INTRODUCTION: The aim of this study is to evaluate the performance of non-invasive tests, including APRI, FIB-4, and FibroIndex, in detecting fibrosis in patients with chronic hepatitis B and C compared to liver biopsy.
METHODS: This study enrolled 236 patients with CHB/CHC who underwent ultrasound-guided liver biopsies between January 2007 and May 2014 at Katip Çelebi University Atatürk Training and Research Hospital. Histological grading of necroinflammation and fibrosis was performed according to the Knodell and ISHAK scoring systems. APRI, FIB-4, and FibroIndex scores were calculated based on their respective formulas. Optimal cutoffs were determined using the Youden method. Sensitivity and specificity were calculated for significant fibrosis and cirrhosis. Statistical analyses were performed using SPSS.
RESULTS: This study evaluated 236 patients with chronic hepatitis B (CHB) and C (CHC) using non-invasive tests to diagnose liver fibrosis and cirrhosis. CHB was more prevalent, accounting for 77.5% of cases, with a slight male predominance in the cohort. Non-invasive tests such as APRI, FIB-4, and FibroIndex demonstrated moderate to good diagnostic accuracy, with better performance generally observed in CHC patients. For instance, APRI exhibited excellent sensitivity and specificity for cirrhosis in CHC. These findings suggest that the effectiveness of these tests varies based on hepatitis type, highlighting the potential need for different diagnostic strategies depending on viral etiology.
DISCUSSION AND CONCLUSION: Non-invasive tests proved to be useful tools for detecting significant fibrosis and cirrhosis. Additionally, FibroIndex demonstrated superior performance with higher sensitivity and specificity compared to other non-invasive tests.

INTRODUCTION: The aim of this study was to compare the efficacy of the ACE (Angiotensin-Converting Enzyme) inhibitor lisinopril on basilar artery vasospasm in an experimental subarachnoid hemorrhage (SAH) model in rats.
METHODS: A total of 32 Wistar albino rats were divided into four groups: Group I (n=8), the control group; Group II (n=8), the vasospasm group; Group III (n=8), the vasospasm group treated with 5 mg/kg/day for 7 days starting within the first 24 hours; and Group IV (n=8), the vasospasm group treated with 10 mg/kg/day for 7 days starting within the first 24 hours. After 7 days, the basilar artery was excised and examined histopathologically under a light microscope.
RESULTS: The study found that 10 mg/kg/day lisinopril significantly prevented vasospasm following SAH. The mean vessel wall thickness was lowest in the lisinopril 10 mg group and highest in the SAH group, with a statistically significant difference. In Group III, a dose of 5 mg/kg/day of lisinopril reduced wall thickness, while in Group IV, a dose of 10 mg/kg/day was more effective. Group III had a greater decrease in lumen area compared to Group II, but not as much as Group IV. Comparing the vessel lumen thickness of Group II with Group I, there was a significant decrease in Group IV. Although not as much as in Group IV, the lumen diameter increased in Group III compared to Group II. Group IV had an increase in lumen diameter similar to that of Group I.
DISCUSSION AND CONCLUSION: The study findings suggest that intraperitoneal administration of lisinopril at a dose of 10 mg/kg/day can prevent morphologic vasospasm after experimental vasospasm. However, the dose of 5 mg/kg/day of lisinopril is less effective than the 10 mg/kg/day dose.

INTRODUCTION: Hypotension is a common problem during colonoscopy with procedural sedation. Perfusion index (PI) has been shown to be predictive of hypotension following the induction of general anesthesia. We hypothesized that PI could predict hypotension during colonoscopy and that a cut-off value could be determined at which hypotension is more common.
METHODS: One hundred and fifty adults belonging to the American Society of Anesthesiologists' physical status I/II, undergoing elective colonoscopy under procedural sedation with propofol, were enrolled in this prospective, observational study. PI, heart rate, blood pressure, and oxygen saturation were recorded during colonoscopy. Hypotension was defined as a mean arterial pressure (MAP) of <65 mmHg.
RESULTS: The incidence of hypotension with predefined MAP criteria was 13%. Baseline PI <1.9 predicted any episode of hypotension with a sensitivity of 73.7%, specificity of 59.3%, positive predictive value (PPV) of 32.5%, and negative predictive value (NPV) of 89%. The area under the ROC curve (AUC) was 0.651 (95% confidence interval: 0.567–0.729, p=0.0275).
DISCUSSION AND CONCLUSION: The perfusion index could be a potential parameter to predict hypotension during propofol sedation. It had a moderately high sensitivity value and a very high negative predictive value.

INTRODUCTION: Artificial intelligence (AI) has become the focus of recent studies, particularly due to its potential to reduce human labor and time loss. The most significant contribution of AI applications in the medical field is expected to be enhancing clinicians' efficiency, reducing costs, and improving public health. This study aims to assess the proficiency of ChatGPT-3.5, one of the most advanced AI applications available today, in its knowledge of current information based on the American Heart Association (AHA) 2020 guidelines.
METHODS: An 80-question quiz in a question-and-answer format, covering the current AHA 2020 application steps, was prepared and administered to ChatGPT-3.5 in both English (ChatGPT-3.5 English) and Turkish (ChatGPT-3.5 Turkish). The questions were originally prepared in Turkish for emergency medicine specialists.
RESULTS: We found a similar success rate of over 80% in all questions posed to ChatGPT-3.5 and two independent emergency medicine specialists with at least five years of experience who did not know each other. ChatGPT-3.5 achieved a 100% success rate in all questions related to the General Overview of the Current AHA Guidelines, Airway Management, and Ventilation chapters in English.
DISCUSSION AND CONCLUSION: Our study indicates that ChatGPT-3.5 provides responses that are as accurate and up-to-date as those given by experienced emergency specialists regarding the AHA 2020 Advanced Cardiac Life Support Guidelines. With future updated versions of ChatGPT, instant access to accurate and current information based on textbooks and guidelines will be increasingly feasible.

INTRODUCTION: This study aims to assess the progression of infection and vaccine response in patients with rheumatic diseases monitored during the COVID-19 pandemic and compare the findings with data from a control group.
METHODS: A total of 106 patients with rheumatic diseases were enrolled, including 63 with ankylosing spondylitis (AS), 42 with rheumatoid arthritis (RA), and 1 with psoriatic arthritis (PsA). The control group comprised 56 participants. We evaluated the participants' demographic characteristics, diagnosis, disease duration, additional systemic diseases, history of COVID-19 infection, the course and severity of infection for those affected, presence of prolonged symptoms, vaccination status, and vaccine side effects.
RESULTS: There were no differences between the patient and control groups in terms of demographic data, vaccination status, COVID-19 experience, and disease duration among those with COVID-19. When compared based on medication use, no significant differences were found in demographic data, vaccination status, and disease duration.
DISCUSSION AND CONCLUSION: When comparing the patient and control groups based on medication use, no significant differences were observed between the groups regarding the frequency of COVID-19, vaccination status before COVID-19 infection, symptoms caused by COVID-19, hospitalization, lung involvement, intubation frequency, need for intensive care, and prolonged post-COVID complaints. The data collected indicate that patients with rheumatic diseases should continue their treatment as usual when they do not have an active infection. The medications they are taking do not pose an increased risk in terms of infection or vaccine-induced immunity.

INTRODUCTION: Due to the nature of their profession, healthcare workers are frequently exposed to blood and bodily fluids, placing them at risk for various infections. Among the main causes of infection risk are blood-borne pathogens such as hepatitis B, hepatitis C, and HIV. This study aims to evaluate the exposure of healthcare workers to blood and bodily fluids and develop strategies to prevent injuries.
METHODS: This study is a retrospective cross-sectional analysis conducted at Health Sciences University Izmir Tepecik Training and Research Hospital between 2014 and 2023. Data were retrospectively collected from the hospital's occupational health and safety unit. Variables analyzed include age, gender, occupation, years of experience, time of injury, and type of exposure. SPSS software was used for data analysis, with continuous variables expressed as medians and categorical data presented as percentages.
RESULTS: The study examined 1,100 healthcare workers. A total of 32.8% of injuries occurred among nurses, while 26.4% involved doctors. Employees with 0–1 years of experience constituted the highest risk group (54.9%). Additionally, 65.2% of injuries occurred during daytime shifts. Among those exposed to known sources, the HBsAg positivity rate was 11.5%, the Anti-HCV positivity rate was 1.5%, and the Anti-HIV positivity rate was 1.4%. A notable increase was observed in annual data during 2018 and 2019, followed by a declining trend after 2020, after which the increase resumed.
DISCUSSION AND CONCLUSION: Preventive measures such as the use of safe needle technologies, continuous infection control training, and the regulation of working hours are recommended to reduce the risk of injuries among healthcare workers. These measures can improve the quality of healthcare services, ensuring the safety of workers and preventing occupational injuries.

INTRODUCTION: Fetal systemic inflammatory response triggered by infection and inflammation in preterm infants contributes to bronchopulmonary dysplasia (BPD) and preterm delivery. This study aims to determine whether there is a relationship between small thymus size and the risk of developing BPD.
METHODS: The cardiothymic/thoracic (CT/T) ratio was measured on AP chest X-ray obtained within the first 6 hours of life in very low birth weight (VLBW) infants weighing less than 1500 g between 2018 and 2023. Clinical information was collected independently from electronic medical records by two neonatologists. The demographic data of the infants included gestational age, mode of delivery, gender, birth weight, and Apgar scores at 5 and 10 minutes.
RESULTS: A total of 195 VLBW newborns (102 boys, 93 girls) were included in the study. The mean gestational age was 28.5 weeks, and the mean birth weight was 1074 grams. There was a statistically significant difference in the incidence rates of BPD by gestational age. The risk of BPD was 6.702 times higher in babies born weighing less than 1000 grams. The CT/T ratio was significantly lower in infants who developed BPD compared to those who did not.
DISCUSSION AND CONCLUSION: The thymus is an essential organ for the immune system. In our study, the finding that lower birth weight and gestational age were associated with a smaller CT/T ratio suggests a higher rate of inflammation, leading to increased morbidity and mortality. Identifying preterm infants with a small thymus may help clinicians recognize those at high risk for developing BPD.

INTRODUCTION: Sarcoidosis is a multisystem granulomatous disease known for its varied clinical presentation and diagnostic complexity. Despite advances in diagnostic modalities, sarcoidosis diagnosis remains challenging, particularly in asymptomatic cases. This study aimed to investigate the distribution and clinical implications of activation markers in sarcoidosis patients during different stages of follow-up.
METHODS: A retrospective analysis was conducted on 61 sarcoidosis patients seen at a tertiary reference chest diseases hospital. Patient demographics, biochemical markers, respiratory function tests, and diagnostic procedures were evaluated. The CD4/CD8 ratio in bronchoalveolar lavage fluid, FEV1 percentage, DLCO (carbon monoxide diffusion test) levels, and serum ACE (serum angiotensin-converting enzyme), calcium were assessed at baseline and during follow-up visits.
RESULTS: Analysis revealed significant variability in activation markers across different stages of sarcoidosis. Bronchoalveolar lavage fluid analysis showed elevated CD4/CD8 ratios (>3.5) in the majority of patients, indicative of disease activity. Additionally, FEV1 percentage and DLCO levels exhibited a progressive decline with advancing disease stages. Serum ACE and calcium levels varied inconsistently and did not show a significant correlation with disease activity.
DISCUSSION AND CONCLUSION: Assessment of activation markers, particularly the CD4/CD8 ratio in bronchoalveolar lavage fluid, provides valuable insights into disease activity and progression in sarcoidosis patients. Monitoring these markers during follow-up visits may aid in the early detection of disease exacerbations and guide treatment decisions. Further research is warranted to elucidate the clinical utility of these markers in sarcoidosis management.

INTRODUCTION: In this study, we aimed to compare bleeding and vascular complications associated with deep incision (with removal of perivascular adipose tissue) and standard incision (without removal of perivascular adipose tissue) approaches in patients who underwent transcatheter aortic valve implantation (TAVI).
METHODS: We retrospectively included 80 adult patients who underwent elective percutaneous TAVI at a tertiary cardiac center between 2012 and 2018. The percutaneous TAVI procedure was performed in 41 patients using the deep incision approach and in 39 patients using the standard incision approach. The primary outcome was bleeding and vascular complications.
RESULTS: The percutaneous TAVI procedure was performed in 41 patients using the deep incision approach and in 39 patients using the standard incision approach. In the deep incision and standard incision groups, respectively, the number of female patients was 27 (65.9%) and 21 (53.8%), while the mean age was 80.46±6.43 years and 78.79±7.87 years. Bleeding, according to the VARC-2 (The Valve Academic Research Consortium-2 Consensus Document) criteria, was lower in the deep incision group but did not reach statistical significance: 17 (41.5%) in the deep incision group vs. 19 (50%) in the standard incision group (p=0.447). Mean hemoglobin decline (g/dL) was significantly lower in the deep incision group (0.55±1.44) compared to the standard incision group (1.93±1.98) (p=0.001). The results for in-hospital mortality, hematoma, pseudoaneurysm, femoral artery dissection, and stenosis were similar between the two groups.
DISCUSSION AND CONCLUSION: In patients undergoing percutaneous TAVI, the mean hemoglobin decline was found to be lower in those who underwent the deep incision approach compared to the standard incision approach. No significant difference was found between the two methods in terms of vascular complications and other bleeding complications.

INTRODUCTION: This study aimed to compare soft tissue and bone tissue cultures obtained from patients with diabetic foot infections accompanied by osteomyelitis.
METHODS: The study included 36 patients aged 18 years and older who underwent bone debridement or amputation due to diabetic foot infection with osteomyelitis between April 1, 2017, and April 1, 2018. The data of 36 patients were analyzed prospectively. Bone tissue cultures were compared with soft tissue cultures taken during debridement or amputation. Statistical analyses were performed using IBM SPSS Statistics 22. The concordance between soft tissue and bone tissue cultures was assessed using the McNemar test and the kappa coefficient.
RESULTS: A total of 36 patients participated in this study, 80.5% (29/36) of whom were male, with a mean age of 64.2±11.6 years (range 43-86). According to the Wagner classification, 14 patients (38.9%) had stage 3, 17 patients (47.2%) had stage 4, and 5 patients (13.9%) had stage 5 diabetic foot wounds. The most common wound localization was the plantar area. Osteomyelitis was diagnosed in 28 patients (68.7%) through clinical evaluation and direct radiographs, in 6 patients (16.6%) by MRI, in 1 patient (2.8%) by CT, and in 1 patient (2.8%) by histopathology. The most frequently isolated microorganisms from bone and soft tissue cultures were Pseudomonas aeruginosa (16.6%), coagulase-negative Staphylococcus (CNS) (15.1%), and Escherichia coli (13.6%). The same microorganism was detected in both bone and soft tissue cultures in 20 (55.5%) of the 36 patients. In five patients (13.9%) with culture-positive soft tissue specimens, bone culture specimens remained sterile. In one patient (2.8%) with a culture-positive bone specimen, the soft tissue specimen remained sterile. One patient (2.8%) had different microorganisms in bone and soft tissue specimens. In nine patients (25%), no bacterial growth was observed in either bone or soft tissue cultures. A total of 29 patients (80.5%) were found to have concordant bone and soft tissue cultures. In the statistical analysis, the kappa coefficient was 0.574, which was considered moderate agreement (p>0.05, kappa coefficient=0.574).
DISCUSSION AND CONCLUSION: According to the results of our study, soft tissue cultures may be used instead of bone tissue cultures to predict microorganisms in diabetic foot osteomyelitis. However, our findings need to be validated by studies with larger sample sizes.

INTRODUCTION: Individuals living with HIV (PLWH) exhibit a higher prevalence of viral hepatitis and syphilis compared to the general population. HIV infection and these co-infections mutually accelerate disease progression. This study aimed to evaluate the seroprevalence of viral hepatitis and syphilis, as well as immunization status against hepatitis, in PLWH.
METHODS: The study included 422 PLWH aged >18 years who visited our clinic from 2020 to 2024. Demographic data and the results of HBsAg, Anti-HBc IgG, Anti-HBs, Anti-HCV, Anti-HAV IgG, VDRL, RPR, TPHA, HBV-DNA, and HCV-RNA tests were retrospectively analyzed through the hospital data system. Tests for Treponema pallidum and Hepatitis A/B/C viruses were performed using the ELISA method.
RESULTS: Of the 422 PLWH included in the study, 381 (90.3%) were male, with a mean age of 39.69±12.75 years. When stratified by age, 58.2% of individuals were between 20 and 39 years old. HIV/syphilis co-infection was observed in 149 individuals (35.3%), while 19 individuals (4.5%) had HIV/HBV co-infection. Anti-HCV test results were positive in 7 patients; however, HCV-RNA tests were negative in all cases. The rate of HBV immunity following vaccination was 55.9%, while natural HBV immunity after previous infection was observed in 16.1% of patients. Immunity against HAV was detected in 79.8% (336) of individuals. Co-infected patients with viral hepatitis were statistically significantly older than those infected with HIV alone (p=0.01). A significant difference was found in the male gender among syphilis co-infected individuals (p=0.001). The prevalence of syphilis was significantly higher in individuals positive for Anti-HBc IgG (p=0.002). No significant difference was found between CD4<200 cells/mm³ and viral hepatitis or syphilis co-infection (p=0.125 and p=0.441).
DISCUSSION AND CONCLUSION: Since syphilis and HBV co-infections are more common in PLWH than in the general population, more effective communication regarding sexually transmitted disease (STD) prevention methods and more frequent screening are necessary in these individuals. Additionally, emphasis should be placed on vaccination programs to improve HBV and HAV vaccination rates in this population.

INTRODUCTION: Dementia is a prevalent neurodegenerative condition, with Alzheimer’s dementia (AD) and vascular dementia (VD) being the two most common subtypes. Despite shared cognitive symptoms, AD and VD have distinct pathophysiological mechanisms, necessitating different approaches for diagnosis and treatment. This study investigates oxidative stress markers, inflammatory cytokines, and neurotrophic factors to identify biomarkers that may differentiate VD from AD, supporting more accurate diagnosis and targeted therapies.
METHODS: A total of 45 participants were grouped into healthy controls (HC), VD, and AD. Serum samples were analyzed for oxidative stress markers (TAS, TOS, OSI), thiol-disulfide balance, inflammatory cytokines (IL-1β, IL-6, TNF-α), and neurotrophic factors (GDNF). The data were statistically evaluated to compare biomarker profiles across groups and identify significant variations.
RESULTS: AD patients exhibited significantly elevated oxidative stress markers (TOS and OSI) and disrupted thiol-disulfide homeostasis compared to VD and HC, suggesting a pronounced oxidative imbalance. Additionally, inflammatory markers (IL-1β and TNF-α) were highest in AD, indicating a heightened neuroinflammatory response relative to VD. GDNF levels were elevated in both AD and VD compared to HC, suggesting a potential compensatory neuroprotective response, although levels were higher in VD.
DISCUSSION AND CONCLUSION: The findings highlight oxidative stress and neuroinflammation as prominent features of AD, with VD displaying relatively lower oxidative markers. Elevated GDNF in both dementia types suggests that neurotrophic support mechanisms may play a role in counteracting neurodegeneration. Differences in thiol-disulfide balance and inflammatory cytokines between VD and AD may also reveal disease-specific mechanisms that could aid in differential diagnosis. This study identifies distinct biomarker profiles in AD and VD, emphasizing the potential for specific oxidative and inflammatory markers to differentiate these conditions. Further research may validate these findings and contribute to developing targeted therapeutic interventions for each dementia subtype.

INTRODUCTION: We aimed to investigate the relationship between possible causes and complications after osteosynthesis with a proximal femoral nail (PFN) in patients with intertrochanteric femoral fractures.
METHODS: A total of 122 patients (50 men, 72 women) who were followed for at least one year were analyzed retrospectively. The mean age of the patients was 74 (range: 24-97). The left side was affected in 73 patients, while the right side was affected in 49 patients. The causes of fractures were simple falls at home in 109 cases, falls from height in 6 patients, and traffic accidents in 7 cases. Patients underwent surgery an average of 6.2 days (range: 1–26) after the trauma. All operations were performed in the supine position under fluoroscopic control with manual traction.
RESULTS: According to the Harris hip score, 6.6% of patients had excellent, 18% excellent, 45% good, 21.3% fair, and 9% poor results. A total of 20 infections (8 superficial, 12 deep), 22 implant failures (12 cut-out, 6 Z-effect, 4 reverse Z-effect), 3 femoral shaft fractures distal to the PFN, 2 nonunions, 1 avascular necrosis in the femoral head, 9 sacral decubitus ulcers, 1 gluteal decubitus ulcer, 1 pulmonary embolism, and 1 thromboembolism were observed. When fracture types and implant failure were compared, the highest implant failure rate was seen in Modified Evans-Jensen type 5 fractures (36.7%), but the relationship was not statistically significant (p>0.05). Infection developed in 8 (26.7%) of 30 patients with type 5 fractures, and this relationship was found to be significant (p<0.05). No statistically significant relationship was found between the presence of systemic disease, gender, age, affected side, time between trauma and surgery, mechanism of trauma, and complications.
DISCUSSION AND CONCLUSION: Modified Evans-Jensen type 5 fractures had the highest complication rate among intertrochanteric fractures treated with PFN. Therefore, applying the nail with proper technique and achieving acceptable reduction is essential to ensure balanced osteosynthesis in such fractures.

INTRODUCTION: In this study, we aimed to determine the level of knowledge and attitudes of family medicine residents in Türkiye regarding polypharmacy and to inform them about the methods and guidelines they can use to reduce polypharmacy.
METHODS: This is a cross-sectional study. A total of 308 physicians participated in our study. A questionnaire was administered to physicians via the internet. The questionnaire consisted of 25 questions, including sociodemographic information, medicine and residency-related details, evaluation of polypharmacy, deprescribing, and clinical evaluation questions about polypharmacy.
RESULTS: Among the participants, 76.3% were female, and 68.5% were receiving family medicine specialty training at a university hospital. A total of 21.8% of physicians had received training on polypharmacy, with a higher rate observed among those working at university hospitals. Additionally, 27.3% of physicians reported that they did not prescribe medications without examining the patients. Before prescribing a new medication, 62.9% of physicians considered that the patient's complaints might be caused by the side effects of another medication they were currently taking. The level of self-sufficiency in deprescribing practice was calculated as an average of 2.03±0.93 out of 5. Physicians who had previously received training on polypharmacy had a significantly higher level of self-sufficiency (2.34±0.88) compared to those who had not (1.95±0.93) (p=0.002).
DISCUSSION AND CONCLUSION: Our study found that physicians generally did not have sufficient knowledge about polypharmacy. To reduce polypharmacy, medical school students, family medicine residents, and family physicians should be provided with appropriate training.

INTRODUCTION: The availability of appropriate screening and diagnostic procedures for hepatitis C virus (HCV) is critical for early diagnosis, reduction in mortality and morbidity, and HCV elimination. In our study, we aimed to evaluate the appropriateness of HCV testing procedures and HCV prevalence both in our hospital and across Türkiye.
METHODS: HCV screening and confirmation procedures performed in our hospital between 01.01.2021 and 01.12.2022 were retrospectively evaluated. In the literature review phase, a pooled analysis was conducted using data from studies performed in Türkiye between 01.01.2019 and 21.12.2024 with a methodology parallel to ours.
RESULTS: A total of 25,137 patients underwent anti-HCV testing, with 181 positive cases (0.72%). After the exclusion process, 151 anti-HCV positive patients remained. Among them, one patient (0.6%) was HCV RNA positive, 76 patients (50.3%) were HCV RNA negative after a history of HCV treatment, and 74 patients (49%) were HCV RNA negative without any treatment history (false anti-HCV positive or HCV spontaneous clearance). The mean and median S/CO ratio in false-positive patients were 11.6±19.21 and 2.5 (IQR: 6.89), respectively. Additionally, the mean and median S/CO ratio in true-positive patients were 74.8±36.43 and 69.45 (IQR: 47.15), respectively. According to the pooled data analysis, the seropositivity rate was 1.3% (range: 0.21%-2.46%), with 13,992 of 1,079,492 anti-HCV tests testing positive. A reflex HCV RNA confirmation test was performed in 77.44% of anti-HCV positive patients, and the confirmed disease rate was 42.5%. In these patients, the minimum anti-HCV S/CO ratio ranged from 1.81 to 12.3, while the optimal S/CO threshold was between 5 and 15.85.
DISCUSSION AND CONCLUSION: Our results indicate that the probability of false anti-HCV positive results is very high, especially when the anti-HCV S/CO ratio is low. Although HCV endemicity remains low in our region, anti-HCV screening is inadequate, and clinicians should be more aware of this issue.