INTRODUCTION: Studies comparing simultaneous bilateral total hip arthroplasty (simBTHA) and staged bilateral total hip arthroplasty (stgBTHA) using a lateral approach are rare. The aim of this study was to compare staged and simultaneous total hip arthroplasty surgeries performed with the lateral approach.
METHODS: In this study, 53 BTHA patients (106 cases) treated in our clinic between 2015 and 2022 were included. Of these patients, 21 received simBTHA and 32 received stgBTHA. The patients were divided into two groups: simBTHA and stgBTHA. The groups were evaluated in terms of periprosthetic fracture, blood transfusion rate, gender, age, Body Mass Index (BMI), ASA scores, operation time, and hospital stay. Functional outcomes and major complication rates were compared between the groups. The Harris Hip Score was used to assess functional outcomes.
RESULTS: Blood transfusion rates and hospital stay times were higher in the simBTHA group than in the stgBTHA group. Periprosthetic infection, pulmonary embolism, hematoma, mortality, and >10 mm leg length discrepancy were not found in either group. Harris scores of the simBTHA group and stgBTHA group were 94.3±6.5 and 92.3±5.9, respectively (p=0.203). The major complication observed was perioperative periprosthetic fracture (PPF) in 4 (7.6%) cases. The PPF rate was higher in the simBTHA group (14.2%) compared to the stgBTHA group (3.1%); however, this difference was not statistically significant (p=0.289). The blood transfusion rate was significantly higher in the simBTHA group than in the stgBTHA group (p=0.010).
DISCUSSION AND CONCLUSION: The main finding of this study is that simBTHA with a lateral approach is associated with increased blood transfusion requirements and periprosthetic fracture complications. Therefore, simultaneous BTHA via the lateral approach may not be preferable, especially in patients with increased perioperative risk.

INTRODUCTION: This study aimed to evaluate the prognostic utility of the albumin–bilirubin (ALBI) score in predicting right ventricular (RV) failure and postoperative outcomes in patients undergoing isolated coronary artery bypass grafting (CABG).
METHODS: A total of 265 patients who underwent elective isolated CABG between 2020 and 2024 at a single tertiary center were retrospectively analyzed. Patients were divided into two groups based on a preoperative ALBI cut-off value of -2.44. Preoperative, operative, and postoperative parameters were compared between groups. The primary outcome was postoperative RV failure. Secondary outcomes included in-hospital mortality, postoperative complications, and recovery metrics. Multivariate logistic regression was used to assess the independent association between ALBI and outcomes.
RESULTS: Patients with high ALBI scores (>-2.44) were significantly older and had worse preoperative profiles, including lower ejection fraction (p=0.003), higher CRP (p=0.017), bilirubin (p<0.001), and BUN (p=0.008). No statistically significant differences were observed in postoperative atrial fibrillation, ICU stay, mechanical ventilation time, reoperation, or mortality between groups. However, high ALBI scores were consistently associated with markers of frailty and systemic inflammation.
DISCUSSION AND CONCLUSION: While the ALBI score did not predict short-term postoperative complications or mortality in isolated CABG patients, it demonstrated strong correlations with known risk factors such as advanced age, hypoalbuminemia, and inflammation. ALBI may serve as a useful adjunct in preoperative risk assessment. Further prospective studies are needed to confirm its role in long-term outcome prediction.

INTRODUCTION: This study aimed to document the presence of cardiac arrhythmia in inpatient physical therapy and rehabilitation patients and to evaluate whether physical therapy and exercises cause an increase in cardiac arrhythmias.
METHODS: The study was conducted with patients hospitalized in the physical therapy and rehabilitation clinic due to any neuromusculoskeletal system disease between January 2022 and June 2022. Twenty-four-hour Holter recordings were performed before any treatment was initiated and again on the 21st day of hospitalization during treatment. Arrhythmias were then evaluated.
RESULTS: A total of 63 patients (mean age: 58±14.5 years; range, 22–86 years) were included. The frequency of supraventricular and ventricular premature beats was 65.1% and 50.8%, respectively, in the initial 24-hour Holter recordings. Ventricular bigeminy was detected in 11.1%, ventricular trigeminy in 11.1%, ventricular couplets in 15.9%, nonsustained ventricular tachycardia in 9.5%, >1000 ventricular premature beats in 9.5%, and sinus pauses over 1.8 seconds in 11% of patients. No statistically significant difference was observed between the first and second 24-hour Holter recordings regarding supraventricular and ventricular arrhythmias.
DISCUSSION AND CONCLUSION: The incidence of arrhythmia in inpatient physical therapy and rehabilitation patients is higher than in the general healthy population. Although the frequency of arrhythmia did not increase during the treatments in our study population, meticulous follow-up for cardiac symptoms and signs is recommended, considering the high risk of cardiovascular disease in this patient group.

INTRODUCTION: This study aimed to compare the morphology of the fossa navicularis (FN) in patients with Chiari type I malformation (CIM) and healthy subjects.
METHODS: Radiologic views of 50 CIM patients (21 men/29 women) with a mean age of 26.93±16.03 years and 50 healthy subjects (29 men/21 women) with a mean age of 33.13±21.40 years were included in this computed tomography study. The presence or absence of FN was noted, and the depth (FN-D), width (FN-W), and length (FN-L) of FN, as well as the clivus length (CL), were measured.
RESULTS: FN was observed in 14 CIM patients (28%) and in eight controls (16%). In CIM patients, FN-L, FN-W, FN-D, and CL were measured as 3.62±1.64 mm, 4.91±1.31 mm, 2.71±1.06 mm, and 43.45±5.62 mm, respectively. In controls, FN-L, FN-W, FN-D, and CL were measured as 4.95±1.18 mm, 3.42±0.97 mm, 1.98±1.22 mm, and 48.01±3.51 mm, respectively. CIM subjects had greater FN-W (p=0.008) but smaller CL (p=0.042). FN-L (p=0.059) and FN-D (p=0.070) were similar between the groups. In CIM patients, all parameters were similar between sexes. In controls, men had greater FN-L compared to women (p=0.029).
DISCUSSION AND CONCLUSION: CIM patients had greater FN-W compared to controls. FN incidence was not affected by CIM. These findings may help clinicians better understand clivus anatomy in CIM patients.

INTRODUCTION: Obesity has been identified as a key risk factor for coronary artery bypass grafting (CABG) surgery. This study examines the short-term effects of obesity on clinical outcomes and mortality following CABG.
METHODS: A total of 216 CABG patients were recruited and categorized into two groups according to body mass index (BMI): ≥35 kg/m² and <35 kg/m². Preoperative data included age, sex, height, weight, EuroSCORE II, diabetes mellitus (DM), hyperlipidemia (HL), chronic obstructive pulmonary disease (COPD), ejection fraction (EF), and smoking status. Postoperative outcomes included intubation time, intensive care unit (ICU) stay, wound complications, sternal separation, atrial fibrillation (AF), cerebrovascular disease (CVD), pleural effusion (PE), mortality, and reoperation.
RESULTS: Patients with BMI ≥35 kg/m² had higher rates of DM, hypertension, HL, COPD, smoking, and EuroSCORE II scores, while EF scores were lower. In this group, the durations of intubation, ICU stay, and hospital stay were longer; wound complications, sternal separation, atrial fibrillation, and pulmonary embolism were more frequent. Obesity was identified as an independent risk factor for prolonged ICU stay (OR: 5.16; 95% CI: 1.39–19.17; p=0.014). No significant difference in mortality rates was observed between the two groups.
DISCUSSION AND CONCLUSION: Although early mortality is not affected in obese patients with BMI ≥35 kg/m², the durations of intubation, ICU stay, and hospital stay are prolonged; wound healing problems, sternal separation, AF, and PE incidence are increased.

INTRODUCTION: To evaluate the frequency of bladder and bowel dysfunction (BBD), functional constipation, and lower urinary tract symptoms in pediatric patients undergoing outpatient surgical procedures.
METHODS: This prospective study included 100 children aged 5–18 years who were scheduled for circumcision, inguinal or umbilical hernia repair, or orchiopexy between August and December 2024. Bowel dysfunction was assessed using the Rome IV criteria, and urinary symptoms were evaluated with the Voiding and Bowel Dysfunction Symptom Score (VBDS). Patients with chronic diseases or previous urological/anorectal surgery were excluded.
RESULTS: The mean age was 7.22±2.90 years, and 97% of patients were male. At least one lower urinary tract symptom was present in 47% of patients. VBDS scores ≥7 were detected in 18% of participants, but only 5% met the Rome IV criteria for functional constipation. The most common symptom was stool-holding behavior (44%), while only 2% had fecal incontinence. BBD was diagnosed in one patient (1%).
DISCUSSION AND CONCLUSION: Although the formal diagnosis of BBD was rare, urinary and bowel-related symptoms were common. Early identification and combined evaluation of urinary and bowel functions are essential for timely intervention and to prevent potential complications.

INTRODUCTION: To evaluate the correlation between the Routine Assessment of Patient Index Data 3 (RAPID3), derived from the Multidimensional Health Assessment Questionnaire (MDHAQ), and the commonly used indices Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) in patients with Ankylosing Spondylitis (AS).
METHODS: A total of 100 patients diagnosed with AS who attended our outpatient clinic between May 18 and September 30, 2009, were enrolled. All patients completed the BASDAI, BASFI, and MDHAQ questionnaires. RAPID3 was calculated using the pain, patient global assessment, and function subscales of MDHAQ. Spearman correlation analysis was used for statistical evaluation.
RESULTS: The mean age was 30±10.9 years, and 69% of the participants were male. The mean disease duration was 5.0±6.7 years. Average BASDAI, BASFI, and RAPID3 scores were 4.93±2.5, 3.94±2.5, and 13.27±7.0, respectively. RAPID3 was strongly correlated with both BASDAI and BASFI (r=0.77 and r=0.72; p<0.001).
DISCUSSION AND CONCLUSION: RAPID3, based solely on patient-reported measures, shows strong correlation with established AS indices and can be considered a practical alternative for clinical monitoring in routine care.

INTRODUCTION: Supraventricular tachycardia (SVT) is the most prevalent arrhythmia among young adults. With the rapid advancement of artificial intelligence technologies, natural language processing models (NLPMs) such as ChatGPT, Gemini, and Bing Chat are becoming increasingly widespread in the field of medicine. We aim to assess the precision and consistency of responses produced by ChatGPT-4o, Gemini, and Bing Chat to frequently asked questions regarding SVT.
METHODS: A list of fifty commonly asked questions regarding SVT was inquired twice, with a one-week interval, to ChatGPT-4o, Gemini, and Bing Chat. Two cardiologists assessed the responses from each NLPM without knowledge of each other’s evaluations. The content was rated using the following scale: totally correct (1), incomplete (2), and incorrect (3).
RESULTS: Most of the responses from all models were rated as either ‘totally correct’, ‘incomplete’, or ‘incorrect’. Even though ChatGPT-4o did not generate any ‘incorrect’ answers, Bing Chat and Gemini produced some incorrect responses. Regarding the accuracy of responses, ChatGPT achieved a score of 92%, Gemini obtained 70%, and Bing Chat reached 58%. ChatGPT-4o also achieved the highest ‘reproducibility’ score at 90%, followed by Gemini at 86%, and Bing Chat at 72%.
DISCUSSION AND CONCLUSION: Our study highlighted that ChatGPT-4o is capable of generating valuable answers to patients’ questions related to SVT. As NLPMs—especially ChatGPT-4o—continue to improve, they hold great potential for the management of chronic conditions like SVT.

INTRODUCTION: The influence of factors believed to affect stability, such as an intact calcar (lesser trochanter), on surgical outcomes in intertrochanteric femur fractures remains debated. This retrospective study aims to clinically and radiologically assess how calcar intactness impacts treatment success and complication risk in patients aged 65–85 years treated with proximal femoral nailing (PFN).
METHODS: We retrospectively evaluated 34 patients aged 65–85 years with intertrochanteric femur fractures treated by PFN at our institution who had complete documentation. Based on preoperative radiographs, patients were assigned to either the intact-calcar group (n=16) or the calcar-fractured group (n=18). We collected demographic, clinical, and radiological data, including age, sex, smoking status, preoperative delay, intensive care requirement, hemoglobin/hematocrit levels, varus alignment, tip-apex distance, lateral cortex integrity, lag screw migration and position, bone resorption, surgical failure (revision/nonunion), and time to union.
RESULTS: The mean age was 77.8±7.5 years in the intact calcar group and 82.7±7.9 years in the calcar-fractured group (p=0.073). Preoperative delay was significantly longer in the calcar-fractured group, averaging 6.7±4.6 days compared to 3.8±1.6 days in the intact calcar group (p=0.02). Rates of varus alignment and tip–apex distance were similar across both groups (p>0.05), and lateral cortex integrity was preserved in approximately 94% of cases. Lag screw migration occurred in 25% of the intact calcar group and 55.6% of the calcar-fractured group (p=0.092), while bone resorption rates were 43.8% and 77.8%, respectively (p=0.076); neither reached statistical significance. Time to union was comparable—100.9±34.7 days for the intact calcar group and 103.4±26 days for the calcar-fractured group (p=0.812)—as were surgical failure rates (p>0.05).
DISCUSSION AND CONCLUSION: Despite a higher risk of mechanical complications from the loss of posteromedial support in calcar-fractured intertrochanteric fractures, precise anatomic reduction, preservation of lateral cortex integrity, and accurate lag-screw placement can achieve union and low failure rates similar to those of stable intertrochanteric fractures with an intact calcar.

INTRODUCTION: Smoking is a major public health concern worldwide. However, smoking cessation significantly reduces the negative outcomes associated with tobacco use. Therefore, smoking cessation treatments play a crucial role in public health. The two primary approaches to smoking cessation are psychotherapy and pharmacotherapy. In this study, we aim to share our experience with cytisine-based smoking cessation treatment in our outpatient clinic, which has recently been introduced in our country.
METHODS: This is a retrospective cohort study conducted on individuals presenting to the Smoking Cessation Outpatient Clinic of Balýkesir Atatürk City Hospital between June 1, 2024, and December 31, 2024. Patients received cytisine treatment for one month, and their demographic data, smoking cessation status, and any reported side effects were recorded.
RESULTS: A total of 754 patients presented to the Smoking Cessation Outpatient Clinic during the study period. After applying the exclusion criteria, the final study population included 557 patients. The smoking cessation rate among participants was 55.3% (n=308). Additionally, 124 out of 557 patients (22.3%) reported experiencing at least one side effect, with a total of 158 side effects recorded. Smoking cessation success was higher among patients who did not experience side effects.
DISCUSSION AND CONCLUSION: For a drug to be deemed appropriate for clinical use, it must be both effective and have minimal side effects. Previous studies have demonstrated the efficacy of cytisine, and its side-effect profile has been well documented in the literature. Our findings indicate that data from our country are generally consistent with existing literature. In our study, the most commonly reported side effects were nausea, dry mouth, and insomnia. We shared our experience with the use of cytisine, which has been recently introduced in our country. Our findings indicate that cytisine is effective in smoking cessation and is associated with mild, tolerable side effects.

INTRODUCTION: Adolescent pregnancies, which directly influence adolescent health, are considered high-risk pregnancies due to poor maternal and fetal outcomes. In this study, we aimed to investigate the effects of adolescent pregnancies, which are a global problem, on early newborn health and to raise awareness about adolescent pregnancies.
METHODS: This study was designed as a retrospective, cross-sectional, single-center study. Newborns of 94 adolescent mothers aged 10–19 who gave birth between January 2021 and January 2022 were included in the study. Newborns of 106 non-adolescent (young adult) mothers aged 20–24 who gave birth during the same period were included in the control group. Anthropometric measurements, demographic data, early morbidity and mortality rates, diagnostic information, and hospitalization data of the babies in both groups were obtained retrospectively from electronic file records.
RESULTS: During the study period, 6.62% (n=94) of 1419 women who gave birth in our hospital were in the adolescent age group, and 7.47% (n=106) were in the young adult age group. Gestational weeks at birth, rates of hospitalization in the neonatal unit, Apgar scores, and mortality and morbidity rates of infants of adolescent mothers were similar to those of young adult mothers (p>0.05). The median birth weight of infants of adolescent mothers was 3060 g (645–4085), which was significantly lower than the 3210 g (688–4410) median birth weight of infants of non-adolescent mothers (p=0.003). The frequency of small for gestational age (SGA) infants born below the 10th percentile for gestational age was 14.9% in adolescent mothers, while only 3% of infants of young adult mothers were born SGA (p=0.003).
DISCUSSION AND CONCLUSION: Adolescent pregnancies are considered high-risk pregnancies. In terms of maternal and neonatal health, close follow-up of adolescent pregnancies in both the early and late periods can help prevent possible complications.

INTRODUCTION: Acute right lower quadrant pain is a common symptom in emergency departments. The most common etiology is acute appendicitis, while other causes may be overlooked. Acute right-sided colonic diverticulitis is one of them. It is usually seen in young male patients. Ultrasonography (USG) and computed tomography (CT) are used for radiologic diagnosis. The aim of this study was to investigate the diagnosis, treatment, and surgical management of right-sided colonic diverticulitis.
METHODS: Patients hospitalized in our clinic between 2018 and 2022 with a diagnosis of right-sided colonic diverticulitis were retrospectively analyzed. Age, gender, WSES grade, surgical status, laboratory values, intravenous antibiotic therapies, length of hospitalization, and mortality were evaluated.
RESULTS: Between 2018 and 2022, a total of 20 patients were followed with acute right-sided colonic diverticulitis. Twelve patients were diagnosed by imaging and clinical examination, while 4 patients (20%) were operated on with a prediagnosis of acute appendicitis, and right-sided colonic diverticulitis was detected perioperatively. All patients diagnosed with acute right-sided colonic diverticulitis in the emergency department and hospitalized were managed conservatively and did not require surgery.
DISCUSSION AND CONCLUSION: In the differential diagnosis of right-sided colonic diverticulitis and acute appendicitis, physical examination and laboratory values are insufficient. Radiologic imaging, especially USG and CT, is essential. Following diagnosis, right-sided colonic diverticulitis can be effectively managed with conservative treatment. In our study, all patients with a radiologic diagnosis were followed conservatively and did not require percutaneous drainage or surgery.

INTRODUCTION: Inflammatory indices derived from routine blood tests, such as the systemic inflammatory response index (SIRI), the derived neutrophil-to-lymphocyte ratio (dNLR), the neutrophil-to-HDL ratio (NHR), and the monocyte-to-HDL ratio (MHR), have gained interest as potential cardiovascular biomarkers. This study aimed to establish reference intervals for these indices in healthy adults and assess their clinical relevance in acute myocardial infarction (AMI), heart failure (HF), and heart failure following AMI.
METHODS: This retrospective study included adult patients from the Istanbul Faculty of Medicine Central Laboratory. Reference intervals were established using the Bhattacharya method, and odds ratios (ORs) were calculated to assess the association between elevated inflammatory indices and cardiovascular conditions.
RESULTS: The upper reference limits (URLs) for the inflammatory indices were as follows: dNLR≤2.57, MHR≤0.49, NHR≤3.62, and SIRI≤1.24. Elevated levels of SIRI, MHR, and NHR were significantly associated with increased odds of AMI (ORs of 3.43, 3.44, and 2.93, respectively). In HF patients, all four indices were significantly elevated, with MHR (OR=7.82) and SIRI (OR=5.52) showing the strongest associations. In the AMI+HF group, SIRI (OR=2.38) and dNLR (OR=2.63) were significantly elevated.
DISCUSSION AND CONCLUSION: This study demonstrates the clinical relevance of CBC-derived inflammatory indices, particularly SIRI and MHR, in distinguishing patients with coexisting myocardial infarction and heart failure. Our robust approach, including healthy controls and precise determination of reference intervals, highlights the potential utility of these markers for enhanced risk stratification and management in cardiovascular disease.

INTRODUCTION: The aim of this study was to evaluate the microbiological diagnostic results of Neisseria gonorrhoeae (N. gonorrhoeae) infections, assess the frequency of empirical antibiotic usage, and determine compliance with current treatment guidelines among patients presenting with urethral discharge.
METHODS: A retrospective analysis was conducted among 387 patients admitted with suspected gonococcal infection between June 2014 and February 2018 to the Departments of Infectious Diseases, Urology, and Gynecology at Ankara Numune Training and Research Hospital. Demographic characteristics, microscopy and culture results, treatment protocols, and antibiotic prescriptions were obtained from hospital information systems. The chi-square test was applied for statistical analysis, and p<0.05 was considered statistically significant.
RESULTS: A total of 387 patients with a mean age of 32.6±10.8 years were included; 99.9% (n=386) were male and 0.1% (n=1) were female. Among these patients, 73.9% (n=286) were referred from the Urology outpatient clinic, whereas 26.1% (n=101) were from Infectious Diseases. The overall isolation rate of N. gonorrhoeae was 13.7% (n=53). Among patients who received empirical antibiotic therapy (n=79), gonococcal culture positivity was 11.4% (n=9), whereas positivity was 14.3% (n=44) among those who did not receive empirical treatment (n=308) (p>0.05). Antibiotics were prescribed based on culture results to 88.1% (n=341) of patients. The most frequently prescribed antibiotic regimen was a combination of cephalosporin+doxycycline+azithromycin (19.1%). Among the 53 patients with gonococcal growth, antibiotics were prescribed to 96.2% (n=51), yet the recommended standard regimen of cephalosporin+azithromycin was administered to only 7.5% (n=4).
DISCUSSION AND CONCLUSION: This study revealed that culture and antimicrobial susceptibility testing were inadequately utilized in the diagnosis and management of gonococcal infections, and empirical antibiotic therapy demonstrated poor compliance with current guidelines. Increased clinical awareness and strict adherence to updated guidelines are required for the accurate diagnosis and effective treatment of gonococcal infections.

Lipoid proteinosis (LP), also referred to as Urbach-Wiethe disease or hyalinosis cutis et mucosae, is a rare autosomal recessive storage disorder. It is characterized by the deposition of amorphous hyaline material in the mucous membranes, skin, brain, and internal organs. The symptoms of lipoid proteinosis are variable but typically begin with hoarseness in the newborn period. Skin-related symptoms usually appear during childhood and include acneiform scars, wart-like papules, and plaques. The clinical presentation of this condition varies between individuals, which can make diagnosis difficult and often requires a detailed dermatological examination.

Hemophilia is a congenital disorder of the blood coagulation system linked to the X chromosome and manifested by a deficiency of blood coagulation factor VIII (hemophilia type A) or factor IX (hemophilia type B). We present our clinical case involving the combination of myocardial infarction (MI) and hemophilia type A. A 42-year-old man with a known history of hemophilia A was admitted to the emergency department of an external center with complaints of pressing chest pain radiating to the left arm. He was treated with 300 mg of ecopyrine and 300 mg of Plavix, and a significant increase in troponin level was detected. The patient was then transferred to the emergency department of our hospital.
In the emergency department, he was evaluated by cardiology. The control troponin level was 72, and the patient was admitted to the coronary intensive care unit with a preliminary diagnosis of non-ST elevation myocardial infarction (NSTEMI). Coronary angiography was planned. Internal medicine and hematology clinics were consulted to adjust anticoagulant therapy for the procedure, and dual antiplatelet therapy (ecopyrine + Plavix) was administered.
After coronary angiography, the patient was evaluated by a joint council of cardiovascular surgery and cardiology, and coronary bypass surgery was recommended. He was transferred to the cardiovascular surgery unit for preoperative preparation. During this period, he was also evaluated by the hematology clinic due to his hemophilia A history. Based on the clinic's recommendation, specific factor VIII (FVIII) therapy was administered pre- and postoperatively, along with daily aPTT monitoring.
No complications occurred during surgery. Cardiopulmonary bypass was initiated once the activated clotting time (ACT) exceeded 450. No bleeding complications were observed in the postoperative period. The patient was successfully discharged.