OBJECTIVE: Interstitial lung disease (ILD) is a frequent and prognostically important manifestation of systemic sclerosis (SSc), with a substantial proportion of patients developing progressive pulmonary fibrosis (PPF) despite immunosuppressive treatment. The objective of the study was to compare real-world lung function trajectories and the occurrence of progressive PPF among patients with SSc-ILD receiving commonly used immunosuppressive therapies.
METHODS: We conducted a retrospective single-center cohort study of adult patients with SSc-ILD receiving immunosuppres-sive therapy, assessing longitudinal changes in pulmonary function and PPF according to international guideline-based criteria.
RESULTS: Among 80 patients with SSc-ILD, mycophenolate mofetil (MMF) was the most frequently used immunosuppres-sive agent across both first-line and subsequent treatment lines. Despite its extensive use, MMF was associated with relatively low rates of progressive PPF (18.2% in first-line and 25% in second/third-line use) and largely stable forced vital capacity over time, with only modest decline in diffusing capacity for carbon monoxide. Cyclophosphamide (CYC) showed transient improvements in lung function at 1 year, followed by stabilization. In contrast, first-line azathioprine (AZA) use was associated with the highest PPF proportion (55.6%).
CONCLUSION: In this real-world SSc-ILD cohort, MMF emerged as the most frequently used backbone therapy after the scleroderma lung study II, with generally stable lung function trajectories observed during follow-up. Higher proportions of progressive PPF were observed among AZA-treated patients, whereas CYC was mainly used as an induction therapy in selected cases. Rituximab, administered alone or in combination with MMF, was more frequently used in patients with progressive or treatment-refractory disease and was associated with relatively low progression proportions in this cohort. These findings reflect treatment patterns and clinical trajectories observed in routine clinical practice rather than comparative treatment efficacy.

OBJECTIVE: This study aimed to investigate potential subclinical structural and microvascular changes in the clinically unaffected fellow eyes of patients with acute central serous chorioretinopathy (aCSC) and to compare these findings with age- and sex-matched healthy controls.
METHODS: In this retrospective study, the fellow eyes of 33 aCSC patients and one randomly selected eye from 40 healthy controls were analyzed. Central macular thickness (CMT), retinal nerve fiber layer thickness (RNFLT), and subfoveal choroidal thickness (SFCT) were measured using optical coherence tomography (OCT). OCT angiography was performed to assess vessel density (VD) in the superficial capillary plexus (SCP), deep capillary plexus (DCP), choriocapillaris plexus (CCP), and peripapillary capillary plexus (PPCP), as well as the foveal avascular zone.
RESULTS: No differences were observed in mean CMT or RNFLT between fellow eyes of aCSC patients (faCSC) and controls; however, superior and inferior macular quadrants were significantly thicker in faCSC eyes (p=0.005 and p=0.007, respectively). SFCT was markedly increased in faCSC eyes compared to controls (333.2±93.16 µm vs. 239.8±34.27 µm; p<0.001). While SCP and DCP VDs did not differ significantly, CCP VD was elevated in the foveal, superior, inferior, and temporal regions of faCSC eyes (p<0.001–p=0.005). PPCP VD was also higher in the superior and temporal quadrants (p=0.02 and p=0.01).
CONCLUSION: Clinically, faCSC patients demonstrate increased SFCT, regional macular thickening, and elevated VD in both CCP and PPCP. These findings indicate that CSC is not exclusively a localized retinal disorder but may involve systemic and bilateral choroidal changes. Early subclinical alterations in the fellow eye highlight the importance of careful monitoring for timely intervention and prevention of disease progression.

OBJECTIVE: This study aimed to investigate whether pre-operative composite indices derived from routine laboratory parameters, namely the fibrosis-4 (FIB-4) index, the aspartate aminotransferase-to-platelet ratio index (APRI), and the homeostatic model assessment of insulin resistance (HOMA-IR), were associated with post-operative percentage of excess weight loss (%EWL) after laparoscopic sleeve gastrectomy (LSG).
METHODS: This retrospective cohort study included 91 adults who underwent LSG at a tertiary referral center. Pre-operative FIB-4, APRI, and HOMA-IR values were calculated from routinely obtained clinical and biochemical parameters. The primary endpoint was %EWL during post-operative follow-up. Patients were also classified as successful (%EWL ≥50%) or suboptimal (%EWL <50%) responders. Comparative analyses, correlation analyses, and multivariable linear regression were performed.
RESULTS: The cohort had a mean age of 39.2±10.0 years and was predominantly female (80.2%). Mean baseline body mass index (BMI) was 45.1±6.3 kg/m2. Mean post-operative %EWL was 51.0±20.2%, whereas total weight loss reached 26.5±8.4%. Marked post-operative metabolic improvement was observed, including significant declines in HOMA-IR, fasting glucose, triglycerides, alanine aminotransferase, and glycated hemoglobin. However, neither FIB-4 nor APRI nor HOMA-IR demonstrated a significant linear association with %EWL, and none remained an independent predictor in the regression model adjusted for age and baseline BMI. In subgroup analyses, the suboptimal weight loss group had a significantly higher baseline BMI and a borderline-higher triglyceride level.
CONCLUSION: Pre-operative FIB-4, APRI, and HOMA-IR appear valuable for metabolic and hepatic phenotyping before surgery, but they do not provide sufficient standalone prognostic discrimination for early post-operative %EWL after LSG. Baseline adiposity may remain more informative than these composite indices for identifying patients at risk of suboptimal relative weight loss.

OBJECTIVE: The objective of the study is to evaluate the association between serum 25-hydroxyvitamin D (25[OH]D) levels and fatigue severity.
METHODS: This single-center, cross-sectional study included 228 participants aged 18–65 years who completed the fatigue severity scale (FSS) questionnaire. Individuals who had received vitamin supplementation within the previous 3 months, had known chronic disease, used regular medication, or had a history of antidepressant/anxiolytic use for depression/anxiety were excluded. Serum 25(OH)D, hemoglobin, ferritin, iron, magnesium, vitamin B12, and folate values were retrieved from the hospital information system. The Mann–Whitney U-test was used for comparisons between genders, and the Spearman correlation test was used for relationships between FSS and biochemical parameters. P<0.05 was considered statistically significant.
RESULTS: A total of 228 participants (57 males and 171 females) were included in the study. Most variables were not normally distributed; therefore, non-parametric analyses were performed. Spearman correlation analysis demonstrated a weak but significant negative correlation between FSS scores and both hemoglobin (p=0.003) and ferritin levels (p=0.001). No significant correlations were found between FSS and vitamin D, vitamin B12, folate, magnesium, or serum iron levels (p>0.05). In group comparisons based on fatigue severity, ferritin levels were significantly lower in the high-fatigue group compared to the low-fatigue group (p<0.001). Hemoglobin levels were also lower in the high-fatigue group (p=0.043). In contrast, vitamin B12 levels were significantly higher in the high-fatigue group (p=0.032). No significant differences were observed between groups in terms of vitamin D, folate, magnesium, or serum iron levels (p>0.05).
CONCLUSION: Serum 25(OH)D levels were not associated with fatigue severity. The observed relationship between fatigue severity and hematological markers (hemoglobin and ferritin) suggests that these parameters should be considered in the clinical evaluation of fatigue.

OBJECTIVE: Displaced scapular fractures are uncommon injuries, and the optimal surgical approach remains controversial. Muscle-preserving techniques may improve post-operative shoulder function by minimizing soft-tissue damage. The purpose of the study was to evaluate the clinical and functional outcomes of open reduction and internal fixation (ORIF) using a muscle-preserving modified Judet approach in displaced scapular fractures and to assess the effect of surgical timing on post-operative shoulder function.
METHODS: This retrospective study included 12 adult patients who underwent ORIF for displaced scapular fractures between 2015 and 2024 with a minimum follow-up of 12 months. Fractures were classified according to the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association system and treated using the modified Judet approach. Functional outcomes were evaluated using the Constant-Murley, Disabilities of the Arm, Shoulder, and Hand (DASH), and University of California, Los Angeles (UCLA) scores, and shoulder range of motion was compared with the contralateral side.
RESULTS: Mean patient age was 35.3±15.0 years, and mean follow-up was 41.6±37.5 months. Fracture union was achieved in all patients at a mean of 7.5±1.7 weeks. No infections, neurovascular injuries, malunion, or infraspinatus atrophy occurred. Final shoulder motion reached 97% forward flexion, 89% abduction, 93% external rotation, and 90.9% internal rotation compared with the contralateral side. Mean constant, DASH, and UCLA scores were 84.0±8.6, 6.1±8.8, and 31.9±3.4, respectively. All patients returned to work at a mean of 4.7±2.3 months.
CONCLUSION: ORIF using a muscle-preserving modified Judet approach provides reliable union, low complication rates, and satisfactory functional recovery in displaced scapular fractures.

OBJECTIVE: To examine changes in motor and non-motor clinical outcomes following participation in a home-based telerehabilitation program incorporating motor-cognitive dual-task exercises in individuals with Parkinson’s disease (PD).
METHODS: This retrospective cohort study analyzed prospectively recorded clinical data obtained from a government-supported telerehabilitation service implemented at a tertiary physical medicine and rehabilitation center in Istanbul, Türkiye. The study included 60 participants with mild-to-moderate PD (Hoehn and Yahr stages 1–3) who completed a 6-week intervention consisting of 30 supervised sessions (60 min/session, 5 days/week). The program combined motor exercises, cognitive tasks, and integrated dual-task activities delivered through synchronous video-based supervision. Clinical assessments included balance (Berg Balance Scale, Mini-BESTest), balance confidence (Activities-specific Balance Confidence Scale), mobility (Timed Up and Go test), manual dexterity (Nine-Hole Peg Test), quality of life (PD Questionnaire-39), depressive symptoms (Beck Depression Inventory), and self-reported urinary/fecal incontinence.
RESULTS: Post-intervention analyses demonstrated statistically significant improvements in all evaluated outcomes (all p<0.001). Participants showed better balance, mobility, and hand dexterity, accompanied by increased balance confidence and improved gait-related performance. Quality-of-life scores improved, while depressive symptom severity decreased following the intervention. The proportion of participants reporting urinary incontinence declined from 40% to 23%, whereas fecal incontinence decreased from 12% to 2%. Effect size analyses demonstrated moderate-to-large improvements across the primary and key secondary outcomes, with the largest effects observed for depressive symptoms, quality of life, and balance-related performance. No intervention-related adverse events were identified during the study period.
CONCLUSION: Participation in a remotely supervised, dual-task–based telerehabilitation program was associated with favorable changes across multiple clinical domains in individuals with PD. The findings suggest that home-based telerehabilitation may represent a feasible and clinically relevant rehabilitation approach within routine practice. Given the retrospective nature of the study and the lack of a control group, the observed findings should be considered preliminary. Prospective randomized controlled trials are needed to confirm these findings and evaluate their long-term clinical significance.

OBJECTIVE: The hemoglobin-albumin-lymphocyte-platelet (HALP) score, an integrated immunonutritional index, has shown significant prognostic value in several aggressive solid tumors. However, its role in the diagnostic workup and predictive stratification of thyroid cancer remains underexplored. This study aimed to comprehensively evaluate the diagnostic efficacy of the pre-operative HALP score and its association with lymph node metastasis (LNM) in patients undergoing thyroidectomy.
METHODS: We retrospectively reviewed 521 consecutive patients who underwent thyroid surgery between 2022 and 2024. Pre-operative laboratory parameters, including thyroid-stimulating hormone (TSH), fT4, albumin, and complete blood count, were recorded. The HALP score was calculated as (Hemoglobin×Albumin×Lymphocytes)/Platelets. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis in combination with multivariate logistic regression. A subgroup analysis was performed for malignant cases to evaluate predictors of LNM.
RESULTS: Of the cohort, 210 (40.3%) patients had malignant pathology. While serum TSH (p<0.001) and fT4 (p=0.043) were significantly higher in the malignant group, the HALP score demonstrated no significant difference (50.8±17.9 vs. 51.2±18.4, p=0.694). ROC analysis yielded an area under the curve of 0.510 for the HALP score, indicating a lack of discriminative power. In multivariate analysis, only Bethesda categories V (odds ratio [OR]: 17.48) and VI (OR: 104.29) were independent predictors of malignancy. For LNM, younger age (p=0.005), higher TSH (p=0.036), and lymphovascular invasion (p<0.001) were significant predictors, whereas the HALP score showed no predictive value (p=0.919).
CONCLUSION: The pre-operative HALP score does not serve as a reliable diagnostic or predictive biomarker for thyroid malignancy or LNM. Pre-operative stratification should remain focused on cytopathology and established clinical-ultrasono-graphic risk factors.

OBJECTIVE: This study aimed to evaluate the nutritional knowledge levels of mothers of children aged 4–6 years attending pediatric outpatient clinics, analyze knowledge levels according to maternal age, education, and income, and investigate their relationship with children’s anthropometric measurements.
METHODS: This cross-sectional study included 282 mothers of preschool-aged children who attended a pediatric outpatient clinic. Nutritional knowledge was assessed using the Nutritional Knowledge Level Scale for Adults, comprising Basic Nutritional Knowledge (BNK) and food preference (FP) subscales. Mothers also rated Nutrition-Health Awareness (NHA) and Dietary Adequacy Self-Assessment (DAS) on a 0–10 visual scale. Children’s height-for-age (HAZ) and weight-for-age (WAZ) z-scores were calculated. Multiple linear regression and correlation analyses were performed.
RESULTS: The median maternal age was 34 (interquartile range [IQR]: 29.25–40) years. Median BNK and FP scores were 58 (IQR: 51–69) and 35 (IQR: 30–40), respectively. Educational attainment was the strongest independent predictor of BNK (p=0.006) and DAS (p=0.033). Household income independently predicted FP (p=0.022) and NHA (p=0.026) after adjusting for age and education. Younger maternal age was associated with higher BNK scores. No statistically significant associations were found between maternal nutritional knowledge variables and children’s HAZ or WAZ scores (all p>0.05).
CONCLUSION: Most mothers demonstrated adequate BNK; however, this did not consistently translate into FP competence or healthy dietary self-perception. Maternal nutritional knowledge was not directly associated with children’s growth outcomes in this cohort, suggesting the pathway from knowledge to child growth is indirect and multifactorial. Nutrition interventions should move beyond knowledge transfer to address practical dietary skills and socioeconomic determinants of eating behavior.

OBJECTIVE: Our aim in this study is to investigate the total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) values of diclofenac sodium, which is a non-steroidal anti-inflammatory analgesic, after sciatic nerve injury, to examine the histopathological changes in the sciatic nerve, and to examine the results and enable important changes in treatment. It is one of the rare studies conducted histopathologically on post-injection sciatic nerve damage of diclofenac sodium, and the parameters of our biochemical approach have not been evaluated before in the literature.
METHODS: study was divided into 5 main groups as control, sham, trauma, isotonic fluid, and diclofenac sodium. Sham, trauma, isotonic fluid, and diclofenac sodium groups were divided into four subgroups as early stage (day 1, day 3) and late stage (day 7 and day 14). Subjects in each group were evaluated daily by neurological examination according to the Tarlov scale. In all groups except the control group, the sciatic nerve was exposed through appropriate surgical procedures. TAS, TOS, and OSI were run on blood samples biochemically. Nerve tissue samples were evaluated histopathologically and immunohistochemically.
RESULTS: There was a significant difference in pairwise comparison of the groups in terms of CASPASE-3 values. A statistically significant difference was found between the groups in terms of myelin thickness and axon diameter. A statistically significant difference was found between the groups in terms of nerve diameter values.
CONCLUSION: Our study demonstrates that intramuscular injections of diclofenac sodium have potential harmful effects. We recommend that alternative methods of using diclofenac sodium intramuscularly be preferred whenever possible due to the potential complications associated with this drug, that healthcare professionals receive necessary training on intramuscular administration, that the procedures be performed more carefully, and that patients be informed about these complications.

OBJECTIVE: Chronic hypoparathyroidism causes disrupted calcium-phosphate balance due to parathyroid hormone (PTH) deficiency. In refractory disease, recombinant PTH (1–34) (teriparatide) can support conventional therapy. This study assessed short-term biochemical and clinical outcomes under real-word of once-daily teriparatide in refractory hypoparathyroidism.
METHODS: Ten patients with chronic hypoparathyroidism who received subcutaneous teriparatide (20 µg/day) between January 2021 and September 2025 were retrospectively analyzed. The median duration of teriparatide therapy was 9 months (interquartile range: 4–22), with a maximum of 27 months. Clinical records, biochemical parameters, and calcium/vitamin D supplementation requirements were systematically reviewed.
RESULTS: Albumin-corrected calcium increased significantly at 3 months (median 7.79 vs. 6.5 mg/dL, p=0.038) but not at 6 months (p>0.05). Phosphorus decreased at 3 months (p=0.012) with a non-significant trend thereafter (p=0.06). No correlation was observed between calcium change and treatment duration (ρ=-0.8, p=0.2). All patients reported symptomatic relief and reduced intravenous calcium requirements, though complete independence was not achieved.
CONCLUSION: Once-daily teriparatide provided transient biochemical improvement and clinical relief in refractory hypoparathyroidism but was insufficient to maintain sustained normocalcemia, suggesting possible pharmacological limitations of once-daily intermittent PTH replacement that warrant further investigation in larger prospective studies. Individualized treatment duration, alternative dosing regimens, and longer-term controlled studies are warranted to optimize therapeutic outcomes.

OBJECTIVE: Heart rate recovery index (HRRI) occurs as a result of vagal reactivation and sympathetic retraction and is an independent risk factor used to assess autonomic nervous system (ANS) function and to determine prognosis in cardiovascu-lar disease and all-cause mortality. It has been shown in various studies that cardiac autonomic dysfunction due to COVID-19 can occur. The aim of our study is to evaluate the effect of COVID-19 on ANS functions in people who have had this disease with HRRI.
METHODS: In this prospective and observational study, patients proven to have had COVID by molecular methods (polymerase chain reaction positivity) and healthy controls were examined. Electrocardiogram, Transthoracic Echocardiography, Hemogram and Biochemistry tests, and exercise stress test were performed in both groups. HRRIs were calculated by sub-tracting heart rates at the 1st, 2nd, 3rd, 4th, and 5th min during the post-exercise relaxation phase from the peak heart rate during exercise. P<0.05 were considered significant.
RESULTS: Study group (n=30) (Female/Male; n=15/15; mean age=39.8±13.3 years; median body mass index=25.9 kg/m2) and control group’s (n=33) (Female)/Male; n=16/17; mean age=41.9±13.2 years; median body mass index=27.2 kg/m2). 1st min and 2nd min relaxation heart rates in the COVID-19 (+) group were found to be significantly higher than in the control group (p=0.042, p=0.049, respectively). In the COVID-19 (+) group, the 1st min, 2nd min, and 3rd min HRRI were found to be significantly lower than in the control group (p<0.001, p=0.006, p=0.039, respectively).
CONCLUSION: According to the results of our study, HRRI is impaired as an indicator of autonomic dysfunction in people who have had COVID-19. This situation correlates with other studies that have results of ANS dysfunction due to COVID-19, and this may pose a risk factor for increased mortality and morbidity.

OBJECTIVE: Seborrheic dermatitis (SD) is a common inflammatory skin disorder; however, its characteristics in intensive care unit (ICU) patients are not well defined. This study aimed to assess the prevalence and severity of SD, as well as its potential associated factors, in ICU patients.
METHODS: This cross-sectional study included 102 adult patients admitted to the ICU. SD was assessed with a standardized clinical scoring system. Demographic characteristics, ICU length of stay, Glasgow Coma Scale scores, level of consciousness, sedation status, immunosuppression, immune dysfunction, comorbidities, and medication use were recorded. Patients with and without SD were compared, and a multivariable logistic regression analysis was performed to identify independent factors associated with SD.
RESULTS: SD was identified in 39 of 102 patients (38.2%). In multivariable analysis, level of consciousness was independently associated with SD (overall p=0.035). Compared with conscious patients, sedated patients had significantly higher odds of SD (odds ratio=5.05, 95% confidence interval 1.41–18.08; p=0.013). No significant associations were observed for age, sex, ICU length of stay, immunosuppression, or immune dysfunction.
CONCLUSION: SD was common among critically ill patients. Level of consciousness emerged as the only factor independently associated with SD, whereas systemic factors and medication use were not significantly associated. Further studies incorporating detailed assessments of skin care practices, local skin factors, and other potential contributing factors are needed to clarify the mechanisms underlying these associations.

Today, minimally invasive oxygen(O2)-ozone(O3) intramuscular lumbar paravertebral injections are used to relieve pain in conditions such as low back pain. Repeated paraspinal, peridural, or spinal O3 injections, when performed under non-aseptic conditions or not performed with proper technique, may carry a risk of parameningeal inoculation of bacteria resulting in meningitis and pneumocephalus. Although this treatment is well tolerated in most cases, the patient may sometimes develop rare but very serious complications. Our study presents a case of pneumocephaly and meningitis due to the injection of an intramuscular O2-O3 mixture directed into the subarachnoid space after dural puncture for the treatment of low back pain. Air-density lesions were detected in the temporal and frontal horns of the left lateral ventricle on the patient’s computed tomography scan of the brain. The cerebrospinal fluid appeared slightly cloudy, with a leukocyte count of 4000/mm3, protein level of 483 mg/dL, glucose at 40 mg/dL, and chlorine at 113 mmol/L. Ensuring that ozone injection therapy is performed by qualified professionals and that strict aseptic precautions are taken before the procedure will prevent serious iatrogenic complications such as pneumocephalus and meningitis.