Başkent University Alanya Hospital

The Pericapsular Nerve Group (PENG) block is a novel regional anesthesia technique that provides adequate analgesia while preserving motor function. This cross-sectional study evaluated the quality, reliability, and educational value of YouTube videos on the PENG block. Thirty-six videos were analyzed using validated scoring systems (GQS, JAMA, DISCERN, and modified DISCERN). Overall video quality was moderate, with higher scores observed in procedural and institutional videos. The findings highlight both the educational potential and the need for quality control in online medical content.

This study aimed to identify predictive factors for the formation of steinstrasse following extracorporeal shock wave lithotripsy (SWL) in patients with medium-sized (10-20mm) renal pelvic stones. This retrospective cohort study, data of 718 patients who underwent SWL for urinary tract stones were analyzed and single, unilateral, radio-opaque renal pelvic stones were included in the study. Patient age, sex, stone side, shape (round/non-round), size, surface area (SA), and presence of hydronephrosis were recorded. Patients were divided into two groups depending on the presence of steinstrasse: Group 1 (with steinstrasse) and Group 2 (without). Demographic, clinical, and radiological parameters were compared between the groups. The mean age of the patients was 50.8 ± 11.2years. The average number of SWL sessions was 2 (range 1-4). Group 1 included 12 patients (23.1%), while Group 2 comprised 40 patients (76.9%). The mean SA in Group 1 was significantly higher than in Group 2 (145.43 vs. 111.69 mm2; p = 0.044). Round stones were more frequently observed in Group 1, whereas non-round stones predominated in Group 2 (83.3% vs. 62.5%, respectively; p = 0.008). The overall SWL success rate was determined as 76.9%. Logistic regression analysis revealed that round stones increased the risk of steinstrasse by 8.333 times (OR = 8.333, 95% CI = 1.604-43.288, p = 0.012). SA was higher in patients who developed steinstrasse. Since the likelihood of steinstrasse formation is elevated in medium-sized round renal pelvic stones, pre-stenting may be appropriate.

Aim: This study aims to compare the sociodemographic characteristics, clinical course, and treatment approaches of patients diagnosed with early-onset bipolar disorder (EOBD, 0.05), except for employment status (p=0.007). The EOBD group had a higher number of manic episodes (p=0.006). Lithium use was more frequent in LOBD patients, although not statistically significant (p=0.295), while olanzapine use was statistically significant (p=0.010). Antidepressant use was low in both groups (p=0.156). Conclusion: Late-onset bipolar disorder may present with distinct clinical features and treatment preferences compared to early-onset cases. Age at onset is a key determinant for clinical management and treatment planning.

This study compared language models' responses to open-ended questions on regenerative therapy guidelines for chronic pain, assessing their accuracy, reliability, usefulness, readability, semantic similarity, and hallucination rates. This cross-sectional study used 16 open-ended questions based on the American Society of Pain and Neuroscience's regenerative therapy guidelines for chronic pain. Questions were answered by ChatGPT-4o, Gemini 2.5 Flash, and Claude 4 Opus. Responses were rated on a 7-point Likert scale for usability and reliability, and a 5-point scale for accuracy. Hallucinogenicity, readability (FKRE, FKGL), and similarity (USE, ROUGE-L) were also assessed. Statistical comparisons were made, with significance set at p < 0.05. Claude Opus 4 showed the highest reliability (5.19 ± 1.11), usefulness (5.06 ± 1.0), and clinical accuracy (4.06 ± 0.68), outperforming ChatGPT-4o (4.13 ± 0.96; 3.94 ± 0.85; 3.38 ± 0.72) and Gemini 2.5 (4.19 ± 0.98; 4.06 ± 0.93; 3.38 ± 0.62). Claude had the lowest reference hallucinations (RHS 4.44 ± 3.18) vs. ChatGPT-4o (8.38 ± 1.86) and Gemini 2.5 (8.75 ± 1.73). In semantic similarity, Claude (0.68 ± 0.08) and Gemini (0.65 ± 0.07) surpassed ChatGPT-4o (0.60 ± 0.09). Gemini led in ROUGE-L F1 (0.12 ± 0.03) vs. Claude (0.10 ± 0.02) and ChatGPT-4o (0.07 ± 0.03). Readability was similar, though Gemini had a higher FKGL (11.3 ± 1.06) than Claude (10.3 ± 2.09). Claude Opus 4 showed superior accuracy, reliability, and usefulness, with significantly fewer hallucinations. Readability scores were similar across models. Further research is recommended.

ObjectiveTo compare the results of endovascular therapy for chronic limb-threatening ischemia (CLTI) in patients categorized under the gray and yellow zones of the patient risk, limb severity, and anatomic pattern (PLAN) concept over a 2-year follow-up period.MethodsPatients who underwent endovascular therapy for peripheral artery disease and presented with CLTI from February 2017 to February 2019 were retrospectively reviewed. The patients were grouped into yellow and gray zones based on the PLAN concept. Preoperative and postoperative walking distances, Rutherford classes, and postoperative target vessel patency rates were recorded and compared between the groups. Follow-up evaluations were performed at 1, 6, 12, and 24 months post-procedure.ResultsOf the 387 patients evaluated, the yellow and gray groups comprised 88 patients each. The overall patency rates were similar between the groups (84 (95.45%) vs. 81 (92.05%), respectively). The occlusion-/stenosis-free survival times, amputation-free survival time, and mean survival time were not significantly different. However, the gray group had a significantly higher number of atherectomy interventions (74 vs. 59) and crosser devices used (62 vs. 42).ConclusionEndovascular therapy is an effective treatment option for patients in the gray zone of the PLAN color coding system.

We aimed to evaluate the awareness of pneumococcal vaccination (PCV13, PPSV23) in general cardiology outpatient clinics and impact of physicians' recommendations on vaccination rates. This was a multicenter, observational, prospective cohort study. Patients over the age of 18 from 40 hospitals in different regions of Turkey who applied to the cardiology outpatient clinic between September 2022 and August 2021 participated. The vaccination rates were calculated within three months of follow-up from the admitting of the patient to cardiology clinics. The 403 (18.2%) patients with previous pneumococcal vaccination were excluded from the study. The mean age of study population (n = 1808) was 61.9 ± 12.1 years and 55.4% were male. The 58.7% had coronary artery disease, hypertension (74.1%) was the most common risk factor, and 32.7% of the patients had never been vaccinated although they had information about vaccination before. The main differences between vaccinated and unvaccinated patients were related to education level and ejection fraction. The physicians' recommendations were positively correlated with vaccination intention and behavior in our participants. Multivariate logistic regression analysis showed a significant correlation between vaccination and female sex [OR = 1.55 (95% CI = 1.25-1.92), p < 0.001], higher education level [OR = 1.49 (95% CI = 1.15-1.92), p = 0.002] patients' knowledge [OR = 1.93 (95% CI = 1.56-2.40), p < 0.001], and their physician's recommendation [OR = 5.12 (95% CI = 1.92-13.68), p = 0.001]. To increase adult immunization rates, especially among those with or at risk of cardiovascular disease (CVD), it is essential to understand each of these factors. Even if during COVID-19 pandemic, there is an increased awareness about vaccination, the vaccine acceptance level is not enough, still. Further studies and interventions are needed to improve public vaccination rates.

Periaortic adipose tissue (PAT) is associated with atherosclerosis. The severity of coronary stenosis with PAT has not been evaluated with conventional coronary angiography (CAG). The aim of the study is to determine the relationship between PAT and coronary stenosis severity/ complexity, and to evaluate it with the periaortic adipose tissue index (PATI), a new index derived from PAT. Patients who underwent CAG and thoracic computed tomography (CT) between January 2017 and January 2022 were included in the study. PAT volume was calculated by evaluating CT images, and PATI was calculated by dividing the PAT volume by the circumference of the descending aorta. Patients were divided into two groups according to the presence of ≥50% stenosis on CAG. The correlation of PAT and PATI with the SYNTAX score was evaluated. In our study, 263 patients [mean age 64.5(54/72), male 164 (62.4%)] were evaluated. Severe coronary artery disease (CAD) was observed in 181 patients (68.8%). PAT volume and PATI were significantly higher in patients with severe stenosis (p&lt;0.001, for both). When PAT and PATI were evaluated alongside CAD risk factors, an independent association between PATI and severe CAD was discovered (β:0.581, p:0.97, β:0.968, p:0.006, respectively). No correlation was found between SYNTAX score and PAT and PATI (r:-0.026, p:0.73, r:-0.019, p:0.19, respectively). In our study, PAT and PATI were higher in patients with severe coronary stenosis, and there was an independent relationship between PATI and severe stenosis. We found no relationship between PAT and PATI and the SYNTAX score.

Abstract Purpose Lacrimal gland sizes are increased in Graves' ophthalmopathy. Lacrimal gland herniation has been reported to be a simple radiological marker. This study aimed to investigate the relationship of lacrimal gland herniation (LGH) with lacrimal gland dimensions, proptosis, and hormonal parameters. Methods Sixty-eight eyes of 34 patients with Graves' ophthalmopathy were evaluated. Lacrimal gland herniation, proptosis, the long and short axis of the lacrimal gland were measured in mm on the right and left sides. TSH, FT4, FT3, Anti-TPO and Anti-TG values of each patient were recorded. Multiple linear regression was applied to determine the factors affecting lacrimal gland herniation. Results 21 female 13 male 34 patients were included in this study. The mean age of the patients was found to be 37.29 ± 11.91 years The regression model for LGH was found to be statistically significant. (R2 right eye :0.57 R2 left eye 0.51 p &lt; 0.001). The predictive variables for LGH were short diameter of the lacrimal gland and proptosis. No statistical significance was found in other variables (p &lt; 0.05). The equation showing right LGH in millimeters was found as-5.268 + Lacrimal gland short-axis x 1.271 + Proptosis x 0.284. The equation showing left LGH in millimeters was found as-3.598 + lacrimal gland short-axis x 0.937 + Proptosis x 0.292. Conclusions Lacrimal gland herniation is associated with lacrimal gland short diameter and proptosis. Our findings support that lacrimal gland herniation may be an important and useful radiological marker in Graves' ophthalmopathy.

Objective: Acute pulmonary embolism (APE) is a highly fatal acute clinical condition. Herein, we aimed to determine the role of blood parameters in the diagnosis and prognostication of APE. Material and Method: This study was conducted retrospectively on patients who had been admitted to our hospital’s emergency department (ED) and diagnosed with APE. Patients with an RV/LV ratio greater than 0,9 on Computed tomography (CT) and hypotension were grouped as massive APE; patients with stable hemodynamics and an RV/LV ratio greater than 0,9 on CT were defined as submissive APE; and patients with stable hemodynamics and an RV/LV ratio smaller than 0,9 on CT were defined as non-massive APE. Results: This study enrolled a total of 200 patients, 82 of which were male (41%) and 118 were female (59%). APE group had a significantly greater D-dimer level than the control group (3.559,5±8.611.3 ng/ml vs 266.6±266.6 ng/ml) (p