INTRODUCTION: Fatigue is a common but underrecognized symptom in knee osteoarthritis (OA), which significantly impacts patients' quality of life. This study aimed to investigate the associations between fatigue severity and clinical variables in individuals with knee OA.
METHODS: This cross-sectional study included 92 patients (mean age 64.09 ± 9.68 years; 62.0% female) clinically diagnosed with knee OA. Fatigue severity was assessed using the Fatigue Severity Scale. Additional assessments included pain intensity via the Visual Analog Scale, functional status using the Knee Injury and Osteoarthritis Outcome Score - Physical Function Shortform (KOOS-PS), and anxiety and depression levels as measured by the Hospital Anxiety and Depression Scale. Body mass index (BMI) was calculated for each participant, and radiographic severity of knee OA was determined using the Kellgren-Lawrence Classification. Spearman’s rank correlation was employed for statistical analyses to determine associations between the variables.
RESULTS: Significant positive correlations were observed between fatigue severity and BMI (r=0.335, p=0.001), pain intensity (r=0.386, p<0.001), anxiety levels (r=0.323, p=0.002), depression levels (r=0.318, p=0.002), and radiographic severity (r=0.464, p<0.001). Additionally, a significant negative correlation was found between fatigue severity and the KOOS-PS score (r=-0.356, p<0.001).
DISCUSSION AND CONCLUSION: Fatigue in knee OA is significantly associated with radiographic severity, pain, mood disorders, functional impairment, and BMI. These findings highlight the importance of considering fatigue as a core component of OA assessment and treatment. Multidisciplinary approaches targeting these factors are recommended to improve patient outcomes.

INTRODUCTION: Achromobacter spp. are uncommon causes of bloodstream infections, typically associated with nosocomial settings and immunocompromised patients. This study aims to evaluate the clinical characteristics, antimicrobial susceptibility patterns, and outcomes of seven pediatric patients with community-acquired Achromobacter bacteremia.
METHODS: A retrospective review was conducted on seven pediatric cases admitted with sepsis and positive blood cultures for Achromobacter spp. between 2020 and 2024. Demographic data, clinical presentation, laboratory findings, microbiologic identification, antimicrobial susceptibility results, treatment regimens, and outcomes were analyzed.
RESULTS: The median age was 16 months; five patients were female. All patients were previously healthy and presented from the community. Fever was the primary symptom, with cough and poor feeding being common additional findings. Four had isolated sepsis, while three had signs of lower respiratory tract infection. Six isolates were identified as Achromobacter denitrificans and one as A. xylosoxidans. All isolates were susceptible to piperacillin-tazobactam and carbapenems. Initial empirical treatment with third-generation cephalosporins was modified to piperacillin-tazobactam and carbapenem upon susceptibility results. All patients recovered and were discharged in good condition, with no deaths observed.
DISCUSSION AND CONCLUSION: Although rare, Achromobacter spp. can cause community-acquired sepsis in previously healthy children. Prompt identification and appropriate antimicrobial therapy guided by susceptibility testing are crucial for favorable outcomes.

INTRODUCTION: The microsurgical anatomy of the posterior circulation is complex and variable. Surgeries performed close to this area are accepted to be highly risky due to important vascular and neural structures. In order to safely and securely treat pathologies in that area, understanding the microsurgical anatomy of the posterior circulation carries tremendous importance for neurosurgeons.
METHODS: In order to reveal the characteristic of vertebrobasilar artery branches of people living in Turkey, we analyzed the arteries of 23 cadaveric brains (46 hemispheres) at the dissection laboratories of the Istanbul University Cerrahpasa Medical Faculty Anatomy Department. The diameter of the vertebral artery, the fusion angle of vertebral arteries, the diameter of the basilar artery were examined.
RESULTS: 13 vertebrobasilar junctions were located across the pontomedullary sulcus, 5 were located below the pontomedullary sulcus, and 5 were above the pontomedullary sulcus. The average diameter measured 5.11 mm, the smallest being 3 mm and the largest measuring 6 mm. Out of all analyzed basilar arteries, only one revealed a fenestration. All results were compared with previous studies and were found to be coherent.
DISCUSSION AND CONCLUSION: Damage to the vertebral artery, basilar artery or any of their branches during surgery may stay asymptomatic. However, the damage may also result in cranial nerve paralysis or go as far as coma due to ischemia. Understanding the anatomy of that area well can minimize this risk of complications and further avoid them.

INTRODUCTION: This research aimed to evaluate the recurrence level of ligation of Intersphincteric Fistula Tract (LIFT) and Laser methods for anal fistula.
METHODS: A total of 71 patients who applied to Tokat Government Hospital and İstanbul Ataşehir Memorial Hospital between 2014 and 2024 were included in the study. The patients were divided into two groups: laser (n=30) and LIFT (n=41). Gender, age, fistula type, recurrence, follow-up period, and number of operations were analyzed in the study.
RESULTS: Gender, age, recurrence, fistula type, and number of operations differences between patient groups were statistically insignificant (p>0.05) (Table 1). The correlation between method, age, gender, number of operations, and fistula type was insignificant (p>0.05) (Table 2). Binary logistic regression analysis results for the effects of method and baseline characteristics on recurrence showed that the effect of method, age, gender, number of operations, and fistula type on recurrence was insignificant (p>0.05) (Table 3). Recurrence durations were similar between operation types, and the difference analysis was statistically insignificant (p>0.05) (Table 4).
DISCUSSION AND CONCLUSION: There was no statistically significant difference between LIFT and laser surgery. The results we obtained show that both LIFT and laser methods give the same results in terms of treatment success.

INTRODUCTION: A reduced treatment response to epoetin (EPO) therapy is a clinical challenge among hemodialysis (HD) patients. Outcomes of roxadustat in HD patients who had hyporesponse to EPO therapy were investigated.
METHODS: This retrospective study analyzed adult patients undergoing long-term HD. Hyporesponsiveness to EPO was defined as a hemoglobin (Hb) level consistently below 10 g/dL despite receiving maximum EPO and having adequate iron stores for at least three months. The target Hb threshold for following roxadustat was defined as ≥11 g/dL.
RESULTS: A total of 227 HD patients were screened, and 25 patients were enrolled. The mean age was 55.1±17.5 years. Median HD duration was 47 (19–118) months. Average Hb during the EPO treatment was 8.7±0.7 g/dL, compared to 9.8±1.3 g/dL during the roxadustat treatment. Increased Hb following roxa-dustat was observed in 17 patients (68.0%). Target Hb was achieved in 14 (56%) patients following roxadustat. Erythropoietin resistance index was 17.6±1.4 IU/kg/gHb in patients who responded to roxadustat, whereas it was 19.4±3.3 IU/kg/gHb in non-responders (p=0.087). The average Hb level was significantly increased during the roxadustat period (p=0.011). Lower uric acid (p=0.003) and higher Kt/V (p=0.044) were observed in patients who achieved target Hb. Pre-treatment transferrin saturation was correlated with the amount of Hb change following roxadustat (p=0.034).
DISCUSSION AND CONCLUSION: The current study should be considered a pioneering effort, and findings support significant treatment success with roxadustat.

INTRODUCTION: This study aimed to evaluate the prevalence of meningioma-like dural-based lesions that were histopathologically diagnosed as non-meningioma tumors, characterize their underlying pathologies, and assess clinical–radiological correlations to improve diagnostic accuracy and patient management.
METHODS: A retrospective dual-center study was conducted, including 210 patients with dural-based lesions resembling meningiomas on MRI between January 2020 and December 2025. Imaging features, histopathological diagnoses, and clinical data were analyzed. Statistical comparisons were performed using univariate and multivariate analyses.

RESULTS: Among the 210 patients, 12.8% (n=27) of lesions initially suspected as meningiomas were histopathologically confirmed as non-meningioma tumors. Metastatic lesions were the most common mimics (63%), followed by high-grade glial tumors (14%), lymphomas (11%), schwannomas (7%), low-grade glial tumors (7%), and primitive neuroectodermal tumors (4%). Homogeneous contrast enhancement and dural tail signs were observed in both meningiomas and their mimics, complicating preoperative diagnosis. Advanced imaging techniques and histopathological examination were critical for accurate differentiation.
DISCUSSION AND CONCLUSION: A significant proportion of dural-based lesions resembling meningiomas are non-meningioma tumors, with metastatic and high-grade glial neo-plasms being the most prevalent. Careful evaluation of imaging features and a multidisciplinary approach, including advanced imaging and histopathological confirmation, are essential for accurate diagnosis and optimal patient management.

INTRODUCTION: Pelvic congestion syndrome (PCS) is usually encountered in female patients of reproductive age. Medical and endovascular interventions are used in the treatment. This study aimed to evaluate the effects of endovascular plug embolization on pain and quality of life in patients diagnosed with PCS.
METHODS: In this retrospective study, 36 patients diagnosed with PCS and who underwent embolization of ovarian veins with the plug method between June 2023 and March 2024 were analyzed. All information such as age, BMI (body mass index), site and side of pain, medical treatments, comorbidities, time between onset of pain and endovascular intervention, accompanying symptoms, positions in which pain increased, and clinics consulted during the diagnostic process were recorded. NRS-11 (Numeric Rating Scale-11) and SF-12 (Short Form-12) scores were recorded before, and one and three months after, the endovascular procedure.
RESULTS: The mean age of the patients was 39.5±8.2 years, and the mean duration of pain was 49.6±32.28 months. Compared to the pre-procedural baseline, the NRS score significantly decreased from 9.3 to 2.06, indicating substantial pain relief. The MCS-12 (Mental Component Summary-12) scores increased from 27.5 to 32.4, reflecting an improvement in patients' mental quality of life. Similarly, PCS-12 (Physical Component Summary-12) scores rose from 26.2 to 47.5, demonstrating enhanced physical quality of life. At the 3-month follow-up, statistical analysis of NRS and SF-12 scores confirmed a significant reduction in pain and an increase in quality of life (p<0.001).
DISCUSSION AND CONCLUSION: Endovascular plug embolization is an effective and safe method in patients with PCS. Endovascular plug embolization in patients with PCS resulted in significant pain reduction and notable improvement in both mental and physical quality of life within three months post-procedure.

INTRODUCTION: The aim of the study is to evaluate the quality and functionality of videos on PGD on YouTube.
METHODS: One hundred videos were evaluated; the date of upload, duration, the person who uploaded the video, and the number of comments, views, likes, and dislikes were recorded. Video Power Index (VPI), modified DISCERN scale, Journal of the American Medical Association (JAMA), and Global Quality Scale (GQS) were used in the evaluation. Videos were divided into three groups: University/Professional Organisations (UOO), Medical Advertising/Profit-Oriented Companies (MPC), and Independent Users (IU).
RESULTS: A significant difference was found between the groups in the modified DISCERN parameter (p 0.042). In modified DISCERN scores, the IU group was significantly lower than the other groups. While no difference was detected in the JAMA parameter (p=0.155), the difference between the groups was found to be significant in the GQS parameter (p=0.002). The IU group had the lowest GQS score.
DISCUSSION AND CONCLUSION: We think that it would be more beneficial if the videos published on the internet, especially YouTube, are prepared by experts by utilising reliable sources of information, current literature, and scoring systems.

INTRODUCTION: This study investigates the oral health status and hygiene practices of children with rheumatic diseases compared to healthy peers. It emphasizes the need to integrate dental care into managing these chronic conditions.
METHODS: Children under 18 years of age with rheumatic diseases were recruited from a pediatric rheumatology clinic. Demographic, diagnostic, and treatment data were collected, and a survey administered via Google Forms assessed general information, oral hygiene practices, and education.
RESULTS: The study included 303 participants: 150 with rheumatic diseases and 153 healthy controls. The results indicated that while dental visit frequency was similar between groups, children with rheumatic diseases were more likely to use manual toothbrushes (93.3% vs. 75.2%) and non-fluoride toothpaste. Both groups showed limited knowledge about toothpaste ingredients, but patients demonstrated slightly less awareness. Many participants had not attended oral hygiene workshops, although there was significant interest in further education.
DISCUSSION AND CONCLUSION: The findings show differences in oral hygiene between children with rheumatic diseases and healthy controls, highlighting the need for targeted care and better rheumatologist-dentist collaboration.

INTRODUCTION: Preterm premature rupture of membranes (PPROM) is associated with an increased risk of pregnancy complications. This study evaluated the changes in coagulation parameters in pregnant women with this condition. The aim of the study is to investigate how coagulation parameters, particularly clotting time tests such as PT and aPTT, vary in pregnant patients with PPROM, which is among the causes of premature birth.
METHODS: This case-control study was retrospectively planned and conducted using data from a tertiary center where maternal-fetal treatment and monitoring were provided. The study participants were divided into three groups: the early PPROM group with complaints of water leakage at 12-24 weeks of gestation, the late PPROM group with complaints of water leakage at 24-37 weeks of gestation, and the control group who did not have any complaints at 12-37 weeks of gestation. The coagulation parameters examined were the activated partial thromboplastin time, prothrombin time, INR, and fibrinogen values.
RESULTS: The study comprised 2086 pregnant women, among whom 606 were diagnosed with early PPROM, 609 were diagnosed with late PPROM, and 871 were included in the control group. Notably, significant prolongation was observed in the PT and aPTT values of the early PPROM and late PPROM patients compared to healthy pregnant women.
DISCUSSION AND CONCLUSION: This study highlighted that the PT and aPTT might be prolonged in pregnant women with PPROM. The potential role of coagulation parameters in the pathophysiology of early and late PPROM may be helpful for effective management of these conditions.

INTRODUCTION: Acute pancreatitis (AP) varies in severity, making early identification of severe acute pancreatitis (SAP) essential. As lipid imbalance has been in-creasingly linked to inflammatory activation, the Atherogenic Index of Plasma (AIP) has been proposed as a potential prognostic marker. This study evaluated the association between AIP and AP severity and assessed whether AIP independently predicts SAP.
METHODS: This retrospective cohort included 203 adult patients with acute pancreatitis. Classification of acute pancreatitis followed the Revised Atlanta Criteria. Demographic, laboratory, and lipid data were extracted from electronic records, and AIP was calculated using triglyceride and HDL-cholesterol values. Analyses included group comparisons, correlation testing, comprehensive ROC analyses, multivariable logistic regression, and a covariate-adjusted ROC.
RESULTS: Among 203 patients, 128 had MAP and 75 had SAP. SAP patients showed significantly higher WBC, glucose, creatinine, AST, ALT, and CRP levels (all p<0.001) and lower HDL-C (p=0.024). Mean AIP was higher in SAP (0.59±0.15 vs. 0.53±0.20; p=0.016) but demonstrated limited discrimination (AUC 0.575; cut-off 0.390; sensitivity 96.0%, specificity 22.7%). AIP was significant in unadjusted and WBC-adjusted models (p=0.023 and p=0.043, respectively), but not in the fully adjusted model including WBC and glucose (p=0.196). The covariate-adjusted ROC showed excellent accuracy (AUC 0.892; sensitivity 84.0%, specificity 79.7%).
DISCUSSION AND CONCLUSION: Although higher in severe cases, AIP did not independently predict severity. While insufficient alone, AIP may contribute supportive value when combined with inflammatory and metabolic markers.

INTRODUCTION: The effectiveness of bowel preparation in colonoscopy is influenced by several factors, including the type of preparation used, timing, and level of hydration. However, the impact of water temperature consumed during bowel preparation on cleansing quality has not been adequately described in the literature. This prospective observational study aimed to compare the effects of cold and lukewarm water consumption during bowel preparation on bowel cleansing quality, patient tolerance, and procedure-related outcomes.
METHODS: A total of 260 patients were included in the study. Participants were divided into two groups according to the temperature of the water consumed during bowel preparation: cold water (2–6°C) and lukewarm water (24–28°C). All patients followed the same bowel preparation protocol, consisting of a sodium phosphate solution and an enema. Bowel cleansing quality was assessed using the Boston Bowel Preparation Scale.
RESULTS: Nausea was more frequently observed in the lukewarm water group (p=0.030), while no significant differences were found in other adverse effects. The withdrawal time was shorter in the lukewarm water group (2.7±1.5 min vs. 3.2±1.8 min; p=0.003). The mean total BBPS score was significantly higher in the lukewarm water group (7.37±1.67 vs. 6.43±2.17; p<0.001).
DISCUSSION AND CONCLUSION: Consumption of lukewarm water during bowel preparation significantly improved bowel cleansing quality, enhanced patient tolerance, and reduced procedure time. These findings suggest that water temperature is an overlooked yet important variable that should be considered in routine colonoscopy preparation protocols.

E-waste has emerged as a crucial environmental concern for many governments globally as a result of the quick development in the usage of electronic and electrical equipment worldwide. According to several studies, dangerous compounds in electronic waste may result in environmental tragedies and health issues for people if proper recycling practices are not adopted. This justifies a reconsideration of the current e-waste management procedures. This report summarizes the advancements made, identifies areas for improvement, and critically evaluates earlier studies on the production of e-waste and management strategies of the key Asia Pacific countries that produce digital garbage. This is done in light of the nation's growing e-waste generation and the significance of e-waste management. The digital era has ushered in unprecedented convenience and innovation, but it has also given rise to a significant challenge: e-waste. The serious effects of inappropriate e-waste disposal on the environment and human health are highlighted by this indepth investigation. It emphasizes the urgent need for responsible practices, global collaboration, and innovative, sustainable solutions to address this complex issue and ensure a healthier, more sustainable future.

We present a 31-year-old patient who underwent hysteroscopic myomectomy following gonadotropin-releasing hormone agonist treatment due to inac-cessible submucous myomas. At the first operation, 15 fibroids and one endometrioma in the right ovary were removed. Hysteroscopy was not performed to remove these submucous fibroids, as all of them covered the uterine cavity, and if they were removed, the walls of the uterine cavity would adhere, resulting in Asherman syndrome. Following laparoscopic myomectomy, the patient was started on leuprolide treatment, a gonadotropin-releasing hormone agonist, for two months. Then hysteroscopy was conducted, and it was observed that all submucous fibroids had undergone significant degeneration, with reduction in size, softening, and could be easily excised.