Objective: Early identification of non-invasive ventilation (NIV) failure in patients with acute hypercapnic respiratory failure due to chronic obstructive pulmonary disease (COPD) exacerbation remains a critical clinical challenge, particularly in emergency departments. This study aimed to evaluate whether early arterial blood gas changes after NIV initiation predict intensive care unit (ICU) admission and in-hospital intubation and to develop a simple predictive model based on early physiological response. Methods: This multicenter retrospective study included 319 patients with COPD exacerbation complicated by acute hypercapnic respiratory failure who were initiated on NIV in the emergency departments of three hospitals. Arterial blood gas parameters were recorded before NIV initiation and 1-3 hours thereafter. Early response was defined as the change in PaCO2 (ΔPaCO2). Multivariable logistic regression models were constructed for ICU admission and intubation. Model discrimination was assessed using receiver operating characteristic curve analysis. Results: During hospitalization, 138 patients (43.3%) required ICU admission, and 70 patients (21.9%) required intubation. Lower post-NIV pH, insufficient reduction in ΔPaCO2, and prior ICU admission independently predicted the need for ICU care and intubation. The model demonstrated good discriminative performance for ICU admission [area under the curve (AUC) =0.787; 95% confidence interval (CI): 0.737-0.837] and for intubation (AUC =0.810; 95% CI: 0.746-0.873). Conclusion: Early physiological response to NIV, particularly post-treatment pH and the magnitude of PaCO2 reduction, provides clinically meaningful prognostic information and may assist early decision-making in emergency settings. External validation is warranted.
Objective: Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infections (LRTIs) in infants and young children. This study evaluated clinical and laboratory factors associated with prolonged hospitalization in pediatric RSV infection. Methods: This retrospective study included children under 18 years of age who were hospitalized with LRTI and had confirmed RSV infection at Aydın Adnan Menderes University Hospital between 2023 and 2025. Demographic, clinical, and laboratory data were collected from hospital records. Patients were divided into two groups according to length of stay (LOS): ≤2 days and >2 days. Multivariate logistic regression analysis was performed using the backward stepwise method. Results: A total of 185 RSV-infected children were analyzed. The median age was 2 months, and 51.9% were male. Patients with LOS >2 days had significantly higher rates of pediatric intensive care (PICU) admission, non-invasive ventilation, mechanical ventilation, and secondary bacterial infections. Laboratory findings in the prolonged-stay group showed higher lymphocyte counts and blood urea nitrogen (BUN) levels but lower mean platelet volume (MPV) levels. No mortality was observed. In the multivariate logistic regression analysis, PICU stay was associated with an approximately 12-fold increased risk of hospitalization lasting longer than 2 days. Conclusion: Hospitalization longer than 2 days was associated with a more severe clinical course. In the multivariate logistic regression analysis, PICU stay was the main factor associated with hospitalization lasting longer than 2 days. Lymphocyte count, MPV, and BUN may provide supportive clinical information; however, their independent prognostic value remains uncertain.
Objective: Anatomical and physiological changes in geriatric patients may make spinal anesthesia technically challenging. The traditional manual palpation technique is a blind approach, and anatomical variations may reduce block success and increase complications. Ultrasonography can provide guidance for spinal anesthesia. This study investigated the effect of preprocedural ultrasound-guided marking on block success in patients aged ≥65 years undergoing lower extremity orthopedic surgery. Methods: This retrospective observational study included 180 patients aged ≥65 years who underwent lower extremity orthopedic surgery under spinal anesthesia at Dokuz Eylül University Faculty of Medicine Hospital. Of these, 88 patients were in the ultrasound-guided marking group and 92 in the manual palpation group. The primary outcome was first-attempt success of spinal anesthesia. Secondary outcomes included puncture attempts, needle redirections, time to return of cerebrospinal fluid, and spinal needle placement time. Results: Demographic characteristics were similar between the groups. The numbers of spinal punctures and needle redirections were significantly lower in the ultrasound group. In addition, spinal needle placement time was significantly shorter in the ultrasound group (p<0.001). Successful spinal anesthesia with a single puncture was achieved in 73.9% of patients in the ultrasound group and in 44.6% of patients in the manual palpation group (p<0.001). Conclusion: Preprocedural ultrasound-guided marking was associated with higher first-attempt success, fewer puncture attempts, fewer needle redirections, and shorter needle-placement time in elderly patients undergoing spinal anesthesia for lower extremity orthopedic surgery. Given the retrospective non-randomized design, these findings should be interpreted as an association rather than a definitive causal effect.
Objective: Mechanical thrombectomy is an effective treatment method for stroke patients with large vessel occlusion. Hemorrhagic transformation and edema can be observed during patient follow-up after mechanical thrombectomy. Transcranial Doppler (TCD) is a method used to evaluate hemodynamic changes following endovascular treatment (EVT), and the examination of patients with TCD contributes to the assessment of early neurological deterioration. Methods: Patients who presented to University of Health Sciences Türkiye, İzmir Tepecik Training and Research Hospital with acute ischemic stroke and underwent mechanical thrombectomy for anterior circulation occlusion were included in the study. Demographic data were recorded, along with initial and 24th-hour National Institutes of Health Stroke Scale (NIHSS) scores, post-procedural revascularization scores, and whether intravenous thrombolysis was performed. Patients were evaluated using TCD within the first 12 hours after EVT, and parameters in the ipsilateral and contralateral vessels were compared to examine their impact on hemorrhagic transformation and edema. Clinical outcomes were assessed using the 3-month modified Rankin scale (mRS). Results: The pulsatility index, peak systolic velocity, and end-diastolic velocity on TCD examination did not significantly affect hemorrhagic transformation and edema when comparing ipsilateral and contralateral vessels. A higher 24-hour NIHSS score was significantly associated with hemorrhagic transformation. Patients with edema were found to have higher mRS scores and an association with clinical outcomes. Conclusion: In our study, the evaluation of early clinical response by TCD examination after mechanical thrombectomy did not demonstrate a significant contribution.
Objective: The healing rates between isolated meniscus repair and meniscus repair performed concomitantly with anterior cruciate ligament reconstruction (ACLR) are still a matter of debate. This study aimed to compare the failure rates and clinical outcomes between isolated meniscus repair and simultaneous ACLR. Methods: This retrospective analysis included 59 patients aged <40 years who underwent arthroscopic meniscus repair. Of these, 32 patients underwent isolated meniscal repair, whereas 27 underwent simultaneous ACLR. Patients were followed at 1, 3, and 6 months postoperatively, and thereafter at 6-month intervals for a minimum of 2 years. Results: No statistically significant differences were observed regarding tear type, tear length, or the affected meniscus. Although the distribution of tear zones was greater in the isolated group, favoring zone 2, this difference was not statistically significant (p=0.095). The preoperative Lachman test was significantly more frequently positive in patients who underwent simultaneous ACLR (p<0.001). When functional scores were evaluated, the preoperative (p=0.006) and postoperative (p=0.032) Tegner activity scores were significantly higher in the simultaneous ACLR group. The revision surgery rate, an indicator of clinical failure, was higher in isolated group; however, this difference did not reach statistical significance(p=0.060). Conclusion: This study demonstrated that the clinical efficacy of meniscus repair is high regardless of whether ACLR is performed, but ACLR may show more favorable trends in some clinical parameters because of its biological and mechanical advantages.
Objective: Adhesive capsulitis (AC) is a painful shoulder condition characterized by progressive restriction of active and passive range of motion. This study aimed to compare the triglyceride–glucose (TyG) index and haematology-derived inflammatory indices between patients with AC and healthy controls and to evaluate their associations with the presence of AC. Methods: In this study, the demographic data, clinical findings and laboratory results of non-diabetic patients with AC were evaluated. Fasting plasma glucose (FPG), lipid profile [triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and total cholesterol], C-reactive protein (CRP), vitamins D and B12, and complete blood count, obtained within the preceding 3 months, were recorded. The TyG index, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were calculated. Results: Seventy-one participants were included (38 controls and 33 AC). The AC group was older and had higher body mass index (both p≤0.001). FPG (p=0.010), LDL (p=0.001), total cholesterol (p=0.049), and TyG index (p=0.020) were higher in AC, whereas NLR, PLR, SII, CRP, HDL, vitamin D, and B12 were comparable between groups (all p>0.05). In adjusted models, age was a consistent predictor of AC [adjusted odds ratio (aOR) 1.094, 95% confidence interval (CI) 1.036–1.155; p=0.001], and LDL was independently associated with AC (aOR 1.019, 95% CI 1.001–1.037; p=0.044). Conclusion: Non-diabetic AC was associated with metabolic dysregulation, while haematology-derived inflammatory indices remained comparable to controls. Beyond symptomatic management, clinicians should consider screening patients with AC for metabolic dysregulation, as this may aid risk stratification and care.
Objective: Painful ophthalmoplegia (PO) is a clinical syndrome with diverse etiologies, often presenting with overlapping features that complicate diagnosis. Early differentiation is essential to guide appropriate investigations and management. To identify clinical examination findings that differentiate the underlying etiologies of PO and to determine features that may aid in clinical decision-making. Methods: This retrospective observational study included patients with PO evaluated at a tertiary neuro-ophthalmology center between January 2014 and January 2024. Clinical, demographic, and laboratory data were collected. Patients were classified into diagnostic groups based on etiology. Comparative analyses and binary logistic regression were used to identify clinical predictors that distinguish cavernous sinus-orbital apex (CS-OA) inflammatory syndrome from other causes. Results: A total of 94 patients were included. CS-OA (28.7%) and carotid-cavernous fistula (CCF) (26.6%) were the most common etiologies. Ptosis was more frequent in CS-OA and was identified as an independent predictor (p=0.031). Chemosis and vision loss were more common in non-CS-OA etiologies and were independently associated with these conditions (p=0.041 and p=0.018, respectively). Chemosis was observed in 88% of CCF cases. Vision loss was most frequent in infectious etiologies, particularly invasive fungal sinusitis. Facial hypoesthesia showed a trend toward an association with CS-OA (p=0.073). Conclusion: Specific clinical findings, particularly ptosis, chemosis, and vision loss, may help differentiate the underlying etiologies of PO. Careful clinical evaluation can provide valuable guidance for diagnostic decision-making, especially in settings with limited access to advanced investigations.
Objective: The tibia is one of the most commonly fractured long bones and is frequently exposed to high-energy trauma. Selecting an appropriate treatment method is essential for successful outcomes and improved patient quality of life. In recent years, the suprapatellar entry intramedullary nailing technique has gained attention as a promising surgical approach. The aim of this study was to evaluate the clinical and radiological outcomes of suprapatellar intramedullary nailing in the treatment of adult tibial shaft fractures. Methods: This retrospective study included adult patients with tibial shaft fractures treated with the suprapatellar intramedullary nailing technique. Fractures were classified using the Arbeitsgemeinschaft für Osteosynthesefragen classification system. Both open and closed fractures were included, and open fractures were classified according to the Gustilo–Anderson classification. Clinical and radiological outcomes were evaluated during follow-up. Results: The mean postoperative fracture healing time was approximately 9 months. Most patients reported minimal anterior knee pain, with only occasional cases of limited knee motion. Observed complications included superficial infections, minor angular deformities, and small limb length discrepancies. Dynamization was required in two patients. The average operative time was approximately 52 minutes. Conclusion: Suprapatellar intramedullary nailing represents a reliable and effective surgical option for the treatment of adult tibial shaft fractures. The technique may facilitate fracture reduction and result in favorable clinical outcomes with acceptable complication rates.
Objective: To evaluate contemporary indications, diagnostic yield, diagnostic limitations, and pregnancy–neonatal outcomes of chorionic villus sampling (CVS) in a tertiary referral population in the era of widespread non-invasive prenatal testing. Methods: This retrospective cohort study included 70 singleton pregnancies that underwent CVS at a tertiary referral center between October 2023 and June 2025. Maternal characteristics, indications for CVS, genetic testing results, and procedure-related outcomes were recorded. Pregnancy loss, the need for repeat invasive testing, termination decisions, and delivery and neonatal outcomes were assessed. Results: Major fetal structural anomalies were the leading indication (40%). Pathological genetic findings were identified in 21.4% of cases. Despite multimodal testing, 5.7% remained without a result, and 17.1% required repeat invasive sampling. No immediate complications occurred. Four pregnancy losses before 24 weeks’ gestation (5.7%) were observed. Three occurred in pregnancies with major structural or chromosomal abnormalities, while one occurred in a structurally normal fetus with inconclusive cytogenetic results. When anomaly-associated cases were excluded, the observed loss rate among structurally normal pregnancies was 1.4%. No membrane rupture or chorioamnionitis occurred. Among live births, 97.2% were delivered at term. Neonatal outcomes were reassuring, and stillbirths (3.1%) were attributable to severe fetal or maternal pathology rather than the CVS procedure. Conclusion: Structural fetal anomalies are now the leading indication for CVS. Post-procedure complications were rare, and most adverse outcomes were observed in pregnancies with underlying fetal or maternal pathology. These findings support the continued role of CVS as a diagnostic option in selected high-risk pregnancies.
Objective: The aim of this study is to compare the digital literacy levels of nurses working in digital and non-digital hospitals and to examine the effect of demographic and professional variables on their digital competence. Methods: This study was designed as a descriptive comparative cross-sectional study and included 219 nurses working in one digital and one non-digital hospital in Türkiye. Data were collected using a structured questionnaire comprising demographic information and a 12-item unidimensional Digital Literacy Scale. The reliability of the scale was confirmed (Cronbach’s alpha=0.948). Statistical analyses were performed using SPSS, including descriptive statistics, independent samples t-tests, one-way analysis of variance, Games-Howell post-hoc tests, and chi-square tests. Results: Nurses working in digital hospitals had significantly higher levels of digital literacy than nurses in non-digital hospitals (p<0.05). No significant differences were observed based on age, education level, or years of experience. However, digital literacy scores increased significantly with greater frequency of digital tool use. No significant relationship was found between professional experience and the frequency of digital interaction. Conclusion: Corporate digital infrastructure and frequency of digital tool usage are key factors affecting nurses’ digital literacy. Encouraging daily digital interactions and providing access to technological resources may help strengthen digital competencies in healthcare settings.
Objective: The aim of this study was to evaluate the clinical outcomes of medial patellofemoral ligament (MPFL) reconstruction with and without tibial tubercle osteotomy (TTO) in patellofemoral instability surgery. Methods: Between January 2020 and January 2025, 23 patients who underwent surgery for recurrent patellar dislocation due to patellofemoral instability, were retrospectively evaluated. Seventeen patients over 18 years of age, without any additional injuries, who had not undergone any surgery other than MPFL reconstruction ± TTO, with at least 12 months of follow-up, were included in the study. Twelve patients underwent MPFL reconstruction (Group 1), while five patients underwent MPFL reconstruction combined with TTO (Group 2). Demographic data of the patients were recorded. Clinical outcomes were assessed using Kujala, Lysholm, and IKDC 2000 scores, as well as visual analog scale (VAS). Results: Of the patients included in the study, 11 were female (65%) and 6 were male (35%), with a median age of 22 years (18-39 years), body mass index of 25.3 (18.2-32.5), and follow-up duration of 32 months (15-150 months). Comparison of preoperative and postoperative clinical scores demonstrated significant improvement in Kujala, Lysholm, and IKDC 2000 scores in both groups (p<0.001), along with a significant decrease in VAS scores (p<0.001). Conclusion: MPFL reconstruction with or without TTO provides satisfactory outcomes in patellofemoral instability surgery. This reconstructive procedure may be considered an effective treatment option for recurrent patellar dislocation and can be combined with TTO in appropriate cases.
Horizontal gaze palsy with progressive scoliosis is a rare autosomal recessive disorder caused by biallelic variants in ROBO3, a gene essential for commissural axon crossing in the hindbrain and spinal cord. It is characterized by the congenital absence of horizontal eye movements and progressive scoliosis, typically presenting in childhood or adolescence.
Objective: Gastric cancer remains an important health problem. Although the classical staging system is the tumor, node, metastasis (TNM) system, stage migration phenomenon may occur depending on the number of lymph nodes removed. Therefore, although there are opinions that lymph node metastasis rate can be used as an alternative to TNM, a clear cut-off value has not been determined. In our study, we aimed to evaluate the survival in TNM staging according to the metastatic lymph node rate. Methods: Patients operated for gastric adenocarcinoma between 2015 and 2022 were evaluated retrospectively. Patients were divided into quartiles according to the metastatic lymph node rate. Mean survival times were compared between the two groups according to TNM stages and metastatic lymph node rate. Results: One hundred ninety-nine patients were included in the study. When survival was evaluated, it was observed that survival decreased with increasing disease stage and metastatic lymph node ratio. All patients with stage 1 and 2 were in the 1st quartile (25%) according to metastatic lymph node ratio. In the evaluation of stage 3 patients, it was seen that survival decreased as the metastatic lymph node ratio increased. Conclusion: Our study revealed that metastatic lymph node ratio of 25% and above is an important parameter in predicting prognosis. Especially in stage 3 patients, metastatic lymph node ratio was shown to be a valuable parameter in predicting survival.
Vesicant agents, particularly analogs of sulfur mustard (SM) and nitrogen mustard (NM), exhibit a striking dichotomy between devastating chemical toxicity and therapeutic potential in oncology. The cytotoxic facet of SM causes rapid cellular damage through bifunctional alkylation, depletion of glutathione and ATP, and PARP hyperactivation. This process manifests as oncosis or necrosis, acute skin vesiculation, eye damage, and respiratory tract injuries. Over decades, genotoxicity mediated by persistent DNA interstrand cross-links, oxidative stress, chronic inflammation, and field cancerization increases the risk of squamous cell carcinoma of the lung and skin. Epidemiological studies, particularly among Iran-Iraq War gas survivors, have confirmed these long-term cancer risks. Mechanistic studies indicate that reactive oxygen species-mediated mutagenesis, stem cell niche disruption, and clonal proliferation play central roles in vesicant-induced carcinogenesis. Paradoxically, these same alkylating mechanisms fueled the therapeutic development of NMs, formed the basis of modern chemotherapy, and raised concerns about secondary malignancies and biosafety. Future research should focus on early-detection biomarkers, PARP and receptor-interacting protein kinase 1 inhibitors that reduce acute toxicity, and advanced carrier systems that minimize genomic damage while maintaining antitumor efficacy. The history of vesicants demonstrates how understanding the mechanisms of a toxic chemical can transform it into a therapeutic tool and guide the evolution of cancer treatment. This review comprised a comprehensive examination of English- and Turkish-language literature, using PubMed-indexed keywords, including ‘vesicant agents’, ‘SM’, ‘NM’, ‘chemotherapy’, and ‘carcinogenesis’.
Objective: This study aimed to compare neurological and ophthalmological findings with diffusion tensor magnetic resonance imaging (DTMRI) results in patients with periventricular leukomalacia (PVL). Methods: This prospective study included 24 premature infants with PVL diagnosed by cranial ultrasonography (USG) or magnetic resonance imaging (MRI). Neurological and comprehensive ophthalmological evaluations were conducted at 3, 6, and 12 months of corrected age. MRI was performed on a 3-Tesla scanner, and DTMRI data were analyzed for fractional anisotropy (FA) and other diffusion parameters. Statistical analyses were performed using SPSS software, with p<0.05 considered significant. Results: Our study included 11 preterm patients with PVL, of whom 72.7% developed cerebral palsy (CP) by 6 months’ corrected age. Cranial USG detected PVL in 63.3% of patients, whereas MRI identified PVL of varying severity: mild (54.5%), moderate (18.2%), and severe (27.3%). Neurological examinations revealed increased muscle tone and brisk deep tendon reflexes (DTRs), findings consistent with early indicators of CP. Ophthalmologic assessments indicated normal light fixation and tracking in most patients, though visual evoked potentials (VEPs) revealed abnormalities in 63.6% of patients. In the DTMRI results, right optic tract, FA values were found to be significantly lower in the patient group compared to the control group (p=0.010). Conclusion: Early neurological signs, such as increased muscle tone and brisk DTRs, are predictive of subsequent CP. Despite improvements in visual tracking, VEP abnormalities highlight the need for comprehensive neuro-ophthalmological evaluations in preterm infants. DTMRI provides valuable insights into white matter microstructure and may help predict neurological and ophthalmological outcomes in infants with PVL.
Objective: Polycystic ovary syndrome (PCOS) is a common endocrine disorder characterized by chronic anovulation and hyperandrogenism. In adolescents, the diagnosis is challenging because of overlap with physiological pubertal changes. Anti-Müllerian hormone (AMH) and insulin-like peptide 3 (INSL3) are proposed biomarkers in adults, but their utility in adolescence is unclear. This study investigated serum AMH and INSL3 levels in adolescents with PCOS and healthy controls and assessed associations with ultrasonographic and biochemical features. Methods: This cross-sectional study included 50 adolescents with PCOS (diagnosed according to the Rotterdam criteria) and 25 healthy controls. Anthropometric measurements, hormonal/biochemical assays, and transabdominal ultrasonography were performed. Correlations between biomarkers, biochemical hyperandrogenism, and ovarian morphology were evaluated. Receiver operating characteristic (ROC) analysis was performed to evaluate the diagnostic performance of AMH. Results: Adolescents with PCOS had significantly higher serum AMH levels than controls (11.1±5.4 vs. 3.8±1.8 ng/mL; p<0.001), whereas INSL3 levels were similar (p=0.806). AMH correlated positively with total testosterone, androstenedione, free androgen index, Ferriman-Gallwey score, luteinizing hormone/follicle-stimulating hormone ratio, ovarian volume, and antral follicle count, and negatively with sex hormone-binding globulin. In the PCOS group, AMH also correlated with INSL3 (r=0.35, p=0.012), particularly in the overweight/obese subgroups. ROC analysis identified an AMH cut-off value of 5.05 ng/mL, with 94% sensitivity and 80% specificity (area under the curve: 0.938, 95% confidence interval: 0.88-0.99). Conclusion: Serum AMH is significantly elevated in adolescents with PCOS and strongly correlates with clinical and biochemical hyperandrogenism and with ovarian morphology, suggesting its role as a supportive but not a standalone diagnostic biomarker. Unlike in adult PCOS, INSL3 showed no diagnostic value during adolescence. Incorporating AMH into clinical assessment may help identify adolescents at risk for persistent PCOS features and future metabolic complications.
Objective: This study aimed to investigate the diagnostic value of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) in predicting intensive care unit (ICU) requirements in pediatric community-acquired pneumonia (CAP). Methods: In this retrospective study, demographic data, clinical findings, and laboratory results of pediatric patients diagnosed with CAP were evaluated. Patients were divided into two groups: those treated in the pediatric ward (Group 1) and those managed in the pediatric ICU (PICU) (Group 2). NLR, PLR, and SII calculated from hemogram parameters, as well as arterial blood gas values (pH, serum lactate), C-reactive protein, and procalcitonin (PCT), were analyzed. Their predictive roles in determining disease severity were assessed. Results: A total of 116 patients were included, of whom 56 (48.3%) were in Group 1 and 60 (51.7%) in Group 2. NLR (p=0.039), PLR (p=0.039), and SII (p=0.026) levels were significantly higher in Group 2. Receiver operating characteristic analysis revealed area under the curve values of 0.718 for NLR, 0.705 for SII, and 0.684 for PLR. NLR, blood pH, serum lactate, and PCT were identified as independent predictors of ICU admission. Hypoxia, comorbid conditions, abnormal vital signs, and elevated inflammatory indices were additional significant risk factors associated with PICU admission. Conclusion: NLR, PLR, and SII may serve as inexpensive and readily available markers to assess disease severity and predict intensive care needs in pediatric CAP. These indices can support rapid clinical decision-making and facilitate risk stratification in practice.
Objective: Eye examinations in infants for vision screening can cause pain and stress. The aim of this study was to evaluate the effect of white noise and swaddling on pain, heart rate, and oxygen saturation in healthy term infants undergoing post-discharge eye examinations. Methods: The study was conducted from September 1, 2022, to March 1, 2023, in the neonatal eye outpatient clinic of a maternity hospital. This randomized controlled trial included 120 term infants randomized to four groups: white noise (n=30), swaddling (n=30), white noise plus swaddling (n=30), and control (n=30). Pain was assessed using the premature infant pain profile scale, and heart rate and peripheral capillary oxygen saturation (SpO2) were measured by pulse oximetry before, 30 seconds after, and at the end of the examination. Results: The groups showed comparable pain scores, heart rates, and SpO2 levels, with no significant differences observed (p>0.05). However, all groups showed significant increases in pain scores and heart rates, and a decrease in SpO2 during the examination compared with baseline (p<0.001). Conclusion: White noise, swaddling, and their combination did not reduce pain or improve physiological parameters during eye examinations in term infants.
Objective: The aim of this study is to assess the difficulty level of artificial intelligence (AI)-generated multiple-choice questions (MCQs) created by large language models (LLMs) using different prompts across various chatbots, compared to human-written questions. Methods: We generated case-based MCQs on obstetrics and gynecology using two distinct prompts across four LLM-based chatbots. Expert-reviewed MCQs were administered to 97 medical students who were undergoing clerkship training in obstetrics and gynecology. Subsequently, item difficulty indices were calculated for each MCQ. Results: The mean difficulty index of the AI-generated questions was 0.30. One prompt produced questions with a difficulty index of 0.34 (classified as difficult), while the other produced a lower difficulty index of 0.25 (classified as more difficult). In contrast, the mean difficulty index of the human-written questions was 0.63, indicating a moderate level of difficulty. Conclusion: Our study highlights the challenges of using AI-generated MCQs in medical education. Although AI offers promising benefits for question generation, the questions produced were generally too difficult for undergraduate medical students. This underscores the need for more detailed and contextually informed prompt designs to better align AI outputs with assessment requirements. Although BDM-based chatbots enhance efficiency in question generation, expert review remains essential to ensure the appropriateness and quality of the items.
Objective: Inflammatory processes play a significant role in the pathogenesis of ectopic pregnancy. Therefore, certain serum inflammatory markers are considered to have potential value in predicting the treatment outcome. The objective of this study is to investigate the relationship between methotrexate (MTX) efficacy in the management of ectopic pregnancy and serum inflammatory markers. Methods: The study was conducted retrospectively at Dokuz Eylül University Hospital. Women aged 18 years or older who were diagnosed with an ectopic pregnancy and underwent treatment between 2015 and 2025 were included. The study population was initially stratified into two groups according to the success or failure of MTX treatment. Patients with successful treatment were further subdivided into single-dose and double-dose MTX cohorts. The groups were compared with respect to characteristic features and ultrasonographic, laboratory, and surgical findings. Results: No significant differences were found in systemic inflammation markers between the groups (p=0.96, p=0.58, p=0.47, p=0.80). When groups with successful and unsuccessful MTX treatment were compared with respect to baseline, fourth-day, and seventh-day β-hCG levels and changes between these measurements, a significant difference was found (p<0.001). β-hCG was an effective predictor of treatment success (p=0.001, p=0.001, p=0.006). Conclusion: No significant correlation was found between serum inflammatory markers and the success of MTX treatment. β HCG levels and their rates of change are thought to be more powerful predictors of MTX treatment success.
