INTRODUCTION: This study aimed to evaluate the effectiveness of Basic Life Support (BLS) training provided to muhtars (community leaders) in Ankara using a
pre-test/post-test design.

METHODS: This descriptive cross-sectional study was conducted between May and October 2025 with 673 volunteer muhtars from 16 districts of Ankara. Participants received a standardized 16-hour training program (8 hours theoretical, 8 hours practical) based on the American Heart Association 2020 guidelines. Knowledge levels were assessed using a 20-item test administered before and after the training. Statistical analyses were performed using the Kruskal–Wallis test and Spearman’s correlation analysis.
RESULTS: The mean test score increased significantly from 63.7±12.7 before training to 90.8±8.8 after training (p=0.001). The overall success rate was 90.3%. A significant positive correlation was observed between educational level and examination performance, with participants having higher education levels achieving better scores.
DISCUSSION AND CONCLUSION: The 16-hour BLS program significantly improved community leaders' theoretical knowledge and practical skills. Given the low bystander CPR rates in Türkiye, training community leaders is a strategic intervention to improve OHCA survival. Periodic refresher training and nationwide adoption of this model are recommended to strengthen community emergency response capacity.

INTRODUCTION: This study aimed to assess the knowledge and use of complementary and alternative medicine (CAM) among parents visiting a pediatric outpatient clinic at a state hospital in Türkiye.
METHODS: A descriptive cross-sectional study was conducted using a 20-question survey developed by the researchers. The participants were parents who brought their children to the clinic for any reason and consented to participate. Data were analyzed using SPSS 26. Descriptive statistics, frequency, percentage, and chi-square tests were used.
RESULTS: A total of 348 parents participated, with 85.6% (n=298) female and 14.4% (n=50) male. The most commonly known CAM methods were massage, cupping, herbal treatments, and leech therapy. The main source of CAM information was family and friends (47.1%), while healthcare professionals were the least common source (11.5%). CAM methods had been used by 80.5% of the participants on their children, mostly for issues such as constipation, coughing, and sore throat. The primary reason for CAM use was ease of access. Most parents reported using CAM rarely, observed partial benefits, and were likely to recommend it to others.
DISCUSSION AND CONCLUSION: CAM practices like massage, cupping, and herbal remedies are widely known and used by parents, typically alongside conventional treatment. This use is influenced mainly by informal sources. CAM methods are perceived as partially beneficial and are mostly used occasionally. Proper evaluation and integration of CAM into medical treatment can enhance safety and effectiveness, promoting a more holistic approach to child healthcare.

INTRODUCTION: Chronic nonbacterial osteomyelitis (CNO) is a rare autoinflammatory bone disorder characterized by sterile osteitis. This study aimed to evaluate the clinical, radiological, and therapeutic characteristics of pediatric patients with CNO and to analyze the evolving diagnostic and management strategies in a tertiary referral center.
METHODS: This retrospective single-center cohort study included 33 children diagnosed with CNO between 2018 and 2024. Demographic characteristics, clinical presentation, laboratory markers, magnetic resonance imaging (MRI) findings, treatment modalities, and outcomes were analyzed.
RESULTS: The cohort showed a slight male predominance (54.5%). The median age at symptom onset was 9 years (IQR 5.5–11.5), with a median diagnostic delay of 24 months. Multifocal involvement was observed in 81.3% of patients, with the femur (51.6%) and vertebrae (29.0%) being the most frequently affected sites. Whole-body MRI was used in 69.6% of cases, facilitating a relatively low bone biopsy rate (21.2%). Regarding treatment, although nonsteroidal anti-inflammatory drugs were used as initial therapy, 93.5% of patients required conventional disease-modifying antirheumatic drugs. Notably, 48.5% required escalation to anti-tumor necrosis factor agents due to disease recalcitrance or relapse. The relapse rate was 36.3% during a median follow-up of 37 months.
DISCUSSION AND CONCLUSION: Pediatric CNO presents with a heterogeneous phenotype. Our findings highlight a regional male predominance and a paradigm shift toward MRI-based diagnosis, reducing the need for invasive biopsies. The high utilization of biologic therapies underscores the refractory nature of the disease in tertiary care settings and supports a proactive, stepwise therapeutic approach to achieve sustained remission.

INTRODUCTION: Juvenile idiopathic arthritis-related uveitis (JIA-U) is the leading cause of non-infectious chronic uveitis in children. Early detection and prevention of vision-threatening complications remain the cornerstones of management. In this study, we aimed to evaluate the distribution and clinical characteristics of uveitis across JIA subtypes, identify the predominant treatment modalities, and determine the risk factors for recurrence.
METHODS: The medical records of patients with JIA-U followed at our center were retrospectively reviewed between January 2017 and March 2022. Demographic and clinical characteristics, JIA subtypes, treatments, frequency of recurrence, structural ocular complications related to uveitis, and interventions were evaluated.
RESULTS: A total of 81 eyes (29 bilateral, 14 left, and 9 right) of 52 patients (34 female, 65.4%) were assessed. Thirty-nine (75%) patients had oligoarticular JIA, 6 (11.5%) had enthesitis-related arthritis, 4 (7%) had polyarticular JIA, and 3 (5.7%) had psoriatic arthritis. Anterior uveitis was the most common anatomical type (73 eyes; 90.1%). Conventional disease-modifying antirheumatic drugs (cDMARDs) were administered to 46 patients (88.5%), while biological DMARDs (bDMARDs) were used in 37 (71.2%) of 52 patients. Eighteen (34.6%) patients had ocular complications. Recurrence was observed in 40 (76.9%) patients. Female sex was found to be a predictive factor for recurrence in multivariate regression analysis (OR 7.716, 95% CI 1.667–35.712, p=0.009).
DISCUSSION AND CONCLUSION: Chronic anterior uveitis is the most common anatomical presentation in JIA-U. Oligoarticular JIA, RF-negative polyarticular JIA, enthesitis-related arthritis, and psoriatic arthritis are the JIA subtypes associated with JIA-U. Female sex is a risk factor for recurrence, and bDMARDs play an important role in the management of recurrent and refractory JIA-U.

INTRODUCTION: Spontaneous ecchymosis is a common yet diagnostically challenging reason for referral to hematology clinics, particularly when platelet counts and routine coagulation tests are normal. In this setting, the diagnostic value of clinical phenotype, bleeding history, and bleeding assessment tools remains uncertain.
METHODS: We conducted a single-center, real-world, observational cross-sectional study including adult patients presenting with spontaneous or recurrent ecchymosis. All patients had normal platelet counts and normal screening coagulation tests and were not receiving antithrombotic therapy. Bleeding severity was assessed using the International Society on Thrombosis and Haemostasis Bleeding Assessment Tool (ISTH-BAT). Laboratory evaluation included von Willebrand factor (vWF) antigen and activity, factor VIII (FVIII), and factor XIII (FXIII) activity.
RESULTS: A total of 143 patients were included (median age: 33 years; 97.2% female). A definitive hemostatic abnormality was identified in 58 patients (40.6%). Abnormal vWF parameters were observed in 25.2% of patients, while reduced FVIII and FXIII levels were detected in 14.0% and 7.7%, respectively. Using conventional sex-specific ISTH-BAT cutoffs, only one patient met the criteria for a pathological BAT score. In contrast, median ISTH-BAT scores were significantly higher in patients with identifiable laboratory abnormalities compared with those without (p=0.047). Clinical features such as ecchymosis distribution and pain were not associated with laboratory abnormalities.
DISCUSSION AND CONCLUSION: In patients presenting with spontaneous ecchymosis, clinical phenotype and standard bleeding score cutoffs have limited diagnostic utility. Interpreting the ISTH-BAT score as a continuous measure of bleeding burden provides clinically meaningful information and may better support diagnostic decision-making in real-world practice.

INTRODUCTION: Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease associated with substantial morbidity and mortality. The GAP (Gender–Age–Physiology) index is widely used for prognostic stratification; however, it does not incorporate cardiovascular parameters. The incremental prognostic value of echocardiographic systolic pulmonary artery pressure (sPAP) beyond the GAP index remains unclear.
METHODS: This retrospective, single-center cohort study included 114 patients diagnosed with IPF. The GAP index was calculated for all patients, and systolic pulmonary artery pressure was estimated using transthoracic echocardiography. Overall survival was analyzed using Cox proportional hazards regression models. The prognostic performance of the GAP index was compared with models incorporating echocardiographic systolic pulmonary artery pressure.
RESULTS: A total of 114 patients with IPF were included (median age: 63 years; 73.3% male). During follow-up, 66 patients (57.9%) died. The GAP index was significantly associated with mortality in both univariate (HR: 1.29, 95% CI: 1.02–1.64, p=0.034) and multivariate analyses (HR: 1.29, 95% CI: 1.02–1.64, p=0.038). Echocardiographically estimated sPAP was not independently associated with survival, and the addition of sPAP to the GAP model did not significantly improve prognostic discrimination.
DISCUSSION AND CONCLUSION: The GAP index remains a robust predictor of mortality in patients with idiopathic pulmonary fibrosis. Echocardiographic systolic pulmonary artery pressure was not independently associated with survival and did not provide incremental prognostic value beyond established physiological indices. These findings suggest that single-time-point echocardiographic assessment of pulmonary artery pressure may have limited utility for mortality prediction in IPF.

INTRODUCTION: This study aimed to retrospectively evaluate the records of patients admitted to our clinic with low back pain who, in addition to a standard home-based core stabilization exercise program, received paravertebral ozone (oxygen-ozone) therapy and to assess its effects on pain severity and functional status.
METHODS: Twenty-seven patients diagnosed with lumbar discopathy and treated with both a core exercise program and paravertebral ozone therapy were included. Pain severity was assessed using the Visual Analog Scale (VAS), and functional status was evaluated using the Oswestry Disability Index (ODI).
RESULTS: Post-treatment VAS scores decreased significantly (pre-treatment: 7.11±1.37; post-treatment: 4.48±0.89; p<0.001). ODI scores also showed a signifi-cant reduction (pre-treatment: 35.37±5.34; post-treatment: 26.70±4.31; p<0.001).
DISCUSSION AND CONCLUSION: The combination of paravertebral ozone therapy and core exercises provides clinically meaningful short-term improvements in both pain reduction and functional outcomes. Combined treatment approaches should be prioritized in low back pain management protocols.

INTRODUCTION: Preoperative component sizing in total knee arthroplasty (TKA) can streamline surgery and support alignment and stability. Linear regression models based on basic demographic and anthropometric measures are practical, but their linear assumptions may miss complex anatomical variation. Although machine learning has been increasingly used for prediction tasks, head-to-head evidence against standard regression models in homogeneous TKA series remains limited.
METHODS: We retrospectively reviewed 224 unilateral primary posterior-stabilized TKAs performed by a single surgeon using one implant system. Predictors included age, sex, height, weight, body mass index, and shoe size. Multivariable linear regression was compared with Random Forest and XG-Boost. Models were trained on 80% of cases with 10-fold cross-validation and evaluated on a held-out 20% test set using R², RMSE, MAE, and ±1-size accuracy.
RESULTS: Height and shoe size were the strongest predictors. The linear regression fit was good (femoral R²=0.63; tibial R²=0.59). Femoral sizing was comparable across approaches (test R²=0.48; ±1 accuracy 37.8–44.4%). For tibial sizing, ML outperformed regression: Random Forest achieved a test R²=0.60 with ±1 accuracy of 48.9%, and XGBoost achieved a test R²=0.56 with ±1 accuracy of 53.3%, versus linear regression (R²=0.40; ±1 accuracy 33.3%).

DISCUSSION AND CONCLUSION: In this homogeneous cohort, linear regression predicted femoral size well, whereas tibial sizing showed greater non-linearity and benefited from ensemble ML. Still, accuracy was insufficient to replace intraoperative judgment. These models may assist preoperative inventory planning and trial component preparation, but external validation across implant systems is needed.

INTRODUCTION: Acute diverticulitis presents with a wide clinical spectrum ranging from mild inflammation to severe complications. Early assessment of disease severity is essential to guide decisions regarding outpatient management, hospitalization, and intervention, as well as to plan appropriate post-episode sur-veillance. This study evaluated clinical and computed tomography (CT)-based predictors of disease severity and hospitalization and examined follow-up and colonoscopy adherence after an episode of acute diverticulitis.
METHODS: This single-center retrospective observational study included 57 patients diagnosed with acute diverticulitis between June 2020 and June 2025. Demographic characteristics, laboratory parameters [C-reactive protein (CRP) and white blood cell count], CT findings, treatment approaches, and follow-up data were analyzed. CT images were re-evaluated using the modified Hinchey classification, and intraperitoneal free air was categorized as none, minimal pericolic, or diffuse. Independent predictors of hospitalization were assessed using multivariate logistic regression.
RESULTS: Thirty-three patients (57.9%) were hospitalized, and 24 (42.1%) were managed as outpatients. Higher CRP levels, advanced modified Hinchey stage, and the presence of free air on CT were associated with hospitalization, longer hospital stay, and the need for percutaneous drainage or surgery (p<0.05). In multivariate analysis, modified Hinchey stage ≥1b was the only independent predictor of hospitalization (OR: 14.32; 95% CI: 1.21–169.80; p=0.035). Among the 32 patients with available follow-up data, colonoscopy completion was strongly associated with follow-up attendance (p<0.001).
DISCUSSION AND CONCLUSION: Modified Hinchey staging plays a key role in predicting hospitalization in acute diverticulitis. Structured follow-up strategies, including scheduled colonoscopy, may improve adherence and support the timely exclusion of underlying malignancy.

INTRODUCTION: This study aimed to compare the effects of two therapeutic ultrasound application techniques, pulsed and continuous, on pain, functional capacity, and quality of life in patients with primary knee osteoarthritis.
METHODS: This assessor-blinded, prospective, randomized controlled clinical trial included patients randomly assigned to three groups: (1) pulsed ultrasound + hot pack + exercise, (2) hot pack + exercise (control), and (3) continuous ultrasound + hot pack + exercise. Ultrasound therapy was applied for 15 sessions over three weeks. All participants were evaluated before treatment, immediately after treatment, and at the two-month follow-up. Pain was assessed using the Visual Analog Scale (VAS); functional status was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Lequesne Index; quality of life was assessed using the SF-36; and muscle strength was measured using isokinetic dynamometry. Statistical analyses were performed using SPSS software with appropriate parametric and non-parametric tests. A p value <0.05 was considered statistically significant.
RESULTS: Pain and WOMAC scores improved over time in all groups. Both pulsed and continuous ultrasound groups demonstrated improvements in Lequesne Index scores and extensor muscle strength; however, no significant difference was observed between the two ultrasound modalities (p>0.05). Improvements were also observed in several SF-36 domains, including physical functioning, bodily pain, and social functioning.
DISCUSSION AND CONCLUSION: Both pulsed and continuous therapeutic ultrasound, combined with hot pack and exercise, improved pain and functional outcomes in patients with primary knee osteoarthritis, with no significant difference between ultrasound modalities.

INTRODUCTION: Acute ankle inversion injury (AAII) is one of the most common injuries seen in emergency departments (EDs). Although MRI is valuable for diagnosis, its use in the ED is often limited by time, cost, and patient comfort. Moreover, severe post-traumatic symptoms can raise concern for misdiagnosis and prompt unnecessary MRI requests. Therefore, the true necessity of early MRI after AAII has increasingly been questioned.
METHODS: A total of 464 patients were included in the study. Group A consisted of 319 patients who underwent MRI during their initial evaluation after trauma, while Group B included 145 patients who received MRI during follow-up based on clinical suspicion. Grade 2 and Grade 3 ligament injuries, osteochondral injuries, tendon injuries, and non-displaced fractures were considered clinically significant pathologies. The proportion of clinically significant findings was compared between the two groups.
RESULTS: MRI revealed pathologies that could lead to functional impairment in 79.3% of Group A and 96.5% of Group B (p<0.001). Ligament injury was present in 48.4%, most commonly ATFL tears (42%). Bone and osteochondral lesions were found in 47.6% of patients. All Grade 3 lesions were located in the talus and associated with sports-related trauma (p<0.001). Bone-cartilage lesions were found in 56.5% of sports injuries vs. 46.1% of non-sports injuries (p=0.109).
DISCUSSION AND CONCLUSION: MRI performed after initial symptom improvement yields greater diagnostic accuracy and reduces unnecessary ED imaging. MRI should be selectively reserved for cases with persistent clinical suspicion on physical examination or when results may alter management.

INTRODUCTION: Pelvic congestion syndrome (PCS) is a clinical condition resulting from dysfunction of the pelvic venous system and is most commonly observed in multiparous women. This study aimed to evaluate the distribution and clinical characteristics of pain in patients with PCS and to assess changes in pain intensity following endovascular treatment.
METHODS: In this retrospective, single-center study, 54 patients with PCS who underwent plug-based ovarian vein embolization between January 2022 and March 2023 were included. Demographic and clinical data, including BMI, pain characteristics, comorbidities, treatments, symptom duration, prior consultations, and associated symptoms, were recorded. Pain intensity was evaluated using the NRS-11 before the procedure and at 1 and 3 months post-intervention.
RESULTS: The mean age was 39.6±8.1 years, and the mean pain duration was 48.9 ± 31.9 months. Chronic comorbidities were present in 19% of patients. Pain most commonly involved the groin (80%), hips (63%), and lower back (48%) and was exacerbated by prolonged standing in all patients. Associated symptoms included postcoital pain (83%), dyspareunia (66%), urinary urgency (36%), and dysuria (23%). Lower extremity varicose veins were observed in 82% of patients, and 87% were multiparous.
DISCUSSION AND CONCLUSION: Pain associated with PCS may present as referred pain involving the hip and lower back, often mimicking musculoskeletal conditions. It should be considered in the differential diagnosis of chronic hip and low back pain, particularly in multiparous women. Greater clinical awareness may reduce diagnostic delay, and further prospective studies are needed to clarify underlying pain mechanisms.

INTRODUCTION: Early aneurysm occlusion is a cornerstone in the management of aneurysmal subarachnoid hemorrhage (aSAH) to prevent rebleeding and secondary brain injury. However, whether operative timing, particularly during off-hours, influences clinical outcomes remains uncertain. To evaluate the association between operative timing and clinical outcomes in patients undergoing treatment for ruptured intracranial aneurysms.
METHODS: This retrospective cohort study included adult patients treated for ruptured intracranial aneurysms at a tertiary neurosurgical center between January 2021 and January 2026. Procedures were categorized as work hours (07: 00–16: 00), evening (16: 00–22: 00), and nighttime (22: 00–07: 00). The primary outcome was functional status at discharge, assessed using the modified Rankin Scale (mRS). Secondary outcomes included mortality and length of hospital stay. Multivariable logistic regression was used to determine whether operative timing independently predicted poor outcome (mRS ≥3) after adjustment for clinical and radiological severity variables.
RESULTS: A total of 315 patients were included, of whom 79.4% were treated during work hours, 10.5% in the evening, and 10.1% at night. Baseline demographic, clinical, and radiological characteristics were comparable across groups. Favorable outcome (mRS 0–2) occurred in 64.0%, 57.6%, and 50.0% of patients, respectively (p=0.21), while mortality rates were 12.8%, 15.1%, and 21.9% (p=0.18). In multivariable analysis, WFNS ≥IV, ASA ≥3, and Fisher ≥III were independently associated with poor outcome, whereas operative timing was not.
DISCUSSION AND CONCLUSION: Although later operative timing showed a trend toward worse crude outcomes, it was not independently associated with clinical outcomes after adjustment for disease severity. Patient-related factors appear to be the primary determinants of outcome in aSAH.

INTRODUCTION: The aim of this study was to compare sociodemographic characteristics, clinical findings, serum CA125 levels, and ultrasonographic- Doppler features among patients with benign, borderline, and invasive ovarian tumors, and to identify factors most strongly associated with invasive disease.
METHODS: This retrospective observational study included 129 patients who underwent surgical management for adnexal masses. According to final histopathological diagnosis, patients were classified as having benign tumors (n=88), borderline tumors (n=6), or invasive ovarian carcinoma (n=36). In an additional analysis, borderline and invasive tumors were combined into a malignant group (n=42) and compared with benign lesions. Demographic data, body mass index (BMI), menopausal status, preoperative serum CA125 levels, presence of ascites, and bilaterality were recorded. All patients underwent detailed transvaginal and/or transabdominal ultrasonography with color Doppler evaluation. Sonographic features and Doppler vascularity were systematically analyzed.
RESULTS: Serum CA125 levels, BMI, presence of ascites, bilateral tumor involvement, solid components, papillary projections with blood flow, increased Doppler vascularity, and larger lesion size were significantly associated with invasive ovarian carcinoma (all p<0.001). Age did not differ significantly between groups, whereas menopausal age was higher in malignant tumors. Benign lesions were generally smaller and showed absent or minimal Doppler flow, while invasive tumors frequently demonstrated moderate to marked vascularity.
DISCUSSION AND CONCLUSION: The combined assessment of clinical parameters, serum CA125 levels, and detailed ultrasonographic and Doppler findings improves preoperative differentiation between benign and malignant ovarian tumors. An integrated diagnostic approach may enhance risk stratification and support appropriate clinical management.

INTRODUCTION: Conventional two-dimensional digital subtraction angiography (DSA) may be insufficient for the evaluation of intracranial stents because of over-lapping anatomy and device-related artifacts. This study investigated the impact of intraoperative flat-panel detector CT angiography (FP-CTA) on treatment decision-making during intracranial stent procedures.
METHODS: In this retrospective, single-center study, 97 patients treated with endovascular stenting between May 2010 and May 2013 were included (78 aneurysms and 19 symptomatic intracranial stenoses). After stent deployment, FP-CTA was obtained to evaluate stent position, expansion, lesion coverage, and vessel patency. Treatment modification was defined as additional stent placement or balloon angioplasty performed solely according to FP-CTA findings.
RESULTS: In the aneurysm cohort, FP-CTA prompted treatment modification in 25/78 patients (32%). Eleven patients (14%) required an additional stent because of incomplete neck coverage, malposition, or poor wall apposition. Fourteen patients (18%) underwent balloon angioplasty for underexpansion or residual in-stent stenosis. No FP-CTA-driven modification was required in the stenosis group. No FP-CTA-related complications occurred.
DISCUSSION AND CONCLUSION: Intraoperative FP-CTA frequently changes the treatment strategy, particularly in stent-assisted aneurysm procedures, by detecting suboptimal deployment that is not evident on DSA. It is a useful adjunctive imaging tool for quality control and the optimization of intracranial stent interventions.

To present a rare case of a ruptured pulmonary hydatid cyst initially mimicking pneumonia in the emergency department. A 22-year-old woman was evaluated for acute cough, chest pain, and malaise. Chest radiography and computed tomography revealed a ruptured hydatid cyst in the right upper lung and an addi-tional small hepatic cyst. Surgical consultation was obtained, and operative management was planned based on the imaging findings. The patient underwent successful surgical intervention and recovered fully without postoperative complications. She remained asymptomatic during follow-up. Ruptured pulmonary hydatid cysts can resemble common respiratory conditions, leading to diagnostic delays. This case highlights the importance of considering hydatid disease in patients from endemic regions who present with nonspecific respiratory symptoms and emphasizes the role of timely imaging and surgical management in achieving favorable outcomes.