CC Attribution-NonCommercial-NoDerivatives 4.0
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.
Copyright (c) 2026 Annals of Medical Research https://creativecommons.org/licenses/by-nc-nd/4.0
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.
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.
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.
A concerning condition in childhood: Hemoptysis or pseudohemoptysis?
Aim: Hemoptysis is defined as expectoration of blood from the lower respiratory tract, whereas pseudohemoptysis is defined as bleeding originating from the upper airways or gastrointestinal tract. Distinguishing between these entities in children is essential because of their differing clinical implications. This study aimed to assess the diagnostic value of clinical features in differentiating hemoptysis from pseudohemoptysis in pediatric patients and to analyze the underlying causes and diagnostic approaches. Materials and Methods: A retrospective review was conducted on 94 pediatric patients who presented with oral bleeding between January 2018 and December 2024. We analyzed data on demographics, bleeding characteristics, clinical findings, diagnostic imaging, and etiologies. Results: Hemoptysis was diagnosed in 51% (n = 48) and pseudohemoptysis in 49% (n = 46) of the cases. Cough, sputum production, and pink-to-bright red blood cells were significantly associated with hemoptysis (p<0.05). In contrast, pseudohemoptysis was more often associated with blood mixed with saliva, which came directly from the mouth. Fever and purulent sputum were more frequent in the hemoptysis group. Abnormal chest X-ray and CT findings were significantly more common in patients with hemoptysis. The leading causes of hemoptysis were parenchymal lung diseases (58.3%) and idiopathic causes (29.2%), whereas pseudohemoptysis was mainly caused by upper respiratory tract conditions, such as adenoid hypertrophy and sinusitis (24.2%), idiopathic etiologies (21.7%), and artificial bleeding (8.8%). Conclusion: In children, only half of the cases presenting with blood in the mouth are true hemoptysis. The most important diagnostic indicators of hemoptysis are bright red to pink color, accompanying cough, and any suspicious findings on chest radiography. The most common underlying causes of hemoptysis and pseudohemoptysis are lower and upper respiratory tract infections, respectively.
Hyperbaric oxygen therapy and contralateral ear hearing thresholds in unilateral sudden sensorineural hearing loss
Aim: To evaluate changes in hearing thresholds of the clinically unaffected contralateral ear before and after hyperbaric oxygen therapy (HBOT) in patients treated for unilateral idiopathic sudden sensorineural hearing loss (ISSNHL). Materials and Methods: In this single-center retrospective observational study, pure-tone audiograms (250 Hz–8 kHz) of the contralateral ears of 101 patients who underwent HBOT were compared before and after treatment. Each session lasted approximately 120 minutes at 2.4 ATA, including compression, oxygen exposure, and decompression phases. Thresholds were age-corrected according to ISO 7029:2017. Depending on distributional assumptions, Wilcoxon signed-rank test were used for paired comparisons (α=0.05). The median number of sessions was 20 (IQR: 10–20). Results: No significant changes were observed across most frequencies. Only at 6000 Hz, a minimal but statistically significant difference was detected (p=0.0049). The hearing thresholds at other frequencies remained stable. Conclusion: Overall, HBOT was not associated with substantial changes in contralateral hearing thresholds. The minor threshold shift observed at 6 kHz may suggest noise exposure during treatment sessions rather than oxidative stress. This highlights the importance of monitoring high-frequency hearing and emphasizes the need for noise control measures during therapy. These findings confirm that HBOT is generally safe for the unaffected ear.
The role of transarterial embolization in the management of hepatic hemangiomas: A retrospective analysis
Aim: Hepatic hemangiomas (HHs) are the most common benign liver tumors, and giant lesions may cause symptoms or complications requiring intervention. Surgical resection carries significant morbidity, and minimally invasive alternatives such as transarterial embolization (TAE) have gained importance. This study aimed to evaluate the clinical and radiological outcomes of TAE with bleomycin–lipiodol emulsion for giant HHs and to examine the relationship between peripheral contrast filling and volumetric response. Materials and Methods: This retrospective, dual-center study included 41 patients who underwent TAE between January 2019 and June 2024. Indications for treatment were symptomatic lesions ≥5 cm, progressive growth of hemangiomas, or all lesions ≥10 cm. Contrast-enhanced MRI or CT was performed at 1, 3, 6, and 12 months post-treatment. Volumetric reduction ratio (VRR) and size reduction were calculated, and angiographic peripheral contrast filling was categorized into four groups (<25%, 25–49%, 50–74%, ³75%). Clinical outcomes, technical success, and complications were analyzed. Results: One patient was identified as a statistical outlier and excluded from the final analysis, which therefore comprised 40 patients (73 HHs). The mean baseline lesion diameter was 8.6 ± 0.5 cm, with a median volume of 178.3 cc (IQR 62.5–376.0). At 12 months, the mean VRR reached 75%, and 90% of patients achieved VRR ≥50%. Patients with ≥75% peripheral contrast filling had significantly greater volume reduction compared with lower filling groups (p < .001). Symptom resolution occurred in 93.5% of symptomatic patients. The overall complication rate was 25%, all of which were minor (SIR Grade A–B), and no major or persistent complications were observed. Conclusion: TAE with bleomycin–lipiodol emulsion is a safe and effective treatment for giant hepatic hemangiomas, providing substantial volume reduction and symptom relief. The degree of peripheral contrast filling may serve as a predictor of treatment success.
The role of mood in complex regional pain syndrome: Cause or consequence?
Aim: Complex Regional Pain Syndrome (CRPS) involves pain and dysfunction in multiple nervous system pathways. Psychological symptoms such as anxiety, depression, and difficulty coping often accompany the physical aspects of the condition. This study sought to examine whether mood-related factors play a causal role in the onset of CRPS or if individuals with pre-existing psychological conditions exhibit increased susceptibility to its development. Materials and Methods: This is a cross-sectional study that included 131 patients with a history of trauma or surgery who were referred for rehabilitation within the first three months following the incident. Among them, 70 patients were diagnosed with CRPS, while 61 patients formed the control group. Each participant underwent evaluation through the Short Form-36, Visual Analog Scale (VAS), Beck Depression Inventory, and the Beck Anxiety Inventory. Results: The study included 62 men and 69 women, with no significant differences in anxiety and depression scores observed between the CRPS group and the control group (p>0.05 for both). However, individuals with CRPS reported notably higher scores on the VAS (p<0.05). In addition, their scores were significantly lower in the Short Form-36 subdomains related to pain intensity (p<0.05), social functioning (p < 0.05), and physical role limitations (p<0.05). Conclusion: The results indicate that an individual's baseline mood does not seem to contribute to the development of CRPS. These mood changes may be only the result of the disease, as pain level, social function, and physical role were determined to be worse in these patients.
Volumetric MRI analysis of the pineal gland and brain ventricles in patients with migraine
Aim: Previous studies have reported reduced melatonin levels and elevated cerebrospinal fluid (CSF) pressure in patients with migraine. However, the volumetric characteristics of the pineal gland, which is the primary source of melatonin, and the brain ventricles, which serve as CSF reservoirs, have not been sufficiently investigated. This study analyzed the volumes of the pineal gland and brain ventricles in migraine patients. Materials and Methods: The study included 21 migraine patients and 22 age- and sex-matched healthy controls. Brain volumetric analyses were performed using high-resolution magnetic resonance imaging (MRI). Pineal gland volumes were manually segmented and measured using ITK-SNAP software, while ventricular volumes were automatically computed using volBrain software. All volumetric measurements were expressed in cubic centimeters (cm³). Results: The groups were comparable in terms of age (p=0.730), gender (p=0.420), and body mass index (p=0.082). Pineal gland volume was significantly reduced in the migraine group. An ANCOVA controlling for total intracranial volume confirmed this significant reduction (F(1, 39) = 34.95, p<0.001, partial η² = 0.473). Likewise, ventricular volumes were significantly smaller in migraine patients (p<0.001). Conclusion: These findings indicate that the reduction in pineal gland volume in migraine patients occurs independently of overall brain size, pointing to a specific structural change relevant to the underlying pathology of the disease.
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.
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
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Renal outcomes of children with ectopic kidneys: A single-center experience
Aim: This study aimed to evaluate the clinical characteristics, associated anomalies, and outcomes of children diagnosed with renal ectopia in a single tertiary care center. Materials and Methods: We retrospectively reviewed the medical records of 58 children with renal ectopia who were followed up between January 2024 and June 2025. Data on demographics, anomalies, laboratory findings, imaging findings, and treatments were analyzed. Results: Among 58 patients (mean age 71.6 ± 56.4 months; 33 females, 25 males), 26 (44.8%) had right renal ectopia and 32 (55.2%) had left renal ectopia. Crossed renal ectopia was present in 9 (15.5%) patients, of whom 7 (77.8%) had crossed-fused renal ectopia. Additional urogenital anomalies included hydronephrosis in 7 (12.1%), neurogenic bladder in 4 (6.9%), and vesicoureteral reflux in 3 (5.2%). Prenatal diagnosis was achieved in 4 (6.9%) patients. Consanguinity was noted in 28 patients (48.3%), and 11 patients (19.0%) had a family history of CAKUT. Voiding cystourethrography was performed in 12 patients (20.7%) and high-grade vesicoureteral reflux was identified in 3 patients. Renal scarring was detected in 8 (15.1%) of the 53 patients who underwent DMSA scintigraphy; of these, 1 patient had hypertension, 1 had proteinuria, 1 was followed with stage 2 chronic kidney disease, and 1 with stage 5 chronic kidney disease. Conclusion: Renal ectopia may be accompanied by additional urogenital anomalies. Early diagnosis and comprehensive evaluation are essential for optimal management and prognosis.
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.
Evaluation of muscle strength and range of motion of upper extremity in breast cancer-related lymphedema
Aim: The objective of this study was to examine the impact of lymphedema on the muscle strength and range of motion of the upper extremities in breast cancer patients with lymphedema. Materials and Methods: Thirty-one female breast cancer survivors with lymphedema were evaluated in this cross-sectional study. The measurement of shoulder, elbow, and wrist flexion and extension strength was conducted using a hand-held dynamometer on both affected and unaffected upper extremities. Subsequently, a digital goniometer was utilized to assess the range of motion in both the affected and unaffected upper extremities. Results: A median age of 61 years (with an interquartile range of 55 to 69 years) was reported for the patients, and dominant right upper extremity was noted for all. The study revealed that the affected extremity exhibited reduced shoulder flexion and extension muscle strength and range of motion, and decreased elbow flexion muscle strength when compared to the unaffected upper extremity (p<0.05). However, a lack of statistical significance was observed in the comparison of elbow extension, wrist flexion and extension strength, and elbow and wrist joint range of motion between the two extremities (p>0.05). Conclusion: In cancer-associated lymphedema, limitations in muscle strength and range of motion are primarily localized to the shoulder region. These findings may serve as a guide for clinicians in the development of targeted rehabilitation interventions, with the aim of restoring mobility and strength in the areas most affected by lymphedema.
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.