Objective: Anesthetics have various effects on intracranial pressure (ICP). We aimed to compare the effects of sevoflurane and desflurane on intracranial pressure during laparoscopic cholecystectomy.
Methods: After obtaining ethical approval and patients’ informed consent, 69 patients scheduled for laparoscopic cholecystectomy were randomized into Group-S and Group-D. Demographic data, hemodynamics, and ultrasonographic optic nerve sheath diameter (ONSD) values were recorded. Patients were administered propofol, fentanyl, and rocuronium for induction of anesthesia. Anesthesia was maintained by administering sevoflurane in Group-S, desflurane in Group-D, and remifentanil infusion. The respiratory rate was adjusted, with end-tidal carbon dioxide (ETCO2) values of 35–40 mmHg. The ONSD measurements, hemodynamics, and ETCO2 levels were recorded at 5 minutes after induction (T1), 3 minutes after creating pneumoperitoneum and reverse Trendelenburg position (T2), 20 minutes of pneumoperitoneum (T3), and 5 minutes after terminating pneumoperitoneum (T4). All parameters were recorded by an anesthesiologist blinded to the groups.
Results: Patients had similar demographic data, intraoperative hemodynamic parameters, SpO2, and end-tidal CO2 levels. There was no difference between the groups in ONSD measured at T0, T1, T2, T3, and T4. Intragroup comparisons revealed that the ONSD was higher at all measurement times than the baseline in both groups.
Conclusion: Sevoflurane and desflurane had similar effects on ICP during laparoscopic cholecystectomy, and the intraoperative ICP was higher than the baseline in both groups

INTRODUCTION: During the COVID-19 pandemic, a decrease in hospital admissions has been observed due to fear of exposure to the infectious agent. This situation has raised concerns about a decrease in presentations and delays in diagnosis among patients with symptoms and suspicion of lung cancer. Additionally, it is argued that the increase in the number of thoracic computed tomography scans due to COVID-19 infection supports the view that lung cancer is being detected in early stages. In this study, we aimed to investigate the impact of the
pandemic on the diagnosis of lung cancer.
METHODS: Patients diagnosed with lung cancer in our hospital between 2019-2021 were evaluated retrospectively. The sex, age, TNM classifications, stages, pathological diagnoses and treatments of the patients were recorded and the one-year periods before and after the start of pandemic were compared.
RESULTS: 348 patients with lung cancers were included in the study. It was observed that 292 of these patients were diagnosed with non-small cell lung cancer, and 56 patients were diagnosed with small cell lung cancer. 182 patients were detected at the 1A-3A stages of non-small cel lung cancer, relatively early stages, while 110 were detected at the 3B-4B stages at diagnosis. The rate of early-stage non-small cell lung cancer diagnosis was 70.3% before the pandemic and 56.1% after the start of pandemic, with a statistically significant difference (p=0.013). It was found that the rate of those who underwent curative surgery in the nonsmall cell lung cancer group after the start of pandemic decreased (83/164, 50.6%) when the patient groups were compared in terms of treatment before the pandemic (80/128, %62.5) (p=0.034).
DISCUSSION AND CONCLUSION: Our findings indicate that lung cancer diagnoses may have been delayed due to the restrictions during the pandemic and the anxiety of contracting the disease, or due to the increased burden on health care system.

INTRODUCTION: Non-alcoholic steatohepatitis (NASH) is one of the most common metabolic diseases of the liver. In patients with NASH, progression to cirrhosis can be observed in approximately 25% over a decade following diagnosis, and it is considered the most frequent cause of cryptogenic cirrhosis. Fibrinogen-like protein-2 (FGL-2) is a sub-member of the fibrinogen superfamily secreted by regulatory T cells. It inhibits the maturation of dendritic
cells and induces apoptosis in B cells, playing a role in innate and adaptive immunity regulation. Recent studies have shown high serum FGL-2 levels are a poor prognostic indicator in patients with viral hepatitis.
METHODS: The study included 30 NASH patients diagnosed by biopsy and a control group of 21 healthy individuals. Serum FGL-2 levels of individuals in both groups were compared. The relationship between the clinicopathological features of individuals in both groups and FGL-2 levels was also examined.
RESULTS: Serum FGL-2 levels in NASH patients were found to be 47±12 ng/ml, while in the control group, it was 37±10 ng/ml. Statistical evaluation was performed using the MannWhitney U test. A significant difference was found between patients classified by biopsy as simple steatosis, borderline NASH, definite NASH, and the control group (p=0.002). A significant difference was also observed when evaluating these four groups among themselves (Kruskal-Wallis test, p=0.012).
DISCUSSION AND CONCLUSION: Our study identified higher serum FGL-2 levels in patients diagnosed with NASH, consistent with steatohepatitis observed in biopsies. Elevated FGL-2 levels may indicate hepatic damage at the microinflammation level. Estimating disease severity, non-invasive monitoring and control of disease progression, selecting patients for aggressive treatment approaches, and intensifying monitoring intervals for cirrhosis and HCC could be crucial. However, more comprehensive studies on this topic are needed.

INTRODUCTION: One of the most frequently used scoring systems routinely to determine whether pneumonia patients need inpatient treatment is the CURB-65 score. Recently, studies conducted with simple, cheap, and rapid blood tests such as hemogram and biochemistry parameters, which every clinician can easily interpret, have gained popularity. This study examined the relationship between blood tests requested in the emergency department (ED) and pneumonia severity and prognosis.
METHODS: The study examined the files of patients who came to the ED with complaints of fever, cough, phlegm and fatigue between January 1 and December 31, 2017. Pneumonia severity according to thorax tomography and CURB-65 score at admission were evaluated. The patient’s vital signs, hemogram, biochemistry and blood gas parameters were examined. It was compared with the ward they were admitted to and their 30-day prognosis.
RESULTS: The files of 117 patients were examined. The age of the patients was significantly higher in the group with severe pneumonia than mild and moderate pneumonia groups. In the group with moderate and severe pneumonia, comorbidities were significantly higher than the mild pneumonia group. The rate of intensive care admission and ex in the group with severe pneumonia was significantly higher than in mild and moderate pneumonia groups. In the ex-group, the CURB-65 score, neutrophil-lymphocyte ratio (NLR), C-Reactive Protein
(CRP)/Albumin and pneumonia severity were significantly higher than the other group.
DISCUSSION AND CONCLUSION: NLR and CRP/Albumin ratios may be as effective as CURB-65 scoring in predicting 30-day mortality, and ED burden can be reduced with simple blood tests

INTRODUCTION: Intrahepatic cholestasis of pregnancy (ICP) is the most common pregnancy-specific liver disease, associated with a 4 to 10-fold increased risk of stillbirth if appropriate interventions are not taken. The aim of the study was to compare the obstetric outcomes of singleton pregnancies with ICP in which pregnancies were achieved spontaneously and by in vitro fertilization (IVF).
METHODS: Women who gave birth between January 2018 and September 2022 were evaluated retrospectively. After applying the inclusion criteria, a total of 91 patients with ICP were eligible, consisting of spontaneously conceived (group 1, n=74) and IVF-conceived (group 2, n=17) pregnancies. The participants in group 2 were classified into two subgroups: fresh embryo transfer (n=9) and frozen embryo transfer (n=8), depending on the method of embryo transfer.
RESULTS: Perinatal outcomes and demographic characteristics, with the exception of age, gravidity, and parity, were similar. While age was significantly higher in group 2 [32 (27-35) vs. 27 (24-31), p=0.017], gravidity and parity were significantly higher in group 1 [2 (1-3) vs. 1 (1-2), p=0.021 and 0 (0-1) vs. 0 (0-0), p=0.009]. Aspartate (AST) and alanine (ALT) transaminase levels, fasting total bile acid (FTBA) level, and treatment dose of ursodeoxycholic acid were significantly higher in the frozen embryo transfer group than in the fresh embryo transfer group [126 (83-242) vs. 32 (31-43), p=0.001; 200±123.9 vs. 51±39.4, 0.001; 44±20.4 vs. 15±5.0, p=0.001, and 100 (750-1250) vs. 750 (750-750), p=0.004].
DISCUSSION AND CONCLUSION: Our results suggest that there is an association between high FTBA, ALT, and AST levels due to estrogen treatment in IVF pregnancies, especially when the frozen embryo transfer method was used.

INTRODUCTION: Obesity continues to be an important problem in childhood as well as in adults worldwide. It is known that obesity experienced in childhood has effects on emotional development besides physical effects. In this study, it was aimed to investigate the effects of obesity on cognitive functions in adolescents, which is the most important step of the transition to adulthood.
METHODS: Obese and non-obese adolescents with no other known health problems were included in the study. In order to evaluate cognitive functions in obese patients and the control group, tests evaluating auditory and visual memory and attention were applied.
RESULTS: As a result of the assessments made, a statistically significant difference was found in terms of visual memory scores and verbal fluency total and sub-dimension total mean scores. No statistically significant difference in terms of WISC-R verbal, performance, and total score means applied to the participants was found.
DISCUSSION AND CONCLUSION: In our study, it was observed that obesity may adversely affect cognitive functions in childhood in some areas. It may be necessary to determine the factors that negatively affect cognitive functions in obese children and to take supportive interventions and measures.

INTRODUCTION: Anesthesiologists are constant members of teamwork, especially in operating room and ICU. However, the relationship between teamwork (TW) and psychological state of anesthesiologist has not been adequately studied in the literature. This study aimed to compare the anesthesiologists with other medical branches in terms of coping strategies and perceived social support, considering the levels of teamwork reliance.
METHODS: We conducted two online surveys. In the preliminary survey, we tested our prediction about the TW levels of anesthesiologists and other branches on medical faculty graduates (n=266). In the main survey with a new sample, we examined the relationship between social support and coping styles against stress in anesthesiology (high TW group, n=107) and dermatology (low TW group, n=91) residents.
RESULTS: Preliminary survey showed that anesthesiology had high TW levels (Mean=4.03), as expected. Dermatology who had low TW levels (Mean=2.53) were selected for the comparison group of the main survey. The main survey indicated that dermatologists (Mdn=16) use the submissive coping approach more than anesthesiologists (Mdn=15; p=.007). There was no significant difference in perceived social support levels of the two groups.
DISCUSSION AND CONCLUSION: We found a relationship between passive coping strategies that aim to protect from negative emotions caused by stressful events rather than solving the problem and low teamwork level. We think that teamwork may contribute to problem-solving processes by helping anesthesiologists to actively cope with stress.

INTRODUCTION: COVID-19 disease has recently affected the whole world and caused drastic changes in people’s lives with its emergence. Hospitals and healthcare personnel are among the most affected sides. Our study aimed to demonstrate the effects of the pandemic on healthcare workers regarding changes in their perceived stress and burnout levels.
METHODS: 110 individuals, including physicians, nurses, and auxiliary personnel working in a neurosurgery clinic, were involved in the study. Demographic information form, Perceived Stress Scale-14 (PSS), and Maslach Burnout Index (MBI) were used during the data collection phase.
RESULTS: No difference was found between PSS and MBI scales between females and males. Higher MBI points were seen in workers who desire to change their occupations. Married participants had higher MBI personal accomplishment scores than single participants. An increase in education level was associated with higher PSS scores. Participants who found their payments unsatisfactory had higher stress and burnout levels.
DISCUSSION AND CONCLUSION: Findings of higher occupational burnout among physicians and nurses than auxiliary personnel have been consistent with previous research. A similar case is also present for lower perceived stress levels among married participants when compared to singles. This finding, which has also been demonstrated in other studies, can be explained by fewer responsibilities for singles.

INTRODUCTION: There are a few studies on the relationship between personality and temperament types and functionality and pain felt in patients with knee osteoarthritis (OA). This study aimed to determine the relationship between personality and temperament characteristics and pain and function in patients with knee OA.
METHODS: The study included 126 patients diagnosed with knee OA who met the inclusion criteria. Eysenck Personality Questionnaire Revised-Short Form (EPQR-S) and Type D Personality Scale (DS-14) were used for personality assessment, Temperament Evaluation of Memphis, Pisa, and San Diego Auto-questionnaire (TEMPS-A) was employed for temperament assessment, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used for OA pain and general function assessment.
RESULTS: Of the participants, 58 (46%) showed Type D personality traits, while depressive temperament was dominant in 18 (14.3%) participants, irritable temperament in 12 (9.5%), and anxious temperament in 16 (17.3%) participants. Those with Type D personality had worse functions, and Type D personality was positively associated with pain and total WOMAC score. Total WOMAC score showed a positive correlation with neuroticism and psychoticism personality traits and cyclothymic and nervous temperament traits.
DISCUSSION AND CONCLUSION: This study demonstrates that pain and total WOMAC score are associated with personality and temperament characteristics in patients with knee OA. In addition to pharmacological and physical therapy, interventions in these areas may be beneficial.

INTRODUCTION: To describe the characteristics of pregnant women diagnosed with adnexal masses and review our experience with diagnosis, management and treatment modalities in this area for which there are no definitive treatment guidelines.
METHODS: All women with adnexal masses during pregnancy whose management and follow-up was completed at a large tertiary referral center between January 2018 and September 2023 were retrospectively evaluated. After applying the exclusion criteria, a total of 19 women who underwent antepartum laparoscopic adnexal surgery (group 1) and 34 women who underwent expectant management (group 2) were included.
RESULTS: Gestational age at birth, cesarean section rates, birthweight and APGAR-5 scores were similar, while the largest mass diameter and CA-125 levels were significantly higher in group 1 (p<0.001 and p=0.014, respectively). Of the patients in group 1, 15 (78.9%) had unilateral complex cysts and 4 (21.1%) had unilateral simple cysts, while there were no bilateral masses. Emergency laparoscopy was performed in 6 (31.6%) of patients for adnexal torsion and in 7 (36.8%) for cyst rupture, while elective laparoscopy was performed in 6 (31.6%) asymptomatic patients with suspected malignancy. While functional cyst was the
most common histopathologic finding, malignancy was found in 2 cases (granulosa cell tumor and endometrioid adenocarcinoma). Preterm births occurred in 8 (41.1%) women, of whom 5 (26.3%) gave birth before 34 weeks’ gestation and 3 (15.7%) between 34-36 weeks and 6 days.
DISCUSSION AND CONCLUSION: Parallel to the increase in ultrasound examinations in early pregnancy, both the overdiagnosis and early detection of adnexal masses during pregnancy have increased. Given the high rate of spontaneous regression in most lesions and the fact that bleeding in ruptured cases is usually self-limiting, an expectant approach would be appropriate in cases without hemodynamic instability, acute abdomen and/or suspected malignancy. Laparoscopy is a safe and efficient surgical approach for surgery.

INTRODUCTION: The aim of this study was to assess vitamin D status and its impact on the initial characteristics of primary hyperparathyroidism (PHPT).
METHODS: This study included consecutive participants diagnosed with PHPT aged 18 years and/or older at a tertiary center between November 2017 and December 2023. A total of 195 subjects not taking vitamin D replacement were reviewed retrospectively. The study population was categorized into three groups according to their vitamin D levels at the time of admission: Group 1: vitamin D ≤19 ng/mL, Group 2: vitamin D 20-29 ng/mL, and Group 3: vitamin D ≥30 ng/mL. Demographic, clinical, biochemical, radiological findings, and postoperative complications were compared between the three groups.
RESULTS: Among 195 patients, 157 (80.5%) were women, and 38 (19.5%) were men. The mean age was 56.4±14.5 years. Sixty-five patients (33.3%) had vitamin D deficiency (VDD), and 48 patients (24.7%) had vitamin D insufficiency. Of the 195 patients, 74 (37.9%) had kidney stones, and 90 (46.2%) had osteoporosis. Fracture frequency was 9.7% (n=19). VDD was associated with higher parathyroid hormone (PTH) levels (p=0.000) and better estimated glomerular filtration rate (p=0.021). When all groups were compared, there were no differences in terms of nephrolithiasis, osteoporosis, and fractures.
DISCUSSION AND CONCLUSION: The present study revealed that VDD was associated with higher PTH levels and better renal function. However, vitamin D status was not associated with classical target organ involvement in PHPT.

INTRODUCTION: Acute appendicitis is a surgical emergency that causes acute abdominal pain. After laparoscopic appendectomy, standard hospital care is nearly 24-h, although some patients need a longer length of hospital stay (LOS). This study aimed to evaluate the factors that influence LOS after appendectomy by examining biochemical and radiologic parameters.
METHODS: This study retrospectively analyzed the data of 185 patients who underwent appendectomy in 2020-2024 in our hospital. Patient files were examined, and preoperative biochemical values such as white blood cell count, lymphocyte count, neutrophil count, C reactive protein (CRP) value, and neutrophil-lymphocyte ratio (NLR) were recorded. Preoperative radiologic examinations, appendix diameter, and presence of periappendiceal free fluid were assessed.
RESULTS: A total of 163 patients were in early discharge group, and 22 patients were in late discharge group. The mean age of the patients was 34.5±8.5 years, and 53.5% were male. The mean discharge was 1.8±1.4 days. Lymphocyte count was statistically significantly lower in late discharge group, and NLR, CRP value, and appendix diameter were statistically significantly higher in late discharge group (p<0.005). Multivariate analysis showed a significant independent effect of NLR and CRP values (p<0.05)
DISCUSSION AND CONCLUSION: Decreased lymphocytes, elevated NLR and CRP values, increased appendix diameter, and presence of periappendiceal free fluid on CT affected patients’ LOS after appendectomy. Patients with these risk factors could be preferentially selected for laparoscopic approach, routine drain placement, late start of normal food, planned late discharge time and should be informed about longer hospitalization.

INTRODUCTION: In this research, it was aimed to evaluate Multivariate analysis of emergency department related deaths in the Europe (the EU) and Turkey.
METHODS: Data set was collected from the World Bank Country Reports for the EU and Turkey from 2002 to 2021. Accident, suicide and disease related mortality rates were used as dependent variables. Independent variables were heath expenditure, rural population and population growth.
RESULTS: Disease mortality, rural population and population growth were significantly higher in Türkiye, whereas suicide mortality and health expenditure were significantly higher in the EU (p<0.05). Location had significant correlation with suicide mortality (r=0.868; p<0.01), disease mortality (r=-0.728; p<0.01), health expenditure (r=0.866; p<0.01) and population growth (r=-0.866; p<0.01). In year-controlled correlation, location had significant correlation with suicide mortality (r=0.997; p<0.01), disease mortality (r=-0.976; p<0.01), health
expenditure (r=0.957; p<0.01), rural population (r=-0.745; p<0.01) and population growth (r=-0.939; p<0.01). For Türkiye, accident mortality was significantly and positively correlated with population growth (r=0.572; p<0.01). Suicide mortality was significantly and negatively correlated with health expenditure (r=-0.710; p<0.01), and positively correlated with rural population (r=0.836; p<0.01). Disease mortality was significantly and negatively correlated with health expenditure (r=-0.486; p<0.01), and positively correlated with rural population (r=0.980; p<0.01). For the EU, accident mortality was significantly and negatively correlated with health expenditure (r=-0.798; p<0.01), and positively correlated with rural population (r=0.998; p<0.01). Suicide mortality was significantly and negatively correlated with health expenditure (r=-0.683; p<0.01), and positively correlated with rural population (r=0.889; p<0.01). Disease mortality was significantly and negatively correlated with health expenditure (r=-0.821; p<0.01), and positively correlated with rural population (r=0.998; p<0.01).
DISCUSSION AND CONCLUSION: Mutual information exchange and health system model analyzes may be useful to prevent deaths due to disease in Turkey and deaths due to suicide in the EU countries.

INTRODUCTION: In this study, the demographic characteristics, causes of trauma, prognosis, and types of trauma of pediatric trauma patients followed in a single center over a period of three years were retrospectively examined.
METHODS: Data of pediatric patients admitted to our (single-center, 8-bed) pediatric intensive care unit due to trauma between January 2020 and January 2023 were retrospectively reviewed from computer records.
RESULTS: This study includes 122 pediatric trauma cases (37 females and 85 males) with an average age of 75±59 months admitted to intensive care with a diagnosis of trauma. The most frequently observed type of trauma was falls from a height in 68 cases (55.7%), the most affected anatomical region was the head and neck region in 75 cases (61.5%), and the most common pathology was intracranial hemorrhage in 55 cases (45.1%). Surgery was necessary for 36% of the cases, and the predominant reason for surgical intervention was observed in 22 cases (18%), primarily attributed to falls from a height. During the course of their stay in the intensive care unit, 13 cases (10.6%) experienced mortality, indicating a mortality rate of 10.6%.
DISCUSSION AND CONCLUSION: Traumas remain a significant cause of mortality and morbidity in the pediatric age group today

INTRODUCTION: We aim to investigate the prevalence of low vitamin D levels in pregnant women receiving medical care at a tertiary hospital by analyzing the seasonal variations in these levels.
METHODS: This study was conducted at the Obstetrics and Gynecology outpatient facility of a tertiary medical institution between February 2020 and February 2024. The demographic data, including maternal age, parity, gestational age, smoking status, vitamin D level, and seasonal information, were duly captured from the first antenatal medical examination records.
RESULTS: After the exclusion of individuals who did not meet the predetermined criteria, a total of 1101 pregnant women were selected to partake in the study. Among the pregnant women, a large proportion (866, 79%) had serum 25(OH)D concentrations lower than 20 ng/mL, with an additional 132 out of 866 (15.2%) having levels below 5 ng/mL. The overall sample group showed a mean vitamin level of 13.71±9.18, while the subset of participants with a vitamin D deficiency had a recorded value of 9.85±4.62. During the fall and summer seasons, a considerable 82% and 72.8% respectively exhibited a significant prevalence of hypovitaminosis D. The trend curve for the seasonal vitamin D levels of the vitamin D-deficient group shows a relatively flat pattern, with an R²=0.0097 score.
DISCUSSION AND CONCLUSION: The findings from our investigation corroborate the implementation of prenatal multivitamins enriched with vitamin D as a preventive measure against musculoskeletal and non-musculoskeletal conditions for maternal and neonatal health.

INTRODUCTION: There are numerous diagnostic, biological, and histological manifestations of salivary gland tumors, each of which offers concerns and difficulties in terms of diagnosis, grading, categorization, and therapy. The purpose of this study was to evaluate and compare the immunohistochemical expression of Bcl-2, caspase-3, and GSTP in benign and malignant salivary gland tumors, as well as how they are connected to a variety of clinicopathological variables.
METHODS: A total of 61 cases of buffered formalin-fixed, paraffin-embedded tissues from previously identified cases of benign and malignant salivary gland tumors were included in this study. The immunohistochemistry staining process was carried out according to the manufacturer’s recommendations, employing polyclonal anti-Bcl-2, anti-caspase-3, and anti-GST antibodies.
RESULTS: The correlation between mean tumor diameter and Bcl-2 expression was shown to be statistically significant (rs=0.258, p<0.05). In pleomorphic adenoma tumor tissues, there were statistically significant correlations between the expression levels of Bcl-2 and caspase-3 (rs=0.66, p<0.01), Bcl-2 and GST (rs=0.61, p<0.01), and caspase-3 and GST (rs=0.73, p<0.01) when tumor types were compared. The tissues with pleomorphic adenoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma had the highest staining intensity of Bcl-2 expression, while the lowest staining intensity of GSTP expression was observed.
DISCUSSION AND CONCLUSION: It seems probable to draw the conclusion that salivary gland tumors that resist apoptosis have elevated levels of Bcl-2 expression. The prognosis for salivary gland tumors may be poor due to the positive correlation between tumor diameter and high Bcl-2 expression.