INTRODUCTION: To investigate the effect of attachment training on maternal–infant attachment.
METHODS: A quasi-experimental, prospective study with a pre- and post-test design was conducted among primiparous pregnant women who visited a tertiary maternity hospital between August 2023 and January 2024 to assess maternal–infant attachment and attachment knowledge level before and after the introduction of online attachment education. Participants were recruited using convenience sampling and allocated to either the experimental group (n=30) or the control group (n=30). The first phase of the study was conducted by administering a set of questions related to sociodemographic characteristics and completing the attachment knowledge questionnaire, followed by online attachment education. After the intervention, pregnant women were assessed using the attachment knowledge questionnaire and the Maternal Attachment Inventory (MAI).
RESULTS: There was a significant increase in pregnant women’s knowledge regarding maternal–infant attachment (p<0.001). The median MAI scores were 100 (range: 88–104) in the experimental group and 98.5 (range: 87–104) in the control group. Although the experimental group had slightly higher MAI scores, the difference between the groups did not reach statistical significance (p=0.103). However, this borderline value may indicate a potential trend toward improved maternal–infant attachment in the intervention group, which could be clinically relevant and warrants further investigation with larger samples.
DISCUSSION AND CONCLUSION: The findings of the study suggest that attachment education may be beneficial in increasing knowledge of maternal–infant attachment.

INTRODUCTION: Non-small cell lung cancer (NSCLC) remains a leading cause of cancer-related mortality worldwide. Early and accurate diagnosis is essential for improving clinical outcomes. BRAF, a key kinase in the MAPK pathway, and PTEN, a negative regulator of PI3K/Akt signaling, are both implicated in tumorigenesis. This pilot study aimed to evaluate the diagnostic potential of serum BRAF and PTEN protein levels in patients with NSCLC.
METHODS: In this cross-sectional pilot study, 60 histologically confirmed NSCLC patients and 20 age- and sex-matched healthy controls were recruited from Istanbul University Oncology Institution. Peripheral blood samples were collected prior to any systemic therapy. Serum BRAF and PTEN concentrations were measured using commercially available ELISA kits (CUSABIO). Statistical analyses included group comparisons, Pearson correlation, and receiver operating characteristic (ROC) curve analysis.
RESULTS: Median serum BRAF and PTEN levels were significantly higher in NSCLC patients compared with controls (p=0.001 for both). A strong positive correlation between BRAF and PTEN was observed (r=0.681, p<0.001). ROC analysis indicated that PTEN (AUC=0.830) demonstrated superior diagnostic accuracy compared with BRAF (AUC=0.765).
DISCUSSION AND CONCLUSION: This pilot study, the first to analyze serum BRAF and PTEN simultaneously in NSCLC, suggests that PTEN may serve as a promising noninvasive diagnostic biomarker. These preliminary results warrant validation in larger, multicenter studies to confirm diagnostic performance and explore integration into clinical workflows.

INTRODUCTION: The prevalence of silent hypoxia in patients with COVID-19 has been reported as 20–50%. There is a need for specific field tests to detect silent hypoxia. This comparative study aimed to investigate whether the 2-minute walk test (2MWT), 40-step walk test (40SWT), and 1-minute sit-to-stand test (1MSTST) can be used as alternatives to the 6-minute walk test (6MWT) in the evaluation of silent hypoxia and functional capacity in COVID-19 patients.
METHODS: Of 135 patients in the COVID-19 ward, 30 participants with moderate-to-severe COVID-19 who met the inclusion criteria were included in the study. Participants performed the 6MWT, 2MWT, 40SWT, and 1MSTST in that order. In addition to performance results, the participants’ heart rate, respiratory rate, saturation levels, and perceived dyspnea and fatigue levels were recorded before and immediately after each test.
RESULTS: Saturation values measured during the 6MWT were positively correlated with those in the 2MWT (r=0.793, p<0.001), 40SWT (r=0.554, p=0.001), and 1MSTST (r=0.806, p<0.001). In terms of performance, there was a moderate positive correlation between 6MWT and 2MWT distances (r=0.542, p=0.002) and a moderate negative correlation between 6MWT distance and 40SWT time (r=-0.605, p<0.001).
DISCUSSION AND CONCLUSION: The 2MWT, 40SWT, and 1MSTST could be used in the clinic as alternatives to the 6MWT in the assessment of silent hypoxia, while the 2MWT and 40SWT could also be used as alternatives for determining functional capacity in patients with acute COVID-19.

INTRODUCTION: Chronic shoulder pain (CSP), commonly caused by rotator cuff disorders, adhesive capsulitis, instability, or arthritis, results in significant functional impairment, psychological distress, and decreased quality of life. Despite the use of physical therapy and intra-articular injections, treatment outcomes may be inadequate, necessitating alternative or adjunctive therapies. This study aimed to assess the efficacy of mesotherapy compared with corticosteroid injections in reducing pain, improving function, and increasing range of motion (ROM) in patients with CSP.
METHODS: In this prospective, single-blind, randomized clinical trial, patients were allocated to either the mesotherapy group (Group 1) or the steroid injection group (Group 2). Group 1 underwent three weekly mesotherapy sessions targeting the shoulder, whereas Group 2 received a single intra-articular injection of 20mg triamcinolone hexacetonide. Pain intensity (Visual Analog Scale [VAS] at rest, during activity, and at night), functional disability (Shoulder Disability Questionnaire [SDQ]), and passive shoulder ROM were measured at baseline, 30 minutes, and 4 weeks post-treatment.
RESULTS: Both groups experienced significant improvements in VAS, SDQ, and ROM scores (p<0.05). However, the mesotherapy group demonstrated significantly greater improvement across most clinical parameters than the steroid group (p<0.05).
DISCUSSION AND CONCLUSION: Mesotherapy is an effective treatment for chronic shoulder pain, offering comparable or superior benefits to corticosteroid injections. It should be considered a valid nonsurgical treatment alternative tailored to patient needs.

INTRODUCTION: This study aimed to evaluate the clinical characteristics, intensive care processes, complications, and prognostic indicators in pediatric drowning cases.
METHODS: A retrospective review was conducted of 28 patients admitted to a tertiary pediatric intensive care unit due to drowning between January 2016 and January 2024. Patients were categorized according to saltwater or freshwater drowning. Demographic data, clinical findings, laboratory values, treatment interventions, and complications were analyzed. Additionally, a subgroup analysis was performed comparing patients with poor outcomes (mortality and/or neurological sequelae) and those with good outcomes.
RESULTS: Among the patients, 78.6% were male. The median submersion time was 6.8 minutes. Cardiac arrest was observed in 32.1% of cases. ARDS and mortality rates were higher in the saltwater group. Subgroup analysis revealed statistically significant associations between poor outcomes and longer CPR duration, lower GCS scores, higher frequency of ARDS and cardiac arrest, lower pH, and more negative base excess (p<0.05).
DISCUSSION AND CONCLUSION: This study identifies key clinical parameters associated with poor prognosis in pediatric drowning. These findings are hypothesis-generating and should be supported by larger, multicenter, prospective studies evaluating survival and neurological recovery after drowning, particularly in saltwater drowning cases.

INTRODUCTION: To evaluate the impact of preoperative frailty, assessed by the Edmonton Frailty Score (EFS), and serum vitamin D and B12 levels on postoperative outcomes in elderly patients undergoing elective coronary artery bypass grafting (CABG).
METHODS: This retrospective cohort study included 62 patients aged ≥65 years who underwent elective CABG between June 2023 and December 2024. Demographic data, comorbidities, EFS, serum vitamin D (25-hydroxyvitamin D), and B12 levels were recorded. Postoperative outcomes included duration of mechanical ventilation, intensive care unit (ICU) stay, sternal dehiscence, wound infection, atrial fibrillation, pneumonia, and mortality. Associations among variables were analyzed using parametric and nonparametric tests and correspondence analysis.
RESULTS: The cohort consisted of 44 males (71%) with a mean age of 71.6±3.8 years. Vitamin D deficiency (<20ng/mL) was observed in 75% of males and 72% of females, while vitamin B12 deficiency (<200pg/mL) was identified in 18% of males and 22% of females. Lower vitamin D levels were significantly associated with prolonged mechanical ventilation and an increased risk of postoperative atrial fibrillation (p=0.013). No significant correlation was found for vitamin B12 levels. Higher EFS scores correlated positively with ICU stay, sternal dehiscence, wound infection, pneumonia, mortality, and longer mechanical ventilation times. Two in-hospital deaths occurred, both in patients with EFS ≥7 and vitamin D deficiency.
DISCUSSION AND CONCLUSION: Preoperative frailty and vitamin D deficiency are strong predictors of adverse postoperative outcomes in elderly patients undergoing CABG. Incorporating frailty and vitamin D assessment into preoperative evaluation may improve risk stratification and perioperative management, potentially reducing complications and improving outcomes.

INTRODUCTION: The importance of illness perception is valid in diseases possessing different patterns of pain, including fibromyalgia (FM), rheumatoid arthritis (RA), osteoarthritis (OA), and neuropathic pain (NP). The aim of this observational study is to investigate the comparison of illness perception using the Illness Perception Questionnaire Revised (IPQ-R) and its correlation with the Beck Depression Inventory and Visual Analogue Scale (VAS) score in FM, RA, OA, and NP patients.
METHODS: A total of 30 RA, 29 OA, 29 FM, and 21 NP patients were enrolled in this cross-sectional study between May 2017 and February 2018. The patients’ demographic characteristics, comorbidities, duration of the disease, smoking status, VAS score, Beck Depression Inventory, and IPQ-R were recorded. Illness perception was compared among these diseases, and the relationship between the Beck Depression Inventory, VAS score, and illness perception was evaluated.
RESULTS: The Beck Depression Inventory was notably higher in NP patients (p=0.032). The emotional representation subgroup of IPQ-R was positively correlated with the Beck Depression Inventory in RA patients (rho: 0.643, p<0.001). Treatment control items, illness coherence items, and emotional representations were correlated with the Beck Depression Inventory in OA patients (rho: -0.406, -0.402, 0.381; p=0.023, 0.025, 0.034 respectively.
DISCUSSION AND CONCLUSION: This evidence of the correlation between IPQ-R, VAS score, and Beck Depression Inventory suggests that more time should be allocated to explain the course of the disease to RA, OA, FM, and NP patients in order to increase both their illness perception and response to treatment.

INTRODUCTION: To compare the functional results obtained after treating the study groups comprising patients with patellar fractures who underwent modified anterior tension band (MATB) surgery with or without plaster cast application.
METHODS: Fractures with >3-mm displacement between the fracture fragments and a step-off of >2 mm on the joint surface were surgically treated. Patients with patellar fractures who underwent MATB and were followed for at least 1 year were included in the study. The need for plaster cast application after surgery was decided based on the surgeon's preference. Of the 42 patients who did not receive plaster cast treatment (group 1), 28 were male and 14 were female, whereas of the 48 patients who received plaster cast treatment (group 2), 31 were male and 17 were female. Functional results were evaluated according to the Lysholm and Bostman scores.
RESULTS: In group 1, the mean Lysholm score was 89.31±9.44, and the mean Bostman score was 25.83±3.81; in group 2, the mean Lysholm score was 90.67±9.2, and the mean Bostman score was 26.9±4.17. When Lysholm and Bostman scores were compared, the difference was not statistically significant (p>0.05). Bone union was achieved in all patients, and no statistically significant differences were found between the groups in terms of the incidence of complications (p>0.05).
DISCUSSION AND CONCLUSION: We found that plaster cast application after MATB had no effect on functional results.

INTRODUCTION: The neutrophil/lymphocyte (NLR), platelet/lymphocyte (PLR), and monocyte/lymphocyte (MLR) ratios are markers indicating the severity of inflammation that can be obtained from the complete blood count (CBC). We examined the relationships between these inflammatory markers (C-reactive protein [CRP], NLR, PLR, and MLR) and disease extent, as evidenced by chest radiography, bacterial burden, and hospital mortality, in patients hospitalized with a bacteriologically confirmed pulmonary tuberculosis (TB) diagnosis.
METHODS: The study included 265 patients diagnosed with pulmonary TB without multidrug resistance. CBC and biochemical values were recorded before TB treatment. The disease was defined as mild, moderate, or severe according to the number and location of cavities. The smear grade was used to determine the bacterial burden at the time of diagnosis, and patients were classified into two groups (grade≥3 or <3) depending on the number of bacilli detected in sputum smear microscopy analysis.
RESULTS: A comparison of the NLR (7.32±6.26 vs. 5.14±4.87), PLR (349.61±241.49 vs. 244.52±167.4), and MLR (0.78±0.43 vs. 0.61±0.34) between patients with severe and moderate/mild disease revealed significantly higher values in patients with severe disease (p<0.001). These values were not significantly correlated with the smear grade (p>0.05). Hospital mortality was observed in nine patients (3%), and the NLR and CRP levels had significant relationships with mortality (p<0.05).
DISCUSSION AND CONCLUSION: NLR, PLR, and MLR obtained from the complete blood count, which is a simple and inexpensive method at the time of diagnosis, were found to be associated with the radiological extent of the disease. In addition, these markers may be useful in the early identification of severe disease.

INTRODUCTION: Familial renal glucosuria (FRG) is a genetic disorder characterized by increased renal glucose excretion despite normal plasma glucose levels. This condition generally has a benign course and is caused by mutations in the SLC5A2 gene, which impair the function of the SGLT2 protein responsible for glucose reabsorption in the kidneys.
METHODS: This study aimed to examine the genetic and clinical characteristics of eight patients diagnosed with FRG who presented to the pediatric department of Düzce University Research and Application Hospital between 2015 and 2021.
RESULTS: Genetic analyses revealed different mutations in the SLC5A2 gene, and their relationships with clinical symptoms were evaluated. The most common symptoms were sudden hunger, polydipsia, and polyuria, with a higher frequency of polyuria and polydipsia observed in male patients.
DISCUSSION AND CONCLUSION: This study emphasizes that the symptomatic course and clinical manifestations of FRG may vary depending on factors such as sex and the type of genetic mutation. Additionally, the findings provide insights into the potential side effects of SGLT2 inhibitors. However, the limitations of the study include the small sample size and its retrospective design. Therefore, future studies with larger sample sizes are needed to improve the accuracy and reliability of these findings.

INTRODUCTION: Healthcare workers frequently encounter occupational risks through direct patient care, invasive procedures, and demanding work environments. Such accidents not only threaten employee well-being but may also disrupt service delivery. This study aimed to describe the characteristics of occupational accidents reported in a tertiary hospital and to examine contributing factors.
METHODS: This retrospective, descriptive study included occupational accidents reported by healthcare staff between January 2018 and May 2021. Records were reviewed to obtain information on demographics, professional roles, locations and types of accidents, the timing of incidents (08: 00–17: 00 vs. outside these hours), and whether labor loss occurred. Data were analyzed using the independent t-test and the chi-square test, with p<0.05 considered statistically significant.
RESULTS: A total of 663 occupational accidents were recorded, most involving female employees (56.6%). The mean age of affected individuals was 31.87±9.78 years. Nurses and midwives experienced the highest proportion of incidents (38.3%). Sharp-object and needlestick injuries were the most frequently reported accident type (63.2%), and more than half of all events occurred during routine working hours (55.0%, n=365). Labor loss was documented in 11.5% of employees (mean 5.30±5.37 days). Sharp-object injuries predominantly affected female workers, whereas male workers were more commonly exposed to battery and violence (p<0.001). Violence was reported most often in the emergency department, while sharp-object injuries occurred mainly in internal medicine units (p<0.001).
DISCUSSION AND CONCLUSION: Occupational accidents in healthcare settings remain a significant concern. The findings highlight the need to strengthen preventive measures, particularly for nurses and midwives and for employees working with sharp instruments during high-workload periods. Efforts to reduce workplace violence in emergency departments and to reinforce practical safety training may help protect healthcare workers and prevent avoidable loss of labor and productivity.

INTRODUCTION: To evaluate the effectiveness of mesotherapy in reducing pain intensity and improving upper limb function in patients with lateral epicondylitis.
METHODS: A retrospective cohort study was conducted between January 2024 and February 2025. Adults with lateral epicondylitis who completed a standardized mesotherapy protocol were included. Pain intensity was assessed using the Visual Analog Scale (VAS), and upper limb function was evaluated using the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire at baseline, immediately after treatment, and at the one-month follow-up. Nonparametric tests and robust regression analyses were employed to analyze outcome changes and predictors of response.
RESULTS: A total of 222 patients were included (mean age, 49.6±9.8 years; 58% female). Mean VAS scores improved from 7.08±1.13 at baseline to 5.9±1.4 post-treatment and 5.4±1.3 at follow-up (p<0.001). QuickDASH scores improved from 64.12±16.53 at baseline to 43.9±14.8 post-treatment and 34.0±13.9 at follow-up (p<0.001). Clinically meaningful pain reduction was achieved by 75.7% of patients, and 97.3% achieved functional improvement. Notably, higher body mass index was associated with attenuated response.
DISCUSSION AND CONCLUSION: Mesotherapy was associated with significant and sustained reductions in pain and functional disability among patients with lateral epicondylitis. These results suggest that mesotherapy is a promising minimally invasive therapeutic option, warranting confirmation through future randomized controlled trials.

INTRODUCTION: Breast cancer is the most common malignancy among women worldwide. Breast-conserving surgery (BCS) is the standard surgical treatment for patients with early-stage breast cancer. Fear of recurrence strongly influences surgical decision-making and significantly impacts the long-term quality of life in breast cancer survivors. The aim of this study was to investigate the independent prognostic factors associated with the risk of ipsilateral breast tumor recurrence (IBTR).
METHODS: A total of 1,388 female patients diagnosed with breast cancer and treated with breast-conserving surgery (BCS) at our hospital between January 2003 and December 2011 were retrospectively evaluated.
RESULTS: The median age of the patients was 50 years (range: 24–85). Mean overall survival was 68.2 months (SD±35.2), and mean disease-free survival was 64 months (SD±33.1). During follow-up, locoregional recurrence (LRR) occurred in 93 patients (6.7%): 67 had local (IBTR), 15 regional, and 11 both local and regional recurrences. Age, presence of lymphovascular invasion, surgical margin status, hormone receptor negativity, and high nuclear grade were significant predictors of recurrence (p<0.001). Recurrence rates rose from 3.6% with surgical margins ≥5 mm to 12.3% with margins <5 mm. Among patients with distant metastasis, 32.1% had LRR, and 42.3% of deaths were linked to LRR.
DISCUSSION AND CONCLUSION: IBTR remains a significant risk factor for breast cancer–related mortality. Special attention should be given to patients with high-risk prognostic factors, and careful evaluation of surgical margin status is of paramount importance.

INTRODUCTION: Urinary tract infections (UTIs) represent one of the most frequent infection-related reasons for outpatient encounters globally and are predominantly community-acquired, with Escherichia coli (E. coli) constituting the principal etiologic agent. Rising antimicrobial resistance in E. coli and the increasing frequency of complicated UTIs pose significant therapeutic challenges. This study aimed to determine the antimicrobial resistance profiles of E. coli isolates causing community-acquired UTIs in outpatients and to identify risk factors associated with the development of complicated UTIs.
METHODS: This retrospective study included adult patients who presented to a tertiary care hospital over a four-year period (between January 1, 2021, and December 31, 2024) with community-acquired UTIs caused by E. coli. Demographic characteristics, clinical features, comorbidities, microbiological data, and antimicrobial susceptibility results were reviewed. Antimicrobial resistance rates were calculated, and factors associated with complicated UTI were evaluated using univariate and multivariate logistic regression analyses.
RESULTS: A total of 414 patients were included, with a mean age of 49.7±18.3 years; 79.2% were female. The highest resistance rates of E. coli isolates were observed against ampicillin (51.9%), cefuroxime (37.7%), cefuroxime axetil (37.4%), and ciprofloxacin (33.6%). In multivariate logistic regression analysis, urolithiasis (Odds Ratio [OR]=2.67, 95% Confidence Interval [CI]=1.38–5.16, p=0.004) and the presence of a urinary catheter (OR=5.34, 95% CI=1.44–19.87, p=0.013) were identified as independent predictors of complicated UTI.
DISCUSSION AND CONCLUSION: High antimicrobial resistance rates emphasize the need for careful antimicrobial stewardship in community-acquired complicated UTIs. Our findings suggest that empirical use of fluoroquinolones may be inappropriate in this setting and that commonly preferred cephalosporins and ciprofloxacin should be used with caution. In addition, targeted evaluation and management of urolithiasis and routine reassessment of urinary catheter necessity may help reduce the burden of complicated UTIs.

Coronary artery anomalies are detected in 0.3–1.3% of patients undergoing angiography and in 1% of autopsy examinations. The origin of the left main coronary artery from the right coronary sinus is a rare condition, accounting for 1–3% of all coronary artery anomalies. This case presents the presence of a left main coronary artery originating from a single ostium in the right coronary sinus and includes a review of the literature. A 47-year-old male patient presented with chest pain and palpitations. His symptoms, which appeared with exertion, had worsened in recent days. Computed tomography (CT) angiography revealed that a single coronary artery originating from a single ostium in the right coronary sinus bifurcated into two branches after a short course, and the left main coronary artery passed in front of the pulmonary trunk. Coronary artery anomalies usually do not present symptoms and are often incidentally detected during coronary angiography. The origin of the left main coronary artery from the right coronary sinus is rare. In our case, the coronary artery originating from a single ostium in the right coronary sinus bifurcated into two branches after a short course. CT angiography should be used for the accurate diagnosis of such anomalies.

A large mass located in the posterior mediastinum was incidentally detected on thoracic computed tomography in a 21-year-old female patient who presented after an in-vehicle traffic accident. The localization of the mass was confirmed by magnetic resonance imaging. The tumor was completely excised, and the sixth rib was partially resected. Histopathological examination established the final diagnosis of intraosseous hemangioma. The patient was discharged without postoperative complications and has remained recurrence-free during 3 years of follow-up.

Undifferentiated pleomorphic sarcoma (UPS) is a rare, high-grade malignant mesenchymal tumor of the head and neck region. In this case report, we present a 34-year-old male patient who underwent surgical resection for a large UPS located on the right side of the neck, followed by reconstruction using a supraclavicular artery island flap (SCAIF). After evaluation of the mass through physical examination and imaging modalities (MRI, CT, and PET-CT), an incisional biopsy confirmed the diagnosis. Surgical management included excision of the mass and a modified radical neck dissection. The resulting large cutaneous defect was reconstructed using a SCAIF. The postoperative course was uneventful, and the patient was discharged on the 15th postoperative day. Histopathological examination confirmed the diagnosis of undifferentiated pleomorphic sarcoma, and the patient was subsequently treated with adjuvant radiotherapy and concurrent chemotherapy. This case highlights not only the diagnostic and therapeutic approach to UPS but also demonstrates that SCAIF is a reliable and effective option for the reconstruction of extensive soft tissue defects in the head and neck region.

Mitral valve surgery is traditionally performed under cardioplegic arrest with aortic cross-clamping. However, in selected high-risk or redo cases, on-pump beating heart mitral valve surgery may represent a valuable alternative strategy. We report two patients who underwent minimally invasive beating heart mitral valve interventions via right thoracotomy. The first patient was a 62-year-old male with severe mitral regurgitation and a mobile mass on the posterior leaflet following previous coronary artery bypass grafting. The second patient was a 67-year-old male presenting with paravalvular leakage after prior mitral valve replacement. Both procedures were performed under normothermic cardiopulmonary bypass with continuous CO₂ insufflation, high-flow perfusion, and careful left heart decompression to minimize the risk of air embolism. In the first case, mitral valve replacement was successfully performed with a mechanical prosthesis after excision of the mobile mass. In the second case, the paravalvular defect was repaired with pledget-reinforced sutures. Postoperative echocardiography confirmed satisfactory valve function and complete resolution of regurgitation in both patients. The postoperative course was uneventful; however, early renal replacement therapy was initiated in the first patient due to pre-existing chronic kidney disease. These cases highlight the feasibility of minimally invasive beating heart mitral valve surgery in selected complex scenarios. Careful attention to technical considerations, such as maintaining a competent aortic valve, continuous venting, high-flow bypass, and CO₂ insufflation, may help reduce the risk of complications.