Clinical comparison of hematuria degree and pathology according to the AUA bladder cancer risk classification

Aim: To determine the relationship between microhematuria level and bladder cancer diagnosis and staging. Methods: A total of 452 patients who visited the Urology Clinic of the Faculty of Medicine of Afyonkarahisar Health Sciences University between 2017 and 2024 with complaints such as hematuria, dysuria, and suprapubic pain, and who underwent TUR-M surgery due to suspected bladder cancer-based on laboratory and imaging methods, were included. The pathology results confirmed the diagnosis of bladder cancer. In addition to demographic information such as age, gender, number of cigarettes smoked, and the presence of other risk factors for urothelial carcinoma (UC), data on hematuria levels, tumor stage and grade, American Urological Association (AUA) risk classification, microhematuria risk stratification, and pathological findings including lymphovascular invasion (LVI) and perineural invasion (PNI) were also recorded. Results: Patients with more than 25 erythrocytes per microliter of urine or those with macroscopic hematuria had higher rates (42.1%) of additional risk factors for UC than other groups (p=0.040). The rate of high-stage and high-grade tumors was significantly higher in the group with >25 erythrocytes per microliter of urine compared to the other groups (p < 0.001, p < 0.001). When analyzing the AUA risk classification across the groups, 42 (32.8%) patients in the 3-10 erythrocyte group and 21 (35%) patients in the 10-25 erythrocyte group were classified as high risk. In contrast, 152 (64.7%) patients in the >25 erythrocyte group were classified as high risk, a rate significantly higher than in the other groups (p < 0.001). Conclusions: Hematuria level is associated with tumor grade, tumor stage, and muscle invasion in bladder cancer. Given this association, it is crucial to carefully assess hematuria levels and the microhematuria risk classifications of patients

Optimal timing in staged bilateral total knee arthroplasty: A retrospective analysis of complications and functional outcomes

Aim: To investigate the association between inter-stage timing and postoperative complications, hospital readmissions, and functional outcomes in staged bilateral TKA. Methods: A retrospective analysis was performed on 815 staged bilateral TKA cases between March 2019 and April 2024. Patients were stratified into four groups based on inter-stage intervals: 3 weeks–90 days, 91–180 days, 181 days–1 year, and >1 year. Demographic data, complication rates, unplanned readmissions, length of hospital stay, and functional outcomes, as Knee Osteoarthritis Outcomes Score for Joint Replacement (KOOS JR) and the Lower Extremity Activity Scale (LEAS), were analyzed. Results: A total of 645 patients (1,290 knees) met inclusion criteria. The 91–180 days group demonstrated the lowest complication rate (1.8%), significantly lower than the 3 weeks–90 days group (13.1%; p<0.001). Functional outcomes were superior in the 91–180 days group, with higher KOOS JR (p=0.035) and LEAS scores (p=0.002). Although hospital stay and readmissions were lower in this group, differences in readmission rates were not statistically significant. Conclusion: Early reoperation within 90 days carries a substantially elevated complication risk. Our data strongly suggest that scheduling the second TKA between 91 and 180 days offers the most favorable balance of safety and functional recovery. These findings address a critical gap in surgical planning for bilateral TKA and warrant further validation through prospective multicenter trials

Comparison of acute ischemic stroke patients receiving thrombolytic therapy: Patients admitted to the emergency department direct and after telestroke thrombolytic therapy and those referred to thrombolytic therapy

Aim: To evaluate treatment times and outcomes in patients receiving intravenous thrombolytic therapy via different protocols. This analysis focused on three distinct patient groups: those directly admitted to a central emergency department with suspected acute ischemic stroke, those brought to the stroke center by emergency services from other centers for thrombolytic therapy, and those receiving telestroke consultation-supported thrombolytic therapy before transfer. Method: This retrospective study reviewed medical records of 198 acute ischemic stroke patients admitted to a tertiary hospital emergency department between January 1, 2017, and December 31, 2020. Demographic data, admission and treatment times, clinical outcomes (modified Rankin and National Institutes of Health Stroke Scale (NIHSS)), and three-month mortality rates were assessed. Results: Common risk factors were hypertension, atherosclerosis, diabetes, and hyperlipidemia. Stroke etiology included large artery atherosclerosis and small vessel occlusion in 26.3% of cases, and cardioembolic stroke in 17.2%. Patients with higher modified Rankin scores also had significantly higher NIHSS. A significant reduction in modified Rankin scores was observed at the third month across patient groups, though no significant differences were found in recanalization times or third-month scores between groups. Conclusion: The “drip and send” method for rapid transfer to stroke centers was shown to be critical in improving clinical outcomes, emphasizing the importance of early intervention in stroke prognosis. This study supports adopting the “drip and send” model as a standard stroke treatment approach

Evaluation of chronic cough in an immunology and allergy clinic in the Black Sea region: Causes, prevalence and outcomes

Aim: Chronic cough, one of the most common symptoms of respiratory diseases, is a condition that negatively affects patients' quality of life, prevents social activities, and is accompanied by a significant social burden. In addition, the causes of chronic cough may vary according to age and geographical location. Therefore, in this study, we wanted to examine the causes and frequency of chronic cough in the Black Sea region. Methods:  One hundred six patients age over 18 years with coughs lasting more than 8 weeks were examined retrospectively at the immunology and allergy polyclinic. Initial evaluations included details on   ACE inhibitory use and smoking, allergy symptoms, reflux,   chronic obstructive pulmonary disease, malignancy symptoms.  Relevant diagnostic tests were performed if suspected. General tests included chest radiographs, pulmonary function tests, allergy prick tests, and neck ultrasounds. Results: The most common causes are respectively asthma (28%), gastroesophageal reflux (26%), allergic respiratory diseases (16%), ACE inhibitor use (13%) and smoking (9.5%), Sjogren’s syndrome (8.4%). The most common allergen detected in allergic respiratory diseases is house dust mite (82%). Conclusion: Asthma is leading causes of chronic cough.  Additionally, 56.7% of asthma cases were allergic asthma. Sjogren’s syndrome also significantly contributes to chronic cough. This study is one of the first studies on the causes and treatment effects of chronic cough in the Black Sea Region of Türkiye

Comparison of the frequency of HLA B27 gene positivity and negativity and biochemical laboratory findings in patients diagnosed with ankylosing spondylitis

Aim: To compare some routinely studied hematological and biochemical parameters in HLA-B27 positive and negative ankylosing spondylitis (AS) patients and to evaluate their potential as early disease activity biomarkers. Methods: This retrospective study included 272 AS patients (136 HLA-B27 positive and 136 HLA-B27 negative) admitted to the Medical Genetics Department of Bolu Abant İzzet Baysal University Izzet Baysal Training and Research Hospital between 2018 and 2020. HLA-B27 genotyping was performed using Real-Time PCR. Demographic and laboratory data were collected from records, and statistical analyses compared biomarker levels between groups using appropriate tests. Results: Significantly higher white blood cell (WBC) count (p=0.033) and lymphocyte (LYM) (p=0.030) were observed in males; females had higher platelet count (PLT) (p=0.013) and procalcitonin (PCT) (p=0.016). The median values of all analyzed biochemical parameters were significantly higher in the HLA-B27 positive group than in the negative group (p < 0.05). HLA-B27 positive females had higher PLT  and PCT, while negative females showed increased PLT, PCT, neutrophil (NEU), and neutrophil-to-lymphocyte ratio (NLR) (p < 0.05). Conclusion: Our study findings suggest that hematological and inflammatory markers vary by HLA-B27 status and gender. In addition, elevated mean platelet volume (MPV) and NLR may serve as useful biomarkers for early diagnosis, monitoring, and prognosis, highlighting the importance of integrating lab parameters with genetic profiling in AS management

Investigation of leukocyte telomere length and hTERT gene MNS16A VNTR variant in microtia patients

Aim: Telomeres are the basis of replicative senescence in somatic cells and control cell division. It has been shown in some studies that telomere shortening is associated with growth retardation and congenital malformations. Microtia is acongenital ear deformity in which the external ear is malformed and underdeveloped. This study aimed to determine whether leukocyte telomere length (LTL) and the MNS16A Variable Number Tandem Repeat (VNTR) variant of the hTERT gene are associated with the risk of microtia in the Turkish population. Methods: A total of 38 volunteers, 18 patients diagnosed with microtia and 20 healthy controls, were included in the study. LTL analysis was performed with the Quantitative PCR method, and relative T/S ratios of patients and controls were calculated. hTERT-MNS16A-VNTR analysis was performed by PCR method and analysed agarose gel electrophoresis. Results: When patients and healthy controls were compared in terms of genotype/allele frequencies; no statistically significant difference was detected in the genotype and allele frequency of the hTERT-MNS16A-VNTR variant. However, when the T/S ratios of the patients were compared with the healthy group, borderline significance was detected in terms of the shortening rate (p=0.055). Conclusions: Our study is the first study in the literature to examine the relationship between microtia and LTL and hTERT-MNS16A-VNTR. The results suggest that the hTERT-MNS16A-VNTR variant may not be associated with microtia, but telomere shortening may have a causal relationship with microtia. Since microtia is a rare congenital anomaly with varying prevalence among populations, studies in different ethnicities and with larger sample groups will further elucidate the relationship between microtia and LTL/hTERT-MNS16A-VNTR

Evaluation of the effects of intermittent fasting on clinical and laboratory parameters in metabolic syndrome

Aim: Metabolic syndrome is associated with serious conditions, including obesity, type 2 diabetes mellitus, hypertension, and cardiovascular disorders. We aimed to study the effects of intermittent fasting on metabolic syndrome. Methods: Patients with metabolic syndrome were enrolled in the study. Before the intervention, anthropometric measurements (body weight, body mass index [BMI], waist and hip circumferences) and laboratory parameters (fasting blood glucose, glycated hemoglobin [HbA1c], fasting insulin) were recorded. All participants were instructed to fast for 14–16 hours per day for three months, consuming two meals during the remaining 8–10 hours. After three months, anthropometric measurements were taken again, and laboratory parameters were reassessed. Data collected before the intervention and at the third month of intermittent fasting were compared. Results: Twenty patients with metabolic syndrome completed the study protocol (7 men and 13 women). The mean age of the participants was 56±12 years. There was a statistically significant reduction in weight (from 94.4±16.7 kg to 89.1±15.9 kg), BMI (from 34.9±5.6 kg/m² to 33±5.5 kg/m²), waist circumference (from 113±13 cm to 105±11.3 cm), and hip circumference (from 118±11 cm to 113±10.4 cm) (p-values: <0.001, <0.001, <0.001, and 0.001, respectively). Moreover, fasting blood glucose (p=0.024), fasting insulin (p=0.001), and HbA1c (p=0.008) levels significantly decreased after three months of intermittent fasting. Conclusion: Intermittent fasting should be considered a nutritional strategy to reduce BMI, waist circumference, and body weight and to improve metabolic parameters

Potential role of serum chemerin values in osteoid osteoma: A prospective cross-sectional study

Aim: Chemerin is a novel adipokine that is being investigated as a diagnostic tool or therapeutic target in many diseases. In this prospective cross-sectional study, we aim to investigate the potential utility of serum chemerin levels as an adjunctive diagnostic tool for osteoid osteoma. Methods: This study consists of 20 patients diagnosed with osteoid osteoma (Group 1) and 20 healthy patients (Group 2). Age, gender, tumor localization, surgery types and chemerin values of all patients were recorded and evaluated. Results: A total of 40 patients, 20 from group 1 and 20 from group 2, were included in our study. Group 1 had a median age of 17.5 (IQR: 15.25-19.75) years, and Group 2 had a median age of 19 (IQR: 17.25-20) years (p=0.172). In terms of gender, 60% (n=12) of Group 1 and 55% (n=11) of Group 2 were male (p=0.749). Tumor nidus size varied among the participants with a median measurement of 8 (IQR: 5.25 to 8.75) mm. The median chemerin level in Group 1 was 0.94 (IQR: 0.68-1.29), while in Group 2, it was 1.89 (IQR: 1.08-3.72). The difference was statistically significant (p<0.001). The cut-off value was determined to be 1.5, with a sensitivity of 100% and a specificity of 62%. Conclusions: The results of our research indicate that patients with osteoid osteoma have lower levels of chemerin than healthy individuals. This suggests that chemerin may have potential as a biomarker for diagnosis. Additionally, our analysis using ROC showed that chemerin has good diagnostic capabilities

Malposition in central venous catheterization and the use of ultrasonography: Is the presence of turbulent flow an alternative to chest radiography?

Aim: To evaluate the rate of malposition in central venous catheterization (CVC) procedures performed by expert physicians in our intensive care units using ultrasound (US). Additionally, we investigated whether the assessment of turbulent flow via USG could eliminate the need for chest radiography and whether USG could serve as a viable alternative to radiographic confirmation. Methods: This prospective observational study was conducted between June 2024 and January 2025 in the intensive care units of Mardin Training and Research Hospital. A total of 162 adult patients who underwent CVC placement were included. Patients were divided into three groups: (1) Conventional CVC placement (n = 53), (2) US-guided CVC placement (n = 51), and (3) US-guided CVC placement with turbulent flow assessment (n = 58). The presence of turbulent flow in the right atrium was evaluated using a rapid injection of saline. The malposition rate and complications were compared among groups. Results: The malposition rate was significantly lower in the US + Turbulent Flow Group (1.5%, n = 1/58) compared to the Conventional CVC Group (7.5%, n = 4/53) and the USG-Guided Group (4.3%, n = 2/51) (p = 0.022). Additionally, no complications were observed in the US-Guided and US + Turbulent Flow Groups, whereas the complication rate in the Conventional CVC Group was 6.67% (n = 4/53) (p = 0.010). Regression analysis showed that turbulent flow detection was significantly associated with correct catheter positioning (p = 0.018, Beta = 2.361). Conclusion: Our findings suggest that US, particularly with turbulent flow assessment, is a highly effective method for confirming CVC placement and may reduce the need for routine chest radiography. The use of US-guided techniques significantly lowers the malposition rate and enhances patient safety. Incorporating turbulent flow assessment into clinical protocols may improve the accuracy of catheter placement and minimize complications

Predicting mortality risk and determining critical factors in intensive care patients: A preliminary study on covid-19 patients

Aim: To predict the mortality risk of COVID-19 patients in the intensive care unit (ICU) using clinical parameters and machine learning approaches. Methods: Data from 307 ICU patients at Erciyes University Hospital (2021–2022) were analyzed. Particle swarm optimization (PSO) and least absolute shrinkage and selection operator (LASSO) methods were utilized for feature selection. Four machine learning algorithms support vector machine (SVM), K-nearest neighbors (KNN), ensemble methods, and artificial neural networks (ANN) were applied to the selected parameters. Results: The top 10 predictive parameters, common to both LASSO and PSO, included sodium, nucleated red blood cell (NRBC) count, magnesium, mean corpuscular hemoglobin (MCH), and lymphocyte count. The best prediction performance was achieved using PSO feature selection and ANN (AUC: 86.77%, sensitivity: 85.12%, specificity: 77.44%, F1-score: 81.10%). Conclusions: This study identifies critical parameters for predicting ICU COVID-19 patient mortality risk, employing two feature selection methods and comparing their performance with four machine learning algorithms. These results offer valuable insights for specialized physicians regarding disease progression and mortality risk prediction, but further research is needed