INTRODUCTION: This prospective randomized controlled trial aimed to evaluate the effectiveness of a flexible multidose GnRH antagonist protocol compared with a long luteal GnRH agonist protocol in normal ovarian responders and a short GnRH agonist protocol in poor ovarian responders, focusing on stimulation characteristics, laboratory outcomes, pregnancy rates, and OHSS.
METHODS: Patients scheduled for IVF with a BMI of 19–32 kg/m² were included. Participants were classified as normal or poor ovarian responders and randomized within each group to GnRH agonist or antagonist protocols using a sealed-envelope method. Follicular development was monitored by transvaginal ultrasonography and serum estradiol levels. Human chorionic gonadotropin was administered when at least two follicles reached 18–20 mm in diameter, followed by oocyte pick-up 35–36 hours later. The primary outcome was oocyte and embryo yield, while secondary outcomes included gonadotropin dose, stimulation duration, estradiol levels, cycle cancellation, clinical pregnancy, and OHSS.
RESULTS: A total of 142 cycles were analyzed (normal responders: Long agonist n=34, antagonist n=28; poor responders: Short agonist n=42, antagonist n=38). In the normal responder group, the stimulation duration was shorter with the antagonist protocol, while the total gonadotropin dose was comparable between protocols. In both response groups, there were no significant differences in the numbers of total and mature oocytes, embryos obtained, embryos transferred, or cycle cancellation rates. Among normal responders, pregnancy rates per cycle, oocyte pick-up, and embryo transfer were similar between protocols. In poor responders, pregnancy rates tended to be lower in the antagonist group; however, the difference was not statistically significant. Mild ovarian hyperstimulation syndrome (OHSS) occurred only in two cases within the normal responder group, with no difference between protocols.
DISCUSSION AND CONCLUSION: The flexible multidose GnRH antagonist protocol yielded comparable oocyte/embryo outcomes and pregnancy rates to agonist protocols in both normal and poor responders, while offering a shorter stimulation duration in normal responders.

INTRODUCTION: The aim of this study is to compare the effects of a corrective exercise program and postural training on craniovertebral angle, shoulder angle, pain, and quality of life.
METHODS: A total of forty-six (n=46) individuals (n=25 female; n=21 male) who met the inclusion criteria were evaluated by a single physical therapist before and after treatment. Participants were randomly assigned to three groups: Corrective exercise group (CEG=17), postural education group (PEG=17), and control group (CG=12). The CEG was included in the FHP corrective exercise program, which included stretching and strengthening exercises, while the PEG received postural education guidelines. No treatment was administered to the CG. Participants were assessed for craniovertebral angle, shoulder angle, pain levels, and quality of life before treatment and after 6 weeks.
RESULTS: As a result, in the intra-group comparison after 6 weeks, statistically significant increases were observed in the CEG and PEG in terms of craniovertebral angle (p=0.001), shoulder angle (p=0.005), and pain (p=0.001), In the CG, increases were observed in craniovertebral angle (p=0.001) and pain (p=0.002). In the pre- and post-measurement of quality of life, no significant difference (p>0.05) was found for all groups except for the physical functioning component (p<0.05).
DISCUSSION AND CONCLUSION: A personalized corrective exercise program and postural education improved craniovertebral angle, shoulder angle, and pain. These findings may highlight that simple, low-cost interventions can be effectively integrated into clinical and preventive settings to address forward head posture.

INTRODUCTION: The purpose of this study was to compare the donor-site morbidity, graft characteristics, and clinical outcomes of primary anterior cruciate ligament (ACL) reconstruction using autografts of hamstring tendon (HT) and peroneus longus tendon (PLT).
METHODS: This was a retrospective cohort study in a single center; 100 patients who underwent primary ACL reconstruction from September 2023 to November 2024 were included for follow-up of at least one year. Patients were divided into 2 groups according to graft type: PLT (n=56) and HT (n=44). The functional evaluation included the International Knee Documentation Committee (IKDC) score, Lysholm score and Tegner activity scale preoperatively and at 12 months. Donor-site morbidity about the ankle was assessed in the PLT group by means of a comparison between both sides using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score. Intraoperatively, graft length and diameter were recorded. Nonparametric tests were used for comparisons between groups, and multivariable linear regression models were used to control for potential confounders.
RESULTS: At 12 months, both groups functional scores showed a notable improvement following surgery. IKDC and Lysholm scores were statistically higher in the PLT group, but the magnitude of these differences was still below the minimal clinically significant thresholds. The groups’ Tegner activity scores were similar. Graft diameter and length were considerably increased by PLT harvest. At the final follow-up, there was no discernible difference between the ipsilateral and contralateral AOFAS scores, suggesting that there was no clinically significant ankle dysfunction.
DISCUSSION AND CONCLUSION: Similar to hamstring autografts in primary ACL reconstruction, PLT autograft produces short-term functional results. PLT can produce a larger graft diameter, but this did not result in a clinically significant improvement in patient-reported outcomes. PLT is a dependable alternative graft option when proper patient selection is taken into account.

INTRODUCTION: Healthcare-associated infections (HAIs) represent a significant public health concern due to attributable mortality, prolonged hospital stays, and increased costs. The aim of this point-prevalence study was to evaluate device utilization rates, the prevalence of HAIs, associated risk factors, and clinical outcomes in the intensive care unit (ICU).
METHODS: On the index day, for each patient, clinical data, infection status, antibiotic use (empirical, definitive, prophylactic), and device utilization were recorded. The definitions of HAIs were based on the Ministry of Health HAIs Surveillance Diagnostic Guidelines.
RESULTS: Data from 104 patients were prospectively collected and analyzed. The median age was 70.5 years, and 57.7% were male. Overall, 69.2% had a central venous catheter (CVC), 95.2% a urinary catheter (UC), 68.3% mechanical ventilation (MV), 11.5% continuous renal replacement therapy and 14.4% parenteral nutritional support. Antibiotic use was identified in 70.2% of patients, with the most frequently isolated pathogens being P. aeruginosa (46.7%) and A. baumannii (20.0%). Patients were stratified into three groups: Community-acquired infection (n=37), nosocomial infection (n=35), and no infection (n=32). In the nosocomial infection group, rates of MV, tracheostomy, CVC, and dialysis catheter utilization were significantly higher (p<0.05). In addition, ICU length of stay was significantly longer in this group (24 days, p=0.001), and mortality was markedly higher (p=0.007). The overall prevalence of HAIs was 13.5%. The most common infection type was central line–associated bloodstream infection (42.9%), followed by catheter-associated urinary tract infections (28.6%), ventilator-associated events (14.3%), and surgical site infections (14.3%). Patients with HAIs had significantly longer ICU stays (54 days vs. 10 days, p<0.001). Mortality rates were 57.1% in the HAIs group and 42.9% in the non-HAIs group; however, this difference did not reach statistical significance (p=0.360). Additionally, APACHE-II scores, MV and tracheostomy rates were significantly higher in HAIs group (p=0.005, p=0.035, p=0.005).
DISCUSSION AND CONCLUSION: The high frequency of antibiotic use and frequent isolation of resistant pathogens underscore the critical importance of antimicrobial stewardship programs, while the predominance of catheter-related infections highlights the necessity of reducing invasive procedures.

INTRODUCTION: Iatrogenic colonoscopic perforation (ICP) is an uncommon but potentially serious complication associated with significant morbidity. Endoscopic clip application has emerged as a minimally invasive alternative to surgery in appropriately selected patients. This study aimed to evaluate the clinical outcomes of ICP cases managed with endoscopic clipping and to explore potential factors associated with treatment failure.
METHODS: A total of 17 patients who were diagnosed with ICP and treated with endoscopic clipping between January 2019 and August 2025 were retrospectively analyzed. Demographic characteristics, perforation-related features, treatment modalities, postoperative complications, time to initiation of oral intake, and length of hospital stay were examined. Treatment success was defined as clinical recovery without the need for surgery, whereas treatment failure was defined as the requirement for surgical intervention following clipping.
RESULTS: Endoscopic treatment was successful in 10 patients (58.8%), while 7 patients (41.2%) required surgery. Age, sex, body mass index, comorbidity profile, previous abdominal surgery, bowel preparation quality, and perforation direction did not differ significantly between groups (all p>0.05). Time to oral intake and length of hospital stay were significantly longer in the failure group (p=0.021). The sigmoid colon was the most common perforation site, identified in 70.6% of cases
DISCUSSION AND CONCLUSION: Endoscopic clip application represents an effective therapeutic option for carefully selected ICP cases. This study provides exploratory data on the outcomes of endoscopic management and offers a foundation for future research in this field.

INTRODUCTION: To investigate the morphometric changes of the renal vessels that Autosomal Dominant Polycystic Kidney Disease (ADPKD) and Simple Renal Cysts (SRC) may cause, and to compare the results with the control.
METHODS: In this study, CT images of 95 cases between the years 2019-2024 were examined via the automation system in the Nephrology Clinic of the Hospital. The cases were grouped as ADPKD, SRC, and control, and morphometric measurements of the renal artery and renal vein were made.
RESULTS: No significant difference was found between the level, angle, diameter, and length of the right and left renal artery leaving from the abdominal aorta and entering the renal hilum. There was also no significant difference in the levels where the right and left renal vein drain into the inferior vena cava, the angle, the length from the renal hilum to the inferior vena cava, and the diameter of the right renal vein between the three groups. However, the differences in the diameter of the left renal vein between ADPKD and control were found to be statistically significant.
DISCUSSION AND CONCLUSION: It was determined that ADPKD and SRC developing due to renal cysts may cause morphometric changes in the renal veins when compared with control. It is thought that detailed knowledge of the vascular structures of these patients in preoperative planning will be effective in preventing complications that may occur during the operation.

INTRODUCTION: The ARISCAT score is a validated tool for predicting postoperative pulmonary complications. However, its relationship with operative characteristics and length of hospital stay in patients referred for preoperative pulmonology consultation remains insufficiently explored.
METHODS: This retrospective observational study included 198 patients who underwent preoperative pulmonology consultation prior to elective surgery. Patients were classified into low-risk and intermediate–high-risk groups according to ARISCAT scores. Demographic data, comorbidities, operative variables, and postoperative outcomes were compared between groups. Associations between ARISCAT scores and clinical parameters were assessed using Spearman correlation analysis.
RESULTS: Among the 198 patients, 166 (83.8%) were classified as low risk and 32 (16.2%) as intermediate–high risk. The intermediate–high-risk group had significantly higher rates of major surgery (93.8% vs. 66.9%, p=0.002), longer operative duration (>2 hours: 65.6% vs. 13.3%, p<0.001), and more frequent use of general anesthesia (93.8% vs. 73.5%, p=0.035). Median length of hospital stay was significantly longer in the intermediate–high-risk group (4.0 vs. 2.0 days, p<0.001). ARISCAT score demonstrated a moderate positive correlation with length of hospital stay (r=0.382, p<0.001). No significant differences were observed in postoperative pulmonary complications or mortality between groups.
DISCUSSION AND CONCLUSION: In patients undergoing preoperative pulmonology consultation, higher ARISCAT scores are primarily associated with increased operative complexity and prolonged hospital stay. Although some score components overlap with perioperative risk factors, the persistent association with length of stay suggests broader perioperative implications. The lack of significant differences in postoperative pulmonary complications may reflect the impact of preoperative respiratory optimization in this selected population.

INTRODUCTION: Type 3 and 4 hiatal hernias are less common and represent the most severe forms, often requiring surgical correction due to significant anatomical displacement and associated gastroesophageal reflux. This study aimed to compare perioperative and postoperative outcomes of Type 3 and 4 hiatal hernia repairs across two age groups (<65 years and ≥65 years) and to analyze the impact of comorbidities, previous abdominal surgeries, and intraoperative findings.
METHODS: A retrospective review was conducted of 105 patients who underwent surgical repair for Type 3 and 4 hiatal hernia between January 2015 and December 2023 at a single tertiary center. Fifty-five patients were younger than 65 years, and 50 were 65 years or older. Among the elderly group, 3 patients underwent open repair and 47 underwent laparoscopic repair. The collected data included demographic parameters, comorbidities, perioperative variables, intraoperative findings, and postoperative outcomes. Statistical analysis was performed using Student’s t-test and chi-square tests, with p<0.05 considered significant.
RESULTS: Elderly patients demonstrated significantly prolonged operative durations, increased intraoperative blood loss, extended length of hospital stay, and a higher incidence of postoperative respiratory complications compared with non-elderly patients. Furthermore, advanced age and elevated American Society of Anesthesiologists scores were found to be significantly associated with delayed postoperative recovery.
DISCUSSION AND CONCLUSION: Laparoscopic repair of Type 3 and 4 hiatal hernia is safe and effective across age groups, including elderly patients with comorbidities, provided that appropriate peri-operative management is applied. There is a substantial need for multicenter prospective studies to generate higher-quality evidence and allow for broader clinical generalization.

INTRODUCTION: To investigate the clinical and surgical factors affecting visual outcomes and recurrence rates following pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD).
METHODS: This retrospective study included 226 patients who underwent PPV for RRD between 2022 and 2024 at a tertiary care center in Türkiye. Demographic data, duration of symptoms, macular status, presence of proliferative vitreoretinopathy (PVR), type of intravitreal tamponade, pre- and postoperative best-corrected visual acuity (BCVA), intraocular pressure (IOP), and recurrence rates were analyzed.
RESULTS: Patients had a mean age of 57.9±14.4 years and were predominantly male (67.7%); 76.5% were macula-off, and 25.7% had PVR. Mean BCVA improved significantly from 1.8±0.7 to 1.0±0.6 logMAR (p<0.001), with preoperative BCVA independently predicting post-operative BCVA (β=0.185, p=0.003). Visual improvement was poorer in eyes with macula-off status (p=0.044) and preoperative PVR (p=0.046), better with earlier surgical intervention (<7 days; p=0.030), and greater with C3F8 tamponade than with other agents (p=0.043), while combined cataract surgery did not influence outcomes (p=0.917). IOP increased modestly from 13.9±3.9 to 15.3±3.9 mmHg (p<0.001); 17.3% of patients required antiglaucomatous therapy, more often with silicone oil (SO) tamponade (p=0.023), without affecting final BCVA (p=0.917). Recurrent RRD occurred in 18.6% of patients and was higher in those with PVR (39.7% vs. 11.3%; p<0.01). Multivariable analysis identified PVR as the only independent predictor of recurrence (OR=3.44, p=0.023), and recurrence was lower with C3F8 than with SO (11.1% vs. 24.1%; p=0.026).
DISCUSSION AND CONCLUSION: These findings underscore the importance of preserving macular attachment, minimizing surgical delay, and recognizing PVR as a key determinant of both functional recovery and recurrence in optimizing outcomes after PPV for RRD.

INTRODUCTION: Atrophic gastritis (AG) is a progressive disease characterized by chronic inflammation of the gastric mucosa, glandular atrophy, and parietal cell loss. Clinically, AG may be asymptomatic or present with nonspecific symptoms. This study aimed to evaluate the demographic and clinical characteristics of patients with AG to improve diagnosis and management.
METHODS: This retrospective study included 192 patients aged 18–65 years diagnosed with AG. Symptoms at initial presentation were analyzed. Gastrointestinal symptoms, including weakness, fatigue, abdominal pain, chest pain, bloating, diarrhea, constipation, reflux, nausea, vomiting, early satiety, dysphagia, and odynophagia, as well as non-gastrointestinal symptoms, such as forgetfulness, attention deficit, tongue fissures, angular cheilitis, skin lesions, bleeding, and generalized bone pain, were recorded.
RESULTS: In this study, 111 patients (58.8%) were female, and the mean age was 50±19.0 years. Sixty patients (31.3%) were illiterate, and 147 (76.6%) were married. Thirty-nine patients (20.3%) smoked, and 3 (1.6%) consumed alcohol. Low income was observed in 162 patients (84.4%). Sixty-nine patients (35.9%) lived in rural areas, and 87 (45.3%) lived in both urban and rural areas. The most frequent complaints were weakness and fatigue in 147 patients (76.6%), epigastric pain in 147 (76.6%), and chest pain in 99 (51.6%).
DISCUSSION AND CONCLUSION: This study shows that AG is more common in middle-aged and older individuals, women, and patients with low socioeconomic status. Early diagnosis and management are essential to prevent complications. The broad spectrum of symptoms highlights the need for a multidisciplinary approach.

INTRODUCTION: To evaluate the relationship between sinus tract diameter and excised specimen volume with postoperative complications and clinical outcomes in patients undergoing surgery for pilonidal sinus disease (PSD).
METHODS: Data from 75 patients who underwent PSD surgery between October 2023 and January 2024 were retrospectively reviewed. Associations between tract diameter and excised volume with postoperative wound infection, wound dehiscence, drain placement, length of hospital stay, and recurrence were analyzed using non-parametric statistical methods.
RESULTS: The median age was 24.5 years (IQR, 10), and 81.3% of the patients were male. Wound infection occurred in 14.7% and wound dehiscence in 41.3%. A significant moderate positive correlation was found between tract diameter and excised volume (Spearman ρ=0.441; p<0.001). Both parameters were higher in drained patients (diameter: p=0.002; volume: p=0.016). Wound dehiscence was more frequent in patients with larger tract diameters (p=0.003). BMI was positively associated with complex tract morphology (p=0.002). The recurrence rate was 1.3% at a median follow-up of 15 months (IQR, 9).
DISCUSSION AND CONCLUSION: Tract diameter and excised volume provide quantifiable indicators of disease severity in PSD and correlate with postoperative outcomes. Larger tract diameter was associated with both wound dehiscence and intraoperative drain use. The low recurrence rate observed is consistent with published outcomes for off-midline surgical techniques. Current evidence does not support routine placement of drains in PSD surgery.

INTRODUCTION: We aimed to evaluate the influence of meteorological parameters (air temperature, wind speed, and relative humidity) on lung involvement in patients with COVID-19.
METHODS: This retrospective, single-center study was conducted between July 14, 2020, and August 31, 2020. We included patients aged between 18 and 65 years who had no chronic diseases and resided within the borders of Ankara province. Air temperature, relative humidity, and wind speed data were included for the last 5 days before the PCR test sample was obtained. We used the Computed Tomography Severity Score and the percentage of diseased lung involvement to examine lung involvement in COVID-19. Computed Tomography Severity Scores were calculated by an emergency medicine physician who examined the CT scans of the patients included in the study. Diseased lung rates on thoracic CT were calculated using the program Aquilion 4.7-Thoracic VCAR, General Electric, USA.
RESULTS: A total of 283 patients were included in the study. Of these patients, 177 (62.5%) were male, and 106 (37.5%) were female. In total, 272 patients (92.1%) lived in central districts, and 11 (3.9%) lived in non-central districts. There was no statistically significant difference in air temperature, relative humidity, or wind speed according to the percentage of diseased lung involvement or Computed Tomography Severity Scores.
DISCUSSION AND CONCLUSION: In our study, neither the Computed Tomography Severity Score nor the lung involvement rate showed a statistically significant association with meteorological parameters. We selected the summer months, when the population spends more time outdoors, because we aimed to better evaluate the effect of meteorological parameters on lung involvement; however, we found that limited changes in air temperature, humidity, and wind speed did not affect lung involvement. In the future, multicenter studies can be conducted in geographical regions with different meteorological data during the same season.

Ankle fracture-dislocations are very common injuries, although it is highly unusual for them to be irreducible. A 55-year-old male patient presented to our department with a bimalleolar supination-external rotation-type ankle fracture-dislocation and multiple metatarsal fractures after dropping a weight on his left foot. After sedation, partial reduction of the ankle fracture was obtained in the emergency room. Following wound care, skeletal traction was applied. To avoid soft tissue complications, it was decided to wait before performing open reduction. The patient was followed up with traction for 2 weeks until the skin was ready for surgery. In the operating room, the tibialis posterior and tibialis anterior tendons were found to be trapped within the medial malleolar fracture site, thereby inhibiting reduction. After removal of the tissue, the ankle was restored to anatomical alignment. At 12 months postoperatively, the patient experienced mild pain and had resumed activities of daily living. At the latest follow-up examination, 38 months after surgery, the patient had moderate pain and stage 4 ankle arthritis. To the best of our knowledge, this is the first reported case of ankle fracture-dislocation accompanied by tibialis anterior tendon and tibialis posterior tendon interposition.

Life-threatening hemoptysis is an uncommon but severe emergency requiring rapid diagnosis and management. Bronchial artery embolization (BAE) is generally the first-line treatment; however, surgical intervention may become necessary when bleeding is refractory, or lung parenchyma is irreversibly damaged. We report the case of a 27-year-old woman with type 1 diabetes mellitus and hypothyroidism who presented with recurrent massive hemoptysis. Despite bronchoscopic evaluation and emergent BAE, only temporary hemostasis was achieved, and the patient developed two cardiopulmonary arrest episodes requiring prolonged resuscitation. Progressive unilateral consolidation with necrotizing changes and persistent bleeding led to an intrapericardial left pneumonectomy. Her postoperative course required prolonged intensive care support, including mechanical ventilation and vasopressors, but no major surgical complications occurred. She gradually recovered and was discharged in stable condition. At 16-month follow-up, she remained asymptomatic. This case emphasizes the challenges in managing massive hemoptysis and highlights pneumonectomy as a life-saving option when conservative measures fail.