional study included 384 elderly subjects who presented to a family medicine outpatient clinic. The University of California, Los Angeles (UCLA) Loneliness Scale for the Elderly and the Geriatric Pain Measure were used to collect data on the variables. Results: The mean age of the 384 elderly participants included in the study was 74.91±7.12 years (range: 65–91). Of the participants, 52.9% were women and 11.7% were living alone. Higher frequencies of analgesic use were associated with higher pain and loneliness scores (p<0.001). A moderate, positive, and statistically significant correlation was found between pain and loneliness scores (r=0.478, p<0.001). In the multivariate linear regression analysis, each 1-point increase in the loneliness score led to a 1.72-point increase in the pain score. Female sex and chronic diseases were associated with 4.63- and 9.65-point increases in the pain score, respectively. Multinomial logistic regression analysis showed that, independent of age, sex, and pain score, each 1-point increase in the loneliness scale score was associated with a higher likelihood of using analgesics ≥15 times/month (OR=1.29), 8–14 (OR = 1.24), and 2–7 (OR = 1.22) times/month. Age and sex did not have any significant effect on monthly analgesic use. Conclusion: There is a positive relationship between loneliness, chronic pain, and frequent use of analgesics in the elderly subjects Psychosocial assessment and support in elderly patients may help reduce excessive analgesic consumption.
Impact of reflux, bruxism, age, and plaque index on anterior tooth wear: A cross-sectional clinical evaluation
Aim: This study aims to evaluate the effect of variables such as gastroesophageal reflux disease (GERD), bruxism, plaque index, and age on erosive wear occurring on the palatal surfaces of maxillary anterior teeth, and to objectively measure this wear using the Anterior Clinical Erosive Classification (ACEC). Materials and Methods: A total of 507 individuals were included. Participants completed self-report questionnaires regarding the presence, previous diagnosis, disease duration, and medication use. Bruxism was assessed through self-report and clinical examination. Erosive wear on maxillary anterior teeth palatal surfaces was measured using ACEC, and plaque accumulation using the Silness and Löe Plaque Index. Statistical analyses included independent sample t-tests and Spearman/Pearson correlation coefficients. Significance was set at p<0.05. Results: Reflux disease was detected in 20.9% of the participants in the study. ACEC scores of individuals reporting reflux symptoms were found to be significantly higher compared to healthy individuals (p<0.05). ACEC scores were also found to be significantly higher in individuals with bruxism than those of without bruxism. In contrast, the plaque index did not show a significant difference between the groups. Additionally, a significant and positive relationship was found between the duration of reflux and ACEC scores (r=0.281, p<0.01). ACEC scores were observed to be higher in individuals receiving reflux treatment compared to those not using medication. Conclusion: These findings indicate that reflux affects not only the gastrointestinal system but also oral and dental health and emphasize the importance of early diagnosis and intervention for dental erosion in individuals with reflux symptoms. Our study reveals the usability of the ACEC in large populations and sheds light on the multifactorial etiology of dental erosion. It also highlights the need to consider the potential abrasive effects of medications used in reflux treatment.
Anterior clinical erosive classification
The relationship between health literacy and digital healthy diet literacy and dietary habits of pregnant women in different trimesters
Aim: This study aimed to investigate the relationship between health literacy, digital healthy diet literacy, and dietary habits of pregnant women in different trimesters. Materials and Methods: This study included 189 pregnant women who had registered for routine prenatal care. The participants were interviewed about their demographic characteristics, general health, smoking and alcohol consumption, medical history, and general dietary habits. In addition, a questionnaire with the Health Literacy Scale and the Digital Healthy Diet Literacy Scale was completed. Results: A positive, weak, and statistically significant correlation was found between prepregnancy body mass index (BMI) and the Health Literacy Scale (p < 0.05). A positive, weak, and statistically significant relationship was found between health literacy and digital healthy eating literacy (r = 0.278; p = 0.007). Conclusion: As the health literacy of pregnant women improves, so does their digital healthy diet literacy. These results demonstrate the importance of promoting health literacy to support healthy dietary behaviors during pregnancy.
First-trimester screening markers in pregnancies complicated by cervical insufficiency: A comparative retrospective study
Aim: This retrospective study aimed to evaluate the relationship between first-trimester screening markers and cervical insufficiency, comparing biochemical parameters and pregnancy outcomes among women with cervical insufficiency, spontaneous preterm birth, and term pregnancies. Materials and Methods: A total of 248 singleton pregnancies were included and divided into three groups: control (term deliveries, n=121), cervical insufficiency with cerclage (n=60), and spontaneous preterm birth (n=67). First-trimester serum markers including pregnancy-associated plasma protein A (PAPP-A), free beta-human chorionic gonadotropin (β-hCG), nuchal translucency (NT), and alpha-fetoprotein (AFP) were analyzed. Obstetric and neonatal outcomes such as gestational age at delivery, birth weight, Apgar scores, and adverse neonatal outcomes were recorded. Results: No significant differences were observed in first-trimester PAPP-A, β-hCG, NT, and AFP levels between the cervical insufficiency and control groups. However, the spontaneous preterm birth group exhibited significantly lower PAPP-A and higher β-hCG levels compared to both other groups (p < 0.001). Gestational age at delivery, birth weight, Apgar scores, and adverse neonatal outcomes were significantly worse in both cervical insufficiency and spontaneous preterm birth groups compared to controls (p < 0.05). Conclusion: First-trimester biochemical markers have limited predictive value for cervical insufficiency but show significant alterations in spontaneous preterm birth. Cervical insufficiency appears to be a localized structural pathology not reflected by early systemic biochemical changes. Clinical management should prioritize second-trimester cervical length assessment and appropriate interventions over reliance on first-trimester serum markers. Further research is needed to identify specific biomarkers for early detection of cervical insufficiency.
Beta-human chorionic gonadotropin (β-hCG)