Objective: This study aimed to evaluate the incidence of composite attachment loss in patients undergoing clear aligner treatment and to identify patient-, tooth-, and treatment-related factors associated with attachment debonding. Methods: Twenty-one patients (17 females, 4 males; mean age 23.86±8.21 years) receiving clear aligner therapy were included. Attachments were bonded according to the manufacturer’s protocol using high-viscosity composite. Patients were followed for 6 months and attachment loss was recorded at routine appointments. Statistical analyses were performed using Fisher’s exact test, Yates’ correction, and Pearson chi-square test, with p≤0.05 considered significant. Results: Among 427 attachments, 21 were lost. Attachment loss was significantly associated with attachment type (conventional vs. optimized, p=0.009) and tooth type (p=0.0005), with the highest loss rate observed in molars. No significant associations were observed between attachment loss and attachment size, dental arch, patient sex, chewing habits, daily aligner wear time, aligner removal frequency, or removal direction. Conclusion: Attachment loss in clear aligner treatment was associated with attachment type and tooth type. Optimized attachments showed improved retention, while molars exhibited the highest attachment loss rate.
Objective: This study aimed to evaluate the relationship between Hounsfield unit (HU) and clinical outcomes after flexible ureteroscopy (fURS), including stone-free rate (SFR), operative time, and postoperative complications. Methods: A total of 300 adult patients who underwent fURS for unilateral renal stones <20 mm between January 2020 and May 2025 were retrospectively analyzed. Demographic characteristics, stone parameters, and perioperative data were recorded. The primary outcome was SFR assessed at 4-6 weeks; residual fragments <4 mm were considered clinically insignificant. Continuous variables were compared using independent-samples t-test or Mann-Whitney U test as appropriate, and categorical variables using chi-square or Fisher’s exact test. Multivariable logistic regression identified predictors of SFR and postoperative complications. Receiver operating characteristic analysis was performed to evaluate the predictive value of HU for prolonged operative time, defined as durations exceeding the median operative time. Results: Mean HU was 948±290, mean stone size was 11.8±4.9 mm, and overall SFR was 80.7%. Larger stone size significantly reduced the likelihood of achieving SFR, while stone multiplicity showed borderline significance. Age, sex, body mass index, and hydronephrosis were not significant predictors. Postoperative complications occurred in 14.8% of patients, and ureteral access sheath use significantly reduced complication risk. HU demonstrated moderate discriminatory ability for predicting prolonged operative duration. Conclusion: HU is a clinically meaningful indicator of procedural complexity following fURS. Incorporating HU together with stone size and anatomical factors may improve preoperative planning, surgical decision-making, and patient counseling.
Colloid (neuroepithelial) cysts are slow-growing, benign, potentially fatal lesions that account for less than 2% of all intracranial tumors. They are most commonly located in the third ventricle, however may be seen along the entire neural axis. A 39-year-old woman presented with a one-year history of increasingly frequent headaches. She had no neurological signs. On magnetic resonance imaging, a cystic mass was observed in the left cerebellum (24×21×20 mm) compressing the fourth ventricle and brainstem. The cystic mass was totally excised, and histopathology confirmed a colloid cyst. The patient was discharged with no neurological deficit. Colloid cysts are very rare in the posterior fossa. The most common symptom is headache. Its origin is not known exactly, but it is thought to develop as a result of abnormal folding of the primitive neuroepithelium. Total excision of colloid cysts is curative.
Objective: Alzheimer’s disease is one of the most common forms of dementia which affects the cognitive, physical, psychological, and social functions of individuals. Cholinesterase enzymes are known to play a pivotal role in the occurrence and progression of Alzheimer’s disease. This study aims to evaluate the anticholinesterase and butyrylcholinesterase inhibitory activities of the mushroom Cantharellus lutescens, which can be found in İstanbul and its surrounding regions. Methods: Extracts of Cantharellus lutescens mushroom were prepared by maceration with hexane, ethyl acetate, and methanol at room temperature. Acetylcholinesterase and butyrylcholinesterase inhibitory activities of these three extracts were determined using the Ellman method. Results: While Cantharellus lutescens hexane extract was determined as the most active extract with 48.07±0.51% acetylcholinesterase inhibition at a concentration of 800 μg/mL, ethyl acetate extract showed the highest activity against butyrylcholinesterase with 29.20±0.80% inhibition at the same concentration. Conclusion: This study evaluates the anticholinesterase activity of an edible mushroom that could be a potential therapeutic agent in the future.
Objective: The primary objective of the study was to compare the efficacy of clomiphene and letrozole in inducing ovulation in infertile women with comorbidities. Secondary objectives included evaluating differences in pregnancy outcomes in terms of pregnancy rates, multiple gestation and adverse effects of the drugs between the two treatment groups. Methods: A cross-sectional study was conducted at CMH Kharian Medical College and associated hospital from January to June 2025. A sum of 120 infertile women with varied comorbidities were enrolled and divided into two treatment groups: letrozole group and clomiphene group. The study estimated and statistically evaluated ovulation rates, pregnancy rates, multiple gestation and adverse effects of the drugs between the groups. Results: The letrozole group demonstrated significantly better outcomes in terms of ovulation (86.7%) and pregnancy rates (66.7%) as compared to clomiphene group (68.3% and 40.0%, respectively). Letrozole was associated with fewer side effects and a lower prevalence of multiple gravidity (5.0%) as compared to clomiphene group (18.3%). Conclusion: Letrozole appears to be more effective and safer than clomiphene citrate for ovulation induction in infertile women with comorbidities. Grounded on these findings, letrozole may be considered a first line treatment option in infertile women with comorbidities.
Objective: Gastric cancer is prevalent both globally and in Türkiye. The primary treatment for this condition is surgical resection. However, because the stomach plays a vital role in the digestive system, its removal can lead to significant morbidity and mortality, as well as considerable alterations in post-operative quality of life. To address these changes, questionnaires such as the EORTC QLQ-C30 and EORTC STO22 have been developed to assess physical, social, and psychological well-being. Methods: The quality of life of patients who underwent surgery for gastric cancer at Bezmialem University Faculty of Medicine was assessed using the EORTC QLQ-C30 and EORTC STO22 questionnaires, which are commonly utilized for measuring quality of life in Europe. Following the approval of the non-interventional ethics committee on July 10, 2018 (approval no: 15/183), a retrospective review was conducted of patients diagnosed with gastric cancer who had undergone either total or subtotal gastrectomy between October 2010 and April 2018. Demographic, pathological, and surgical data were collected. Eighty-five surviving patients, who were at least three months post-adjuvant therapy and free of recurrence, were contacted to participate. The Turkish versions of the EORTC QLQ-C30 and EORTC STO22 questionnaires were administered prospectively. Subsequently, statistical methods were employed to compare the total gastrectomy and subtotal gastrectomy groups. Results: A comparison was conducted between the pathologies and quality of life of 43 patients who underwent total gastrectomy and 42 patients who had subtotal gastrectomy. The results from the EORTC QLQ-C30 questionnaire indicated that diarrhea occurred more frequently in the total gastrectomy group. Additionally, the EORTC STO22 questionnaire revealed a higher incidence of dysphagia in this same group. Conclusion: Based on this information, it was concluded that patients who underwent subtotal and total gastrectomy experienced a similar global quality of life; however, specific symptoms such as diarrhea and dysphagia were more favorable in the subtotal group. It is recommended that distal subtotal gastrectomy be considered preferable, as long as surgical procedures adhere to oncological standards, since it better preserves patient comfort by limiting these specific postoperative symptoms.
Objective: Assessment of an individuals’ need for care in the preoperative period and implementation of structured care supported by evidence-based practices are important to improve patient comfort in the postoperative period. The present study investigated how preoperative care dependency is associated with postoperative comfort in patients undergoing hip replacement surgery. Methods: A descriptive correlational study was carried out with 120 patients at a training and research hospital in Türkiye between July 2021 and April 2022. Data were collected using an “Information Form”, the “Care Dependency Scale”, and the “Post Hip Replacement Comfort Scale”. Results: The patients’ mean age was 68.56±14.75 years, and 72.5% (n=87) were female. The patients’ mean scale scores of “Care Dependency Scale” and “Post Hip Replacement Comfort Scale” were 66.16±17.48 and 3.51±0.50, respectively. A weak yet statistically significant positive relationship was found between the scales (r=0.339, p<0.001), indicating that lower preoperative care dependency was associated with higher postoperative comfort. Conclusion: Evaluating patients’ care needs during the preoperative period may support postoperative comfort. These findings underscore the importance of tailored nursing interventions to address preoperative care dependency.
Objective: The aim of this study was to evaluate the relationship between smartphone addiction and the viscoelastic properties (tone, stiffness, elasticity) of selected upper extremity and cervical muscles and movement-based reaction time in university students. Methods: This cross-sectional study included 216 university students. Participants were divided into addicted and non-addicted groups using the Smartphone Addiction Scale-Short Version (cut-off score: males ≥31, females ≥33). Muscle viscoelastic properties were assessed using the MyotonPRO device, and movement-based reaction time was evaluated via the SWAY application. Results: Mostly low-level but significant positive correlations were found between muscle viscoelastic properties, screen time, and SWAY average scores. Moderate correlations were observed between some parameters of the flexor carpi ulnaris and extensor carpi radialis muscles and both the SWAY average and daily screen time. Conclusion: Smartphone addiction was associated with changes in selected muscle viscoelastic properties, while only weak associations with movement-based reaction time were observed. These findings suggest that excessive smartphone use may be related to minimal neuromuscular adaptations rather than clinically definitive impairments.
Objective: This study investigates sex differences by assessing the frontal sinus (FS), maxillary sinus (MS), and sphenoid sinuses (SS) on paranasal sinus computed tomography (CT) images to evaluate their comparative discriminatory power for sex estimation. Methods: A total of 419 individuals (206 males and 213 females) aged 20-49 years who underwent paranasal sinus CT were retrospectively included in the study. Linear measurements of the FS (height, width, depth, and the distance between the most superior points), MS (height, width, depth, anteroposterior width at the midpoint, and the intermedial wall distance), and sphenoid sinus (height, width, depth) were obtained. Statistical analyses were performed using R software. Intra- and interobserver reliability were assessed using intraclass correlation coefficients. Descriptive statistics were calculated for all variables. The discriminatory power of each measurement for sex estimation was evaluated using receiver operating characteristic curve analysis. Additionally, multivariate logistic regression analysis incorporating all parameters was conducted to assess their combined predictive value. A significance threshold of p<0.05 was applied for all analyses. Results: Of the 22 paranasal sinus dimensions measured, 19 were larger in males than in females. The most accurate measurements were left (74%) and right FS (73%) depth. The formula derived from the logistic regression analysis of right FS depth, left FS depth, left FS width, right MS height, right MS depth, right MS width, left MS depth, left MS midpoint width, and left SS height demonstrated 76% accuracy. Conclusion: The formula produced by multiple logistic regression analyses estimated sex with accuracy of 76%. The findings support the use of paranasal sinus dimensions can be utilized for sex estimation. National scale studies are needed.
Objective: In the literature, β-sitosterol (BS), one of the primary phytosterol components found in plant-based dietary sources, has been reported to exhibit antidiabetic, antimicrobial, enzyme-inhibiting, anti-inflammatory, antioxidant, trypanocidal, anticancer, and antinociceptive effects. Therefore, in our present study, we aimed to isolate BS from the genus Nepeta (N. trachonitica, N. aristata, N. italica, N. baytopii, and N. stenantha) using column chromatography (silica gel) and to elucidate BS using chromatographic methods (NMR and MS). Methods: Detailed studies (in vitro and in silico) were conducted on metabolic enzymes (carbonic anhydrase, tyrosinase, α-amylase, urease, α-glucosidase, and lipase) of BS, isolated as the main component from five different Nepeta species, and statistically compared with standard drugs. Results: It was observed that BS had effective inhibitory effects when compared with standard drugs in inhibiting urease (IC50, 21.60±0.01 μM) and tyrosinase (IC50, 6.60±0.02 μM). In kinetic studies, BS was found to have an effective inhibitory capacity on α-glucosidase with an inhibitory constant of 25.67 µM. BS was found to have a high binding affinity with tyrosinase in molecular docking. In addition, the complex of tyrosinase and BS, which had not undergone molecular dynamics simulation in previous studies, reached stability at 4 nm in the RMSD graph, and the binding energy was recorded as -4.39 kcal/mol in the MM/PBSA analysis. Conclusion: The in silico results supported that Nepeta species and BS are effective on the dermatological enzyme (tyrosinase) and may be candidates for a new dermatological product.
Objective: To evaluate the pathology-specific correction performance and photorealistic output quality of the Gemini 2.5 Flash Image model (also known as “Nano Banana”; Google LLC, Mountain View, CA, USA) across multiple periocular and extraocular pathologies and appearance-related findings. Methods: This retrospective study included 45 standardized clinical photographs representing nine periocular/extraocular pathologies and appearance-related findings. Each image underwent single-step, prompt-based editing using Gemini 2.5 Flash Image. Two independent raters scored images on pathology correction (Q1) and naturalness (Q2) using 5-point Likert scales. Ordinal statistics, Gwet’s agreement coefficient (AC), and multilevel cumulative logistic models were applied. Results: Median scores were high for both Q1 and Q2 across raters. Images rated ≥4 ranged from 84-91% for Q1 and reached 100% for Q2. Interrater agreement was excellent (Q1 AC=0.9466; Q2 AC=0.9878). Highest correction performance was observed for blepharoptosis and exotropia, while lower eyelid blepharoplasty need and thyroid eye disease showed comparatively reduced correction. Conclusion: Prompt based large language models enabled editing provided clinically meaningful correction with high photorealism across most pathologies, suggesting a practical alternative to dataset dependent conventional image generation approaches.
Addiction is a complex and multifaceted condition that significantly affects individuals’ physical, psychological, and social well-being. Beyond substance dependence, addiction encompasses behavioral disorders such as gambling, excessive technology use, and compulsive shopping. Historically, substance use has been deeply embedded in societal and cultural practices, evolving from medicinal and ritualistic applications to modern regulatory frameworks. Advances in neuroscience have elucidated the pivotal role of neurotransmitters and brain structures, particularly the reward system, in the development and persistence of addiction. While chemical addictions—such as those involving alcohol, nicotine, and illicit drugs—profoundly alter physiological processes, behavioral addictions impair impulse control and reward processing, resulting in compulsive behaviors. The diagnosis of addiction adheres to standardized frameworks, including the Diagnostic and Statistical Manual of Mental Disorders, fifth edition and the International Classification of Diseases, tenth edition, which assess severity based on behavioral patterns and physiological responses. Treatment approaches encompass pharmacological interventions and psychological therapies, with an increasing emphasis on holistic and multidisciplinary strategies. National and international organizations, such as the World Health Organization, the United Nations Office on Drugs and Crime, and Yeşilay, play a crucial role in addiction prevention, rehabilitation, and policy development. A comprehensive understanding of addiction necessitates an integrated approach that combines biological, psychological, and social perspectives. This review aims to provide an in-depth analysis of addiction and its implications for public health, guiding further research and policy advancements in the field. Future research should focus on innovative therapies and personalized treatment plans to enhance recovery outcomes.
Objective: Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine disorder characterized by diverse phenotypes that differ in metabolic and hormonal risk. The integrated profiles of vitamin D, body mass index (BMI), insulin resistance, anti-Mullerian hormone (AMH), and lipid parameters across these phenotypes remain incompletely defined. The aim of the study was to compare serum 25-hydroxyvitamin D [25(OH)D], AMH, insulin resistance [homeostasis model assessment of insulin resistance (HOMA-IR)], BMI, and lipid profiles among the four PCOS phenotypes defined by the Rotterdam criteria. Methods: This retrospective study included 420 women aged 18-40 years with PCOS classified as phenotype A (hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology), B (hyperandrogenism and ovulatory dysfunction), C (hyperandrogenism and polycystic ovarian morphology), and D (ovulatory dysfunction and polycystic ovarian morphology). Serum 25(OH)D, AMH, fasting glucose, fasting insulin, and lipid parameters were measured; HOMA-IR was calculated. Data were analyzed using one-way ANOVA or Kruskal-Wallis tests (p<0.05 was considered significant). Results: Phenotype distribution was A: 35.7%, B: 28.6%, C: 21.4%, and D: 14.3%. Significant inter-phenotype differences were found for BMI, HOMA-IR, AMH, high-density lipoprotein (HDL) cholesterol, and triglycerides (all p<0.01). Phenotypes A and B showed higher mean BMI (31.5±6.1, 30.8±5.8 kg/m²) and HOMA-IR [3.9 (2.8-5.5), 3.7 (2.7-5.1)] and lower HDL cholesterol (41.5±8.5, 42.8±9.1 mg/dL) compared with C and D (p<0.001). Triglycerides were higher in A and B, while AMH was elevated in A [8.8 (6.5-11.2) ng/mL] and C [8.5 (6.8-11.0) ng/mL] versus D [7.1 (5.5-9.5) ng/mL] (p=0.008). No significant differences were observed in vitamin D, total cholesterol, or low-density lipoprotein cholesterol (p>0.05); vitamin D deficiency was prevalent in all phenotypes. Conclusion: Hyperandrogenic and anovulatory PCOS phenotypes (A and B) exhibit more adverse metabolic profiles with higher BMI, insulin resistance, and dyslipidemia. Vitamin D deficiency was widespread but phenotype-independent. Phenotype-specific evaluation may improve metabolic risk stratification and individualized management in women with PCOS.
Objective: This study aimed to investigate how perceived stress, job burnout and mental fatigue affect neck and craniofacial pain and disability in academics. Methods: The study included 592 academics with a mean age of 40.11±9.82 years. Neck pain and disability status were determined using the neck disability index (NDI), cranial and facial pain status with the Craniofacial Pain and Disability Index (CFPDI), perceived stress levels with the perceived stress scale-14 (PSS-14), job burnout with the burnout assessment tool (BAT), and mental fatigue was measured using the mental fatigue subscale of the Chalder Fatigue Scale (CFS-mental). Results: Moderate positive correlations were found between the NDI and PSS-14, BAT, and CFS-mental (r=0.418-0.573, p<0.001). Weak positive correlations were found between the CFPDI and PSS-14, BAT and CFS-mental scores (r=0.232-0.354, p<0.001). The PSS-14, BAT and CFS parameters explained 34.2% of the variance in NDI and 13.2% of the variance in CFPDI. Conclusion: Psychogenic factors were found to affect neck and craniofacial pain and disability in academics. Therefore, when treating this professional group, psychogenic factors should be considered.
Objective: This study compared the rates of computed tomography pulmonary angiography (CTPA) requests, diagnostic yield and clinical outcomes between general practitioners and emergency medicine specialists with residents in suspected pulmonary embolism (PE). Methods: This retrospective, multicenter, observational study was conducted in a tertiary education and research hospital and a secondary state hospital in T & uuml;rkiye. Patients over 18 years of age who underwent CTPA for suspected PE were included. Demographic data, physician designation, CTPA results and emergency department outcomes were recorded. Diagnostic yield, admission and mortality rates were compared between groups. Results: A total of 363 patients were included; the median age was 61 years (interquartile range: 48-72) and 52.3% were female. General practitioners evaluated 101 patients (27.8%), while specialists/residents evaluated 262 (72.2%). The overall PE positivity rate was 30.3%. Diagnostic yield was significantly higher in the specialist/resident group (37.4% vs. 11.9%, p<0.001). In multivariate analysis, evaluation by specialists/ residents was identified as an independent predictor of PE diagnosis (odds ratio: 4.76, 95% confidence interval: 2.44-9.09, p<0.001). Among PE-positive patients, discharge rate was lower (21.8% vs. 59.7%), while ward admission rate (42.7% vs. 20.9%), intensive care unit admission rate (35.5% vs. 19.4%) and mortality (19.1% vs. 7.1%) were significantly higher. Conclusion: Emergency medicine specialists and residents demonstrated greater diagnostic selectivity and markedly higher diagnostic accuracy compared with general practitioners. These findings emphasize the critical role of specialist involvement in PE diagnosis and suggest that structured decision support systems may enhance diagnostic efficiency among general practitioners in emergency settings.
Objective Local anesthetic systemic toxicity (LAST) is a rare but potentially life-threatening complication of local anesthetic use. Despite its clinical importance, medical specialists often have limited knowledge on this topic, and structured training is rarely implemented. This study aimed to evaluate the effectiveness of a brief, structured online educational module in improving knowledge of LAST among anesthesiology and intensive care specialists. Methods This cross-sectional pre-post study included anesthesiology and intensive care specialists in & Idot;stanbul. Participants completed a 15-item multiple-choice knowledge test before and after a short educational intervention. The educational content, adapted from UpToDate (R), was presented as a two-page plain-text document designed for 3-4 minutes of reading. Wilcoxon signed-rank tests were used to compare pre- and post-intervention scores, and multiple linear regression was performed to identify predictors of baseline knowledge. Results A total of 200 participants completed both assessments. The mean knowledge score increased significantly from 11.7 +/- 1.7 to 12.8 +/- 1.2 after the intervention (p<0.001). Improvements were most notable in knowledge of risk factors, prevention, and lipid emulsion therapy. Regression analysis indicated that older age and prior LAST training were negatively associated with baseline knowledge, while anesthesiology specialization was a positive predictor. Conclusion A brief, focused online module significantly improved LAST-related knowledge among anesthesiology and intensive care specialists. These results emphasize the value of targeted education in enhancing preparedness for rare but critical complications in clinical practice.
Objective: Distal radius fractures are the most common fractures of the upper extremity. The aims of this study were to determine the radiologic parameters that could predict maintenance of reduction during conservative treatment of distal radius fractures and to present the functional outcomes at 6th month of treatment in individuals with and without loss of reduction. Methods: A total of 146 individuals that were treated conservatively (reduction and casting) were included. Radiographic parameters including radial inclination, radial height, articular step-off, three-point index (TPI), cast index, and padding index were examined. The clinical outcomes were assessed at the 6th month of reduction by visual analog scale (VAS), QuickDASH and Mayo wrist score. Logistic regression analysis was performed to determine the predictive value of radiographic parameters in loss of reduction. Results: The mean age was 40.17 +/- 13.30. Loss of reduction was detected in 21.2%. Significant differences were found in the articular step-off, TPI and cast indices between individuals with and without loss of reduction (p<0.05). TPI and cast index were found to be highly predictive for loss of reduction in fractures with and without extension to the distal radius joint, respectively. There was no difference in functional parameters other than VAS between individuals with and without loss of reduction (p>0.05). Conclusion: Among the radiographic measures, TPI and cast indexes were the ones which had the higher predictive value for loss of reduction during conservative treatment in distal radius fractures.
Objective: The aim of this study is to evaluate the efficacy and safety of four-factor prothrombin complex concentrate in reversing the anticoagulant effect in patients presenting to the emergency department with bleeding associated with direct oral anticoagulants. Methods: This single-center, retrospective study evaluated the dosage and efficacy of prothrombin complex concentrate in reversing the anticoagulant effect in patients presenting to the emergency department of a tertiary hospital due to bleeding associated with direct oral anticoagulants or due to elevated international normalized ratio prior to an emergency procedural intervention associated with direct oral anticoagulants. Results: Of the 20 participants, 65% were 80 years of age or older. The most common presenting complaints were gastrointestinaland musculoskeletal bleeding. The participants received a total of 34 doses (500 IU/20 mL) of prothrombin complex concentrate, and pre-and post-treatment coagulation test results showed significant improvement. However, no significant relationship was observed between hospital outcome (i.e., death or discharge) and the treatment protocols. Four patients developed thromboembolic events after treatment, and two of these had received more than one prothrombin complex concentrate dose. Conclusion: Four-factor prothrombin complex concentrates are useful adjuncts for the urgent reversal of the direct oral anticoagulants-associated anticoagulant effects, particularly
