INTRODUCTION: To perform an extensive evaluation of the relationship between anxiety and depression levels in patients diagnosed with anal fissure, the effects of acute pain on psychiatric disorders, and the impact of surgical treatment on those psychological effects.
METHODS: One hundred five patients diagnosed with anal fissure between January 2022 and June 2024 and 99 healthy controls were included in the study. The Hospital Anxiety and Depression Scale (HADS) was employed for psychiatric evaluation and a visual analogue scale (VAS) for pain severity. The data were analyzed using the Mann-Whitney U test, the chi-square test, and Spearman’s correlation analysis.
RESULTS: Depression (HADS-D) scores were significantly higher in the patient group than in the control group (p<0.01). Although anxiety (HADS-A) scores were also higher in the patient group, the difference was not statistically significant (p=0.129). Both anxiety and depression scores were significantly higher in women than in men (p<0.05). No powerful correlation was observed between VAS scores and anxiety or depression (r=0.68, p<0.001). Surgical treatment produced significant improvement in pain and anxiety (p<0.01), but a need for additional measures for depression management was observed (p>0.05).
DISCUSSION AND CONCLUSION: High rates of depression and anxiety and an association with pain severity were determined in patients with anal fissure. Surgical treatment plays an important role in the therapeutic process, particularly with its positive effects on pain and anxiety. These findings emphasize the need for a multidisciplinary approach.

INTRODUCTION: We aimed to predict the distinction between mild and severe Covid-19 pneumonia by using computerized tomography (CT) and laboratory system.
METHODS: Our study was planned retrospectively. Our study included 587 patients, 263 (44.8%) women and 324 (55.2%) men, who applied to the emergency department. Hemogram and biochemistry parameters were used. The Chest CT Severity Score (CT score) was calculated for each patient’s lung involvement (0: No involvement, 1: 0%-25%; 2: 26%-50%; 3: 51%-75%; 4: 76%-100%). A distinction was made between mild and severe Covid-19 pneumonia.
RESULTS: According to the logistic regression analysis, when the Hb and ALP values increase by 1 unit, the risk of high involvement is respectively; 9.4%(p=0.045)(OR=0.906) and 0.8% (p=0.010)(OR=0.992) will decrease. When ALT and CRP values increase by 1 unit, the risk of high involvement is respectively; It will increase by 1% (p=0.041)(OR=1.010) and 1.6% (p=0.000)(OR=1.016). In addition, as NLR, PLR, and AST/ALT ratios increase, the CT score will increase (r=0.226; p=0.000, r=0.163; p=0.000, r=0.209; p=0.000, respectively).
DISCUSSION AND CONCLUSION: CT score can be estimated using laboratory data that is quick and easy to access. We found that Hb, ALT, ALP and CRP values and CT score are predictable in Covid-19 cases. We think that our study will contribute to other studies on Covid-19 pneumonia.

INTRODUCTION: Biotinidase deficiency (BD) is a rare autosomal recessive metabolic disorder leading to neurological, dermatological, and, potentially, respiratory complications. While neurological and cutaneous manifestations of BD are well-documented, respiratory involvement remains less explored.This study aimed to evaluate respiratory function in patients diagnosed with BD, specifically assessing the presence of chronic respiratory symptoms and their potential relationship with BD.
METHODS: We conducted a retrospective study of 13 patients with confirmed BD who presented with respiratory complaints at our pediatric pulmonology clinic. Clinical evaluations, pulmonary function tests (PFTs), and bronchodilator responsiveness were assessed. Statistical analyses were performed using SPSS 25.0.
RESULTS: The median age of patients was 9 years (IQR: 9-13), with 61.5% being female. A total of 77% had parental consanguinity. Three patients (23.1%) exhibited obstructive patterns on PFTs, all of whom demonstrated significant bronchodilator responsiveness. These patients were treated with long-acting beta-agonists and inhaled corticosteroids, resulting in resolution of symptoms within three weeks. No significant correlation was observed between biotinidase enzyme activity and respiratory parameters.
DISCUSSION AND CONCLUSION: The prevalence of reversible airway obstruction in BD patients closely aligns with the general population prevalence of asthma, suggesting that these findings may be coincidental rather than causally related to BD. Standard asthma therapy effectively alleviated symptoms, further supporting this interpretation. Future research with larger cohorts and long-term follow-up is warranted to clarify the respiratory implications of BD.

INTRODUCTION: The aim of this study was to determine the effects of eicosapentaenoic acid (EPA), gamma linolenic acid (GLA), and antioxidant-enriched enteral nutrition on oxidative stress and oxygenation in patients with acute respiratory distress syndrome (ARDS).
METHODS: This prospective randomized controlled clinical trial included 41 patients sus-pected of having of ARDS. Group C received high-carbohydrate enteral nutrition, and group E received enteral nutrition enriched with EPA, GLA, and antioxidants. The control group included 10 healthy volunteers used to compare basal enzyme levels. Oxidative stress was evaluated via measurement of catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GPx), xanthine oxidase (XAO), and malonaldehyde (MDA) levels in blood sam-ples. Patients were followed-up for 7 d, and on d 1, 4, and 7 blood samples were collected. Ventilatory settings, including the PaO₂: FiO₂ ratio, positive-end expiratory pressure (PEEP), peak inspiratory pressure (PIP), and minute ventilation volume (MV), were recorded daily.
RESULTS: In total, 31 of the 41 patients completed the study. Findings for d 1 showed that the ARDS patients had antioxidant enzyme deficiency, as compared to the healthy controls. XAO and GPx levels in group E increased daily and the difference between successive days were significant (p<0.05). CAT and SOD levels in groups C and E did not differ between days. In group E the MDA level decreased significantly over time (p<0.05). There weren’t any significant differences in PEEP, PIP, MV, or the PaO₂: FiO₂ ratio between baseline and d 7 of the study. Oxygenation in group E did improvement during the study.
DISCUSSION AND CONCLUSION: EPA, GLA, and antioxidant-enriched enteral nutrition in patients with ARDS increased antioxidant enzyme levels and reduced lipid peroxidation, which decreased oxida-tive stress, but did not improve gas exchange or oxygenation.

INTRODUCTION: We aimed to evaluate patients who presented to our clinic with large adrenal lesion and underwent surgical treatment through either a laparoscopic or open approach, focusing on endocrinological, surgical, and pathological aspects, in the context of existing literature.
METHODS: In this retrospective study, the records of 757 patients admitted to our clinic for adrenal lesion between 2013 and 2024 were examined. Lesions larger than 5 cm were found in 38 of them. The data of 32 patients who met the study criteria and were operated with the surgical approach determined by an experienced surgeon were analyzed. Clinical, laboratory, surgical and pathological findings were evaluated comprehensively.
RESULTS: Hormonal analysis of 32 patients included in the study revealed functional lesions in 23 patients (71.9%) (Group 1) and non-functional lesions in 9 patients (28.1%) (Group 2). The most common histopathological diagnosis after surgical resection was pheochromocytoma, which was observed in 12 patients (37.5%). The median volume of all large adrenal lesions was 118.3 cm³ (interquartile range [IQR] 51.9-296.3). The median volume of Group 1 lesions was 159.1 cm³ (IQR 46.8-436.8), while the median volume of Group 2 lesions was 100.1 cm³ (IQR 72.2-156.5) (p>0.05). When analysed according to surgical approach (laparoscopic vs. open), open surgery was performed more frequently in Group 1 compared to Group 2 (p=0.035). The median Ki-67 index values were 4 (IQR=1-20) for Group 1 and 6 (IQR=3.5-57.5) for Group 2 with no significant difference between the groups (p>0.05).
DISCUSSION AND CONCLUSION: This study highlights the necessity of a multidisciplinary approach in managing large adrenal lesions, involving endocrinologists, skilled surgeons, and pathologists for optimal treatment. Tailored surgical decisions and preoperative preparation based on tumor functionality and size are essential for minimizing risks and ensuring successful outcomes.

INTRODUCTION: Endoscopic retrograde cholangiopancreatography (ERCP) is a challenging procedure that requires high-level skills, especially because the risks associated with performing ERCP in patients with altered anatomy are increased. In order to safely and effectively perform ERCP, specialized training and experience are important.
METHODS: This is a retrospective study on the outcome of the first 30 ERCP cases performed by a surgeon newly trained in a public hospital. Patients were divided into two sets of 15 cases in order to evaluate the development of the skill. Data are analyzed regarding success rates, procedure duration, and complications.
RESULTS: Technical success and clinical improvement were achieved in 76.7% each. First-at-tempt success improved from 46.7% in Group 1 to 86.7% in Group 2, showing skill maturation. Procedure time was significantly shorter in Group 2, at 31.67 vs 50.33 minutes in Group 1 (p<0.001). Complications were rare, in one patient with bleeding and one patient with pancreatitis (3.3%).
DISCUSSION AND CONCLUSION: The data indicates that the success rate and efficiency of ERCP rise with experience, demonstrating the need for recently trained surgeons to attend structured training courses. There is minimal complication incidence that puts in view the importance of protocols and experience in safeguarding patients. It has also brought challenges identified, including anesthesia and equipment problems, that indicate a need for procedural support to enhance success. Advanced ERCP training courses that emphasize technical and cognitive skills can optimally prepare surgeons, especially in resource-constrained settings, to safely and effectively carry out these complex interventions.

INTRODUCTION: Thoracentesis is a simple bedside diagnostic method to collect samples of pleural effusion (PE) readily. In this study, we aimed to investigate and define the etiology of pleural effusion with routine cytological examination along with the examination of cytology and cell blocks.
METHODS: Patients (404 cases), who underwent primary thoracentesis in the period from 2018 to 2022, were included in the study retrospectively. All collected patient samples were submitted to the pathology laboratory for the cytological examination.
RESULTS: The vast majority of the PE specimens (320 cases; 79.2%) were classified as benign. Sixty-six (16.3%) cases were diagnosed as malignant. Ten cases were considered as non-diagnostic and 8 cases were considered as suspected for malignancies. No statistically significant differences were found in the age and sex between the serous and hemorrhagic effusion groups. Statistically significant differences were identified based on the cytopathologic diagnosis (p=0.001).
DISCUSSION AND CONCLUSION: Etiologic classification of pleural effusion as benign or malignant can be made with high diagnostic accuracy by examining the cell blocks in combination with the cytological examination of the pleural fluid.

INTRODUCTION: This study aims to investigate maternal serum NGAL (Neutrophil Gelati-nase-Associated Lipocalin) levels in pregnant women diagnosed with fetal pyelectasis during antenatal follow-up and to evaluate the relationship between fetal pyelectasis and maternal serum NGAL levels.
METHODS: This prospective study included 39 pregnant women diagnosed with fetal pyelec-tasis at 20–22 weeks of gestation and 33 pregnant women without pyelectasis as the control group. Fetal pyelectasis was classified based on the anteroposterior diameter of the renal pelvis: 4–7 mm as “mild pyelectasis” and 7-10 mm as “moderate pyelectasis.” Maternal blood samples were collected from both groups, and serum NGAL levels were measured using the ELISA method and analyzed statistically.
RESULTS: The fetal pyelectasis group was further categorized into mild and moderate sub-groups. NGAL levels showed a significant difference across the groups (p=0.008). The mod-erate pyelectasis group had significantly higher NGAL levels compared to the control group (p=0.005), whereas the mild pyelectasis group did not show a significant difference. Multino-mial logistic regression analysis demonstrated that NGAL levels increased with the severity of pyelectasis.
DISCUSSION AND CONCLUSION: Maternal serum NGAL levels were found to be associated with the severity of fetal pyelectasis, suggesting its potential as a non-invasive biomarker. However, further studies with larger sample sizes are needed to validate its use in prenatal diagnosis.

INTRODUCTION: The aim of this study was to investigate the long-term prognosis of patients of glomerulonephrýtýs developýng after Severe acute respiratory syndrome coronavirus 2 (Sars-Cov-2) ýnfectýon and vaccýnatýon patients.
METHODS: In this case series, we reported a total of 24 newly diagnosed GN cases after SARS-CoV-2 mRNA vaccinesor SARS-CoV-2 infection. We recorded the urea creatinine, albumin, proteinuria, albuminuria values at 1st, 3rd, 6th, 12th, and 24th month follow-ups from our patients' file records. We evaluated their treatment responses and long-term renal prognoses.
RESULTS: Results: A total of 24 patients were evaluated. GN developed after vaccination in 18 patients (75%) and after infection in 6 patients (25%). The most common GN in our case series was membranous glomerulonephritis (MN)(12 of 24, 50%). 5 patients had IgA nephropathy (IGAN) ( 20%), 3 had idiopathic immune complex glomerulonephritis (ICGN,12.5%), 1 had anti-glomerular basement membrane disease (Anti-GBM), 1 had minimal change disease (MCD) and 1 had MPO-ANCA associated glomerulonephritis. Only 4 of the patients are followed up in remission in the 2nd year.
DISCUSSION AND CONCLUSION: Long-term follow-up data on glomerulonephritis (GN) developing after vaccination and infection remains scarce in the literature. We present the long-term follow-up results of our GN patients who developed the condition after vaccination and infection, aiming to contribute to addressing this knowledge gap. Our clinical observations suggest that patients who developed GN post-infection exhibited poorer treatment responses. Therefore, despite ongoing vaccine discussions, we reiterate the importance of community vaccination as a crucial protective measure.

INTRODUCTION: This study aimed to evaluate the effectiveness and safety of CDK4/6 inhibitor therapy in patients aged ≥70 years diagnosed with hormone receptor-positive (HR+) HER2-negative metastatic breast cancer (MBC). Given the unique challenges faced by older adults due to comorbidities and potential treatment-related toxicities, this study aimed to provide insights into real-world outcomes in this population.
METHODS: This retrospective, single-center analysis included 43 patients aged ≥70 years diagnosed with HR+ HER2- MBC who started CDK4/6 inhibitor treatment between May 2020 and December 2022. Data were collected from medical records, including demograph-ics, ECOG performance status, treatment details, and adverse events. Progression-free survival (PFS) and overall survival (OS) were evaluated using Kaplan-Meier analysis, whereas subgroup comparisons were performed using logrank tests. Cox proportional hazard models were used to identify the factors associated with PFS and OS.
RESULTS: The median age was 76.7 years, and 46.5% of the patients presented with de novo metastasis. CDK4/6 inhibitors were administered as first-line treatment in 41.9% of patients, second-line therapy in 46.5 %, and third-line therapy in 11.6 %. The median PFS was 16.0 months, with patients with ECOG PS 0 or 1 achieving significantly longer PFS (20.0 months) than those with ECOG PS≥2 (5.8 months, p<0.01). The median OS was 25.3 months, with better outcomes for ECOG PS 0 or 1 (29.3 months) than for ECOG PS≥2 (15.9 months, p<0.01). Dose reductions occurred in 32.6% of patients but did not significantly affect the PFS.
DISCUSSION AND CONCLUSION: CDK4/6 inhibitors are effective in older adults with HR+ HER2- MBC, par-ticularly those with an ECOG PS of 0 or 1 with manageable toxicities with dose reductions. These findings highlight the importance of assessing ECOG PS when managing treatment in older patients. Dose adjustments were feasible without compromising efficacy, suggesting that personalized treatment can optimize outcomes. Further research with larger cohorts is required to confirm this hypothesis.

INTRODUCTION: Caregiving to neurosurgical patients is the demanding task load to caregiver some physical, psychological, social and economic issues. We focused on neurooncological and neurovascular patients and aimed to investigate stress burden of caregivers and to identify factors contributing to it for this group of patients.
METHODS: 20 subarachnoid hemorrhage, 20 malignant tumor and their caregivers were included. Patients’ neurophysical condition were evaluated using Barthel index. Caregivers’ physical, psychological burden was measured by “Caregiver Strain Index”. Both of index were completed during preoperative period and at 3rd month postoperativel. The probable predictor factors for caregivers on stress burden of caregiver was investigated.
RESULTS: For oncological and vascular patient groups, preoperative Barthel index scores were 15.45 (±4.04) and 12.6 (±5.9) respectively. Barthel index scores showed improvement of their clinical condition in vascular group as a difference at 3th months. Caregiver Strain Index scores were similar in both caregiver groups preoperatively (5.3 and 5.1 respectively; p=0.87). However, when both groups are compared, Caregiver Strain Index scores at 3rd month postoperatively showed a significantly higher stress burden for caregivers of oncological patients (p=0.01).
DISCUSSION AND CONCLUSION: During hospital stay, both groups had similar dependency levels and their care-givers also showed similar stress burden. Reducing dependency level of oncological patients and clinical improvement of vascular patients resulted in a clear difference between the stress levels of caregivers. An organized education plan with a holistic approach may reduce caregiver’s physical, psychological and social burden and improve patient’s activities of daily living and surgical outcome.

INTRODUCTION: Unexplained Anemia(UEA) cases may require Bone Marrow Aspiration(BMA) and Bone Marrow Biopsy (BMB) for diagnostic purposes.These procedures are performed interventionally and may lead to various complications.In our study, we planned to investi-gate the necessity of these procedures in UEA cases with mild anemia and grade 1 anemia with Hemoglobin (Hb) level between 10-12 g/dL.
METHODS: Our study is retrospective and patients diagnosed with UEA who applied to the hematology outpatient clinic were included in the study. BMA and BMB results, as well as physical examination results and all laboratory findings of 40 AA patients over the age of 50 with Hb of 10-12 g/dL were examined.Peripheral smears and bone marrow storage iron of all cases were examined. Presence of bistopenia/pancytopenia, splenomegaly, dysplastic findings, and cases of anemia with a known and obvious cause were excluded from the study.
RESULTS: When the results of the cases evaluated due to AA were examined, malignant or non-malignant hematological disease was not found. In the patient group aged 44 and over, Anemia of Chronic Disease (ACD) ranked first with 62.5%, while Iron Deficiency Anemia (IDA) ranked second with 37.5%.
DISCUSSION AND CONCLUSION: As a result; In cases of UEA, grade 1 anemia, Hb 10-12 g/dL, detailed physical examination, detailed system interrogation, imaging methods and peripheral smear show the importance of laboratory examinations.Our study results suggest that BMA and BMB exam-inations are not an absolute necessity in this patient group if anamnesis, physical examination and correct tests are performed. Current guidelines emphasize the need to perform BMA and BMB in UEA cases. Hb<10 g/dL is accepted as real and significant anemia. Additionally, findings such as the presence of dysplasia and bistopenia/pancytopenia are significant findings for Myelodysplastic Syndrome(MDS) and Aplastic Anemia. Our study shows that when these findings are excluded in patients with Grade 1 anemia, a differential diagnosis of anemia can be made without BMA and BMB.

INTRODUCTION: Subclinical hypothyroidism (ScH) is characterized by elevated thyroid-stimulating hormone (TSH) levels while serum thyroxine (T4) concentrations remain within normal limits. Despite the well-documented association between obesity and ScH, the underlying mechanisms remain poorly understood. This study aims to investigate thyroid functions in both obese and non-obese children and adolescents, examining TSH, T4, and T3 levels along-side anthropometric measurements and to explore potential associations between thyroid hormone levels and metabolic parameters in obese children.
METHODS: In this retrospective study, medical records of children aged 5–18 years presenting for obesity evaluation were analyzed. Participants were categorized into two groups: Obese (body mass index [BMI] ≥95th percentile) and control (<95th percentile). The obese group was further stratified into those with high TSH (>4.5 µIU/mL) and normal TSH (≤4.5 µIU/mL). Anthropometric measurements, pubertal status, and biochemical parameters, including TSH, free triiodothyronine (fT3), fT4, and metabolic markers, were assessed.
RESULTS: A total of 98 children (66 obese, 32 controls) were included. Within the obese group, children with high TSH exhibited significantly lower fT4 levels (p=0.021) but did not differ in fT3 levels, fT3/fT4 ratio, BMI, waist circumference, or metabolic parameters, including glucose, insulin resistance, and lipid profile. No significant correlation was observed between TSH levels and insulin resistance.
DISCUSSION AND CONCLUSION: Our findings suggest that ScH in childhood obesity is associated with lower free thyroxine levels. However, metabolic alterations, including insulin resistance and dyslipidemia, were not found to be directly related to TSH levels. Future studies should aim to clarify the long-term implications of ScH in pediatric obesity and identify optimal management strategies for affected children.

INTRODUCTION: To describe the characteristics, management and treatment options of patients with a history of tubal sterilization who wish to become pregnant again and prefer tubal anastomosis (TA) surgery for this purpose, examine the factors involved in deciding on treatment options, describe our surgical technique and review our results.
METHODS: Between January 2020 and January 2021, all women who underwent TA surgery with the mini-laparotomy approach in a high-density public hospital were retrospectively examined. After describing the surgical technique, demographic data, medical characteristics, peri- and postoperative features including pregnancy rates and outcomes of participants were retrospectively reviewed.
RESULTS: After excluding five patients with missing data, two patients who underwent con-comitant myomectomy and endometriosis surgery and one patient who refused to partic-ipate, 13 participants were included in the study. Eleven of these women became pregnant after TA surgery, while the overall pregnancy and live birth rates were 84.6% and 53.8%, respectively. No woman older than 40 years had a live birth.
DISCUSSION AND CONCLUSION: Parallel to the rise in divorce rates and subsequent new marriages in our coun-try, we are increasingly facing with women who have undergone tubal sterilization and wish to become pregnant again. In vitro fertilization (IVF) should be considered as an option for this group of patients, especially for those over 40 years of age, as TA surgery carries some surgical and anesthesiologic risks. However, even in times of significant advances in assisted reproductive techniques, TA still plays an important role with satisfactory results in restoring fertility after tubal ligation. Tubal anastomosis via a mini-laparotomy with pure saline per-tubation is a safe, inexpensive and effective option for such patients, especially for couples with limited financial resources or for couples who are planning more than one pregnancy and do not wish to undergo IVF for religious reasons.

INTRODUCTION: The aim of this study is to investigate the relationship between paraoxonase 1/arylesterase activity which have antioxidant properties and microalbuminuria in patients with type 2 diabetic.
METHODS: The study included 48 patients (24 women and 24 men) with type 2 diabetes mellitus and microalbuminuria and 17 healthy volunteers as the control group (8 women and 9 men). Demographic data of the patients (age, gender, chronic disease); height-weight-body mass index (BMI), waist circumference, systolic and diastolic blood pressure and biochemical tests, fasting blood glucose (FBG), HbA1c, total cholesterol, triglyceride, LDL, HDL, CRP, urea, creatinine levels and spot urine albumin/creatinine ratios were recorded. In addition, serum paraoxonase (PON) and arylesterase (ARE) levels were studied.
RESULTS: PON and ARE levels were found to be significantly lower in the type 2 diabetes with microalbuminuria (p<0.05). No statistically significant correlation was detected between ARE and PON and other parameters in the patient group (Spearman Correlation Analysis). Based on the ROC curve analysis, the laboratory cut-point used to obtain the best predictive results for differentiating the diabetic patients from the controls was PON 8.85 U/mL (sensitivity 95.83; specificity 47.06) and ARE 5.47 ng/mL (sensitivity 93.75; specificity 47.06).
DISCUSSION AND CONCLUSION: PON and ARE levels were found to be significantly lower in type 2 diabetes mellitus patients with microalbuminuria, and there was no relationship between PON1/ARE activity and microalbuminuria.

INTRODUCTION: Currently, there is no consensus on the timing of intrauterine insemination (IUI). The aim of this study is to compare whether simultaneous, 24 hours later, or 36 hours later IUI after triggering with human chorionic gonadotropin (hCG) following ovulation induction influences clinical pregnancy outcomes.
METHODS: This randomized controlled prospective study was conducted between December 2017 and December 2018 with 123 patients who applied to the infertility clinic for pregnancy demand and underwent IUI. All patients underwent basal ovarian testing and transvaginal ultrasonography for infertility assessment on days 2-4 of menstruation, hystero-salpingography (HSG) performed in the follicular phase, and semen analysis after 3-5 days of abstinence. Patients were categorized into three groups based on IUI timing, ensuring it did not fall on a weekend. Group 1 consisted of patients who underwent IUI on the same day as hCG-triggered ovulation, Group 2 included those who underwent IUI 24 hours after hCG trigger, and Group 3 comprised patients who underwent IUI 36 hours after hCG trigger.
RESULTS: Data from 123 patients meeting the study criteria and a total of 198 cycles were analyzed. IUI was performed simultaneously with trigger in 48 cycles, 24 hours after trigger in 66 cycles, and 36 hours after trigger in 84 cycles. A total of 29 pregnancies (14.6%) were achieved out of 198 cycles, with a pregnancy success rate of 23.5% per patient. In Group 1, 9 pregnancies (18.8%) were achieved in 48 cycles, 9 pregnancies (13.6%) in Group 2 out of 66 cycles, and 11 pregnancies (13.1%) in Group 3 out of 84 cycles. There was no statistically significant difference in pregnancy success rates among the groups based on IUI timing after trigger (p=0.65).
DISCUSSION AND CONCLUSION: There was no statistically significant effect of performing IUI simultaneously, 24 hours later, or 36 hours later after hCG trigger on clinical pregnancy outcomes.

INTRODUCTION: Studies have highlighted the adverse effects of metabolic syndrome (MetS), a cluster of cardiovascular disease risk factors, on cognitive functions. This study aimed to explore early cognitive function changes in middle-aged patients recently diagnosed with MetS and to compare the sensitivity of the ATP III and World Health Organization (WHO) criteria in relation to cognitive functions.
METHODS: This cross-sectional study included 64 participants, 39 patients with MetS according to ATP III criteria and 25 healthy controls matched for age, sex and education. Of the 39 MetS patients, 30 also met the WHO criteria. Metabolic parameters and neuropsychological assessments were compared between the MetS and control groups according to both criteria.
RESULTS: According to ATP III criteria, central obesity is the most common criterion in MetS patients, while in WHO criteria, it comes after the mandatory criterion of insulin resistance. Control patients did not meet any MetS criteria. The findings showed that MetS patients classified according to ATP III had significant impairments in attention (digit span test, p=0.042), executive functions (Stroop color test, p=0.048; word fluency, p=0.024; similarity test, p=0.001), memory (logical memory, p=0.001; visual memory, p=0.001; immediate recall, p=0.001; delayed recall, p=0.011), and learning (p=0.001). In contrast, MetS patients classified according to WHO showed impairments mainly in executive functions (word fluency, p=0.022; similarity test, p=0.001), memory (logical memory, p=0.007; visual memory, p=0.002; immediate recall, p=0.003), and learning (p=0.001).
DISCUSSION AND CONCLUSION: MetS is linked to impairments in attention, executive functions, memory, and learning abilities in middle-aged individuals, even at the early stages of the condition. Defining MetS according to the ATP III criteria might said to be more sensitive for assessing cognitive decline, as it identifies deficits across a wider range of cognitive domains compared to the WHO criteria.

Intraepineural hemangiomas are extremely rare. Only 13 cases of median nerve hemangiomas have been reported in the literature. We report a case that presented with bilateral paresthesia, hypoesthesia and pain at median nerve sensory area. During the operation an intraneural hemangioma was noticed on the left side. After total excision of the mass and release of the median nerve, there were no recurrence of symptoms after 5-months post-operative follow-up period. Histological examination of the mass confirmed the diagnosis of cavernous hemangioma. Although rare, any mass in the vicinity of the median nerve should be carefully examined and peripheral nerve hemangiomas should be considered in the differential diagnosis of carpal tunnel syndrome.