Colorectal cancer (CRC) screening uptake in Türkiye remains suboptimal, despite the presence of a national screening program. Understanding whether barriers arise primarily from patient-related factors or system-level constraints is essential for effective policy planning. This study aimed to evaluate barriers to CRC screening across the screening pathway using patient, procedural, and provider perspectives. A descriptive cross-sectional study was conducted between January and June 2025 at a tertiary training and research hospital. Three distinct groups were surveyed: 100 screening-naïve outpatients aged 50-70 years, 100 patients undergoing diagnostic or screening colonoscopy, and 50 general surgeons performing or referring for colonoscopy. Study-specific questionnaires, pilot-tested for clarity but not formally validated, were used to assess screening awareness, attitudes, perceived barriers, and strategies for improvement. The data were analyzed descriptively. Among screening-naïve outpatients, 54% had no prior awareness of CRC screening, and only 28% had received a physician recommendation for screening. Fear of a serious diagnosis (45%) and pain or discomfort (40%) were commonly reported concerns; however, most respondents indicated that these would not deter screening. Among patients undergoing colonoscopy, 77% underwent the procedure for symptoms rather than preventive screening, while post-procedure satisfaction was high. Surgeons predominantly identified system-level barriers, particularly long waiting times (90%) and an insufficient number of trained endoscopists (92%), as major limitations in effective screening delivery. The primary perceived barrier to CRC screening in Türkiye appears to be limited system capacity rather than patient reluctance. Improving screening uptake will likely require coordinated public awareness efforts, structured national reminder systems, and expansion of the number of adequately trained endoscopists, alongside endoscopy infrastructure.

High-grade serous ovarian cancer (HGSOC) is the most lethal gynecologic malignancy, typically affecting postmenopausal women. BRCA1 mutation carriers are at increased risk of developing early-onset disease. While bariatric surgery reduces the incidence of several obesity-related cancers, its potential impact on hormonally driven malignancies in genetically predisposed individuals remains unclear. We report a rare case of early-onset HGSOC in a 21-year-old woman with morbid obesity and type 2 diabetes who underwent Roux-en-Y gastric bypass in 2010. Following significant weight loss, she regained regular menstruation and discontinued insulin therapy. After progressive weight regain, she underwent revisional bariatric surgery in 2020. Three years later, she presented with an ovarian cyst and elevated tumor markers. Imaging suggested malignancy, and biopsy confirmed HGSOC with a BRCA1 mutation. The patient underwent optimal cytoreductive surgery followed by chemotherapy and commenced olaparib maintenance therapy. As of September 2024, she remains disease-free. This case raises the concern that bariatric surgery, by restoring ovulatory function and altering metabolic and hormonal balance, may unmask a latent susceptibility to cancer in genetically predisposed patients. The temporal association between metabolic surgery and early-onset ovarian cancer warrants further investigation into postoperative hormonal shifts and cancer surveillance strategies. Bariatric surgery in women with hereditary cancer syndromes should be approached with caution. Preoperative genetic counseling, multidisciplinary assessment, and long-term oncologic surveillance are essential to ensure patient safety.

Distinguishing mild (Hinchey 1a/1b/2) from severe (Hinchey 3/4) diverticulitis is critical for appropriate management. This study evaluated the predictive value of inflammatory biomarkers and imaging features for early risk stratification. We conducted a retrospective analysis of patients with acute diverticulitis between 2017 and 2024 at the hospital's general surgery department. Receiver operating characteristic analysis was used to determine optimal cut-off values for C-reactive protein (CRP) and procalcitonin, while computed tomography (CT) findings were assessed for their discriminative capacity. A total of 72 patients were included in the study. There were 59 patients in the mild diverticulitis group and 13 patients in the severe diverticulitis group. Patient demographics were similar between the groups. Procalcitonin demonstrated superior predictive performance [area under the curve (AUC) 0.795] compared to CRP (AUC 0.755). The cut-off values for procalcitonin and CRP were 0.095 and 104.5, respectively. Specific CT patterns showed high specificity for severe disease. The combination of biomarkers and imaging criteria significantly improved diagnostic accuracy, with pelvic abscess localization emerging as a key indicator of severity. A biomarker-guided approach incorporating procalcitonin and targeted CT evaluation enables reliable early identification of severe diverticulitis. This strategy may enhance clinical decision-making regarding antibiotic selection and surgical consultation while reducing unnecessary interventions in mild cases.

Breast cancer accounts for 31.8% of female cancers in Saudi Arabia, with 56% of cases diagnosed before age 50, 14 years younger than in Western countries. Aggressive subtypes (TNBC: 18-24%; HER2+: 25-28%) are common, and dense breast tissue reduces the effectiveness of mammography. Currently, no age-specific screening protocols exist for this unique epidemiological profile. This study aimed to assess the age-specific diagnostic accuracy of mammography, ultrasound, and magnetic resonance imaging (MRI), and to characterize molecular subtype distribution in Saudi breast cancer patients to guide personalized screening guidelines. A retrospective cohort study was conducted at a tertiary care center in Riyadh, Saudi Arabia (January 2021-December 2023). Medical records of 148 women aged 30-70 with histopathologically confirmed breast cancer (BI-RADS 4/5) were analyzed. The sensitivity and specificity of imaging modalities were assessed across age groups (30-39, 40-49, 50-59, ≥60 years). Subtype distribution and breast density (BI-RADS A-D) were correlated with imaging performance using chi-square tests and logistic regression (SPSS v28, STARD 2015 guidelines). The mean age was 48 years, with 56.4% of cases occurring in women under 50 (peak incidence: 40-49 years, 34.1%). Ultrasound sensitivity exceeded mammography in women under 50 (85.3% vs. 74.5%, p<0.01), while MRI demonstrated the highest overall accuracy (91.7%, 95% confidence interval 89.2-93.5). TNBC prevalence decreased with age (24.7% in 30-39 years to 12.0% in ≥60 years, p<0.01), while invasive lobular carcinoma incidence doubled (8.2% to 18.0%, p<0.001). Delayed diagnosis (>60 days) lowered 2-year survival by 21% (p=0.003). Ultrasound is more effective than mammography for early detection in Saudi women under 50 years old, while MRI remains highly accurate across all age groups. National screening guidelines should adopt biennial ultrasound-first screening starting at age 40, with MRI reserved for high-risk cases and BI-RADS 3-4 lesions.

Although blood transfusion is necessary for addressing anemia, coagulopathy, and systemic inflammation, transfusions also carry risks that may influence morbidity and mortality. This study, of patients with burns treated at a tertiary care centre, was conducted from October 2024 to May 2025. It aimed to investigate the association between blood and blood product transfusion requirements and clinical outcomes in adult patients with severe burns. Additionally, the study identified other predictors of mortality, and examined the prognostic role of common biochemical markers and complications in determining patient outcomes. This retrospective cohort study analyzed 82 eligible adult patients with burns. Patients were considered eligible if they were 18 years of age or older, were admitted for acute burn injury and had complete clinical and laboratory data. Demographic, clinical, laboratory, and transfusion data were retrieved from electronic medical records. Cox proportional hazards regression was used to identify independent predictors of mortality, while Kaplan-Meier analysis assessed survival trends. Participants were grouped into survivors (n=33) and non-survivors (n=49). Non-survivors required higher total volume of red blood cells (11 vs. 6 units), fresh frozen plasma (11 vs. 5 units), and platelets (4 vs. 0 units), particularly in the intensive care unit (ICU) setting. Compared to survivors, non-survivors also had elevated creatinine levels, lower platelet counts, and higher rates of complications such as pneumonia and dialysis. Cox regression confirmed total body surface area burned as the strongest independent predictor of mortality. High transfusion requirements in the ICU are associated with increased mortality in patients with severe burns and may serve as a surrogate marker for disease severity. These findings support the need for restrictive, individualized transfusion strategies and underscore the importance of integrating transfusion parameters into early risk assessment and prognostic models in burn care.

Park's method of submucosal hemorrhoidectomy has not gained widespread clinical use despite its minimally invasive nature. However, combining this technique with modern bipolar technology LigaSure™ offers a promising approach to surgical treatment of hemorrhoidal disease. A patient with stage III hemorrhoidal disease underwent surgery under subarachnoid anesthesia in the Lloyd Davis position. The procedure involved lifting external hemorrhoids with an Allis clamp to expose internal hemorrhoids. Using monopolar coagulation, a linear incision was made in the distal skin covering left lateral external hemorrhoids. The surgeon carefully separated varicose veins from sphincter fibers. The LigaSure™ device was then used to dissect hemorrhoidal tissue in the submucosal layer toward the hemorrhoidal artery origin. The artery was ligated 1 cm above the dentate line using bipolar technology while preserving the mucosa. Similar techniques were applied to remove right posterior and anterior hemorrhoidal tissue. The result showed three small incisions on the anoderm with complete preservation of the anal canal mucosa. The modified technique allows excision of hemorrhoidal tissue and ligation of arteries without sutures, preserving the lining of the anal canal. This approach potentially results in shorter hospital stays, less postoperative pain, and promotes rapid recovery.

Colorectal cancer (CRC) is a major health problem worldwide. According to estimates for the year 2030, cancer will be the number one cause of death for both genders. CRC is the third most common type of cancer and the second most common cause of cancer-related deaths. Various parameters are needed to provide information about the course and prognosis of the disease. The study included 103 patients diagnosed with CRC between 2017 and 2023. The patients' HALP scores were retrospectively analyzed together with clinical data. The relationship between survival times, disease stage, and treatment response was examined. The obtained data showed that low HALP scores were associated with worse overall survival. Although the HALP score cut-off value was found to be different in various studies conducted on benign or malignant diseases, a low HALP score indicates a poor prognosis. In our study, a HALP score below 23 was found to be associated with low overall survival. This study suggests that a low HALP score is associated with poor prognosis and could serve as a valuable prognostic marker in the clinical management of CRC patients. However, certain limitations must be considered. While albumin is a marker of systemic inflammation and nutritional status, its specificity is limited in acute and chronic inflammatory conditions, which may impact the prognostic value of the HALP score. Further investigation into the biological mechanisms underlying this relationship and the potential of the HALP score in predicting treatment response would enhance its clinical applicability.

Profunda femoris artery (PFA), a branch of femoral artery primarily supplies blood to skin, muscles of the inner thigh and proximal femur and plays a significant role in collateral blood supply. This study aimed to investigate the origin, branching pattern and morphometries of PFA in cadavers. Lower limbs of male and female cadavers (n=41) were analyzed for origin of PFA, lateral circumflex artery (LCFA) and medial circumflex artery (MCFA), distance from mid-inguinal point, course, branching pattern and their external calibers. Data were tabulated and analyzed using SPSS. The PFA showed origins that are posterolateral, posteromedial, and posterior. The distance between PFA and the midpoint of the inguinal ligament was (L=3.7-6.2; mean =5.19±0.7 cm; R=3.2-6.2 cm, mean =4.74±0.9 cm). The origin of MCFA was medial (R=61%, L=52%) and posteromedial (R=39%, L=48%); LCFA was lateral (R=100%, L=78%) and posterolateral (R=0%, L=22%). The average diameter of PFA, MCFA, & LCFA was (L=5.04, 2.9, 2.8 cm and R=5.4, 3.09, 3.71 cm). The paired t-test with a significant p-value (95% confidence) demonstrated that differences in the diameters of the arteries at the specified levels between the left and right limbs could have clinical implications, such as differences in blood flow or susceptibility to vascular conditions. To reduce intra-operative and post-operative complications in the femoral region branches during diagnostic and surgical procedures, it is essential to comprehend the normal and variant positions and distances of the PFA's origin and its circumflex branches.