Objective: This study aimed to evaluate the impact of the mini-clinical evaluation exercise (mini-CEX) on clinical competence and educational outcomes in otorhinolaryngology (ENT) training across different educational levels. Methods: A systematic review and meta-analysis was conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-analyses 2020 guidelines. PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar were searched for studies assessing the mini-CEX in ENT education. Eligible studies included pre-post or observational designs reporting quantitative outcomes. Random-effects meta-analysis was used to calculate standardized mean differences (SMD) with 95% confidence intervals (CIs). Risk of bias was assessed using NIH and Newcastle-Ottawa tools. Results: Five studies, including 506 trainees and over 2,600 mini-CEX encounters, were included. Mini-CEX implementation resulted in a large, statistically significant improvement in overall clinical competence (SMD=1.29; 95% CI 1.01-1.57; p<0.001), with moderate heterogeneity (I & sup2;=52%). Improvements were observed across all competency domains, with the largest effects in physical examination and history-taking skills. The assessment was feasible within routine clinical practice, with high levels of learner engagement and faculty acceptance. Conclusion: Mini-CEX is an effective and practical formative assessment tool for improving clinical competence in ENT training. Its integration into competency-based curricula may support sustained improvements in clinical performance.
Objective: Methanol intoxication is life-threatening and often needs urgent intervention due to severe metabolic disturbances. This study aims to evaluate Chernoff faces (CF) as a visual tool for representing patient prognosis. It also aims to support rapid clinical decision-making in cases of methanol intoxication. Methods: This retrospective study included 81 patients who presented to the emergency department with methanol intoxication. Key biochemical parameters-pH, bicarbonate (HCO3), base excess, and creatinine-were recorded before and after dialysis. CF, a graphical method for displaying multidimensional data, were used to visualize these values. The technique illustrated both individual-and group-level changes in metabolic status. Results: The cohort comprised 81 patients (6 females, 75 males; mean age: 52.9 years). After dialysis, significant improvements were observed: pH and HCO3 levels increased, while blood urea nitrogen and creatinine levels decreased. Chernoff's facial features clearly depict these changes. Pre-dialysis patients exhibited distressed facial expressions, reflecting severe acidosis. Post-dialysis faces appeared more harmonious and "smiling", suggesting metabolic recovery. This visual shift was consistent across the entire group and in selected individuals. The method effectively and intuitively demonstrated clinical improvement. Conclusion: CF provides a practical, visually intuitive method for monitoring metabolic recovery in methanol intoxication. By enabling rapid assessment of complex data, this tool enhances decision-making, particularly in time-sensitive settings like mass poisonings. Further studies will expand its use to other clinical contexts requiring the swift interpretation of multidimensional parameters.
Objective: The speech intelligibility index (SII) quantifies the proportion of speech that is audible to a listener. Its predictive accuracy is based on the acoustic and phonetic properties of the language it uses. Our study evaluated the feasibility of using the English-based SII for Turkish-speaking individuals with sensorineural hearing loss, comparing younger and older adults. Methods: In this retrospective cross-sectional study, 161 participants (68 younger adults and 93 older adults) with bilateral sensorineural hearing loss were included. Hearing thresholds, word recognition scores (WRS), and SII values were analyzed. Non-parametric statistical analyses, including the Wilcoxon signed-rank test for paired comparisons, Mann-Whitney U test for group differences, Spearman's rank correlation for associations, and Fisher Z-test with bootstrap analysis to compare correlation coefficients were conducted to evaluate differences and relationships among audiological measures. Results: Significant positive correlations were found between SII and WRS in both age groups (r=0.73 for younger adults; r=0.65-0.70 for older adults). Older adults had higher high-frequency thresholds and lower WRS (p<0.001), but no age-related differences were observed in SII or the pure-tone average. Conclusion: The English-based SII can be used as a provisional tool for Turkish speakers, but age-related and frequency-specific variations highlight the need for a language-specific model.
Objective: Preeclampsia is a multisystemic disorder characterized by inflammation, platelet dysfunction, and target-organ involvement. Early identification of disease severity is crucial for improving maternal and fetal outcomes. This study aimed to evaluate the association between preeclampsia severity and hematological, biochemical, and derived inflammatory parameters. Methods: This retrospective study included 135 pregnant women diagnosed with preeclampsia between 2020 and 2025 at a single tertiary center. Patients were classified as having mild or severe preeclampsia based on American College of Obstetricians and Gynecologists criteria. Hematological alanine aminotransferase (ALT), creatinine], and derived indices [neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), plateletto-neutrophil ratio (PNR)] were recorded. Group comparisons were performed using Student's t-test, Mann-Whitney U test, or Fisher's exact test as appropriate. Statistical significance was set at p<0.05. Results: Severe preeclampsia was associated with significantly higher hemoglobin (p=0.019), WBC (p=0.005), neutrophil counts (p=0.004), and AST, ALT, and creatinine levels (p=0.003, p<0.001, p=0.002, respectively). Platelet counts were lower in severe cases (p=0.0411). No significant differences were found in MPV (p=0.833), NLR (p=0.614), or PLR (p=0.109). PNR was significantly higher in the mild group (p=0.001), whereas NLR and PLR did Conclusion: Severe preeclampsia is characterized by intensified inflammation, increased platelet consumption, and more pronounced organ involvement. Among the inflammatory indices, PNR differed significantly between severe and mild disease groups, whereas NLR and PLR did not differ significantly. Combined assessment of hematological and biochemical markers may provide a more comprehensive and reliable approach for evaluating preeclampsia severity. PNR may represent a potential supportive parameter associated with disease severity; however, further studies, including diagnostic performance analyses, are required.
Objective: The aim of the study is to determine the need for voice therapy after type 3 thyroplasty surgery by using the voice self-assessment method. Methods: A total of 31 male patients who underwent type 3 thyroplasty and 31 male control subjects without voice or pitch complaints were included. Each group's Turkish Voice Handicap Index-10 and Turkish Self-evaluation of Voice Quality Survey were administered online. Results: There are statistically significant differences between surgery and control groups in both total and subgroup scores of the Turkish Voice Handicap Index-10 Scale and the Turkish Self-evaluation of Voice Quality Survey. Conclusion: Individuals who have undergone a voice-deepening procedure experience emotional, physical, and functional problems related to their voice. In these patients, voice therapy in support of surgery is necessary to prevent potential hypofunction, improve voice quality, and preserve vocal health.
Objective: This study aimed to compare nasalance values obtained using the Praat-assisted Nasalance Meter (PANM) and the Nasometer II model (NMII) 6450 by examining the effects of hardware and software configurations and evaluating the strength of the linear relationships between measurements derived from these systems. Methods: A total of 60 healthy participants (17 men, 43 women) aged 18-23 years were included. Acoustic signals were recorded and analyzed separately using PANM and NMII hardware and software configurations. PANM measurements were obtained using 80-1000 Hz and 300-750 Hz bandpass filters, whereas NMII measurements were obtained using a 300-750 Hz bandpass filter. Data were analyzed using Pearson correlation and two-way repeated-measures analysis of variance (ANOVA). Results: Positive correlations were observed between nasalance scores obtained from different hardware and software configurations (p<0.05). Repeated-measures ANOVA revealed significant main effects of both software and hardware across speech materials. NMII software yielded higher nasalance scores than PANM software, whereas PANM hardware produced higher scores than NMII hardware in most speech materials. Similar patterns were observed across different types of speech materials. Conclusion: The findings demonstrate that nasalance scores obtained from the PANM and NMII systems vary according to hardware and software configurations. Although measurements showed linear associations, the consistent differences observed across speech materials indicate that system-specific technical properties influence score magnitude. Therefore, hardware and software configurations should be carefully considered when interpreting and reporting nasalance scores in clinical and research settings.
Objective: The anterior quadratus lumborum block (aQLB) is commonly used for postoperative pain relief following laparoscopic cholecystectomy (LC). Dexamethasone is known to prolong and enhance analgesia when used as an adjuvant in peripheral nerve blocks. Some studies suggest that systemic administration may be as effective as perineural administration. However, studies directly comparing interfascial administration of dexamethasone in fascial plane blocks with systemic administration remain limited. This study aims to compare the analgesic efficacy and side-effect profiles of interfascial versus systemic administration of dexamethasone with the aQLB. Methods: This retrospective study included 72 patients who underwent elective LC under general anesthesia. All patients received preoperative bilateral aQLBs. Patients were assigned to Group IV (n=33), which received intravenous dexamethasone, or to Group IF (n=39), which received interfascial dexamethasone. The primary endpoint was the time to first rescue analgesic. Secondary endpoints were 24-hour tramadol use, intraoperative remifentanil consumption, numeric rating scale scores at 1,4,8,12, and 24 hours, and side effects. Results: No statistically significant difference was observed between groups in the time to first rescue analgesia; however, median times favored Group IF (5.3 hours vs. 4 hours). The median total tramadol consumption in the first 24 hours was 100 mg [interquartile range (IQR): 150 mg] in Group IV and 75 mg (IQR: 100 mg) in Group IF, with no significant difference between the groups (p=0.256). Numeric rating scale scores and remifentanil use were similar. Nausea was significantly more frequent in Group IF (41%) than in Group IV (18%) (p=0.036). Conclusion: Both systemic and interfascial administration of dexamethasone, when combined with an aQLB in patients undergoing LC, provided comparable postoperative pain relief. However, systemic administration was associated with a lower incidence of postoperative nausea, suggesting it may be preferable for patients at higher risk of this side-effect.
