OBJECTIVE: Dyspnea is a frequent yet potentially life-threatening complaint in emergency departments. This study aimed
to compare the predictive accuracy of the National Early Warning Score and the Manchester Triage System for key clinical
outcomes among dyspneic ED patients.
METHODS: We retrospectively analyzed 726 adult dyspneic patients presenting to a tertiary ED. Demographics, initial vital signs, MTS triage category, and calculated NEWS values were recorded at admission. Outcomes included hospital ward admission, intensive care unit admission, in-hospital mortality, 48-hour reattendance, and length of stay. Statistical analyses comprised chi-square, Kruskal–Wallis, and logistic regression models.
RESULTS: The mean age was 61.1 years, and 52.9% were female. Of the patients, 13.8% were admitted to wards, 3.2%
to ICUs, and 2.3% died; 4.1% reattended within 48 hours. NEWS risk stratification strongly aligned with MTS categories
(p<0.001). Higher NEWS scores were associated with older age, higher respiratory and pulse rates, lower blood pressure,
and reduced oxygen saturation. NEWS independently predicted hospital admission (OR=4.47, p<0.001) and ICU admission (OR=1.94, p=0.001), whereas MTS predicted ICU admission (inverse association, OR=0.34, p<0.001) and mortality (OR=0.30, p<0.001).
CONCLUSION: NEWS more accurately predicted hospital and ICU admission, while MTS was more strongly associated
with mortality in dyspneic ED patients. These complementary roles suggest that combining both tools—or developing a dyspnea- specific hybrid model—may enhance risk stratification and improve outcomes.

OBJECTIVE: Investigate radiologic and radiometabolic features affecting the diagnostic success of transthoracic biopsy
(TTB) procedures guided by Thoracic Ultrasonography (TUS).
METHODS: The electronic medical records of all patients who underwent TUS-guided TTB procedures (TUS-TBB) were retrospectively reviewed. Patients with a final diagnosis of primary lung cancer (LC), established via TUS-TBB or other diagnostic modalities, were included in the study. The cohort was stratified into two groups: those in whom the TUS-TBB procedure was diagnostic and those in whom it was non-diagnostic. Clinical, demographic, radiological [Chest Computed Tomography (CT)], and radiometabolic (PET-CT) characteristics were compared between the two groups.
RESULTS: A total of 107 patients with a final diagnosis of lung cancer were included in the study. Of these, 91 (85%) were
male, with a mean age of 67.8±11.4 years. The mean maximum diameter of the mass lesion on chest CT was 68.2±31 millimeters (mm), and the mean maximum standardized uptake value (SUVmax) on PET-CT was 14.1±6.9. A necrotic component/ ametabolic area within the lesion on PET-CT was present in 43 (40.2%) patients and absent in 64 (59.8%). The most frequent histopathological subtype was adenocarcinoma, observed in 46 (42.9%) cases. While 41 (38.3%) patients underwent transthoracic fine-needle aspiration biopsy (TTFNAB) under TUS guidance, 66 (61.7%) patients underwent tru-cut biopsy (TCB). The TUS-TBB procedure was diagnostically successful in 87 (81.3%) of the cases. The presence of a necrotic component within the lesion on PET-CT was identified as the sole independent risk factor significantly impacting the diagnostic success of the procedure (p=0.010).
CONCLUSION: TUS-TBB procedures demonstrate high diagnostic success. In carefully selected patients, pre-procedural
evaluation of lesion metabolic activity using PET-CT may enhance the diagnostic success of the biopsy.

OBJECTIVE: Although much is known about facial aesthetics, the role of head shape remains underexplored. Understanding individuals’ awareness, preferences, and interest in cranial aesthetic interventions may guide future approaches.This study aimed to assess Turkish individuals’ perception of dolichocephalic, mesocephalic, and brachycephalic head shapes, along with their self-awareness, satisfaction, interest in correction, and preferred methods.
METHODS: We surveyed 100 participants (52 women, 48 men), excluding healthcare professionals, those with cranial surgery histories, and certain bald men. Preoperative lateral profile photographs of a female and a male facial aesthetic surgery patient were obtained. After measuring biparietal distances and establishing cranial indices, these images were digitally modified to represent each head shape type. Using these images, participants evaluated their head shape, satisfaction, awareness, and preferred interventions if considering surgery. Each participant’s cranial index was also objectively measured by adjusting posterior cranial measurements for classification. Statistical analyses (SPSS v22) used chi-square tests (p<0.05).
RESULTS: Cranial index analysis showed 53% were brachycephalic. Overall, 65% were satisfied, 18% dissatisfied, and 17% never considered their head shape. Awareness differed significantly between attentive and non-attentive groups (p<0.001). Mesocephalic identification accuracy (87.88%) exceeded brachycephalic (p<0.00001) and dolichocephalic (p<0.000001). Only 11% considered cosmetic correction (p<0.001), with fat transfer preferred by 50% (p=1.0).
CONCLUSION: Head shape influences aesthetic perception. Mesocephalic shapes are favored, while brachycephalic shapes correlate with greater dissatisfaction, potentially raising interest in occipital augmentation. Despite significant awareness differences, low intervention interest suggests the need for broader education and larger, diverse studies to clarify evolving preferences and guide future craniofacial aesthetic practice.

OBJECTIVE: Childhood absence epilepsy (CAE) is defined by cognitive, behavioral, and neurophysiological abnormalities, but its impact on auditory function remains underexplored. Using Genetic Absence Epilepsy Rats from Strasbourg (GAERS), this study aimed to examine both peripheral and central auditory pathways function to better understand the auditory consequences of CAE.
METHODS: The experimental and control groups consisted of six-month-old male GAERS (n=6) and Wistar (n=6) rats.
Auditory functions were assessed using distortion product otoacoustic emissions (DPOAE) and auditory brainstem responses (ABR). DPOAE amplitudes and ABR wave thresholds, latencies, and amplitudes were analyzed for group comparison.
RESULTS: DPOAE amplitudes were significantly reduced across all tested frequencies in epileptic rats compared to controls. In addition, ABR thresholds were slightly elevated compared to controls, but remained within clinically normal limits. Prolonged latencies were obtained in all waves except Wave I, indicating subcortical auditory pathway involvement in the epileptic group. A distinct ABR amplitude pattern emerged in epilepsy, characterized by increased Wave I–II amplitudes, a marked reduction at Wave III, and subsequent increases at Waves IV–V.
CONCLUSION: The results showed both peripheral and central auditory nervous system dysfunction in GAERS rats, providing translational insight into CAE. Subclinical abnormalities in auditory neuronal processing may contribute to speech-in-noise difficulties, language impairments, and learning problems in affected children. Early detection and follow-up are valuable for the clinical management of auditory involvement in pediatric epilepsy.

OBJECTIVE: This study aimed to evaluate the effects of the February 6, 2023, earthquakes in Turkiye on anxiety and depression levels and their impact on erectile dysfunction (ED).
METHODS: A total of 164 men aged 25–55 were enrolled between July 15, 2024, and January 15, 2025. Ninety-seven patients who presented with ED after the earthquakes were included as the study group, and 67 healthy individuals without ED were enrolled as controls. All participants completed the Arizona Sexual Experiences Scale (ASEX), Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D), World Health Organization Quality of Life-BREF (WHOQOL- BREF), and International Index of Erectile Function (IIEF-5). Statistical analyses were conducted using chi-square, t-tests, and ANOVA.
RESULTS: There were no significant differences between the groups regarding age and marital status. Patients with ED
had significantly higher ASEX, HAM-A, and HAM-D scores and significantly lower WHOQOL-BREF scores compared to controls (p=0.001). Among ED patients, 52 (53.6%) had severe ED, 40 (41.2%) had moderate, and 5 (5.2%) had mild symptoms. ASEX scores were significantly higher (p=0.01), and WHOQOL-BREF general health scores were significantly lower in patients with severe ED compared to those with milder forms (p=0.001).
CONCLUSION: The February 6 earthquakes were associated with increased anxiety and depression and decreased quality of life in men, which significantly contributed to the prevalence and severity of ED. These findings highlight the importance of addressing sexual health as part of post-disaster psychosocial support.

OBJECTIVE: In the differential diagnosis of biliary colic and acute cholecystitis, physical examination, non-specific biochemical tests, and imaging methods are used. The aim of this study was to investigate the differential diagnostic power of NEUTRI, NEUT-GI, RE-LYMP, and AS-LYMP parameters, which show neutrophil and lymphocyte activation, and are obtained with fluorescence flow cytometry during full blood count.
METHODS: In this prospective cohort study, patients presenting with right upper quadrant pain were separated into two
groups according to the diagnoses of acute cholecystitis and biliary colic. The conventional inflammatory markers and the
NEUT-RI, NEUT-GI, RE-LYMP, and AS-LYMP values were compared. Receiver Operating Characteristics (ROC) Curve analysis was performed to investigate the diagnostic power of the inflammatory markers.
RESULTS: In the acute cholecystitis group, C-reactive protein, white blood cells, neutrophil, monocyte, and immature
granulocyte counts were higher, and the lymphocyte count was lower. The NEUT-RI and NEUT-GI values were significantly higher, and the RE-LYMP value was significantly lower in the acute cholecystitis group. The AS-LYMP values were similar in both groups. In the ROC analyses, the AUC values were 0.914 for CRP, 0.842 for WBC, 0.873 for neutrophils, and 0.823 for immature granulocyte count. A poor diagnostic performance was determined for NEUT-RI and NEUT-GI with AUC values of 0.662 and 0.612, respectively. The AUC for RE-LYMP and lymphocyte count was non-significant at <0.6.
CONCLUSION: The results showed that NEUT-RI and NEUT-GI have limited diagnostic power in the differential diagnosis of acute cholecystitis from biliary colic, and RE-LYMP and AS-LYMP are insufficient diagnostically.

OBJECTIVE: The role of cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (RCC) is controversial. The aim of this study was to compare survival outcomes between nephrectomy and non-nephrectomy groups in patients with de novo metastatic renal cell carcinoma receiving tyrosine kinase inhibitors (TKI).
METHODS: This retrospective study included 99 patients with de novo metastatic renal cell carcinoma, stratified according to receipt of cytoreductive nephrectomy. Baseline clinicopathological variables, including International Metastatic RCC Database Consortium (IMDC) risk category, Eastern Cooperative Oncology Group (ECOG) performance status, sarcomatoid features, Fuhrman grade, and TKI regimen, were collected. Overall survival was evaluated using Kaplan–Meier analysis.
RESULTS: Among 99 patients, IMDC risk categories were favorable in 21 (21.2%), intermediate in 52 (52.5%), and poor in 26 (26.3%). CN was performed in 67 patients (67.7%). Pazopanib and sunitinib were used in 50 (50.5%) and 49 (49.5%) patients, respectively. In comparison with the nephrectomy cohort, a greater percentage of patients in the non-nephrectomy cohort were classified as poor risk (37.5% vs. 20.8%, p=0.010). Overall survival differed significantly across IMDC risk groups (p=0.001). In the favorable-risk subgroup, median overall survival was longer with nephrectomy than without surgery (42 vs. 12 months, p=0.042). There was no significant difference in survival between pazopanib and sunitinib treatment (14 vs. 16 months, p=0.251).
CONCLUSION: CN was associated with improved overall survival in the favorable-risk subgroup, whereas no significant
survival difference was observed in intermediate- or poor-risk groups.

OBJECTIVE: Anemia is a prevalent public health issue characterized by a reduction in hemoglobin concentration, often accompanied by nonspecific symptoms that overlap with various other medical conditions. Despite its high global and national prevalence, especially among women, the diagnostic value of clinical symptoms in identifying anemia remains uncertain. In this study, we aimed to determine the prevalence of anemia and evaluate the frequency and severity of anemia-related symptoms.
METHODS: This cross-sectional study was conducted among medical students aged 18–35 between February and May
2025. Participants completed a detailed symptom questionnaire encompassing 44 anemia-related symptoms and underwent capillary hemoglobin measurement. Statistical analyses included group comparisons and regression analyses to explore the association between symptoms and anemia status.
RESULTS: A total of 251 participants (150 women, 101 men; median age: 22 Years) were included. The overall prevalence of anemia was 28.3%, significantly higher in women (35.3%) than in men (17.8%, p=0.025). The most frequently reported symptoms among anemic participants included fatigue (87.3%), malaise (85.9%), and attention deficit (78.9%). No statistically significant differences were observed in the frequency or severity of symptoms between anemic (median: 18 Symptoms) and non-anemic participants (median: 19 Symptoms)(all p>0.05). Regression analyses did not identify any predictive model for anemia based on symptomatology.
CONCLUSION: Anemia was found to be prevalent even among young and otherwise healthy individuals. Anemia-related
symptoms were common and similar across both anemic and non-anemic participants, suggesting that such nonspecific complaints may reflect underlying physiological processes or nutritional deficiencies rather than anemia alone.

OBJECTIVE: Total hip arthroplasty (THA) is one of the orthopaedic surgeries performed today that yields satisfactory results. The surgeon volume has an important effect on the success of THA and we predict that surgeon-related variables can be brought to the most optimal level with experience.
METHODS: Patients who underwent primary THA surgery between 2015 and 2024 and had at least 1 year of follow-up
were included in the study. High volume (HV) in surgeons who performed at least 20 primary THA operations in at least 3
consecutive years. Surgeons with 5 years or more of experience in orthopedics and traumatology were defined as low volume (LV). Acetabular inclination angle, limb length discrepancy, femoral stem malalignment, and hip rotation center conformity according to the Ranawat triangle method were determined from postoperative radiographs.
RESULTS: In the study investigating the relationship between primary THA and surgeon volume, a significant relationship
was found between surgical time, hospital stay, dislocation, blood loss, leg length discrepancy and hip rotation center according to Ranawat triangle as surgeon experience increased. No significant relationship was found between the groups in terms of revision surgery, acetabular inclination angle, femoral stem malalignment and periprosthetic infection.
CONCLUSION: As in every field, there is a linear relationship between increasing experience in a surgery or disease group and successful results in orthopedics and traumatology. Complication rates may decrease with the increase in HV surgeons in every field. For this reason; increasing the experience of surgeons in a certain field in orthopedics and traumatology will help them follow new developments in this field.

OBJECTIVE: Body mass index (BMI) is a well-established prognostic factor in many cancer types. While BMI has been paradoxically associated with improved outcomes under immune checkpoint inhibitors (ICIs), its role in toxicity risk remains underexplored. This study examines the relationship between BMI and both progression-free survival (PFS) and immune-related adverse events (irAEs) in patients with advanced non-small cell lung cancer (NSCLC) receiving second-line treatment with nivolumab.
METHODS: This retrospective study examined 305 patients with histologically confirmed stage IV NSCLC who experienced progression after platinum-based chemotherapy. Patients were grouped based on whether their BMI was above or below the median value of 24.8 kg/m². PFS was assessed using Kaplan-Meier analysis. Frequencies of endocrine, hema-tologic, gastrointestinal, hepatic, and pulmonary toxicities were compared between BMI groups. Statistical significance was set at p<0.05.
RESULTS: No statistically significant difference in PFS was observed between BMI groups (<24.8: 7.53 months vs. ≥24.8: 8.30 months, p>0.05). Endocrine irAEs, however, occurred more frequently in patients with a higher BMI (p=0.034). No significant associations were found between BMI and hematologic (p=0.637), hepatic, gastrointestinal, or pulmonary irAEs. BMI was not predictive of PFS but was associated with endocrine toxicity. CONCLUSION: These findings suggest that BMI may serve as a simple indicator for toxicity risk stratification in immunotherapy settings.

OBJECTIVE: Maternal obesity correlates with metabolic and inflammatory alterations that may affect biomarkers of the serotonin system. Serotonin is also thought to influence the fetal neurobehavioral system. This research analyzed the levels of maternal serum serotonin, maternal serum serotonin transporter (SERT), and umbilical cord arterial serotonin in obese versus non-obese pregnant women.
METHODS: Maternal serum serotonin, maternal serum serotonin transporter (SERT), and umbilical cord arterial serotonin levels were compared between obese and non-obese pregnant women. A total of pregnant women undergoing cesarean delivery were included. The levels of serotonin and SERT in maternal serum and umbilical cord arterial blood were measured, and statistical analyses were performed to compare the groups.
RESULTS: Maternal serum serotonin was higher in the obese group than in the non-obese group (440.34 [275.26–542.40] ng/mL vs 237.00 [167.05–368.36] ng/mL; p=0.003). Umbilical cord arterial serotonin was higher in the obese group (188.17 [101.10–243.36] ng/mL vs 118.19 [64.32–189.71] ng/mL; p=0.019).No significant maternal serum SERT was observed.
CONCLUSION: Obese and non-obese pregnant women undergoing cesarean delivery showed differences in maternal and umbilical cord arterial serotonin levels. No significant difference was observed in maternal serum SERT levels. These findings suggest that maternal obesity affects serotonin biomarkers, which may have implications for fetal neurobehavioral development.

OBJECTIVE: The aim of the present study was to compare the diagnostic performance of physical examination, routinely used laboratory markers, and radiological imaging modalities in adult patients with suspected acute appendicitis (AA), and to evaluate the relative contribution of each diagnostic tool under real-world clinical conditions.
METHODS: This prospective observational study included 665 consecutive adult patients who underwent appendectomy for AA. Preoperative laboratory parameters, including white blood cell count, C-reactive protein, neutrophil count, neutrophil percentage, total bilirubin, and indirect bilirubin, were recorded. Radiological findings from computed tomography and ultrasonography were documented. Physical examinations were independently performed without access to laboratory or imaging results by both a general surgery resident and a specialist general surgeon. Physical examination findings were categorized as compatible, suspicious, or incompatible with AA. Histopathological examination of all specimens served as the reference standard.
RESULTS: Of the 665 patients, 242 (36.4%) were women, and 423 (63.6%) were men, with a mean age of 34.9±14.2 years. The negative appendectomy rate was 5.8%. Resident physical examination demonstrated the highest sensitivity (95.2%) and overall diagnostic accuracy (88.9%). Among laboratory markers, neutrophil count showed high sensitivity (87.9%), while total and indirect bilirubin demonstrated the highest specificity (89.7% and 94.7%, respectively). Computed tomography achieved a sensitivity of 85.7%, whereas ultrasonography showed lower diagnostic performance, particularly in specificity.
CONCLUSION: Physical examination remains a highly effective diagnostic tool for AA when performed systematically and should be integrated with laboratory and selective imaging rather than replaced by them.

OBJECTIVE: Human metapneumovirus (HMPV) is a clinically important respiratory pathogen causing severe lower respiratory tract infections, particularly in infants, elderly individuals, and immunocompromised patients. Despite its substantial disease burden and global circulation, no HMPV-specific antiviral therapy has been approved to date. This unmet clinical need underscores the importance of identifying rapidly translatable therapeutic strategies. The present study aimed to identify potential inhibitors of the HMPV fusion (F) protein through a structure-based drug repurposing approach, leveraging the advantages of existing safety and pharmacokinetic profiles of approved antivirals.
METHODS: Thirteen antiviral agents predicted to interact with the HMPV F protein were selected from the DrugBank database. Comprehensive in silico molecular docking analyses were conducted to evaluate ligand–protein interactions, with Ribavirin used as a reference compound and positive control. Binding affinity values were quantitatively compared, using the Ribavirin binding energy (–6.2 kcal/mol) as a benchmark for relative performance.
RESULTS: The docking analyses revealed that multiple approved antiviral agents—namely Ledipasvir, Velpatasvir, Paritaprevir, Elbasvir, Pibrentasvir, Glecaprevir, Voxilaprevir, Ombitasvir, Grazoprevir, Dasabuvir, and Sofosbuvir—exhibited significantly higher binding affinities to the HMPV F protein than Ribavirin. These findings highlight the unexpected and mechanistically relevant interaction potential of hepatitis C virus–targeting antivirals with the HMPV fusion machinery, suggesting a novel avenue for therapeutic intervention.
CONCLUSION: This study provides compelling in silico evidence that drug repurposing of clinically approved antiviral agents may accelerate the development of effective HMPV-specific therapies. By targeting the highly conserved and functionally critical HMPV F protein, the identified candidate compounds offer strong translational potential and justify prioritization for experimental validation and preclinical investigation. Collectively, these results contribute to filling a critical therapeutic gap and support drug repurposing as a viable and time-efficient strategy to address emerging and neglected viral respiratory infections.

OBJECTIVE: Informed consent is the cornerstone of modern medical ethics, but current documentation systems negatively impact patient autonomy and clinical quality due to deficiencies in readability, comprehensibility, and standardization. These is-sues hinder patient participation and require innovative solutions. This study introduces the AI-powered LuminaConsent system to address standard deficiencies, comprehensibility issues, and efficiency constraints in urological informed consent documents. METHODS: In a three-armed comparative study, LuminaConsent (artificial intelligence), Turkish Urological Surgery Asso-ciation standard forms, and expert-developed documents were evaluated in 10 urological procedures. The system is based on the RAG architecture, which uses OpenAI’s GPT-4o-mini model and a special knowledge base consisting of 12 clinical publications. Three independent urology specialists conducted a blind evaluation using a 100-point scale across five areas: scientific content accuracy, patient communication effectiveness, quality of risk-benefit information, perioperative guidance, and legal-ethical compliance.
RESULTS: LuminaConsent achieved higher performance with mean scores of 82.33 points (SD±4.2) versus 78.77 points (SD±6.1) for professional society standards and 57.43 points (SD±3.8) for specialist documentation, representing statisti-cally significant improvements of 43.3% over specialist practices (p<0.001) and 4.5% over professional society standards (p<0.05). The system demonstrated consistent high-quality output across all procedures while generating comprehensive documentation within 96-180 seconds compared to traditional processes requiring multiple days.
CONCLUSION: LuminaConsent offers a pioneering model for systematic AI integration in clinical practice with its evidence-based content generation and bilingual processing capabilities. The findings support the potential to empower patient auton-omy, reduce application variations, and improve ethical standards.

Human Metapneumovirus (HMPV) is a leading viral cause of respiratory infections worldwide, particularly affecting children, elderly adults, and immunocompromised individuals. Since its discovery in 2001, HMPV has been recognized as a significant pathogen responsible for both upper and lower respiratory tract infections, often manifesting as bronchiolitis, pneumonia, and wheezing in infants, as well as acute respiratory distress syndrome (ARDS) in older adults and immunocompromised patients. Although it shares clinical features with Respiratory Syncytial Virus (RSV), HMPV is genetically distinct, posing unique chal-lenges for diagnosis, treatment, and prevention. This review provides a comprehensive analysis of HMPV, focusing on its virus structure, genetic makeup, taxonomy, clinical features, and epidemiology. It also explores advances in diagnosis, prevention, and therapeutic strategies, highlighting the urgent need for continued research to address the global burden of HMPV.

Calcium oxalate (CaOx) nephrolithiasis is the most common type of kidney stone disease worldwide. Recent studies show that its development cannot be explained solely by renal solute handling; instead, it reflects a broader interaction between dietary habits, the intestinal microbiota, and host metabolic responses. Intestinal absorption of calcium and oxalate—two central drivers of lithogenesis—is shaped by both microbial composition and dietary patterns. Although Oxalobacter formigenes was initially regarded as the main oxalate-degrading organism, newer studies indicate that a wider disturbance of the gut micro-biota, especially the loss of short-chain fatty acid (SCFA)–producing species, may increase susceptibility to stone formation. In this review, nutritional, microbial, and mechanistic evidence is brought together to examine how diet—particularly salt, animal protein, calcium, oxalate, fruits, vegetables, and water intake—modulates the gut–kidney axis. Diets high in salt or animal protein tend to shift the microbiota toward more pro-inflammatory and acidogenic profiles, while fiber-rich, plant-based di-ets and adequate hydration appear to support microbial diversity, SCFA production, and epithelial barrier integrity. Probiotic and synbiotic interventions have also gained attention as potential strategies to reduce stone recurrence by targeting gut microbial function. Taken together, current findings suggest that the gut–kidney axis is a dynamic metabolic link between diet, microbial ecology, and renal physiology. Future studies combining multi-omics methods with personalized nutritional approaches may help develop more effective microbiota-based prevention and treatment strategies for CaOx nephrolithiasis.