Objective: Prolactinoma is the most common hormone-secreting pituitary tumor in the pediatric population. Although it is less common in children and adolescents than in adults, it accounts for 50% of childhood pituitary adenomas. Data on prolactinomas in the pediatric population are still limited. In this study, the symptoms, laboratory data, radiological findings, and therapeutic outcomes of prolactinomas in children and adolescents were assessed.
Methods: This retrospective study included pediatric patients diagnosed with prolactinomas before 18 years of age, who presented at Istanbul Medeniyet University, Professor Doctor Suleyman Yalcýn City Hospital during an 8-year period (August 2015 to November 2023).
Results: Seventeen patients (13 female; 76.4%) with prolactinoma were included. Median age at diagnosis was 14.7 years (12.2-16.1 years) in girls, 11.8 years (6.8-16.2) years) in boys. All boys and most of girls (62%) had macroadenomas (≥1 cm). The most common presenting symptom was amenorrhea/oligomenorrhea in girls and, mass effects and gynecomastia in boys. The median prolactin (PRL) level was significantly higher in the macroprolactinoma group than in the microprolactinoma group (262.5 vs. 178 ng/mL; p=0.035). Cabergoline was introduced to all patients as first line treatment and normal PRL level was achieved in 88.3% of them after a two-year treatment. One male and one female patient were unresponsive to 2 mg/week cabergolin treatment therefore underwent transsphenoidal surgery. PRL elevation recurred in six of seven patients (86%) after the withdrawal of cabergoline treatment.
Conclusion: A macroprolactinoma is more common in children and adolescents than a microprolactinoma in adults. Increased PRL levels, male gender and the presence of mass effects at the time of diagnosis are associated with macroprolactinomas diagnosed during childhood and adolescence. Cabergoline was highly effective in the treatment of pediatric prolactinomas. However, due to the high recurrence rate of hyperprolactinemia after withdrawal of a 2-year treatment, use of cabergoline for a longer duration (≥3 years) before the first withdrawal attempt might be beneficial to reduce the risk of recurrence in selected pediatric cases with macroprolactinoma.

Objective: The aim of this study is to determine the iodine deficiency status of school-age children in Canakkale, whose data were not known before.
Methods: The population of the research was created from students in the 7-11 age group studying in primary schools. 316 students were selected for the study group by multi-stage stratified sampling method. Physical examinations and anthropometric measurements of the children were performed. A survey was conducted to their families regarding the use of iodized salt. Iodine level was measured spectrophotometrically from the collected spot urine sample.
Results: One hundred forty-nine of the study group (47.2%) were male and 167 (52.8%) were female. Mean age was 8.74 ± 1.09 years, mean height SDS was 0.45 ± 1.09, mean weight SDS was 0.62 ± 1.27. Iodine deficiency was detected in 25% (79) of the study group, and most of them (20.5%) had mild iodine deficiency and 51.8% of the children. The mean iodine level in Canakkale was 15.8 ± 8.43 μg/dL.
Conclusion: In our study, we showed that the average urinary iodine level in school-age children in Canakkale was sufficient. However, we showed that Canakkale is an endemic region for iodine deficiency due to its high rate of mild urinary iodine deficiency.

Objective: Candida auris, a novel species, has been increasingly associated with hospital outbreaks worldwide in recent years. C. auris is regarded as a global health problem due to issues with the identification of C. auris, variable antifungal resistance profiles and the requirement for infection prevention and control (IPC) measures. With this study, we aimed to present our experience with two patients with C. auris fungemia who were referred to the Pediatric Burn Center of our hospital at different timepoints and share the antifungal treatment strategy and IPC management policies implemented in the clinic.
Methods: C. auris isolates were identified using MALDI-TOF MS (VITEK MS, bioMérieux, France). Antifungal susceptibility tests were performed at the Turkish Public Health Institution (THSK) using the broth microdilution (BMD) method. The BMD was carried out in accordance with the Clinical and Laboratory Standards Institute procedures.
Results: A patient (3-year-old girl) with C. auris which was identified at an external center and negative fungal screening results was transferred to our pediatric burn center. On the 41st day of her hospitalization, she was diagnosed with catheter-related bloodstream infection (CRBSI) by C. auris. She received antifungal treatment for a total of 52 days, including caspofungin for 12 days, followed by micafungin for 40 days. Three months after the detection of the index case, a second patient (2-year-old girl) was diagnosed with CRBSI by C. auris on the 27th day of hospitalization. This patient received antifungal treatment for a total of 42 days, including 30 days of combination therapy (liposomal amphotericin B and voriconazole). Immediately after the recognition of the index C. auris case, Infection prevention and control (IPC) measures were formulated and implemented. IPC measures included strict isolation of the patient infected with C. auris, and screening of all other patients and the environment. C. auris was not detected in any of the patients screened. None of the environmental swabs tested positive for C. auris.
Conclusion: Collaboration between clinical microbiology laboratories and the IPC committee is essential for making correct and early diagnosis, optimizing the management of precautions and reducing the spread of infection in the hospital.

Objective: The unfavorable effects of air pollution on respiratory health have been shown in many studies. Exposure to air pollution can lead to developing asthma and losing control over existing asthma. In this study, we aimed to evaluate the investigation of indoor air pollution in children with asthma.
Methods: 130300 measurement data obtained from all participants’ home environments (29 patients diagnosed with asthma and 13 controls) were compared. The BLATN BR-SMART Multi-function Air Quality Monitor measured PM2.5, CO2, and formaldehyde (HCHO) levels.
Results: The age and sex distributions of the patients and controls were similar. The median age of asthmatic patients was 14 years (IQR: 9), and the median age of controls was 13 years (IQR: 9). The number of household members in the homes of asthmatic patients (median: 4, IQR: 1) was significantly higher than the controls (median: 3, IQR: 1) (p=0.035). Asthmatic patients’ houses were closer to the highway than the controls (p=0.019). The frequency of homes being closer than 100 meters to the main road was higher in asthmatics (n=17, 65.4%) than in controls (n=3, 23.1%) (p=0.019). Based on all measurements, CO2 and HCHO levels in the asthmatic patient group were higher than in the controls. Although the PM2.5 levels were also higher in asthmatic patients, this difference was statistically insignificant. According to the asthmatic patients’ daytime air pollution parameters, PM2.5 levels were higher, especially between the hours of 18.00 - 06.00, when the number of people in the house was the highest.
Conclusion: Indoor PM2.5, CO2, and formaldehyde levels were higher than controls. Management of environmental factors along with medical treatment is also essential to achieve better asthma control.

Background: The incidence of aspiration pneumonia (AP) is rising due to an increasing population with chronic conditions. This study investigates the association between albumin-based composite indicators—blood urea nitrogen/albumin (B/A), lactate dehydrogenase/albumin (L/A), and C-reactive protein/albumin (C/A) ratios—and AP-related mortality.
Methods: In this retrospective study, adult patients diagnosed with AP between 2022 and 2023 were analyzed. Patients' demographics, clinical data, and lab results were recorded. Albumin-based composite indicators were calculated, and outcomes were observed up to 28 days post-admission, categorizing patients as survivors or non-survivors.
Results: The study involved 67 patients, with a median age of 80. The 28-day mortality rate was 38.8% (n=26). There were no substantial demographic or clinical differences between survivors and non-survivors (p>0.05). However, non-survivors exhibited notably lower serum albumin levels (p>0.001). Additionally, B/A and C/A ratios were significantly higher in non-survivors (p< 0,05). B/A ratios above 1.03 and C/A ratios above 6.15 correlated significantly with mortality (p=0.023 and p=0.026).
Conclusions: The results indicate that lower serum albumin levels and higher B/A and C/A ratios are significantly linked to AP-induced mortality. These albumin-based indicators may serve as useful markers for early risk assessment and outcome prediction in AP patients.

Aim/Background: Necrotizing fasciitis (NF) is a severe and potentially life-threatening soft tissue infection characterized by rapid necrosis, primarily affecting the fascia and deep soft tissues. Despite its low incidence, NF poses significant challenges due to its aggressive nature and high mortality rates. This retrospective study aimed to assess clinical characteristics and prognostic factors influencing mortality rates among patients diagnosed with NF at a tertiary care facility.
Materials and Methods: Patients diagnosed with NF at the emergency department of tertiary care hospital in Turkiye between August 1, 2017, and July 31, 2023, were included in the study. Demographic data, clinical features, underlying factors, laboratory findings, and outcomes were reviewed.
Results: A total of 69 adult patients were included in the study. Among cases, 51 survived (73.5%) and 18 died (26.5%). There were 43 males (62.3%) and 26 females (37.7%) with a mean age of 55.8 ± 16.1 years. The most common symptoms were pain/tenderness (84.1%), erythema (75.4%), local swelling (72.5%), and crepitus (44.9%). Diabetes mellitus, lower systolic blood pressure, higher pulse rates, elevated white blood cell counts, and polymicrobial infections were associated with poor outcomes (p<0.001, p=0.020, p<0.001, p=0.016, and p<0.001, respectively).
Conclusion: NF is a rare surgical emergency. Early diagnosis, prompt intervention, and multidisciplinary management are crucial in mitigating NF's devastating consequences. Recognizing poor prognosis factors in patients can guide their management.

Aim: Heart failure is a clinical syndrome. Caused by functional or structural dysfunction of the heart. taking early decisions for interventional procedures and predicting the treatment process will be beneficial for patients and will shorten the waiting times for the emergency department. we evaluated the capability of C-Reactive Protein (CRP) and Albumin Combined Indexes to predict the need for intubation in Acute Heart Failure.
Methods: This study was designed prospectively. Patients with signs and symptoms such as weakness, shortness of breath, abnormal findings in lung sounds, jugular fullness, peripheral edema, and ankle swelling at the time of admission were evaluated. All patients were diagnosed with acute heart failure in the Emergency Department (ED).
Results: A total of 220 patients were included. The median age was 77. CRP Albumin Ratio (CAR) was higher in the intubated group. Glascow Prognostic Score (GPS) and modified Glascow Prognostic Score (mGPS) sensitivity, specificity, accuracy and other values were the same.
Conclusions: These scores, which are simple and do not require additional examination, can be used to predict the clinical progress of patients.

Objective: Sarcopenia is defined as an age-related loss of muscle quantity as well as quality. Also, is associated with morbidity and mortality. Multiple Myeloma (MM) has a unique aspect with its bone involvement. We aimed to investigate the effect of hematopoietic stem cell transplantation on sarcopenia in MM patients using both CT and metabolic compartment of F-18 FDG PET/CT.
Methods: Patients with MM and received first line treatment and were eligible for autologous stem cell transplantation (ASCT) were included. FDG PET images before transplantation and after 120 days of ASCT were recorded.
Results: When were grouped as below and above 60 years of age, a decrease in muscle mass after treatment were observed in both groups (p<0.001). For patients older than 60 years, age was observed to have a significant effect on muscle mass, independent of the treatment (p=0,001). Regarding metabolic assessment of muscles with PET imaging, the lumbar region was observed to be affected by treatment for both age groups (p<0.001). Metabolic volume measurement of the femoral region did not show such difference related to treatment or age.
Conclusion: We observed a loss in muscle mass in patients with MM related with treatment. Since PET / CT imaging is routinely used to evaluate disease and may also be used for the evaluation of muscle as quantity as quality. Awareness of sarcopenia should be increased in patients with MM and caregivers and be supported by physiotherapists to preserve and even to increase muscle mass and strength.

OBJECTIVE: There is limited knowledge regarding the clinical, biochemical, and functional characteristics of patients with osteosarcopenia. The present study aims to explore the presence of osteosarcopenia in patients aged 65 years and over who have a history of falls and hip fractures.
METHODS: Seventy-six participants (77.6% women) aged 65 years and over (mean age 81±6.75 years) who were admitted to the orthopedic clinic of our hospital due to hip fracture. The diagnosis of osteopenia/osteoporosis was established based on the bone mineral density measurement using the dual-energy x-ray absorptiometry. The SARC-F scale was used to screen patients for sarcopenia. The muscle mass was determined by the appendicular lean mass (ALM). The muscle strength was evaluated by the handgrip strength. SPSS for Windows 25.0 (IBM Statistical Package for Social Sciences) software package was used in the statistical analysis of the study data.
RESULTS: A total of 76 patients were evaluated, including 59 (77.6%) females and 17 (22.4%) males. The mean age of the patients was 81±6.75 years. The prevalence of osteosarcopenia in the entire study group was 36.8%. The prevalence rate was higher in males (59%) than in females (30.5%) (p<0.05). The ALM and the handgrip strength were lower in patients with osteosarcopenia (p<0.05). The mean body weight, total fat mass, fat mass index, and upper arm circumference were the lowest in the group of patients with osteosarcopenia (p<0.05).
CONCLUSION: The present study found that the prevalence of osteosarcopenia was higher in patients with hip fracture. There is a limited number of studies in literature directly evaluating the relationship between osteosarcopenia and hip fracture. The presence of osteosarcopenia is often overlooked when the bone fracture is the prevailing clinical condition. Osteosarcopenia is frequently the accompanying diagnosis in patients with hip fracture.

Objective: The Gleason Score is the most widely used grading system for prostate adenocarcinoma and it is the strongest predictor of the patient's clinical outcome similar to other grading systems, and, plays a key role in determining the most effective treatment strategy for the patient. The Gleason scoring system is subject to both intraobserver and interobserver variability. This study aims to assess the interobserver agreement for prostate adenocarcinoma within the Gleason grading system at our center, as well as identify contributing factors.
Methods: A total of 119 cases diagnosed with prostatic adenocarcinoma, Giresun Training and Research Hospital were included in the study. Tissue samples from the cases had been subjected to routine laboratory procedures; three micron sections were obtained from formalin-fixed paraffin blocks and stained H&E.Statistical investigation was conducted on the agreement between Gleason pattern, Gleason sum score, and grade group data among three observers.
Results: In the evaluation, interobserver agreement was found to be minimal. (Gleason pattern k=0.285, total Gleason sum score k=0.309, Grade group k=0.313). The assessment indicated higher agreement in determining low grade compared to high grade, with a decrease in interobserver agreement as the grade increased. Moreover, interobserver agreement demonstrated an increase over the years (p<0.001).
Conclusion: The findings underscore the ongoing inadequacy of interobserver agreement in the Gleason scoring system. Improvement suggestions involve conducting studies to ascertain in-clinic interobserver agreement enhancing training, facilitating information sharing, and employing accessible and easily applicable artificial intelligence-supported programs.

Objective: It is considered that the underlying reason for metabolic anomalies and ovarian dysfunction in polycystic ovary syndrome (PCOS) is low-grade chronic inflammation. Therefore, we aimed to investigate Tenascin-C (TN-C) levels in PCOS. This is the first study to document the impact of inflammation with TN-C in this specific population.
Methods: A total of 90 participants, consisting 30 PCOS patients, 30 Polycystic Ovarian Morphology (PCOM) patients, and 30 matched healthy controls between September 2018 and April 2019 enrolled. All participants were randomized by age and body mass index. Demographic, clinical characteristics, ultrasonographic features, lipid profile, hormonal and metabolic parameters were collected.
Results: When comparing serum TN-C levels between PCOS, PCOM and control subjects, a statistically significant difference was observed only between subjects with PCOS and control subjects (p=0.009). ROC analysis demonstrated that PCOS could be predicted with 89.7% sensitivity and 45.5% specificity when TN-C levels are cut off at 1.87 ng/ml.
Conclusion: This study indicated that TN-C level was higher in the PCOS group compared to PCOM and control groups, while it was similar between the PCOM and the control groups. It may be suggested that TN-C levels may contribute to the differentiation between PCOS and PCOM.

OBJECTIVE: The aim of this study was to investigate the effects of the February 6 earthquake on the bacteria grown in urine cultures and antibiotic resistance of patients admitting to the urology outpatient clinic.
METHODS: In this study, 11397 urine samples requested by the urology outpatient clinic between January 2022 and December 2023 were examined. We evaluated the urine cultures and antibiotic resistance profiles of the pathogens in patients clinic in years 2022 and 2023 separately and post-earthquake year 2023 as two separate periods as the first 6-month period immediately after the earthquake. The pathogens grown in urine cultures and antibiotic resistance profiles were examined retrospectively. Only one of the same strains isolated in consecutive repeated growths in the urine cultures of the patients was included.
RESULTS: Of the 11397 urine cultures, 6914 were requested in 2022 and 4483 were requested in 2023. There was no statistical difference in the growth rate between the years (13.1%-14.1%). When the demographic data of the first and last 6 months of 2023 were compared, statistical differences were found between the first and last six months of 2023 in terms of the number of patients for whom culture was requested, the number of culture positives, the reproduction rate, and the number of male and female patients. The total number of patients for whom urine culture was requested was 4483 (1471 in the first six months - 3012 in the last six months) (p=0.008) and the number of culture-positive patients was 630 (184-446) (p=0.007). The reproduction rate were found to be 12.5% and 14.8%, respectively (p=0.047). It was found that the resistance rates of Escherichia coli (E.coli) to gentamicin (GN), cefuroxime (CXM), cefixime (CFM) and ceftazidime (CAZ) groups of antibiotics was higher in the first six-month period of 2023 (p<0.05). Similarly, the resistance rate of Klebsiella spp. to CXM and CAZ group of antibiotics was found to be higher in the first six-month period of 2023 (p<0.05).
CONCLUSION: The results of our study show that the conditions in communal living areas after the February 6 earthquake had an increasing impact on antibiotic resistance rates and antibiotic resistance rates of certain groups of antibiotics, especially the Enterobacterales group were higher in the first half of 2023.

Context: Understanding the health system and the clinical and learning experiences from the perspective of complexity theory requires a reflective and contextual approach. The context in which experience takes place consists of multidimensional elements that influence each other, such as sociocultural environment, work/educational climate, stakeholders, educational/healthcare system. In this framework, it is important to read and analyze the parties' experiencial narratives within their contexts.
Objective: The aim of this study is to analyze the narratives of the team working in a surgical clinic about their clinical education and health care experiences in terms of the "institutional, clinical and national system" as one of the contextual elements in which the experience is lived.
In line with this purpose, the research problems were identified as follows: (1) what are the experiences and narratives of the team regarding the system in clinical education and health care processes, (2) how do the parties relate to the system, and (3) what are the outcomes of different ways of relating?
Method: This narrative study was conducted in the surgical clinic of a university hospital. The voluntary participant group consisted of 31 participants, including clinical instructors (n=5), surgical residency students (n=5), medical students/interns (n=15) and nurses (n=6) working as a team in the clinic. The narratives obtained through in-depth interviews were analyzed using the "Three-Stage Contextual Theme Analysis" created for this study.
Findings: The themes that emerged from the analysis were grouped under three contextual categories: "clinical system: structure, functioning and workload", "clinical environment, climate and culture", "national, social environment and extra challenging situations". The themes related to the consequences of these contextual experiences were grouped under two categories: "ways of coping/not coping" and "consequences/effects".
Conclusion: The contextual dimension of the experience can cause parties to live experiences in their own way and to focus more on their context and not see enough of what others experience. This points to the importance of planning, conducting and evaluating clinical education, research and health care processes within their context, including the system.

Clinical decision support (CDS) tools play a crucial role in assisting healthcare professionals in making informed decisions. However, the full potential of CDS systems has not been realized due to various usability issues. This paper provides an overview of usability issues identified in CDS tools, including graphical user interface issues, user experience problems, terminology clarity, and user control problems. Several usability assessment methods, such as heuristic evaluation, think-aloud testing, cognitive walk-through, and surveys, are employed to evaluate CDS tool usability. These methods reveal strengths and weaknesses in CDS tool design, guiding improvements to enhance usability. The findings of this review emphasize the importance of incorporating user feedback, employing iterative processes, and addressing interface design challenges to optimize the usability and acceptance of CDS tools in healthcare settings. By addressing these usability issues, healthcare professionals can leverage CDS tools effectively to improve patient outcomes.

Immunosuppressors and immunomodulators are widely used for the treatment of rheumatic diseases. Among them are the conventional Disease-Modifying Antirheumatic Drugs (DMARDs) such as methotrexate, azathioprine, antimalarials, cyclosporine, etc. These drugs can induce remission or control inflammation, improving patients' outcomes. Nevertheless, there is some concern that these drugs may have a carcinogenic potential, favoring the appearance of tumors. Herein, a narrative review of malignancy risk after using conventional DMARDs is done. (NCI-2023-12-14)