Aim: To determine the rate of antibiotic escalation within the first 72 hours of FN (Febrile neutropenia) episodes in pediatric patients and to evaluate the association of escalation with inflammatory biomarkers and clinical outcomes.Methods: We retrospectively reviewed 84 FN episodes in children with malignancies treated between January 2017 and December 2021. Demographic and clinical data, initial and 72-hour antibiotic regimens, laboratory parameters (CRP, procalcitonin [PCT], interleukin-6 [IL-6], neutrophil-to-lymphocyte ratio [NLR]), blood culture results, length of hospital stay, and 30-day readmission were collected. Escalation was defined as a change to a broader-spectrum antibiotic within 72 hours. Logistic regression and comparative statistical tests were applied.Results: Escalation occurred in 27% (23/84) of FN episodes, most frequently from piperacillin-tazobactam to meropenem. Patients requiring escalation had significantly higher median CRP (115 vs. 62 mg/L, p=0.01), PCT (1.3 vs. 0.5 ng/mL, p=0.02), and IL-6 (120 vs. 65 pg/mL, p=0.04) levels. Blood culture positivity was more common in the escalation group (52% vs. 23%, p=0.01). NLR was higher in escalation cases (8.2 vs. 5.6), with borderline statistical significance (p=0.06). Median length of hospital stay was longer in escalation patients (10 vs. 7 days, p=0.02). Thirty-day readmission did not differ significantly between groups.Conclusions: Approximately one-quarter of FN episodes required antibiotic escalation within 72 hours. Elevated CRP, PCT, IL-6, and blood culture positivity were associated with escalation. These findings underscore the potential role of biomarkers in guiding early escalation decisions and optimizing antibiotic stewardship in pediatric FN.
Aim: Autism spectrum disorder (ASD) is defined by difficulties in social interaction and communication, along with restricted behavioral patterns. Although studies have noted vitamin deficiencies in children with ASD, there is limited data linking these deficiencies to the severity of the disorder. This study aimed to identify the serum vitamin D and B12 status of children diagnosed with ASD and their impact on disorder severity.Methods: ASD diagnoses were established through psychiatric examinations based on DSM-5 criteria. A child/adolescent psychiatrist assessed each study participant's autism severity by the Childhood Autism Rating Scale (CARS). A questionnaire was used to document sociodemographic and clinical information. Vitamin D and B12 levels were accessed retrospectively through the hospital system.Results: This study included 57 children aged 24-72 months diagnosed with ASD. Vitamin D levels were below the recommended level in nearly half of the ASD cases, while only two cases had insufficient vitamin B12 levels. A statistically significant negative correlation was found between the CARS score and vitamin D levels (r = -0.406, p = 0.002). Further linear regression analysis revealed that lower vitamin D levels were associated with higher CARS scores (p = 0.011).Conclusion: Children diagnosed with ASD are at an elevated risk of nutritional deficiencies, which could potentially contribute to the etiology of the disorder and also influence its severity. Providing vitamin and mineral supplements may be beneficial in avoiding subsequent medical conditions and mitigating disorder symptoms.
Aim: The two main forms of traumatic spinal cord injury exist. The first type of injury occurs when mechanical forces compress blood vessels and damage both axons and neural membranes. The second type of injury occurs through pathophysiological and metabolic processes which start after the initial damage. Glutamate over-expression is an important secondary injury mechanism. We examined pregabalin's neuroprotective effect on ADNP (Activity Dependent Neuroprotective Factor) levels in a rat spinal cord injury model.Methods: The fourth Wistar male rats received random assignments to five distinct groups: the 1. grup (no any surgical approach), 2. group (laminectomy only), 3. group (spinal cord injury without medication), 4. group (spinal cord injury and the methylprednisolone treated), 5. group (spinal cord injury and the pregabaline treated group). Spinal cord injury was produced by climp compression. Functional evaluations were done using the inclined plane test and criteria of Drummond and Moore, evaluation of blood levels and tissue levels of ADNP were done by ELISA, and Immunohistochemistry. The glial cells and neural cells evaluated by Hematoxylin and eosin staining of tissue.Results: The results showed no important variations in motor function between different spinal cord injury groups (p=0.053). The pregabalin group had significantly higher neural cell counts (9.68 ± 3.58) than both group 3 (5.06 ± 2.55) and group 4 (6.80 ± 2.59) (p
Donepezil, a reversible acetylcholinesterase inhibitor that increases parasympathetic activity by enhancing cholinergic tone, is used to preserve cognitive function in patients with Alzheimer’s disease. However, donepezil may slow conduction, particularly at the sinoatrial and atrioventricular nodes, which increases the risk of bradycardia, sinus arrest, or high-grade AV block, particularly in elderly or comorbid patients. Complete AV block is rarely seen with donepezil use. Herein, we present a case of complete AV block in an 87-year-old woman receiving donepezil therapy, which resolved spontaneously following theophylline treatment.
Aim: Our study aimed to evaluate the reliability and quality of YouTube videos related to testicular cancer and assess changes in their quality over time.Method: In July 2024, this study retrospectively analyzed publicly accessible YouTube videos. The first 172 videos retrieved using the keyword “testicular cancer” were evaluated. The videos were analyzed and scored using the modified DISCERN, Journal of the American Medical Association (JAMA), and Global Quality Scale (GQS) scoring systems. After applying the exclusion criteria, 151 videos were included in the final analysis.Results: The most common sources of the videos were health information websites and individual physicians/urologists. In our study, the mean JAMA, modified DISCERN, and mean GQS scores were 1.01 ± 0.92, 1.73 ± 1.32, and 1.79 ± 0.92, respectively. The average duration of videos uploaded after the onset of the coronavirus disease 2019 pandemic was significantly longer, whereas the average number of views was higher for videos uploaded during or before the pandemic. However, no statistically significant differences were found between the two periods in terms of JAMA, GQS, and modified DISCERN scores. Additionally, a positive correlation was observed between video duration and the modified DISCERN, JAMA, and GQS scores.Conclusion: Our study demonstrated that the quality of YouTube videos related to testicular cancer has not improved over time, and the production of low-quality content continues. Additionally, no significant change in video quality was observed after the pandemic.
Calcium channel blockers are commonly used to treat hypertension, a leading cause of illness and death worldwide. Amlodipine is among the most frequently prescribed drugs in this category. We report a case of isolated hyperphosphatemia that occurred in temporal relation to long-term use of a medication containing amlodipine as the active ingredient. A 43-year-old woman was found to have markedly elevated serum phosphate levels during routine laboratory testing, whereas her renal function, calcium, parathyroid hormone, and vitamin D levels were within normal ranges. Secondary causes of hyperphosphatemia were ruled out. The patient was asymptomatic. After discontinuing the amlodipine-containing medication and initiating a dihydropyridine calcium channel blocker (nifedipine), serum phosphate levels returned to normal and remained stable during follow-up. This observation suggests a possible link between long-term amlodipine use and isolated hyperphosphatemia. The finding should be viewed as hypothesis-generating, and additional studies are necessary to clarify the underlying mechanisms.
Letter to Editor: Role of intracoronary imaging in STEMI patients undergoing primary PCI
Aim: This descriptive cross-sectional study investigates the associations between social media use and prenatal attachment, depression, anxiety, and body image among pregnant women.Methods: The study included 134 pregnant women presenting to a tertiary healthcare facility in southern Turkey. Data were gathered using a sociodemographic questionnaire, the Prenatal Attachment Inventory (PAI), the Depression-Anxiety-Stress Scale-21 (DASS-21), and the Body Image Scale (BIS), and analyzed with SPSS 25.Results: The participants’ mean age was 29±5 years, and 66.5% were unemployed. Instagram was the most commonly used platform (49.3%). The majority (90.3%) followed pregnancy-related content and used social media for 1–3 hours daily. No significant association was found between duration of social media use and PAI scores, nor between PAI and depression, anxiety, stress, or body image (p>0.05). BIS scores showed positive correlations with DASS-21 depression (r=0.244; p=0.004), anxiety (r=0.174; p=0.045), and stress (r=0.253; p=0.003). Increased social media use during pregnancy was associated with higher DASS-21 depression (p=0.016) and anxiety (p=0.009). Following informative content (evidence-based content) was linked with higher PAI scores (p=0.013), whereas following other mothers’ experiences was associated with higher BIS scores indicating greater body dissatisfaction (p=0.012).Conclusion: Social media appears to have both supportive and potentially adverse effects on pregnant women’s psychosocial well-being. Integrating social media awareness and digital literacy into prenatal counseling may help promote healthier emotional and behavioral outcomes.
Gastrointestinal stromal tumors (GISTs) represent the most prevalent mesenchymal neoplasms of the gastrointestinal (GI) tract, typically originating in the stomach (60%) and small intestine (30%). Among the segments of the small intestine, the jejunum is a relatively uncommon site for GIST occurrence. The coexistence of GISTs in patients with a prior history of breast cancer is exceedingly rare, and poses a unique diagnostic and therapeutic challenge due to the possibility of metastatic disease versus a second primary tumor. We present the case of a 55-year-old female with a prior diagnosis of breast carcinoma, who was incidentally found to have a jejunal mass during routine oncologic surveillance. Radiological and endoscopic evaluations raised suspicion for a submucosal tumor, which was subsequently confirmed as a jejunal GIST via histopathological and immunohistochemical analysis following surgical resection. The patient underwent curative segmental jejunal resection with negative margins and had an uneventful postoperative recovery. Risk assessment based on size and mitotic index placed the tumor in a low-risk category, and no adjuvant therapy was deemed necessary. This case highlights the importance of considering GISTs in the differential diagnosis of incidental small bowel masses, especially in patients with a history of malignancy, and underscores the role of complete surgical excision in achieving curative outcomes.
Aim: To evaluate the treatment outcomes of canalicular laceration in pediatric and adult patients, and investigate factors that affect the development of epiphora.Methods: Data from 90 patients who underwent canalicular laceration repair between April 2014 and February 2022 were analyzed. We included twenty-seven children and sixty-three adult patients with a minimum 6-month follow-up.Results: The mean age was 7.48±4.5(1-18)years in the pediatric group and 39.81±12.4 (19-65 years). years in the adult group. The mean time between injury and surgery was 1.52±1.67 days in the pediatric group and 2.3±1.4 days in the adult group. The difference was not statistically significant (p>0.05) Mini-Monoka stent was inserted in 24 patients, a bicanalicular silicone tube in 2 patients, and no implant in one patient in the pediatric group. Mini-Monoka stent was inserted in 49 patients, a bicanalicular silicone tube in 9 patients, and no implant in 5 patients in the adult group. Only 1(%3,7) patient had postoperative epiphora in the pediatric group, 8 (%12,6) patients in the adult group. Complaints of epiphora were less frequent in the pediatric group (p:0.05). In both groups, lower canalicular laceration was more common. Outdoor injuries and the need for additional surgery were more frequent in the adult age group.Conclusion: Based on our study, we found that trauma due to a traffic accident, the presence of an additional injury of the periorbital area, and operation without stent insertion have a significant effect on increasing epiphora. We believe early intervention with a stent-assisted surgery would minimize the problems that may occur in both groups.
The purpose of this paper is to evaluate developments, focusing specifically on hydrogel applications used in the treatment of knee osteoarthritis. This evaluation aims to provide accurate and sufficient information, thereby preventing inaccurate or incomplete information among patients and healthcare professionals, clarifying the purpose of hydrogel treatment applications and their implications for patients, and preventing unnecessary expectations, disappointments, and financial losses that may arise in patients. A literature review was conducted, and relevant publications were accessed through the Scopus, Web of Science, EBSCO, and Google Scholar databases. Currently, an increasing number of studies focus on the use of hydrogel products in the treatment of osteoarthritis. While studies on hydrogel treatment have shown promising results, it is crucial to remember that their effectiveness can vary from patient to patient. In some cases, the need for surgical intervention can be postponed with the treatment applied, but this may not necessarily eliminate the need for surgical intervention in the long term. Furthermore, the products or materials used in hydrogel treatment have very different compositions and a wide range of products. Today's technology makes access to information much easier. Patients and healthcare professionals can be influenced by social media. It's important to understand that the term "hydrogel treatment" doesn't connote a single treatment modality, drug, or product. Healthcare professionals and patients should be informed on this matter. Treatments implemented with incomplete or flawed approaches, in particular, can lead to excessive patient expectations, disappointment, and a significant financial burden. This comprehensive review article presents basic information from the literature, along with new developments and research, to provide a simple and understandable overview of the products and methods that can be used in hydrogel treatment.
Aim: This study aimed to determine the prevalence of anxiety and depression among patients with chronic obstructive pulmonary disease (COPD) and examine the relationship between psychological symptoms and dyspnea severity across Global Initiative for Obstructive Lung Disease (GOLD) defined COPD stages. Methods: A cross-sectional study was conducted between July 2018 and July 2019 at a pulmonary diseases outpatient clinic. Sixty-one patients with COPD were evaluated using the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Hospital Anxiety and Depression Scale (HADS), and the Modified Medical Research Council (mMRC) dyspnea scale. Results: Anxiety and depression scores increased significantly with higher mMRC grades (BAI: p = 0.012; BDI: p = 0.018). Using established cut-offs, clinically relevant anxiety was present in 9.8% (BAI ≥16; n = 6) and 8.2% (HADS-A ≥10; n = 5) of the patients. Clinically relevant depression was present in 11.5% (BDI ≥ 17; n = 7) and 26.2% (HADS-D ≥ 7; n = 16) of the patients. Dyspnea severity (mMRC) was moderately associated with anxiety scores (Spearman’s ρ = 0.407, p = 0.001) and had a weaker, borderline association with depressive symptoms (ρ = 0.251, p = 0.051). Smoking status was correlated with depressive symptoms (BDI: p = 0.025; HADS-D: p = 0.012). Pack-years correlated weakly but significantly with anxiety (ρ = 0.371, p = 0.005) and depression (ρ = 0.309, p = 0.022). No association was detected between FEV1% and the psychological scale scores. Conclusion: Dyspnea severity and smoking exposure were associated with greater psychological distress in patients with COPD. These findings support the integration of routine psychological screening into comprehensive COPD management strategies.
Brain temperature is increasingly recognized as an active regulator of brain function with important implications for neurological disorders. This editorial explores the role of brain temperature across molecular, cellular, and network levels, highlighting its influence on neuronal excitability, synaptic efficiency, and large-scale connectivity. Because even small temperature fluctuations can significantly affect ion channel dynamics and neural signaling, thereby influencing cognitive processes such as attention and memory. Disturbances in brain temperature are closely associated with neuroinflammation and neurodegeneration. Localized hyperthermia may exacerbate oxidative stress, mitochondrial dysfunction, and neuronal injury. These findings suggest that optimal thermal balance is critical for maintaining neuronal integrity. Therapeutically, it has been demonstrated that temperature modulation, particularly hypothermia, has neuroprotective effects in acute brain injury by reducing metabolic demand and inflammation. However, its role in chronic neurodegenerative conditions remains unclear. A major limitation in this field is the lack of reliable, non-invasive methods for measuring brain temperature in vivo. In conclusion, integrating thermodynamic principles into neuroscience may provide novel insights, biomarkers, and therapeutic strategies for neurological diseases.
Aim: Lumbar disc herniation (LDH) is a common condition in young adults, causing pain radiating to the hip and leg and often accompanied by neurological symptoms. LDH leads to significant pain, functional impairment, and reduced quality of life (QoL). This study aimed to examine the associations among pain intensity, disability, and QoL in individuals diagnosed with LDH.Methods: This cross-sectional study included 155 patients (74 females, 81 males; mean age 34.1±7.71 years) who presented to X State Hospital with MRI-confirmed LDH. Pain intensity was assessed with the Visual Analog Scale (VAS), disability with the Oswestry Disability Index (ODI), and QoL with the WHOQOL-BREF. Because the study variables were non-normally distributed, associations were analyzed using Spearman’s rank correlation coefficients.Results: Pain intensity showed significant negative correlations with the physical (ρ= −0.281), psychological (ρ= −0.265), social (ρ= −0.205), and environmental (ρ= −0.162) QoL domains (p
Decisions about sample size and statistical power are often treated as a technical afterthought in research proposals, squeezed into a single sentence or delegated entirely to software. Yet these decisions sit at the intersection of scientific validity, feasibility, and ethics and directly determine whether a study can answer its primary question in a trustworthy way. Sample size calculation and power analysis should no longer be regarded as optional technicalities appended at the end of a protocol. They are central to scientific integrity, determining whether a study can credibly answer its research question, justify the burdens placed on participants, and make a meaningful contribution to the literature. In this editorial, we aim to draw attention to sample size calculation and power analysis, outlining their conceptual foundations, practical implementation, and ethical implications in contemporary research.
Aim: Individuals with subjective cognitive impairment (SCI) and major depressive disorder (MDD) are at high risk of developing neurodegenerative diseases. Studies suggest that SCI may be associated with concurrent cognitive performance and is also strongly associated with depressive symptoms. In this context, we aimed to evaluate the relationship between SCI and depression severity and to reveal predictive factors for SCI with current cognitive performance. Methods: Forty-two patients with MDD were divided into two groups: patients with and without SCI. All participants were administered the Montreal Cognitive Assessment (MoCA) and the Hamilton Depression Rating Scale (HAM-D). A logistic regression model was used to add demographic characteristics to the results obtained. Results: Individuals with SCI (n=21) were older (p=0.014) and less educated (p=0.006) than non-SCI patients (n=21) with MDD. Additionally, the mean of the MoCA total score was significantly higher in the non-SCI group (Student's t Test, p=0.011). Depression severity was the same throughout the groups (HAM-D, 𝜒2: 2.10, p= 0.28). Language dysfunction is one of the MoCA subtests, language impairment emerged as a key predictor in the binary logistic regression model, identified through Backward Wald elimination, for detecting depressive patients with SCI (p=0.007; OR=0.366; 95% CI 0.177-0.756). Conclusion: Our findings suggest that SCI accurately reflects concurrent cognitive performance in a clinic-based sample of MDD. The results also suggest that the clinical interpretation of SCI should take into account the possible impact of depression on the language domain.
Aim: This study aims to investigate the impact of the COVID-19 pandemic on the incidence of surgical site infections (SSIs), to identify associated risk factors, and to propose evidence-based strategies for reducing morbidity, mortality, and healthcare-related costs. Methods: The study included 5,064 patients who underwent surgery between March 1, 2018, and March 1, 2022, at the University of Health Sciences, Bağcılar Training and Research Hospital. Patients who developed surgical site infections (SSIs) within 30 days postoperatively were evaluated. A total of 62 cases occurred prior to the COVID-19 pandemic, and 39 cases were identified during the pandemic period. Results: A total of 2,864 patients underwent surgery before the COVID-19 pandemic, and 2,200 patients during the pandemic. Among these, 287 (10%) and 274 (12.5%) procedures were gynecological surgeries, respectively. Surgical site infections (SSIs) were identified in 62 patients (2.2%) prior to the pandemic and in 39 patients (1.8%) during the pandemic. The mean age of the patients was 33 ± 10 years, and the mean body mass index (BMI) was 33 ± 7. The majority of procedures were cesarean sections, with 96% of incisions performed using the Pfannenstiel technique. Overall, 21% of the patients were smokers, 42% had a history of prior surgery, and 19% had at least one comorbid condition. Conclusion: Although a decrease in the rate of surgical site infections (SSIs) was observed during the COVID-19 pandemic compared to the pre-pandemic period, this difference was not statistically significant. Our findings suggest that adequate infection prevention measures were effectively implemented both before and during the pandemic, and that the additional precautions introduced in response to the pandemic did not have a significant impact on reducing the incidence of SSIs.
Aim: This study aimed to compare the functional outcomes of comminuted (AO/OTA C3) patellar fractures treated with tension band wiring technique to those of simple two-part fractures (AO/OTA C1) treated with the same method. Methods: Patients who underwent surgery for patellar fractures between 2017 and 2023 were retrospectively analyzed. A total of 83 patients met the inclusion criteria (C1: n=45; C3: n=38). All patients underwent open reduction and internal fixation with the tension band wiring technique. Functional outcomes were evaluated using the Böstman score. Statistical analysis was performed with SPSS 20.0 software. Results: There was no statistically significant difference between the groups in terms of age, sex, side, follow-up duration, or implant removal rates (p>0.05). The mean Böstman score was significantly higher in the C1 group (23.33±5.07) compared to the C3 group (19.58±6.48; p=0.005), indicating better functional outcomes in the simpler fracture type. Conclusion: The tension band wiring technique yields satisfactory results in simple two-part patellar fractures. However, it may be insufficient for comminuted fractures, suggesting a need for evaluating alternative surgical fixation techniques for such cases.
Aim: The aim of this study was to evaluate the accuracy, comprehensiveness, and readability of information provided by large language models (LLMs) supported by natural language processing (NLP) technologies regarding otitis media (OM) based on responses to questions asked by patients and their relatives. Method: In this descriptive, cross-sectional evaluation study, 60 frequently asked questions by patients and their relatives regarding OM were classified under four subheadings (general information, diagnosis, follow-up and therapy, and surgery and complications) and answered by three different LLMs (Google Gemini 2.5 Flash, Microsoft Copilot, ChatGPT-4o). The answers were evaluated for accuracy by two experienced otorhinolaryngology specialists using a 5-point Likert scale. The readability of the responses was analyzed using the Coleman-Liau Index (CLI) and Simple Measure of Gobbledygook (SMOG) index to determine readability levels corresponding to academic education levels and to compare the models. Results: The artificial intelligence (AI) models received similarly high scores for accuracy in their responses to patient questions related to OM. In the readability analysis, Gemini responses were found to be statistically significantly more readable than those of the other models, according to the SMOG and CLI indices. The ChatGPT responses required a higher level of education; in particular, the readability of the answers under the “diagnosis” subheading was found to have the highest rate of graduate-level education requirement. Conclusion: Although the three commonly used AI models provided similarly accurate responses to OM-related questions, differences in readability were observed among the LLMs. For AI to effectively support patient education and promote treatment adherence, both the accuracy and readability of the content are essential.
Aim: To evaluate the effect of age on treatment selection, radiological outcomes, and complications in distal radius fractures. Materials and Methods: A total of 97 patients aged ≥18 years with distal radius fractures treated between January and December 2020 were retrospectively reviewed and categorized into three age groups of 18–44, 45–64, and ≥65 years. Conservative (splint/cast with or without closed reduction) and surgical (mostly, volar locking plate-screw) treatments were applied. Volar tilt, volar angulation, radial length, radial inclination, intra-articular step-off, and gap were measured at three time points. Results: Age groups were found to be significantly associated with treatment modality and the presence of complications (p
