Introduction: Although the Central Physician Appointment System (MHRS) implemented in Türkiye in 2010 improved access to healthcare services, patients cannot directly schedule radiological imaging appointments. This study aims to predict the likelihood of radiology appointment cancellations at city and state hospitals using machine learning algorithms. Methods: Radiology appointment data recorded between January 2021 and June 2024 at a city hospital and a state hospital were analyzed. The dataset contained more than 3 million rows, with independent variables including age, gender, International Classification of Diseases-10 diagnosis codes, and imaging type. Logistic regression, random forest, and support vector machine (SVM) models were developed and evaluated using accuracy, precision, recall, and F1-score. Results: Appointment cancellations were less frequent at the city hospital than at the state hospital. Logistic regression achieved 82% accuracy and demonstrated the best performance among the conventional models. Following additional validation procedures with different train-test splits, random forest and SVM achieved accuracies of approximately 97.66% and 97.69%, respectively. Higher cancellation rates were observed among patients aged 18-30 and for non-urgent procedures. Most cancellations occurred either 3-5 days before the scheduled date or on the same day. Conclusion: Predicting radiology appointment cancellations with machine learning supports efficient use of hospital resources. Developing tailored strategies based on hospital type can improve capacity management, patient satisfaction, and overall service quality.
Introduction Despite advancements in early pregnancy monitoring, accurately identifying asymptomatic fetal loss remains a significant clinical challenge. In light of conflicting evidence in the literature, this prospective study was designed to conduct a multimodal comparative evaluation of sonographic markers [gestational sac (GS), yolk sac (YS), crown-rump length (CRL)], serum progesterone, and a comprehensive panel of systemic inflammatory indices [neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), mean platelet volume (MPV), platelet distribution width] in the context of first-trimester missed abortion. Methods A total of 129 pregnant women (51 with missed abortion and 78 healthy controls) at 6-9 gestational weeks were prospectively enrolled. Serum progesterone and complete blood count parameters were analyzed at the time of diagnosis. Diagnostic performance was evaluated using receiver operating characteristic (ROC) analysis, and independent associations were evaluated using multivariable logistic regression. Results In the missed abortion group, GS and CRL measurements were significantly smaller (p<0.001), whereas YS diameter was significantly larger than in healthy pregnancies (p=0.039). Serum progesterone levels were markedly lower in cases (10.4±5.2 ng/mL vs. 17.1±5.1 ng/ mL, p<0.001). Multivariable analysis identified lower serum progesterone [odds ratio (OR): 0.791], smaller GS diameter (OR: 0.839, p=0.004), and larger YS diameter (OR: 2.255, p=0.044) as strong independent indicators of missed abortion. ROC analysis confirmed that serum progesterone had the highest discriminatory power [area under the curve (AUC): 0.840, p<0.001)], followed by CRL (AUC: 0.754), and GS diameter (AUC: 0.738). While absolute lymphocyte counts were significant in univariate models (p=0.012), systemic inflammatory markers (NLR, LMR, MPV) failed to show independent diagnostic performance. Conclusion Morphometric sonographic parameters and serum progesterone levels are independently associated with first-trimester missed abortion, reinforcing their reliability as clinical indicators for identifying non-viable pregnancies. Conversely, routine systemic inflammatory markers lack a sufficient independent association to serve as useful standalone markers for asymptomatic fetal loss. Clinical assessment should prioritize standardized sonographic and hormonal profiles over hematological indices.
Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic substantially changed healthcare delivery and may have influenced antimicrobial resistance (AMR) through increased empirical antibiotic prescribing, prolonged intensive care admissions, and extensive use of invasive interventions. As leading causes of healthcare-associated bloodstream infections, Acinetobacter spp. and Pseudomonas spp. represent important indicators for evaluating changes in resistance patterns over time. This study investigated temporal variations in AMR among these pathogens before, during, and after the COVID-19 pandemic. Methods: A retrospective observational study was conducted at University of Health Sciences Türkiye, İstanbul Haseki Training and Research Hospital using blood culture isolates collected from January 2017 to December 2023. Adult hospitalized patients with non-fermentative Gram-negative bloodstream isolates were included. Antimicrobial susceptibility testing was interpreted according to the European Committee on Antimicrobial Susceptibility Testing breakpoints applicable at the time of analysis, and resistance profiles were compared across the pre-pandemic, pandemic, and post-pandemic periods. Results: Overall, 740 Acinetobacter spp. and 268 Pseudomonas spp. isolates were evaluated. Acinetobacter spp. demonstrated a progressive increase in resistance to meropenem, colistin, gentamicin, and amikacin, with the highest resistance rates observed after the pandemic (all p<0.001). Meropenem resistance reached 98%, whereas colistin resistance increased to 32.2%. In contrast, Pseudomonas spp. exhibited significantly lower resistance to amikacin, gentamicin, ciprofloxacin, and imipenem during the post-pandemic period (all p<0.05), although the proportion of isolates with intermediate susceptibility increased for several antimicrobial agents. Conclusion: Distinct changes in AMR patterns were observed following the COVID-19 pandemic, and these changes differed between bacterial species. The substantial increase in resistance among Acinetobacter spp., compared with the relatively favorable susceptibility profile of Pseudomonas spp., reinforces the need for ongoing local resistance surveillance, effective antimicrobial stewardship programs, and strengthened infection prevention measures.
Introduction: Despite technological developments, morbidity and mortality in emergency colorectal surgery remain high. Despite efforts to diagnose colorectal cancer early, more than 20% of patients still undergo emergency surgery. How do outcomes in these patients differ from outcomes in patients with benign disease? Very few studies provide information on this subject; therefore, the aim of our study was to determine the effects of malignancy in patients who have undergone left-sided emergency colorectal resections. Methods: Patients undergoing emergency left-sided colectomy at a single tertiary hospital were included in this observational study. Demographics, Charlson comorbidity index, perforation, duration of surgery, preference for primary anastomosis or end colostomy, and benign or malignant etiologies were all examined. Morbidity was defined as a Clavien–Dindo grade III or higher complication. Risk factors for both morbidity and mortality were first evaluated using univariate analyses. Multivariable logistic regression analyses were then performed for both morbidity and mortality. Results: The study included 76 patients, 46 (60.5%) of whom were men. The mean age was 61.5 years, and the most common cause was colorectal cancer (n=46, 60%). Perforation was observed in 32.8% of patients (n=25), and obstruction in 38.1% of patients (n=29). The morbidity rate was 27.6% and the 90-day mortality rate was 15.7%. In univariate tests and multivariable regression analyses, malignancy was not associated with morbidity (p=0.879, p=0.711) or mortality (p=0.416, p=0.453). In both univariate and multivariable analyses, perforation was the only factor significantly related to morbidity and mortality. Conclusion: Malignancy was not identified as a direct cause of morbidity and mortality in emergency left-sided colectomies. Perforation was significantly associated with morbidity and mortality. In these high-risk surgeries, multicenter studies with larger patient groups are needed to detect causes of deterioration and to improve outcomes.
Introduction: Minimal approaches have become popular in cardiac surgery in recent years worldwide; as in other surgical specialties, minimal right anterior thoracotomy (RAT) and minimal right lateral thoracotomy (RLT) techniques can be used for some cardiac procedures. This study compares and presents the operative and postoperative advantages and disadvantages of both techniques. Methods: Between March 2021 and July 2024, a total of 40 patients underwent cardiac surgery via direct vision minimally invasive right thoracotomy approach at Cardiovascular Surgery Center of University of Health Sciences Türkiye, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital. Eight of these patients underwent surgery with the RAT technique, and 32 underwent surgery with the RLT technique. Operative and postoperative outcomes were compared. Results: One patient who underwent RAT died during the operative period, and two patients who underwent RLT died during the postoperative period. Cross-clamp and cardiopulmonary bypass times were longer for RAT during the operative period. While there was no difference in extubation times or intensive care stay durations, tube drainage times and hospital stays were shorter for RLT in the postoperative period. Conclusion: These findings suggest a potential clinical advantage of direct-vision RLT; however, they require further validation in large-scale, prospective studies. The situation may be different in camera-assisted approaches.
