Medical Park Gaziantep Hospital

Background: Brain death (BD) diagnosis is ethically and clinically crucial, especially in potential organ donor cases where rapid and accurate determination is vital. Although computed tomography angiography (CTA) provides high specificity, its variable sensitivity may lead to false negatives, necessitating complementary diagnostic methods.Purpose: This study aimed to evaluate the diagnostic performance and observer reliability of precentral gyrus cortical thickness measurements in BD diagnosis and to compare them with the 4-point CTA method.Materials and Methods: This retrospective study included 42 clinically confirmed BD patients and 144 healthy controls. Brain CT and CTA images were analyzed by two independent, blinded radiologists at two separate time points. Precentral gyrus cortical thickness was measured in both hemispheres, and 4-point CTA scoring was performed. ROC curve analysis determined cut-off values, sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV). Intra- and interobserver reliability was evaluated using ICC, Cohen’s Kappa, and Bland–Altman analyses.Results: The 4-point CTA showed 97% accuracy, 88% sensitivity, and 100% specificity. Precentral gyrus cortical thickness achieved approximately 90% sensitivity, specificity, and accuracy. Observer agreement was excellent (ICC=0.988–0.999; p

Impaired wound healing in patients with diabetes mellitus is a major clinical problem resulting from chronic hyperglycemia, which disrupts immune function and prolongs inflammation. Cell-based therapies such as mesenchymal stem cells (MSCs) and stromal vascular fraction (SVF) have shown promise in promoting tissue repair, yet comparative data between SVF and adipose-derived stem cells (ADSCs) remain limited. In this experimental study, a diabetic rat model was used to compare the effects of allogeneic SVF and allogeneic ADSCs on wound healing. Wound areas were measured on days 5, 10, and 14. Histological analyses, including assessments of reepithelialization, fibrosis, and epithelial tongue length, as well as cytokine level measurements, were performed to evaluate tissue regeneration and inflammation. Both SVF and ADSC groups demonstrated significantly smaller wound areas compared with controls at all time points (P<0.05). On days 5, 10, and 14, the wound areas were 3.127±0.382, 0.833±0.360, and 0.552±0.185cm2 in the control group; 1.968±0.533, 0.543±0.165, and 0.347±0.144cm2 in the SVF group; and 2.242±0.565, 0.432±0.137, and 0.276±0.131cm2 in the ADSC group, respectively. Histological evaluation revealed enhanced reepithelialization and greater epithelial tongue length in both treatment groups. No significant differences were observed between SVF and ADSC groups. IL-12 levels on day 5 decreased in the SVF group (76.01±13.65ng/L) and increased in the ADSC group (96.50±19.66ng/L) compared with the control group (84.81±15.03ng/L) (P=0.047). Both allogeneic SVF and ADSC therapies significantly accelerated wound healing in diabetic rats. Given its simpler and faster isolation process, lower cost, and comparable efficacy to ADSCs, SVF may represent a practical and effective alternative for enhancing diabetic wound repair.

Objective: This study aimed to compare the clinical outcomes of navigation-assisted and conventional (freehand) ventriculoperitoneal (VP) shunt placement in pediatric hydrocephalus patients. Methods: A retrospective review was conducted of 164 patients under the age of 18 who underwent VP shunt placement for hydrocephalus between 2015 and 2023 and had a minimum postoperative follow-up of 12 months. The conventional technique was used in 116 patients. The navigation-assisted technique (intraoperative ultrasonography or frameless neuronavigation) was used in 48 patients. Demographic data, hydrocephalus etiology, catheter tip position (Yim classification), revision rates, infection, complications, and length of hospital stay were recorded. Catheter tip position was assessed on postoperative imaging by two independent investigators. Results: No significant differences were found between the groups in terms of age, sex, and hydrocephalus etiology. The optimal catheter placement rate was significantly higher in the navigation-assisted group compared to the conventional technique (81.25% vs. 60.34%, p = 0.017). The revision rate was significantly lower in the navigation-assisted group (16.67% vs. 38.79%, p = 0.010). The mean hospital stay was shorter in the navigation-assisted group (7.85 ± 3.97 days vs. 10.20 ± 3.70 days, p < 0.001). The groups were similar in terms of infection (2.08% vs. 9.48%, p = 0.183) and overall complication rates (14.58% vs. 16.38%, p = 0.959). Conclusions: Navigation-assisted VP shunt placement in pediatric hydrocephalus patients is associated with a high rate of optimal catheter position, a low revision rate, and a short hospital stay. These findings support the use of navigation technology in pediatric hydrocephalus surgery, but also reveal that infection and complications are unassociated with the surgical technique.

Background: Microsatellite instability-high (MSI-H) or mismatch repair-deficient (dMMR) colorectal cancer (CRC) accounts for approximately 5% of metastatic CRC cases. Immune checkpoint inhibitors (ICIs) are the standard of care based on pivotal clinical trials; however, real-world data, particularly from low-resource countries, remain scarce, and prognostic factors are not yet fully defined. Therefore, we evaluated the efficacy and the safety of ICIs in a multi-center cohort. Methods: This multi-center retrospective study included 45 patients treated with ICIs across six oncology centers in Türkiye between June 2017 and December 2024. Patients received either anti-PD-1/PD-L1 monotherapy or anti-CTLA-4-based combination therapy. Key clinical variables and 1-, 2-, and 3-year OS and PFS outcomes were systematically collected. Results: The median age was 61 years, and most patients (75.6%) received ICIs in later treatment lines. After a median follow-up of 24.1 months, median OS and PFS were not reached. The estimated 1-, 2-, and 3-year OS rates were 82%, 76.1%, and 76.1%; PFS rates were 75.6%, 67.5%, and 67.5%, respectively. In multivariate analysis, an ECOG < 1 (HR: 0.072; 95% CI: 0.012-0.453; p = 0.005), a metastatic burden of fewer than two sites (HR: 0.211; 95% CI: 0.052-0.860; p = 0.030), and absence of antibiotic exposure within one month prior to immunotherapy initiation (HR: 0.145; 95% CI: 0.034-0.614; p = 0.009) were independently associated with improved overall survival. For PFS, ECOG < 1 (HR: 0.172; 95% CI: 0.052-0.573; p = 0.004), a metastatic burden of fewer than two sites (HR: 0.248; 95% CI: 0.078-0.788; p = 0.018), and no recent antibiotic exposure (HR: 0.209; 95% CI: 0.064-0.687; p = 0.010) remained independent predictors of prolonged survival. Conclusions: We observed overall survival outcomes similar to those reported in phase III clinical trials of immunotherapy in MSI-H/dMMR colorectal cancer, despite a substantial proportion of patients receiving immunotherapy in later lines of treatment. These findings support immune checkpoint inhibitors as the standard of care for MSI-H/dMMR metastatic colorectal cancer and emphasize the importance of improving access to immunotherapy, particularly in low-resource settings.

Aim: This study aimed to evaluate the diagnostic performance of the Delta Neutrophil Index (DNI) and Neutrophil-to-Lymphocyte Ratio (NLR) in distinguishing malignant from benign primary brain tumors during the preoperative period. Methods: This retrospective cohort study was conducted at a tertiary university hospital. A total of 140 participants were included 60 patients with malignant glial tumors, 50 patients with benign brain tumors, and 30 healthy controls without inflammatory, infectious, or hematologic disease. Preoperative complete blood count results obtained within seven days before surgery were analyzed. Results: Patients with malignant tumors were significantly older than those in the benign and control groups (p < 0.001). DNI, NLR, PLR, MLR, and SII values were all significantly elevated in the malignant group (p < 0.001, for all comparisons). ROC analysis revealed high diagnostic accuracy for DNI (AUC = 0.847) and NLR (AUC = 0.850), with optimal cut-off values of 3.50 and 3.95, respectively. In multivariable logistic regression adjusted for age, DNI > 3.5 (OR = 20.67; 95% CI: 3.35-127.64; p = 0.001), NLR > 3.95 (OR = 21.17; 95% CI: 3.28-136.50; p = 0.001), and CRP (OR = 1.52; 95% CI: 1.20-1.93; p = 0.001) remained independent predictors of malignancy. The combined model including DNI and NLR achieved the highest diagnostic accuracy (AUC = 0.937; age-adjusted AUC = 0.943), with a sensitivity of 88.3% and a specificity of 86.0% after age adjustment. Conclusions: Both DNI and NLR demonstrated significant value in differentiating malignant from benign primary brain tumors prior to surgery, with DNI emerging as the most powerful independent predictor. The combined use of DNI and NLR substantially improved diagnostic accuracy, suggesting that simple hematologic indices may serve as practical, noninvasive adjunctive tools in the preoperative assessment of brain tumor malignancy. These markers may assist in surgical prioritization, patient counseling, and clinical decision-making, particularly in resource-limited settings.

Iron deficiency is a prevalent comorbidity in patients with heart failure (HF) and is associated with adverse outcomes. Traditional markers such as ferritin and transferrin saturation may be misleading due to the confounding impact of systemic inflammation. This study aimed to develop and validate the Adjusted Ferritin Inflammation Index (AFII), a novel composite score integrating ferritin/C-reactive protein (CRP) ratio and albumin levels, to improve mortality risk stratification in HF patients. This retrospective cohort study included 322 patients with HF and reduced or mildly reduced ejection fraction (HF with reduced ejection fraction: left ventricular ejection fraction ≤40%; HF with mildly reduced ejection fraction: left ventricular ejection fraction 41%-49%). Patients were evaluated for iron parameters between January 2017 and September 2023. Laboratory values (ferritin, CRP, and albumin) were obtained at admission for inpatients or at the first outpatient evaluation. Baseline characteristics were compared between survivors and deceased patients. Adjusted Ferritin Inflammation Index was derived using logistic regression and calculated as: AFII = (Albumin × -0.168) + (Ferritin/CRP × -0.012) + 6.958. The score was log-transformed (Base 2), and the optimal cut-off (2.1) was determined via receiver-operating characteristic curve analysis. Mortality predictors were assessed using Cox regression, and survival differences were analysed with Kaplan-Meier curves. During a median follow-up of 41 months, 106 patients (32.9%) died. In multivariate Cox regression, AFII ≥ 2.1 independently predicted mortality (hazard ratio: 2.155; 95% confidence interval: 1.361-3.412; P = .001), along with New York Heart Association (NYHA) class, sodium, brain natriuretic peptide, and smoking. Ferritin and transferrin saturation were not associated with survival (P = .733 and P = .790, respectively). The AFII showed superior predictive performance [area under the curve (AUC): 0.713] compared with ferritin/CRP (AUC: 0.438) and albumin (AUC: 0.694). Kaplan-Meier analysis showed significantly reduced survival in patients with AFII ≥ 2.1 across the overall cohort (3-year survival: 54.9% vs 84.6%). Adjusted Ferritin Inflammation Index is a novel inflammation-adjusted metric that independently predicts mortality in HF with reduced ejection fraction/HF with mildly reduced ejection fraction patients and outperforms traditional iron markers. Its use may enhance risk stratification and inform future strategies for iron deficiency management in HF.

Objective: To compare the clinical outcomes of endoscopic third ventriculostomy (ETV) alone versus single-stage ETV combined with ventriculoperitoneal (VP) shunt placement in pediatric obstructive hydrocephalus, and to determine whether the combined approach reduces early failure in high-risk etiologies without increasing complication rates. Methods: A retrospective cohort of 59 children treated for obstructive hydrocephalus between 2010 and 2024 was analyzed. Patients underwent either ETV alone (n=26) or single-stage ETV with VP shunt placement (n=33). Etiology, demographic characteristics, intraoperative findings, postoperative complications, revision surgeries, and radiological outcomes were systematically recorded. Treatment success was defined as the absence of additional cerebrospinal fluid diversion procedures and sustained clinical-radiological stability during follow-up. Early and late complications, infection rates, and mortality were also evaluated. Statistical analyses included the Student t-test or Mann-Whitney U test for continuous variables and Fisher exact test for categorical variables, with significance set at p&lt;0.05. Results: Aqueductal stenosis was the most common etiology (64.4%), followed by posthemorrhagic obstruction (16.9%), fourth ventricular outlet obstruction (11.9%), and tumor-related obstruction (6.8%). Treatment success was significantly higher in the combined ETV+VP shunt group compared with the ETV-alone group (87.9% vs. 65.4%, p=0.038). Revision surgery was required in 9 ETV patients (34.6%) and 4 combined-procedure patients (12.1%, p=0.038). Early infection rates were identical between groups (2 cases each, p=1.000), and late infection rates did not differ significantly. Overall infection rates (p=0.744) and mortality (4 vs. 3 patients, p=0.696) were comparable between the two approaches. Conclusion: In this cohort, single-stage ETV with VP shunt placement was associated with a higher treatment success rate compared with ETV alone, particularly in infants and children with posthemorrhagic ventricular obstruction. These findings suggest that the combined strategy may help address early physiological limitations of ETV and could be considered a safe and promising option in appropriately selected pediatric patients with obstructive hydrocephalus.

Boerhaave syndrome remains a life-threatening condition due to rapid mediastinal contamination and sepsis, prompting growing interest in minimally invasive alternatives to surgery. Alongside surgery and endoscopic stenting, endoscopic vacuum therapy (EVT) has emerged over the past decade as an organ-preserving treatment option that combines defect closure with continuous internal drainage—an advantage over conventional stents, which often migrate and fail to control underlying contamination. This narrative review synthesizes current evidence on the role of EVT and hybrid vacuum–stent technologies in the management of spontaneous esophageal rupture. Across recent multicenter cohorts, observational studies, and case series, EVT demonstrates high defect closure rates (80–90%), particularly when applied early in contained perforations and in patients at increased operative risk. Comparative data suggest that, while stents provide effective luminal sealing, EVT offers a distinct advantage in controlling sepsis through active drainage, thereby reducing the need for adjunctive interventions in selected cases. Hybrid systems such as the VACStent further integrate luminal patency, sealing, and negative pressure, allowing nutritional intake while maintaining effective drainage. However, the available evidence remains heterogeneous and largely non-randomized, and EVT appears less effective in the presence of extensive contamination, large chronic cavities, or advanced sepsis. Current data support EVT as a central component of individualized, multimodal management strategies for Boerhaave syndrome, complementing rather than replacing surgical and stent-based approaches. Further prospective and comparative studies are required to refine patient selection and optimize treatment algorithms.

Abstract Aim The aim of this study is to examine the effect of the time interval between birth and the first hearing screening test on screening results, to determine the most appropriate screening time between birth and discharge, and to reduce parental anxiety and costs. Methods Our study included all newborns screened with the ABR device between October 20, 2023, and March 31, 2024, as part of the newborn hearing screening program at the audiology clinic. Only those who passed bilaterally were given a “Pass” result. Those who remained unilateral or bilateral were given a “Fail” result and were referred. Results The study included 1,838 participants, 50.1% of whom were female and 49.9% male. It was determined that 1,131 participants passed bilaterally, 707 remained bilateral, 1,268 passed on the right, and 1,222 passed on the left. When the groups were compared within themselves and in pairs, the success rate of the screening test performed on the 5th day and thereafter was higher, and there was a statistically significant difference. Conclusion According to our study, the likelihood of bilateral passing increases as the day of the test increases, especially after the third day.