OBJECTIVE:Our aim in this study is to investigate the total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) values of diclofenac sodium, which is a non-steroidal anti-inflammatory analgesic, after sciatic nerve injury, to examine the histopathological changes in the sciatic nerve, and to examine the results and enable important changes in treatment. It is one of the rare studies conducted histopathologically on post-injection sciatic nerve damage of diclofenac sodium, and the parameters of our biochemical approach have not been evaluated before in the literature. METHODS:study was divided into 5 main groups as control, sham, trauma, isotonic fluid, and diclofenac sodium. Sham, trauma, isotonic fluid, and diclofenac sodium groups were divided into four subgroups as early stage (day 1, day 3) and late stage (day 7 and day 14). Subjects in each group were evaluated daily by neurological examination according to the Tarlov scale. In all groups except the control group, the sciatic nerve was exposed through appropriate surgical procedures. TAS, TOS, and OSI were run on blood samples biochemically. Nerve tissue samples were evaluated histopathologically and immunohistochemically. RESULTS:There was a significant difference in pairwise comparison of the groups in terms of CASPASE-3 values. A statistically significant difference was found between the groups in terms of myelin thickness and axon diameter. A statistically significant difference was found between the groups in terms of nerve diameter values. CONCLUSION:Our study demonstrates that intramuscular injections of diclofenac sodium have potential harmful effects. We recommend that alternative methods of using diclofenac sodium intramuscularly be preferred whenever possible due to the potential complications associated with this drug, that healthcare professionals receive necessary training on intramuscular administration, that the procedures be performed more carefully, and that patients be informed about these complications.
Today, minimally invasive oxygen(O2)-ozone(O3) intramuscular lumbar paravertebral injections are used to relieve pain in conditions such as low back pain. Repeated paraspinal, peridural, or spinal O3 injections, when performed under non-aseptic conditions or not performed with proper technique, may carry a risk of parameningeal inoculation of bacteria resulting in meningitis and pneumocephalus. Although this treatment is well tolerated in most cases, the patient may sometimes develop rare but very serious complications. Our study presents a case of pneumocephaly and meningitis due to the injection of an intramuscular O2-O3 mixture directed into the subarachnoid space after dural puncture for the treatment of low back pain. Air-density lesions were detected in the temporal and frontal horns of the left lateral ventricle on the patient's computed tomography scan of the brain. The cerebrospinal fluid appeared slightly cloudy, with a leukocyte count of 4000/mm3, protein level of 483 mg/dL, glucose at 40 mg/dL, and chlorine at 113 mmol/L. Ensuring that ozone injection therapy is performed by qualified professionals and that strict aseptic precautions are taken before the procedure will prevent serious iatrogenic complications such as pneumocephalus and meningitis.
OBJECTIVE:This study aimed to evaluate the nutritional knowledge levels of mothers of children aged 4-6 years attending pediatric outpatient clinics, analyze knowledge levels according to maternal age, education, and income, and investigate their relationship with children's anthropometric measurements. METHODS:This cross-sectional study included 282 mothers of preschool-aged children who attended a pediatric outpatient clinic. Nutritional knowledge was assessed using the Nutritional Knowledge Level Scale for Adults, comprising Basic Nutritional Knowledge (BNK) and food preference (FP) subscales. Mothers also rated Nutrition-Health Awareness (NHA) and Dietary Adequacy Self-Assessment (DAS) on a 0-10 visual scale. Children's height-for-age (HAZ) and weight-for-age (WAZ) z-scores were calculated. Multiple linear regression and correlation analyses were performed. RESULTS:The median maternal age was 34 (interquartile range [IQR]: 29.25-40) years. Median BNK and FP scores were 58 (IQR: 51-69) and 35 (IQR: 30-40), respectively. Educational attainment was the strongest independent predictor of BNK (p=0.006) and DAS (p=0.033). Household income independently predicted FP (p=0.022) and NHA (p=0.026) after adjusting for age and education. Younger maternal age was associated with higher BNK scores. No statistically significant associations were found between maternal nutritional knowledge variables and children's HAZ or WAZ scores (all p>0.05). CONCLUSION:Most mothers demonstrated adequate BNK; however, this did not consistently translate into FP competence or healthy dietary self-perception. Maternal nutritional knowledge was not directly associated with children's growth outcomes in this cohort, suggesting the pathway from knowledge to child growth is indirect and multifactorial. Nutrition interventions should move beyond knowledge transfer to address practical dietary skills and socioeconomic determinants of eating behavior.
OBJECTIVE:The objective of the study is to evaluate the association between serum 25-hydroxyvitamin D (25[OH]D) levels and fatigue severity. METHODS:This single-center, cross-sectional study included 228 participants aged 18-65 years who completed the fatigue severity scale (FSS) questionnaire. Individuals who had received vitamin supplementation within the previous 3 months, had known chronic disease, used regular medication, or had a history of antidepressant/anxiolytic use for depression/anxiety were excluded. Serum 25(OH)D, hemoglobin, ferritin, iron, magnesium, vitamin B12, and folate values were retrieved from the hospital information system. The Mann-Whitney U-test was used for comparisons between genders, and the Spearman correlation test was used for relationships between FSS and biochemical parameters. P<0.05 was considered statistically significant. RESULTS:A total of 228 participants (57 males and 171 females) were included in the study. Most variables were not normally distributed; therefore, non-parametric analyses were performed. Spearman correlation analysis demonstrated a weak but significant negative correlation between FSS scores and both hemoglobin (p=0.003) and ferritin levels (p=0.001). No significant correlations were found between FSS and vitamin D, vitamin B12, folate, magnesium, or serum iron levels (p>0.05).In group comparisons based on fatigue severity, ferritin levels were significantly lower in the high-fatigue group compared to the low-fatigue group (p<0.001). Hemoglobin levels were also lower in the high-fatigue group (p=0.043). In contrast, vitamin B12 levels were significantly higher in the high-fatigue group (p=0.032). No significant differences were observed between groups in terms of vitamin D, folate, magnesium, or serum iron levels (p>0.05). CONCLUSION:Serum 25(OH)D levels were not associated with fatigue severity. The observed relationship between fatigue severity and hematological markers (hemoglobin and ferritin) suggests that these parameters should be considered in the clinical evaluation of fatigue.
OBJECTIVE:To examine changes in motor and non-motor clinical outcomes following participation in a home-based telerehabilitation program incorporating motor-cognitive dual-task exercises in individuals with Parkinson's disease (PD). METHODS:This retrospective cohort study analyzed prospectively recorded clinical data obtained from a government-supported telerehabilitation service implemented at a tertiary physical medicine and rehabilitation center in Istanbul, Türkiye. The study included 60 participants with mild-to-moderate PD (Hoehn and Yahr stages 1-3) who completed a 6-week intervention consisting of 30 supervised sessions (60 min/session, 5 days/week). The program combined motor exercises, cognitive tasks, and integrated dual-task activities delivered through synchronous video-based supervision. Clinical assessments included balance (Berg Balance Scale, Mini-BESTest), balance confidence (Activities-specific Balance Confidence Scale), mobility (Timed Up and Go test), manual dexterity (Nine-Hole Peg Test), quality of life (PD Questionnaire-39), depressive symptoms (Beck Depression Inventory), and self-reported urinary/fecal incontinence. RESULTS:Post-intervention analyses demonstrated statistically significant improvements in all evaluated outcomes (all p<0.001). Participants showed better balance, mobility, and hand dexterity, accompanied by increased balance confidence and improved gait-related performance. Quality-of-life scores improved, while depressive symptom severity decreased following the intervention. The proportion of participants reporting urinary incontinence declined from 40% to 23%, whereas fecal incontinence decreased from 12% to 2%. Effect size analyses demonstrated moderate-to-large improvements across the primary and key secondary outcomes, with the largest effects observed for depressive symptoms, quality of life, and balance-related performance. No intervention-related adverse events were identified during the study period. CONCLUSION:Participation in a remotely supervised, dual-task-based telerehabilitation program was associated with favorable changes across multiple clinical domains in individuals with PD. The findings suggest that home-based telerehabilitation may represent a feasible and clinically relevant rehabilitation approach within routine practice. Given the retrospective nature of the study and the lack of a control group, the observed findings should be considered preliminary. Prospective randomized controlled trials are needed to confirm these findings and evaluate their long-term clinical significance.
OBJECTIVE:Interstitial lung disease (ILD) is a frequent and prognostically important manifestation of systemic sclerosis (SSc), with a substantial proportion of patients developing progressive pulmonary fibrosis (PPF) despite immunosuppressive treatment. The objective of the study was to compare real-world lung function trajectories and the occurrence of progressive PPF among patients with SSc-ILD receiving commonly used immunosuppressive therapies. METHODS:We conducted a retrospective single-center cohort study of adult patients with SSc-ILD receiving immunosuppressive therapy, assessing longitudinal changes in pulmonary function and PPF according to international guideline-based criteria. RESULTS:Among 80 patients with SSc-ILD, mycophenolate mofetil (MMF) was the most frequently used immunosuppressive agent across both first-line and subsequent treatment lines. Despite its extensive use, MMF was associated with relatively low rates of progressive PPF (18.2% in first-line and 25% in second/third-line use) and largely stable forced vital capacity over time, with only modest decline in diffusing capacity for carbon monoxide. Cyclophosphamide (CYC) showed transient improvements in lung function at 1 year, followed by stabilization. In contrast, first-line azathioprine (AZA) use was associated with the highest PPF proportion (55.6%). CONCLUSION:In this real-world SSc-ILD cohort, MMF emerged as the most frequently used backbone therapy after the scleroderma lung study II, with generally stable lung function trajectories observed during follow-up. Higher proportions of progressive PPF were observed among AZA-treated patients, whereas CYC was mainly used as an induction therapy in selected cases. Rituximab, administered alone or in combination with MMF, was more frequently used in patients with progressive or treatment-refractory disease and was associated with relatively low progression proportions in this cohort. These findings reflect treatment patterns and clinical trajectories observed in routine clinical practice rather than comparative treatment efficacy.
OBJECTIVE:Heart rate recovery index (HRRI) occurs as a result of vagal reactivation and sympathetic retraction and is an independent risk factor used to assess autonomic nervous system (ANS) function and to determine prognosis in cardiovascular disease and all-cause mortality. It has been shown in various studies that cardiac autonomic dysfunction due to COVID-19 can occur. The aim of our study is to evaluate the effect of COVID-19 on ANS functions in people who have had this disease with HRRI. METHODS:In this prospective and observational study, patients proven to have had COVID by molecular methods (polymerase chain reaction positivity) and healthy controls were examined. Electrocardiogram, Transthoracic Echocardiography, Hemogram and Biochemistry tests, and exercise stress test were performed in both groups. HRRIs were calculated by subtracting heart rates at the 1st, 2nd, 3rd, 4th, and 5th min during the post-exercise relaxation phase from the peak heart rate during exercise. P<0.05 were considered significant. RESULTS:Study group (n=30) (Female/Male; n=15/15; mean age=39.8±13.3 years; median body mass index=25.9 kg/m2) and control group's (n=33) (Female)/Male; n=16/17; mean age=41.9±13.2 years; median body mass index=27.2 kg/m2). 1st min and 2nd min relaxation heart rates in the COVID-19 (+) group were found to be significantly higher than in the control group (p=0.042, p=0.049, respectively). In the COVID-19 (+) group, the 1st min, 2nd min, and 3rd min HRRI were found to be significantly lower than in the control group (p<0.001, p=0.006, p=0.039, respectively). CONCLUSION:According to the results of our study, HRRI is impaired as an indicator of autonomic dysfunction in people who have had COVID-19. This situation correlates with other studies that have results of ANS dysfunction due to COVID-19, and this may pose a risk factor for increased mortality and morbidity.
OBJECTIVE: This study aimed to evaluate the effects of the February 6, 2023, earthquakes in Turkiye on anxiety and depression levels and their impact on erectile dysfunction (ED). METHODS: A total of 164 men aged 25-55 were enrolled between July 15, 2024, and January 15, 2025. Ninety-seven patients who presented with ED after the earthquakes were included as the study group, and 67 healthy individuals without ED were enrolled as controls. All participants completed the Arizona Sexual Experiences Scale (ASEX), Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D), World Health Organization Quality of Life-BREF (WHO-QOL-BREF), and International Index of Erectile Function (IIEF-5). Statistical analyses were conducted using chi-square, t-tests, and ANOVA. RESULTS: There were no significant differences between the groups regarding age and marital status. Patients with ED had significantly higher ASEX, HAM-A, and HAM-D scores and significantly lower WHOQOL-BREF scores compared to controls (p=0.001). Among ED patients, 52 (53.6%) had severe ED, 40 (41.2%) had moderate, and 5 (5.2%) had mild symptoms. ASEX scores were significantly higher (p=0.01), and WHOQOL-BREF general health scores were significantly lower in patients with severe ED compared to those with milder forms (p=0.001). CONCLUSION: The February 6 earthquakes were associated with increased anxiety and depression and decreased quality of life in men, which significantly contributed to the prevalence and severity of ED. These findings highlight the importance of addressing sexual health as part of post-disaster psychosocial support.
Calcium oxalate (CaOx) nephrolithiasis is the most common type of kidney stone disease worldwide. Recent studies show that its development cannot be explained solely by renal solute handling; instead, it reflects a broader interaction between dietary habits, the intestinal microbiota, and host metabolic responses. Intestinal absorption of calcium and oxalate-two central drivers of lithogenesis-is shaped by both microbial composition and dietary patterns. Although Oxalobacter formigenes was initially regarded as the main oxalate-degrading organism, newer studies indicate that a wider disturbance of the gut microbiota, especially the loss of short-chain fatty acid (SCFA)-producing species, may increase susceptibility to stone formation. In this review, nutritional, microbial, and mechanistic evidence is brought together to examine how diet-particularly salt, animal protein, calcium, oxalate, fruits, vegetables, and water intake-modulates the gut-kidney axis. Diets high in salt or animal protein tend to shift the microbiota toward more pro-inflammatory and acidogenic profiles, while fiber-rich, plant-based diets and adequate hydration appear to support microbial diversity, SCFA production, and epithelial barrier integrity. Probiotic and synbiotic interventions have also gained attention as potential strategies to reduce stone recurrence by targeting gut microbial function. Taken together, current findings suggest that the gut-kidney axis is a dynamic metabolic link between diet, microbial ecology, and renal physiology. Future studies combining multi-omics methods with personalized nutritional approaches may help develop more effective microbiota-based prevention and treatment strategies for CaOx nephrolithiasis.
OBJECTIVE: Anemia is a prevalent public health issue characterized by a reduction in hemoglobin concentration, often accompanied by nonspecific symptoms that overlap with various other medical conditions. Despite its high global and national prevalence, especially among women, the diagnostic value of clinical symptoms in identifying anemia remains uncertain. In this study, we aimed to determine the prevalence of anemia and evaluate the frequency and severity of anemia-related symptoms. METHODS: This cross-sectional study was conducted among medical students aged 18-35 between February and May 2025. Participants completed a detailed symptom questionnaire encompassing 44 anemia-related symptoms and underwent capillary hemoglobin measurement. Statistical analyses included group comparisons and regression analyses to explore the association between symptoms and anemia status. RESULTS: A total of 251 participants (150 women, 101 men; median age: 22 Years) were included. The overall prevalence of anemia was 28.3%, significantly higher in women (35.3%) than in men (17.8%, p=0.025). The most frequently reported symptoms among anemic participants included fatigue (87.3%), malaise (85.9%), and attention deficit (78.9%). No statistically significant differences were observed in the frequency or severity of symptoms between anemic (median: 18 Symptoms) and non-anemic participants (median: 19 Symptoms)(all p>0.05). Regression analyses did not identify any predictive model for anemia based on symptomatology. CONCLUSION: Anemia was found to be prevalent even among young and otherwise healthy individuals. Anemia-related symptoms were common and similar across both anemic and non-anemic participants, suggesting that such nonspecific complaints may reflect underlying physiological processes or nutritional deficiencies rather than anemia alone.
OBJECTIVE: Maternal obesity correlates with metabolic and inflammatory alterations that may affect biomarkers of the serotonin system. Serotonin is also thought to influence the fetal neurobehavioral system. This research analyzed the levels of maternal serum serotonin, maternal serum serotonin transporter (SERT), and umbilical cord arterial serotonin in obese versus non-obese pregnant women. METHODS: Maternal serum serotonin, maternal serum serotonin transporter (SERT), and umbilical cord arterial serotonin levels were compared between obese and non-obese pregnant women. A total of pregnant women undergoing cesarean delivery were included. The levels of serotonin and SERT in maternal serum and umbilical cord arterial blood were measured, and statistical analyses were performed to compare the groups. RESULTS: Maternal serum serotonin was higher in the obese group than in the non-obese group (440.34 [275.26-542.40] ng/mL vs 237.00 [167.05-368.36] ng/mL; p=0.003). Umbilical cord arterial serotonin was higher in the obese group (188.17 [101.10-243.36] ng/mL vs 118.19 [64.32-189.71] ng/mL; p=0.019).No significant maternal serum SERT was observed. CONCLUSION: Obese and non-obese pregnant women undergoing cesarean delivery showed differences in maternal and umbilical cord arterial serotonin levels. No significant difference was observed in maternal serum SERT levels. These findings suggest that maternal obesity affects serotonin biomarkers, which may have implications for fetal neurobehavioral development.
OBJECTIVE:Dyspnea is a frequent yet potentially life-threatening complaint in emergency departments. This study aimed to compare the predictive accuracy of the National Early Warning Score and the Manchester Triage System for key clinical outcomes among dyspneic ED patients. METHODS:We retrospectively analyzed 726 adult dyspneic patients presenting to a tertiary ED. Demographics, initial vital signs, MTS triage category, and calculated NEWS values were recorded at admission. Outcomes included hospital ward admission, intensive care unit admission, in-hospital mortality, 48-hour reattendance, and length of stay. Statistical analyses comprised chi-square, Kruskal-Wallis, and logistic regression models. RESULTS:The mean age was 61.1 years, and 52.9% were female. Of the patients, 13.8% were admitted to wards, 3.2% to ICUs, and 2.3% died; 4.1% reattended within 48 hours. NEWS risk stratification strongly aligned with MTS categories (p<0.001). Higher NEWS scores were associated with older age, higher respiratory and pulse rates, lower blood pressure, and reduced oxygen saturation. NEWS independently predicted hospital admission (OR=4.47, p<0.001) and ICU admission (OR=1.94, p=0.001), whereas MTS predicted ICU admission (inverse association, OR=0.34, p<0.001) and mortality (OR=0.30, p<0.001). CONCLUSION:NEWS more accurately predicted hospital and ICU admission, while MTS was more strongly associated with mortality in dyspneic ED patients. These complementary roles suggest that combining both tools-or developing a dyspnea-specific hybrid model-may enhance risk stratification and improve outcomes.
OBJECTIVE: Although much is known about facial aesthetics, the role of head shape remains underexplored. Understanding individuals' awareness, preferences, and interest in cranial aesthetic interventions may guide future approaches.This study aimed to assess Turkish individuals' perception of dolichocephalic, mesocephalic, and brachycephalic head shapes, along with their self-awareness, satisfaction, interest in correction, and preferred methods. METHODS: We surveyed 100 participants (52 women, 48 men), excluding healthcare professionals, those with cranial surgery histories, and certain bald men. Preoperative lateral profile photographs of a female and a male facial aesthetic surgery patient were obtained. After measuring biparietal distances and establishing cranial indices, these images were digitally modified to represent each head shape type. Using these images, participants evaluated their head shape, satisfaction, awareness, and preferred interventions if considering surgery. Each participant's cranial index was also objectively measured by adjusting posterior cranial measurements for classification. Statistical analyses (SPSS v22) used chi-square tests (p<0.05). RESULTS: Cranial index analysis showed 53% were brachycephalic. Overall, 65% were satisfied, 18% dissatisfied, and 17% never considered their head shape. Awareness differed significantly between attentive and non-attentive groups (p<0.001). Mesocephalic identification accuracy (87.88%) exceeded brachycephalic (p<0.00001) and dolichocephalic (p<0.000001). Only 11% considered cosmetic correction (p<0.001), with fat transfer preferred by 50% (p=1.0). CONCLUSION: Head shape influences aesthetic perception. Mesocephalic shapes are favored, while brachycephalic shapes correlate with greater dissatisfaction, potentially raising interest in occipital augmentation. Despite significant awareness differences, low intervention interest suggests the need for broader education and larger, diverse studies to clarify evolving preferences and guide future craniofacial aesthetic practice.
OBJECTIVE:Informed consent is the cornerstone of modern medical ethics, but current documentation systems negatively impact patient autonomy and clinical quality due to deficiencies in readability, comprehensibility, and standardization. These issues hinder patient participation and require innovative solutions. This study introduces the AI-powered LuminaConsent system to address standard deficiencies, comprehensibility issues, and efficiency constraints in urological informed consent documents. METHODS:In a three-armed comparative study, LuminaConsent (artificial intelligence), Turkish Urological Surgery Association standard forms, and expert-developed documents were evaluated in 10 urological procedures. The system is based on the RAG architecture, which uses OpenAI's GPT-4o-mini model and a special knowledge base consisting of 12 clinical publications. Three independent urology specialists conducted a blind evaluation using a 100-point scale across five areas: scientific content accuracy, patient communication effectiveness, quality of risk-benefit information, perioperative guidance, and legal-ethical compliance. RESULTS:LuminaConsent achieved higher performance with mean scores of 82.33 points (SD±4.2) versus 78.77 points (SD±6.1) for professional society standards and 57.43 points (SD±3.8) for specialist documentation, representing statistically significant improvements of 43.3% over specialist practices (p<0.001) and 4.5% over professional society standards (p<0.05). The system demonstrated consistent high-quality output across all procedures while generating comprehensive documentation within 96-180 seconds compared to traditional processes requiring multiple days. CONCLUSION:LuminaConsent offers a pioneering model for systematic AI integration in clinical practice with its evidence-based content generation and bilingual processing capabilities. The findings support the potential to empower patient autonomy, reduce application variations, and improve ethical standards.
Human Metapneumovirus (HMPV) is a leading viral cause of respiratory infections worldwide, particularly affecting children, elderly adults, and immunocompromised individuals. Since its discovery in 2001, HMPV has been recognized as a significant pathogen responsible for both upper and lower respiratory tract infections, often manifesting as bronchiolitis, pneumonia, and wheezing in infants, as well as acute respiratory distress syndrome (ARDS) in older adults and immunocompromised patients. Although it shares clinical features with Respiratory Syncytial Virus (RSV), HMPV is genetically distinct, posing unique challenges for diagnosis, treatment, and prevention. This review provides a comprehensive analysis of HMPV, focusing on its virus structure, genetic makeup, taxonomy, clinical features, and epidemiology. It also explores advances in diagnosis, prevention, and therapeutic strategies, highlighting the urgent need for continued research to address the global burden of HMPV.
OBJECTIVE: Childhood absence epilepsy (CAE) is defined by cognitive, behavioral, and neurophysiological abnormalities, but its impact on auditory function remains underexplored. Using Genetic Absence Epilepsy Rats from Strasbourg (GAERS), this study aimed to examine both peripheral and central auditory pathways function to better understand the auditory consequences of CAE. METHODS: The experimental and control groups consisted of six-month-old male GAERS (n=6) and Wistar (n=6) rats. Auditory functions were assessed using distortion product otoacoustic emissions (DPOAE) and auditory brainstem responses (ABR). DPOAE amplitudes and ABR wave thresholds, latencies, and amplitudes were analyzed for group comparison. RESULTS: DPOAE amplitudes were significantly reduced across all tested frequencies in epileptic rats compared to controls. In addition, ABR thresholds were slightly elevated compared to controls, but remained within clinically normal limits. Prolonged latencies were obtained in all waves except Wave I, indicating subcortical auditory pathway involvement in the epileptic group. A distinct ABR amplitude pattern emerged in epilepsy, characterized by increased Wave I-II amplitudes, a marked reduction at Wave III, and subsequent increases at Waves IV-V. CONCLUSION: The results showed both peripheral and central auditory nervous system dysfunction in GAERS rats, providing translational insight into CAE. Subclinical abnormalities in auditory neuronal processing may contribute to speech-in-noise difficulties, language impairments, and learning problems in affected children. Early detection and follow-up are valuable for the clinical management of auditory involvement in pediatric epilepsy.
OBJECTIVE: In the differential diagnosis of biliary colic and acute cholecystitis, physical examination, non-specific biochemical tests, and imaging methods are used. The aim of this study was to investigate the differential diagnostic power of NEUT-RI, NEUT-GI, RE-LYMP, and AS-LYMP parameters, which show neutrophil and lymphocyte activation, and are obtained with fluorescence flow cytometry during full blood count. METHODS: In this prospective cohort study, patients presenting with right upper quadrant pain were separated into two groups according to the diagnoses of acute cholecystitis and biliary colic. The conventional inflammatory markers and the NEUT-RI, NEUT-GI, RE-LYMP, and AS-LYMP values were compared. Receiver Operating Characteristics (ROC) Curve analysis was performed to investigate the diagnostic power of the inflammatory markers. RESULTS: In the acute cholecystitis group, C-reactive protein, white blood cells, neutrophil, monocyte, and immature granulocyte counts were higher, and the lymphocyte count was lower. The NEUT-RI and NEUT-GI values were significantly higher, and the RE-LYMP value was significantly lower in the acute cholecystitis group. The AS-LYMP values were similar in both groups. In the ROC analyses, the AUC values were 0.914 for CRP, 0.842 for WBC, 0.873 for neutrophils, and 0.823 for immature granulocyte count. A poor diagnostic performance was determined for NEUT-RI and NEUT-GI with AUC values of 0.662 and 0.612, respectively. The AUC for RE-LYMP and lymphocyte count was non-significant at <0.6. CONCLUSION: The results showed that NEUT-RI and NEUT-GI have limited diagnostic power in the differential diagnosis of acute cholecystitis from biliary colic, and RE-LYMP and AS-LYMP are insufficient diagnostically.
OBJECTIVE: Human metapneumovirus (HMPV) is a clinically important respiratory pathogen causing severe lower respiratory tract infections, particularly in infants, elderly individuals, and immunocompromised patients. Despite its substantial disease burden and global circulation, no HMPV-specific antiviral therapy has been approved to date. This unmet clinical need underscores the importance of identifying rapidly translatable therapeutic strategies. The present study aimed to identify potential inhibitors of the HMPV fusion (F) protein through a structure-based drug repurposing approach, leveraging the advantages of existing safety and pharmacokinetic profiles of approved antivirals. METHODS: Thirteen antiviral agents predicted to interact with the HMPV F protein were selected from the DrugBank database. Comprehensive in silico molecular docking analyses were conducted to evaluate ligand-protein interactions, with Ribavirin used as a reference compound and positive control. Binding affinity values were quantitatively compared, using the Ribavirin binding energy (-6.2 kcal/mol) as a benchmark for relative performance. RESULTS: The docking analyses revealed that multiple approved antiviral agents-namely Ledipasvir, Velpatasvir, Paritaprevir, Elbasvir, Pibrentasvir, Glecaprevir, Voxilaprevir, Ombitasvir, Grazoprevir, Dasabuvir, and Sofosbuvir-exhibited significantly higher binding affinities to the HMPV F protein than Ribavirin. These findings highlight the unexpected and mechanistically relevant interaction potential of hepatitis C virus-targeting antivirals with the HMPV fusion machinery, suggesting a novel avenue for therapeutic intervention. CONCLUSION: This study provides compelling in silico evidence that drug repurposing of clinically approved antiviral agents may accelerate the development of effective HMPV-specific therapies. By targeting the highly conserved and functionally critical HMPV F protein, the identified candidate compounds offer strong translational potential and justify prioritization for experimental validation and preclinical investigation. Collectively, these results contribute to filling a critical therapeutic gap and support drug repurposing as a viable and time-efficient strategy to address emerging and neglected viral respiratory infections.
OBJECTIVE:The role of cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (RCC) is controversial. The aim of this study was to compare survival outcomes between nephrectomy and non-nephrectomy groups in patients with de novo metastatic renal cell carcinoma receiving tyrosine kinase inhibitors (TKI). METHODS:This retrospective study included 99 patients with de novo metastatic renal cell carcinoma, stratified according to receipt of cytoreductive nephrectomy. Baseline clinicopathological variables, including International Metastatic RCC Database Consortium (IMDC) risk category, Eastern Cooperative Oncology Group (ECOG) performance status, sarcomatoid features, Fuhrman grade, and TKI regimen, were collected. Overall survival was evaluated using Kaplan-Meier analysis. RESULTS:Among 99 patients, IMDC risk categories were favorable in 21 (21.2%), intermediate in 52 (52.5%), and poor in 26 (26.3%). CN was performed in 67 patients (67.7%). Pazopanib and sunitinib were used in 50 (50.5%) and 49 (49.5%) patients, respectively. In comparison with the nephrectomy cohort, a greater percentage of patients in the non-nephrectomy cohort were classified as poor risk (37.5% vs. 20.8%, p=0.010). Overall survival differed significantly across IMDC risk groups (p=0.001). In the favorable-risk subgroup, median overall survival was longer with nephrectomy than without surgery (42 vs. 12 months, p=0.042). There was no significant difference in survival between pazopanib and sunitinib treatment (14 vs. 16 months, p=0.251). CONCLUSION:CN was associated with improved overall survival in the favorable-risk subgroup, whereas no significant survival difference was observed in intermediate- or poor-risk groups.
