Taksim German Hospital

Cerebrospinal fluid (CSF) leak remains one of the most serious complications of endoscopic sinus surgery (ESS). Although rare, its consequences may include meningitis, pneumocephalus, intracranial abscess, and long-term neurological morbidity. This expanded manuscript presents a comprehensive academic review of preventive strategies, surgical techniques, anatomical considerations, and postoperative management regarding CSF leaks in ESS. Among the critical intraoperative hazards, catastrophic orbital hemorrhage and CSF leak represent the two complications most universally dreaded by rhinologic surgeons. Both events underscore the necessity of meticulous preoperative planning, high-resolution CT evaluation, and disciplined intranasal dissection that respects natural boundaries. Although the majority of ESS procedures proceed uneventfully, even small breaches in the skull base may lead to CSF rhinorrhea, with potential sequelae including meningitis, intracranial abscess, pneumocephalus, prolonged hospitalization, and the need for revision surgery. Early intraoperative recognition—such as identifying clear pulsatile fluid, the reservoir sign, or sudden visualization of dura—is essential, as timely repair can prevent both acute morbidity and delayed complications.The purpose of this work is to provide surgeons with a clear, structured framework to minimize risk and to optimize outcomes through evidence-based repair protocols.

Abstract Aim of this study was to evaluate the demographic characteristics, injury patterns, emergency department resource use, and intervention requirements of patients who presented to a tertiary hospital following the earthquakes centered in Kahramanmaras on February 6, 2023. These earthquakes, among the deadliest in the region's recent history, caused widespread destruction and placed unprecedented strain on health care systems. In this retrospectively planned study, 134 patients diagnosed with trauma-related injuries who presented to the emergency department within the first 7 days following the earthquakes were analyzed. The patients were categorized into two groups: severe injury (cases requiring major surgery or intensive care or resulting in mortality) and minor injury. Demographic data, injury mechanisms, imaging usage, interventions, and clinical outcomes were compared. Of the patients, 11.9% (n = 16) were in the severe injury group. These patients were of older age (mean 50.1 ± 12.4 years) and more frequently underwent imaging (computed tomography and magnetic resonance imaging) and required surgical interventions and intensive care (p < 0.05). The most common causes of injury were being trapped under rubble and falls from height. While 85.1% of patients arrived by their own means, severe injuries were still present in this group. Intensive use of imaging, surgical consultations, and interventions in the emergency department were recorded. The mortality rate was 1.5%. In disasters such as earthquakes, advanced health services, with trauma surgery at the core, must be supported not only by local responses but also by comprehensive referral and coordination systems that are preestablished both regionally and nationally.

Response to neoadjuvant chemotherapy (NACT) in locally advanced gastric cancer varies. This study compares tumor response to NACT across anatomical locations, considering clinicopathological differences. This retrospective study included 212 patients with gastric adenocarcinoma who received NACT followed by surgery. Tumors were classified by location (antrum-pylorus, corpus-fundus, cardia). Treatment response was assessed using the Modified Ryan Scoring System (0 = complete, 1 = near complete, 2 = partial, 3 = minimal/none). Tumor locations were antrum-pylorus (30.2%), corpus-fundus (28.3%), and cardia (41.5%). Localization showed no statistically significant differences in response (p = 0.337). However, cardia tumors were more frequent in Groups 3 (40.9%) and 4 (48.1%), which showed poorer pathological responses, whereas antrum (34.6%) and corpus (38.5%) tumors were more common in Group 1, representing patients with a pathological complete response. These findings suggest that cardia tumors may have a lower response to NACT, although definitive conclusions cannot be drawn. In multivariate analysis, only advanced T stage (T3-4) was independently associated with poor tumor regression grade response (odds ratio 14.3, 95% confidence interval 5.4-37.5, p < 0.001). Tumor response to NACT varied by anatomical location, although differences were not statistically significant. Cardia tumors showed a trend toward lower response rates. To the authors' knowledge, this is the first study evaluating gastric anatomical subgroups in this context. While not conclusive, the findings suggest that tumor location may influence treatment strategies, warranting validation in larger studies.

Background/Objectives: The accurate evaluation of the fibrosis stage is critical for improving chronic hepatitis B (CHB) management and patient outcomes. This study aimed to compare the diagnostic accuracy of non-invasive fibrosis markers with liver biopsy for detecting significant, advanced fibrosis and cirrhosis. We further investigated the diagnostic performance of non-invasive markers according to HBeAg status to provide further insight into their clinical utility across patient subgroups. Methods: This single-center retrospective study included 536 treatment-naive patients with CHB who underwent liver biopsy. Patients were categorized into four groups according to the fibrosis stage: "no significant fibrosis" (F0-F2), "significant fibrosis" (F3-F6), "advanced fibrosis" (F4-F6), and "cirrhosis" (F5-F6). AAR, AAPRI, APRI, API, FIB-4, GPR, and S-index were compared among these groups. Results: In total, 536 treatment-naïve patients were analyzed (63.2% male; mean age 44.8 ± 12.9 years), of whom 25.4% were HBeAg-positive. API, FIB 4, GPR, and S-Index showed good performance (area under the curve [AUC] ≥ 0.8-0.9) in defining advanced fibrosis (≥F4), AAPRI, AAR, API, and APRI showed good performance ([AUC] < 0.700) in defining cirrhosis. The analysis showed that GPR had the highest AUC for ≥F3 (0.719) and ≥F4 (0.838), while FIB 4 had the highest AUC for cirrhosis (0.865). Conclusions: These findings highlight the value of non-invasive markers as inexpensive and easily applicable methods for clinicians in assessing the stage of liver fibrosis. The integration of these scores into the routine monitoring of chronic hepatitis B patients is expected to expand, enhancing clinical decision-making and reducing the necessity for liver biopsies.

This study aimed to reveal the experiences of midwives who assisted women giving birth water. A phenomenological design, which is one of the qualitative research methods, was used in the study that was conducted with freelance midwives between June and August 2023. The sample of the study consisted of 14 midwives who met the inclusion criteria and agreed to participate in the research. Data were collected face to face using a 'Descriptive Information Form' and a 'Semi-Structured Interview Form' and were analysed using the thematic analysis method and the MAXQDA Analytics Pro2020 software. Midwives' narratives about water birth were grouped under three themes: water birth process, water birth team, and evaluation of water birth. The eight categories that made up these themes were conveniences, difficulties, characteristics of the team, equipment used during birth, difficulties in using the equipment, prenatal preparation, midwives' self-evaluations, and views about pregnant women's experiences. According to this study, midwives talked more about the category of convenience than difficulties regarding the water birth process. It was determined that all midwives repeated the code of comforting the pregnant woman, which is in the convenience category under the theme of the water birth process. The most frequently stated difficulty was ensuring that the water was kept as clean as possible. Midwives reported that they most frequently observed that pregnant women gave birth more easily in water.

BackgroundAdipocytokines, along with macrophages infiltrating adipose tissue, contribute to chronic low-grade inflammation, which leads to insulin resistance and type 2 diabetes. Understanding insulin resistance in non-diabetic individuals and its cellular mechanisms is key for developing effective treatments and improving current protocols. This study aimed to investigate the levels of Retinol Binding Protein 4 (RBP4), Lipocalin-2, and high-sensitivity C-reactive protein (hsCRP) in individuals with impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and type 2 diabetes mellitus (T2DM).MethodsThis prospective case-control study included individuals with IFG, IGT, and newly diagnosed T2DM. Routine laboratory tests, including fasting blood glucose, insulin, HbA1c, and lipid profiles, were collected and analysed. RBP4, Lipocalin-2, and hsCRP levels were measured using the ELISA method.ResultsSignificant differences were found in fasting blood glucose, insulin, triglycerides, total cholesterol, and HOMA-IR values among the study groups. hsCRP levels were significantly elevated in the IGT and T2DM groups compared to controls, while RBP4 and Lipocalin-2 levels showed no significant differences. A positive correlation was observed between hsCRP and HbA1c in the IFG group, as well as between hsCRP and Lipocalin-2 in the T2DM group.ConclusionsThis study demonstrates that hsCRP and Lipocalin-2 are associated with early glucose metabolism abnormalities and may serve as markers for insulin resistance and inflammation in prediabetes and T2DM. Future research is needed to clarify the roles of these biomarkers and their potential as therapeutic targets in diabetes prevention and treatment.