INTRODUCTION: While various risk factors and changes in the incidence of developmental dysplasia of the hip (DDH) over the last few decades have been discussed, the exact cause of DDH is currently unknown. This study aimed to determine the incidence and risk factors of DDH using hip ultrasonography (Graf method). The relationship between ultrasonographic findings and risk factors for DDH was prospectively evaluated.
METHODS: A total of 339 patients, 211 females (62.24%) and 128 males (37.76%), were prospectively studied. In all patients, risk factors for DDH—such as female sex, breech presentation, being the first female baby, type of birth, oligohydramnios, high birth weight, and multiparity—were recorded in their medical files. All patients underwent hip ultrasound between the fourth and sixth weeks, performed by the same radiologist. The relationship between dysplastic hips and risk factors was determined using the Graf method.
RESULTS: Breech presentation was observed in 39 cases (11.5%), oligohydramnios in 6 cases (1.8%), multiple pregnancy in 9 cases (2.7%), a history of being the first female baby in 107 cases (31.6%), high birth weight in 38 cases (11.2%), cesarean section in 150 babies (44.2%), a positive family history of DDH in 7 babies (2.1%), and torticollis in 1 baby (0.3%). Type 1a and 1b hips were detected in 304 babies (89.6%), type 2a hips in 31 cases (9.1%), type 2b and 2c hips in 2 cases (0.5%), and type 3 hips in 2 cases (0.5%). A significant association was found between DDH and female sex, as well as high birth weight (p<0.05).
DISCUSSION AND CONCLUSION: The etiology of DDH remains unclear, although many risk factors have been identified. This study demonstrated that DDH can occur in babies without any known risk factors. Therefore, we recommend routine hip ultrasonography for all newborns between Weeks 4 and 6.

INTRODUCTION: The triglyceride-glucose index (TyGi) is recommended as a reliable and simple insulin resistance (IR) marker in patients. This study aimed to clarify the role of TyGi in prediabetic patients and to compare its correlation with insulin resistance.
METHODS: A total of 176 patients who applied to the Endocrinology Department outpatient clinic and underwent a 3-hour OGTT were included in the study. The patients were divided into two groups (normal, prediabetes) according to the OGTT results. IR was calculated using the homeostatic model assessment (HOMA-IR) formula. The ADA criteria were used to diagnose prediabetes. The formula ln (fasting triglyceride [mg/dL]×fasting glucose [mg/dL]/2) was used to determine the TyGi.
RESULTS: Higher mean TyGi (8.79±0.08 vs. 8.43±0.05) and HOMA-IR (4.28±0.43 vs. 2.41±0.21) values were observed in prediabetic subjects compared to normoglycemic subjects. During the OGTT, TyGi correlated with glucose, HbA1c, and HOMA-IR measurements. The area under the curve (AUC) for HbA1c (0.754) was greater than that for HOMA-IR (0.725) and TyGi (0.674) in diagnosing prediabetes. The cut-off values for prediabetes were TyGi > 8.50 (sensitivity: 66.1%, specificity: 42.7%) and HOMA-IR > 2.25 (sensitivity: 62.5%, specificity: 32.6%).
DISCUSSION AND CONCLUSION: TyGi is nearly as effective as HbA1c as a diagnostic marker for prediabetes, and the cut-off points for identifying prediabetes were determined as TyGi > 8.50 and HOMA-IR > 2.25.

INTRODUCTION: We aimed to present the cumulative antibiogram data of bacteria isolated from outpatient, intensive care unit (ICU), and non-ICU service patients between January and December 2023.
METHODS: The data were evaluated according to CLSI-M39 criteria.
RESULTS: The three most frequently isolated bacteria in ICU patients were A. baumannii, P. aeruginosa, and K. pneumoniae, respectively. No antibiotics were identified as suitable for empirical treatment of these bacteria. Amikacin and carbapenems were found suitable for empirical treatment of E. coli. MRSA was detected in 24.2% of isolates, and vancomycin resistance was found in 6.5% of E. faecium isolates. Ampicillin was found to be a suitable empirical treatment option for E. faecalis. In non-ICU patients, the three most frequently isolated bacteria were E. coli, K. pneumoniae, and E. faecalis. No empirical treatment option was found for K. pneumoniae, but amikacin and carbapenems could be used for E. coli isolates. Amikacin was also found suitable for empirical therapy for P. aeruginosa. MRSA prevalence was 33.6%. Vancomycin resistance was not detected in enterococci. Ampicillin, linezolid, and glycopeptides were considered suitable empirical treatment options for E. faecalis. In outpatients, E. coli, E. faecalis, and K. pneumoniae were the most frequently isolated agents. Aminoglycosides and carbapenems were suitable empirical treatment options for E. coli and K. pneumoniae, while ampicillin was suitable for E. faecalis. MRSA was detected in 22.2% of isolates, and no vancomycin resistance was observed in enterococci.
DISCUSSION AND CONCLUSION: It is concerning that there are no antibiotics suitable for empirical treatment of Gram-negative rods other than E. coli in ICU patients, and of E. coli and P. aeruginosa in non-ICU patients. The MRSA rate was found to be higher in non-ICU patients compared to ICU and outpatient groups. No resistance was observed in S. aureus to linezolid or glycopeptides. High susceptibility to ampicillin was noted in E. faecalis across all patient groups, making it suitable for empirical treatment. It is recommended to identify the causative bacteria as early as possible without waiting for antibiogram results and to initiate empirical treatment guided by the hospital’s cumulative antibiogram data.

INTRODUCTION: Triplet pregnancies are high-risk gestations associated with increased maternal and neonatal complications. This study evaluates maternal and neonatal outcomes in triplet pregnancies to improve perinatal care strategies.
METHODS: This retrospective cohort study analyzed triplet pregnancies delivered at Zeynep Kamil Women and Children's Diseases Training and Research Hospital between August 2013 and February 2025. Data were collected from electronic medical records. Inclusion criteria were triplet pregnancies ≥20 weeks or birth weight >500 g. Maternal complications, chorionicity, and neonatal outcomes were assessed using IBM SPSS Statistics 23.0.
RESULTS: A total of 63 triplet pregnancies were included. The mean maternal age was 28.06±0.68 years. 61.9% of pregnancies were spontaneous, while 28.6% resulted from IVF. Trichorionic pregnancies accounted for 63.5% of cases. PIH (17.5%), GDM (12.7%), and ICP (6.4%) were the most common complications. The mean gestational age was 30.8 weeks, with 63.5% delivering before 34 weeks. NICU admission was required in 74.1% of neonates, and 18% experienced neonatal mortality.
DISCUSSION AND CONCLUSION: Triplet pregnancies carry significant risks due to preterm birth and low birth weight, increasing NICU admissions and perinatal mortality. Optimizing embryo transfer policies and perinatal care strategies is crucial. A multidisciplinary approach is essential to improve outcomes.

INTRODUCTION: Displaced proximal humerus fractures in pediatric patients are rare. Concepts such as remodeling potential, degree of deformity, and functional demands guide treatment decisions. The aim of this study is to compare the treatment outcomes between skeletally immature patients treated surgically and non-surgically for Neer-Horwitz type III–IV displaced proximal humerus fractures.
METHODS: A total of 52 skeletally immature patients under the age of 15 who were treated for displaced proximal humerus fractures between 2015 and 2021 were included. The patients were divided into two groups: those treated non-surgically (n=22) and those treated surgically (n=30). Radiological outcomes were evaluated by measuring fracture angulation at initial presentation, as well as at the 3rd and 12th months post-fracture. Functional outcomes were assessed using QuickDASH scores at the 3rd and 12th months.
RESULTS: Initial angulation was significantly higher in the surgical group compared to the non-surgical group (p=0.001). However, angulation at 3 months post-fracture was significantly lower in the surgical group (p=0.001). At 12 months, no significant difference was observed between the groups. Regarding functional outcomes, the mean QuickDASH scores at 3 months were significantly lower in the surgical group (p=0.001), indicating better early functional recovery. However, no significant difference was found between the groups at 12 months post-fracture.
DISCUSSION AND CONCLUSION: Although surgical treatment provided better radiological and functional outcomes in the early post-fracture period, long-term outcomes were similar between both groups. These findings suggest that treatment decisions for pediatric proximal humerus fractures should be individualized based on patient age, fracture displacement, and functional expectations. Both surgical and non-surgical treatments can yield satisfactory outcomes in the long term.

INTRODUCTION: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is widely used for sampling mediastinal and intraparenchymal lymph nodes. This study aims to determine the diagnostic sensitivity of EBUS-TBNA in tuberculosis (TB) diagnosis and to establish the optimal number of punctures required for accurate sampling.
METHODS: Patients who underwent EBUS-TBNA as the initial diagnostic procedure between August 2020 and October 2023 in the pulmonology clinic were retrospectively evaluated. The study included patients with pathological findings of granulomatous lymphadenitis and a confirmed TB diagnosis. Biopsy materials were analyzed for acid-fast bacilli (AFB), mycobacterial culture, PCR results, and pathology reports.
RESULTS: Among 595 patients who underwent EBUS-TBNA as their initial diagnostic procedure, 101 (16.9%) were diagnosed with TB. Of these, 72 patients (71.28%) were diagnosed directly via EBUS-TBNA, whereas additional bronchoscopic procedures were required for 29 patients (28.72%). The mean size of the sampled lymph nodes was 1.9±0.4 cm, with an average of 5.46 aspirations performed per lymph node. The prevalence of TB among patients who underwent EBUS-TBNA was 16.9%, and the sensitivity of EBUS-TBNA in diagnosing TB was 71.28%.
DISCUSSION AND CONCLUSION: EBUS-TBNA is a safe and effective method for diagnosing intrathoracic tuberculous lymphadenitis. An average of five punctures per lymph node provided an optimal sample size for microbiological evaluation, thereby enhancing diagnostic performance.

INTRODUCTION: Sonography is now one of the most widely utilized diagnostic methods for carpal tunnel syndrome (CTS) in clinical practice. The extensive use of sonography has made it necessary for clinicians to determine the relationship of these parameters with disease characteristics. The aim of this study was to examine the correlation between the clinical and electrodiagnostic characteristics of CTS patients and various sonographic measurements.
METHODS: Clinical and demographic variables, including hand dominance, symptom duration, and pain intensity, were documented. Neuropathic pain was investigated using the Self-Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS); symptom severity and functional status were assessed with the Boston Carpal Tunnel Questionnaire (BCTQ). Cross-sectional areas (CSA) of the median nerve at the maximum, tunnel inlet, outlet, and pronator quadratus levels were measured, and Δmax, Δinlet, and Δoutlet were calculated. The correlation between sonographic measurements and clinical and electrophysiological findings was examined.
RESULTS: Of the 46 participants, pain intensity was positively correlated with CSAinlet (r=0.293, p=0.046), Δmax (r=0.359, p=0.013), Δinlet (r=0.356, p=0.014), and Δoutlet (r=0.330, p=0.025). CSAoutlet (r=0.365, p=0.013) and Δoutlet (r=0.382, p=0.009) showed a positive correlation with neuropathic pain intensity. Sonographic parameters did not show a significant correlation with S-LANSS or BCTQ (p>0.05). A significant correlation was found between CSAmax and median motor distal latency (r=0.286, p=0.020) and sensory amplitude (r=−0.256, p=0.029).
DISCUSSION AND CONCLUSION: Different sonographic measurements represent different aspects of CTS; combining these data according to clinical needs will be useful in the management of these patients.

INTRODUCTION: Current guidelines on atrial fibrillation (AF) recommend prescribing oral anticoagulants (OACs) for high-risk patients. However, the rate of OAC prescriptions by emergency department (ED) physicians remains lower than expected. This study explores the barriers that prevent ED physicians from prescribing OACs at discharge for newly diagnosed AF patients.
METHODS: This qualitative case study included semi-structured interviews with 26 emergency medicine specialists and residents at a tertiary care hospital with 280,000 annual emergency visits. The interviews comprised 26 open-ended questions across three sections. Thematic analysis was used to identify factors influencing physician decision-making.
RESULTS: Inductive content analysis of the interviews revealed three key themes: (1) management of AF in the ED, (2) thromboprophylactic approach, and (3) opinions and recommendations. Physicians frequently consulted cardiologists for AF management. The primary barrier to prescribing OACs was concern over inadequate follow-up after discharge. Physicians emphasized the need for healthcare system revisions, particularly early cardiology outpatient follow-ups post-ED discharge and long-term monitoring by family physicians, to increase OAC prescription rates.
DISCUSSION AND CONCLUSION: The study highlights the need to clearly define the role of ED physicians in managing AF patients. A comprehensive improvement plan should address systemic barriers, establish a seamless diagnosis–treatment–prescription–follow-up chain, and enhance physician education. These measures could improve adherence to guidelines and optimize care for AF patients.

INTRODUCTION: Migraine is a common and disabling neurological disorder, often managed with pharmacological treatments such as eletriptan, a serotonin receptor agonist, and dexketoprofen, a nonsteroidal anti-inflammatory drug (NSAID). This study compared the clinical effectiveness and patient-reported outcomes of these two medications in female migraine patients.
METHODS: A total of 40 female migraine patients were divided into two treatment groups: 18 received dexketoprofen, and 22 received eletriptan. Clinical assessments included the Headache Impact Test-6 (HIT-6), Migraine Disability Assessment (MIDAS), Allodynia Questionnaire, and Visual Analog Scale (VAS). Correlations among these measures were analyzed within each group, and Fisher’s Z-test was used to compare correlation strengths.
RESULTS: The eletriptan group had significantly higher HIT-6 (p<0.001) and allodynia scores (p=0.002) than the dexketoprofen group. However, there were no significant differences in MIDAS and VAS scores between the groups. Correlation analysis showed a stronger association between HIT-6 and MIDAS in the eletriptan group (r=0.622) compared to the dexketoprofen group (r=0.491). HIT-6 and allodynia were significantly correlated in the dexketoprofen group, while HIT-6 and VAS were significantly correlated in the eletriptan group.
DISCUSSION AND CONCLUSION: These findings suggest that eletriptan may be more effective for severe migraines associated with central sensitization, while dexketoprofen may be more beneficial for mild to moderate migraine cases. Understanding these differences can help guide personalized migraine treatment strategies.

INTRODUCTION: The aim of this study was to investigate the adequacy of ultrasound-guided biopsies of thyroid nodules performed by a surgeon.
METHODS: The study included ultrasound-guided biopsies performed on 96 nodules in 71 patients between August 2021 and September 2024. The results were evaluated retrospectively.
RESULTS: A total of 96 nodules in 71 patients underwent ultrasound-guided 25-gauge needle thyroid biopsy. The diagnostic adequacy rate was 91.6% (88 nodules), and the non-diagnostic rate was 8.33% (8 nodules). Of the patients included in the study, 11 were male (15.5%) and 60 were female (84.5%) with a mean age of 47.04±14.76 years.
DISCUSSION AND CONCLUSION: Ultrasound-guided thyroid fine needle aspiration biopsy can be performed successfully by experienced and adequately trained surgeons. Biopsies performed by the surgeon have many benefits, such as time and cost savings. Therefore, we believe that providing ultrasonography training during surgical residency is important. In addition, the 25-gauge needle is a reliable option in terms of diagnostic accuracy.

INTRODUCTION: Artificial intelligence (AI) is revolutionizing medical education, with large language models (LLMs) such as ChatGPT-4 (OpenAI) and Google Gemini (Google AI) increasingly used as learning tools. This study examines ChatGPT-4 and Google Gemini’s accuracy in answering board-level psychiatry examination questions and classifying question difficulty.
METHODS: This cross-sectional study evaluated ChatGPT-4 and Google Gemini using 993 validated board-style psychiatry questions from BoardVitals. AI models were tested using standardized prompts, and their responses were analyzed for accuracy and difficulty classification.
RESULTS: Both ChatGPT-4 and Google Gemini demonstrated high accuracy, significantly surpassing the peer benchmark of 75.95% (p<0.001). No statistically significant difference was found between the models in overall accuracy (ChatGPT-4: 90.4%, Google Gemini: 90.8%; p=0.658). Both models exhibited only fair agreement with BoardVitals' difficulty categorizations, with ChatGPT-4 (κw=0.373) and Gemini (κw=0.30) frequently underestimating difficult questions.
DISCUSSION AND CONCLUSION: ChatGPT-4 and Google Gemini show high accuracy in answering psychiatry board-style questions, highlighting their potential as adjunctive tools in medical education. However, their limitations in higher-order reasoning and difficulty classification underscore the need for further refinement. Future research should explore AI integration into real-world clinical decision-making while ensuring human oversight to maintain reliability and ethical considerations.

INTRODUCTION: Knee osteoarthritis, marked by cartilage degeneration in the medial compartment, disrupts joint load balance and diminishes quality of life. Medial open-wedge high tibial osteotomy (MOWHTO) is a surgical procedure aimed at correcting these deformities. This study evaluates how different implant types used in MOWHTO affect the posterior tibial slope angle (PTSA), patellar height, and functional outcomes.
METHODS: Between 2017 and 2023, a retrospective study at Yeditepe University Kosuyolu Hospital analyzed 231 patients who underwent MOWHTO. Patients were categorized based on the implant type used: symmetric blocked plate (n=179), Puddu plate (n=26), and asymmetric blocked plate (n=26). The study evaluated pre- and postoperative parameters, including PTSA, hip-knee-ankle (HKA) angle, complication rates, and patient satisfaction. Statistical analyses involved paired t-tests for continuous variables, one-way ANOVA or Kruskal-Wallis tests for group comparisons, and chi-square tests for complication rates. The normality of data distribution was assessed using the Kolmogorov–Smirnov test for groups with n≥30 and the Shapiro–Wilk test for groups with n<30.
RESULTS: Postoperative changes in PTSA varied by implant type: the symmetric blocked plate group exhibited an average increase of +1.50°±0.85°, the Puddu plate group showed +1.90°±1.10°, and the asymmetric blocked plate group had a minimal change of +0.31°±0.65°. The mean operative time was 90.23±12.5 minutes, and the average hospital stay was 3.02±0.9 days. Patient satisfaction averaged 8.52±1.1 out of 10. Notably, the incidence of tibial plateau fractures was significantly higher in the asymmetric blocked plate group (15.38%, p=0.029).
DISCUSSION AND CONCLUSION: Implant types can significantly affect PTSA and surgical outcomes after MOWHTO. All symmetrical plates showed similar PTSA changes, whereas this change was lower in the asymmetrical blocked plate group. Implant selection and surgical planning are critical for optimization of surgical outcomes.

INTRODUCTION: Essential tremor (ET) is the most common movement disorder, and studies suggest that in addition to motor symptoms, there may also be non-motor symptoms. In this study, we aimed to investigate the clinical characteristics and the impact of disease severity on daily life in Turkish patients with ET.
METHODS: Thirty patients with ET and 30 gender-matched healthy controls were included. The Montreal Cognitive Assessment (MoCA), Pittsburgh Sleep Quality Index (PSQI), Non-Motor Symptoms Questionnaire (NMSQ), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were utilized to assess and compare psychiatric and cognitive status and sleep disturbances, and to investigate whether these symptoms are related to the severity of motor symptoms. Tremor severity was evaluated by the Fahn–Tolosa–Marin Tremor Rating Scale (FTM-TRS).
RESULTS: The average BDI, BAI, and NMSQ scores were significantly higher in the patient group (p<0.005). A positive correlation was observed between disease duration and PSQI, BAI, and NMSQ scores (p=0.028, p=0.041, p=0.047, respectively). FTM-TRS scores showed a negative correlation with MoCA and a positive correlation with PSQI, BDI, BAI, and NMSQ scores (p=0.005, p<0.001, p=0.005, p=0.004). The average MoCA score in patients over 45 years old was significantly lower (p=0.008).
DISCUSSION AND CONCLUSION: Our results indicated that non-motor symptoms such as anxiety, decreased sleep quality, and impaired cognitive functions accompanying ET significantly affect patients' quality of life. Therefore, evaluating and treating non-motor symptoms should be considered essential for the rehabilitation of patients with ET.

Parietal thrombus of the aorta can occur in any part of it and can be one of the main causes of distal embolism. Usually, their genesis is due to the presence of an undermined atherosclerotic plaque, on the basis of which adhesion of thrombotic masses occurs. Intimate dissection can also be a prognostic factor for aortic thrombosis. A 48-year-old female patient with a history of cancer was admitted to the general surgery clinic on 03.01.2022 for surgery because metastatic cancer was detected in the large intestine. The patient had abdominal pain for one month. Abdominal CT angio revealed FFT in the descending aorta. The general condition of the patient, who was in the postoperative period of hemi-colectomy, was good, and she was oriented. Many authors prefer anticoagulant therapy in combination with distal embolectomy or thrombectomy of the affected part of the aorta. Others find it appropriate to use only anticoagulant therapy, excluding any surgical intervention. The best strategy was defined in a meta-analysis by Z. Fayad, who argued that anticoagulant therapy should be started at the time of diagnosis, and he stated that surgical treatment is acceptable in patients with a low risk of postoperative complications and one or more presences.

Myasthenia gravis (MG) is an autoimmune disease of the neuromuscular junction caused by autoantibodies to acetylcholine receptor antibodies (AchRs). Patients with myasthenia gravis (MG) usually present with diffuse muscle weakness. Myasthenic weakness typically affects extraocular, bulbar, or proximal limb muscles. Clinical manifestations often begin in the eye muscles and are characterized by ptosis. When MG is isolated to ocular symptoms only, it is referred to as ocular myasthenia gravis (OMG). OMG can also present atypically, mimicking isolated cranial nerve palsies. A 21-year-old male patient with no significant medical history presented to the emergency department with complaints of diplopia, blurred vision, and headache. Neurological examination revealed bilateral outward gaze limitation. The patient, who had no history of chronic disease or regular medication use and had no special features in his family history, was diagnosed with myasthenia gravis after extensive tests. This case highlights that myasthenia gravis in young patients may present with atypical symptoms, deviating from the traditional manifestations, thus providing a valuable educational contribution to clinical practice.

Levonorgestrel-containing intrauterine systems (LNG-IUS) are widely used for contraception and the treatment of abnormal uterine bleeding. However, they can rarely lead to serious allergic reactions. This study aims to present a case of a 38-year-old woman who developed acute urticaria and angioedema two months after the insertion of an LNG-IUS and to synthesize similar cases reported in the literature. The patient's clinical findings, laboratory results, and treatment process were examined in detail. Allergic reactions associated with LNG-IUS and similar intrauterine devices were reviewed in the literature. Two months after LNG-IUS insertion for abnormal uterine bleeding, the patient developed widespread urticaria and facial angioedema. The urticarial lesions on the patient’s back and torso are presented in Figures 1 and 2. Despite daily treatment with 15 mg of oral methylprednisolone and 5 mg of desloratadine, her symptoms did not improve. The patient was evaluated by an allergist, and the removal of the LNG-IUS was recommended. Following the removal of the device, she responded to systemic therapy, and her symptoms completely disappeared within 15 days. Although acute urticaria and angioedema developing during LNG-IUS use are rare, clinicians should be aware of this potential adverse effect. In allergic reactions related to LNG-IUS, symptoms may resolve entirely with device removal and appropriate medical management.