Adli Tıp Kurumu

Objectives: Acute coronary syndromes (ACS) are life-threatening manifestations of cardiovascular disease caused by thrombus after endothelial injury. Clopidogrel, a P2Y12 inhibitor, is widely used in ACS, but its antiplatelet response may reduce by drug interactions, inadequate dosing, and CYP2C19 polymorphisms, causes clopidogrel resistance (CR). Mean platelet volume (MPV), an indicator of platelet size and activation, has also been associated with adverse cardiovascular outcomes. This study evaluated to show temporal changes in CR and MPV, the relationship between them in ACS patients.Materials and Methods: This single-center prospective study included 90 ACS patients aged 18–80 years treated with clopidogrel (600 mg loading dose followed by 75 mg/day). Blood samples for MPV and CR were obtained within 24 hours of admission and after one month defined as first and second analyses. Platelet aggregation analysed by Multiplate aggregometry. Cut off values were ≥460 AU(aggregation unit) for CR and ≥9.3 fL for MPV.Results: Most patients were male (83.3%), the mean age was 57.4±10.2 years and hypertension was the most common risk factor (49%). While MPV values didn’t differ between both analyses (8.58±0.75 vs 8.59±0.71 fL, p=0.89), CR significantly increased over time (254.76±180.9 vs 348.2±175.2 AU, p=0.0001). CR observed in 27 patients (32.35%) and MPV values were similar in these patients at both analyses. Among patients prescribed lipid-lowering therapy firstly, AU values increased significantly (251.08±170.34 AU vs 344.3 ±167.8 AU p=0.0001).Conclusions: Clopidogrel resistance increased over time without parallel changes in MPV, suggested different mechanisms underlying clopidogrel response. So routine CR test should be limited to selected high-risk patients.

Objective: Thyroid nodules are a common clinical finding, with diagnostic strategies guided by ultrasonographic features and fine-needle aspiration biopsy (FNAB) interpreted via the Bethesda system. This study aimed to evaluate the prevalence, clinical characteristics, and cytological classification of thyroid nodules in a rural district hospital.Materials and Methods: This retrospective cross-sectional study included 1,400 adult patients who underwent thyroid ultrasonography and laboratory testing between January 2018 and October 2024 at Alaca State Hospital. Nodules ≥1 cm or with suspicious ultrasound features were biopsied, and cytological results were reported according to the Bethesda System.Results: Thyroid nodules were detected in 33.5% of patients, with a higher prevalence in females (p < 0.001) and euthyroid individuals (39.98%). FNAB was performed in 144 patients, with most results classified as Bethesda II (68.06%). Bethesda III and IV comprised 9.72% and 2.78%, respectively, while categories V–VI accounted for 2.08%. Patients with nodules were older (median: 54 vs. 45 years, p < 0.001) and had lower median TSH levels (1.48 vs. 2.26, p < 0.001). ROC analysis indicated age as a modest predictor of nodule presence across thyroid states.Conclusion: Thyroid nodules are prevalent in rural populations, particularly among older, euthyroid women. Most nodules are benign, but cytological assessment remains essential for malignancy risk stratification. Age, TSH, and gender may inform diagnostic prioritization in resource-limited settings.

ObjectiveSuicide is a major public health issue affectingmillions of people worldwide. In particular, hanginghas increasingly become a more frequently chosenmethod of suicide. Understanding the characteristicsof suicide cases is of great importance for thedevelopment of effective prevention strategies.This study examined suicide cases by hanging thatoccurred within a specific region. Autopsy findings,along with the location and time of the incidentand the sociodemographic characteristics of theindividuals, were evaluated collectively to identifyfactors associated with this type of suicide.Material and MethodThis retrospective observational study examinedfindings from 80 autopsies conducted due to hangingrelateddeaths in Isparta province, Türkiye, between2012 and 2020, as well as data about the individuals.Variables such as sociodemographic characteristics,type of hanging, autopsy findings, material used, historyof psychiatric illness, suicide note, and contributingfactors were defined categorically. Statistical differencesbetween variables were assessed using the chisquaretest, and the significance level was set at p <0.05.ResultsThe majority of the examined cases consisted of maleindividuals (n = 58, 72.5%). Cervical vertebral fractureswere significantly more frequent among individualsaged 65 years and older compared to other agegroups (p < 0.05). The use of scarves among womenand the presence of hyoid bone fractures among menwere found to be statistically significant (p < 0.05).Suicide cases were most frequently observed duringthe autumn season (n = 30, 37.5%) and predominantlyoccurred within home environments (n = 56, 70%).ConclusionThe findings reveal that suicide is associated withdemographic and environmental factors and that ageand gender are significantly correlated with certainautopsy findings. The data obtained indicate thatsuicide prevention strategies should be developed byfocusing on both individual and environmental riskfactors.

Although lip-to-speech synthesis (L2S) has achieved significant progress in recent years, current state-of-the-art methods typically rely on intermediate representations such as mel-spectrograms or discrete self-supervised learning (SSL) tokens. The potential of latent diffusion models (LDMs) in this task remains largely unexplored. In this paper, we introduce SLD-L2S, a novel L2S framework built upon a hierarchical subspace latent diffusion model. Our method aims to directly map visual lip movements to the continuous latent space of a pre-trained neural audio codec, thereby avoiding the information loss inherent in traditional intermediate representations. The core of our method is a hierarchical architecture that processes visual representations through multiple parallel subspaces, initiated by a subspace decomposition module. To efficiently enhance interactions within and between these subspaces, we design the diffusion convolution block (DiCB) as our network backbone. Furthermore, we employ a reparameterized flow matching technique to directly generate the target latent vectors. This enables a principled inclusion of speech language model (SLM) and semantic losses during training, moving beyond conventional flow matching objectives and improving synthesized speech quality. Our experiments show that SLD-L2S achieves state-of-the-art generation quality on multiple benchmark datasets, surpassing existing methods in both objective and subjective evaluations.

Aims: The aim of this study is to systematically evaluate the performances of large language model-based generative Artificial Intelligence (Gen-AI) tools, Gemini and Copilot, in the generation and assessment of multiple-choice questions (MCQs) for use in medical education.Methods: A total of 335 MCQs were generated from two virtual patient cases using standardized prompts. Gen-AI tools selected the 56 best-quality items based on criteria encompassing the intended distributions regarding acceptable level of performance (ALP), Miller's competency pyramid (Miller) and Bloom's revised taxonomy (Bloom) levels, as well as alignment with learning objectives (LOs). Expert medical educators and current Gen-AI tools assessed these items based on the identification of misleading/confusing distractor(s) for borderline candidates -minimally competent examinees- (to calculate ALP values) and the identification of key(s), as well as Miller and Bloom levels, LO alignment, stem appropriateness, and technical item flaws. "AI-extended consensus" served as intersubjective consensus model (the gold standard). Generation performance was quantified by alignment with this consensus, and assessment performance by the degree to which Gen-AIs shifted or preserved Expert assessments. Analyses included ICC for reliability, Po/Cohen’s/Fleiss’ Kappa for categorical agreement, and inferential tests (Exact McNemar and Wilcoxon signed-rank) for detecting systematic bias and directional shifts.Results: Gen-AIs demonstrated markedly different performance patterns in assigning cognitive levels. For Miller, Gemini generated MCQs exhibited superior consistency with the intersubjective consensus (ICC(2,k)=0.82), whereas for Bloom, Copilot-generated MCQs demonstrated this superiority (ICC(2,k)=0.97). Both tools performed well in LO alignment and key identification, but their approaches to stem structure diverged substantially. Experts perceived the MCQs to be easier than the Gen-AIs claimed, and the current Gen-AI versions found them even easier than both the generating versions and the Experts did. In terms of assessment behaviour, Gen-AIs showed a systematic stringency tendency in Miller classifications, statistically significantly shifting Expert consensus from 'knows' to 'knows how' (p

Aim: To compare the effects of different parasacral transcutaneous electrical nerve stimulation (TENS) protocols on bladder function, overactive bladder (OAB) symptoms, quality of life and perception of subjective improvement (PSI) in women with OAB. Methods: Twenty-nine women with OAB were randomly divided into 2 groups: once session TENS per week (group 1, n=13), three sessions TENS per week (group 2, n=16). Bladder function with a 3-day bladder diary, OAB symptoms with Overactive Bladder Questionnaire-Version 8 (OAB-V8) and Patients’ Perception of Intensity of Urgency Scale (PPIUS), quality of life with the King’s Health Questionnaire (KHQ) were evaluated at pre-intervention, mid-term (3th week) and post-intervention. PSI were evaluated with Likert type scale at post-intervention. Results: Significant decrease was observed in the average number of voids/day and PPIUS scores in both groups (p<0.05). There was a greater decrease in OAB-V8 score in group 2 (p<0.05). No significant decrease was observed in KHQ scores of group 1 (p>0.05), however, improvement was observed scores of group 2 (p<0.05). In intergroup comparisons, a greater decrease was detected in OAB-V8, PPIUS and KHQ scores in group 2 compared to group 1 (p <0.05) (Table 1). A greater increase was found in PSI scores in group 2 compared to group 1 (p<0.05). Conclusions: Parasacral TENS applied three sessions per week was more effective than once session per week in improving bladder function, OAB symptoms, quality of life, and PSI score. It can be recommended to patients with OAB.

Amaç: Bu araştırmanın amacı, iki geleneksel ve sağlıklı beslenme modeli olan Türk ve Akdeniz mutfaklarının farklı yemek gruplarındaki enerji, makro ve mikro besin ögesi içeriklerini karşılaştırarak benzerlik ve farklılıkları ortaya koymaktır. Gereç ve Yöntem: Türk mutfağından 281 ve Akdeniz mutfağından 252 geleneksel tarif örneği seçilmiş, yemek gruplarına göre sınıflandırılarak bir porsiyon ve 100 kkal başına enerji ve besin ögesi içerikleri analiz edilmiştir. Bulgular: Bulgular, Akdeniz mutfağının genel olarak enerji, protein, toplam yağ, karbonhidrat, doymuş yağ asidi ve diyet posası açısından Türk mutfağından daha yüksek değerler sergilediğini göstermektedir; yalnızca sodyum içeriğinde Türk mutfağı bazı gruplarda daha yüksektir. Çorbalar, et ve kümes hayvanları ile börek-mantı-çörek gruplarında Akdeniz mutfağı, porsiyon başına enerji ve besin ögesi yoğunluğu açısından anlamlı üstünlük göstermektedir (p<0.001). Sebze yemeklerinde enerji, protein, yağ, karbonhidrat ve doymuş yağ asidi Akdeniz mutfağı lehine belirgin iken, diyet posası açısından fark istatistiksel olarak anlamlı bulunmamıştır. Kurubaklagil yemeklerinde enerji, yağ ve doymuş yağ asidi içeriği Akdeniz mutfağında yüksek saptanmış, protein ve karbonhidrat farkları anlamlı değildir. Dolma, sarma ve pilav gruplarında ise Akdeniz mutfağı porsiyon başına makro besin ögeleri ve sodyum içeriklerinde üstünlük göstermektedir (p<0.05). Makro ve mikro besin ögelerinin 100 kkal başına karşılaştırılmasında grup bazlı farklılıklar gözlenmiş; Türk mutfağı bazı yemeklerde karbonhidrat, doymuş yağ ve sodyum açısından öne çıkarken, Akdeniz mutfağı yağ, doymuş ve tekli doymamış yağ ile protein açısından üstünlük sağlamaktadır. Vitamin ve mineral içerikleri açısından da mutfaklar arasında istatistiksel farklılıklar saptanmıştır. Sonuç: Türk ve Akdeniz mutfaklarının enerji ve besin ögesi farklılıklarının değerlendirildiği bu çalışmada Akdeniz mutfağı porsiyon başına enerji ve makro besin ögelerinde genellikle üstün bulunurken, Türk mutfağında yağın azaltılması ile sebze ve kurubaklagil tüketiminin artırılmasının sağlıklı beslenme açısından önemli olduğu sonucuna varılmıştır.

Introduction: Aortic dissection is critical, and recent studies increasingly highlight the prognostic value of laboratory parameters alongside diagnostic CT angiography. Materials and Methods: This study included 23 adult patients diagnosed with aortic dissection between January 2023 and January 2025, analyzing the association between admission lab data, derived scores, and outcomes like mortality and ICU stay. Results: Neutrophil count was found to be significantly higher in patients who died (p = 0.03), with 57.1% sensitivity and 68.8% specificity in predicting mortality. A significant negative correlation was found between HALP score and ICU length of stay (r = –0.471, p = 0.023), whereas CRP levels were positively correlated with ICU stay duration (r = 0.504, p = 0.014). Conclusion: Neutrophil count, HALP score, and CRP levels may serve as useful biomarkers for predicting the prognosis of aortic dissection and aiding early risk stratification

Aim: This study evaluated the validity and reliability of the 10-item Stroke Awareness Knowledge Scale (SAKS) for assessing stroke recognition among emergency department (ED) witnesses. It examined associations between demographics, SAKS scores, and behavioural patterns (initial response, transport type, prehospital delay). Material and Methods: Content, face, and construct validity and internal consistency of SAKS were assessed. The same sample (n = 255) was used for validation and cross-sectional analyses. Demographics, SAKS scores, and behavioural parameters were examined. Results: SAKS showed strong Scale-level Content Validity Index (S-CVI = 0.94), borderline-acceptable sampling adequacy (Kaiser–Meyer–Olkin Measure [KMO] = 0.71), explained 51.5% of variance, and had borderline-acceptable internal consistency (α = 0.65). Most witnesses were female, close relatives, and had ≤high school education. High scores (≥80) were observed in 63.9% of cases. While 72.2% reported calling 112 emergency medical service (EMS) at symptom onset, 39.2% arrived by ambulance to the ED, and 44.7% arrived more than 4.5 hours after symptom onset. Demographics were not associated with transport or response, except that first- or second-degree relatives had shorter delays; women and lower-educated participants scored higher, but the differences were not statistically significant. Higher scores correlated with EMS calls. The knowledge–response gap was 22.1%, and the knowledge–transport and response–transport gaps were 60.7% and 57.6%, respectively. Delays were more frequent among men, lower-educated participants, non-EMS users, and those with higher scores, though these differences were not significant. The most common delay reason was waiting for symptoms to resolve. Misbelief in 112 EMS ambulance fees persisted even among highly educated and high-scoring groups. Conclusion: SAKS is valid for ED, prehospital, or community use but requires refinement. Greater awareness improved EMS call volume, but substantial knowledge–action gaps remained. Future research should focus on understanding and reducing the gap between knowledge and action.

The Ukraine-Russia conflict has triggered a severe public health emergency marked by damaged healthcare infrastructure, disrupted disease control, mental health crises, and massive displacement. Over 300 attacks on healthcare facilities have crippled essential services, while infectious diseases like tuberculosis and COVID-19 face increased risks due to service interruptions. The war’s mental health toll is especially high among children and adolescents. Environmental hazards and contamination further threaten safety. Türkiye’s strategic location and diplomatic engagement position it as a key mediator, hosting ongoing peace talks that include prisoner exchanges and ceasefire discussions. Lasting agreements remain elusive, however, amid competing political interests. Integrating public health priorities into peace negotiations is critical to rebuilding healthcare systems, managing disease, and addressing mental health. Türkiye’s balanced diplomacy offers an important pathway to link human security with conflict resolution, emphasizing health resilience as essential for sustainable regional stability and peace.