INTRODUCTION: This study was planned to retrospectively compare the effect of shoulder hemiarthroplasty and plate osteosynthesis on shoulder and hand functionality in patients with proximal humerus fracture.
METHODS: From 2014 to 2019, patients with Neer III proximal humerus fractures were retrospectively reviewed. Among them, 13 patients underwent shoulder hemiarthroplasty (7 males and 6 females with an average age of 66.08±12.99 years old); while 13 patients underwent osteosynthesis(4 males and 9 females with an average age of 54.67±20.05 years old). Hand and shoulder functionality were evaluated with Disabilities of the Arm, Shoulder and Hand (DASH-T) Score, modified Constant-Murley score (CMS), Duruöz Hand Index (DHI) and Michigan Hand Outcomes Questionnaire (MHQ) and Jamar hand-held dynamometer. Additionally, surgery satisfaction of the patients were determined.
RESULTS: There was no statistically significant difference in DASH-T score (p=0.769), DHI total score (0.222), hand grip strength (p=0.268) and surgery satisfaction (p=0.899) between the groups. There was a significant difference in modified CMS score in favor of osteosynthesis group (p=0.008). There was no statistically significant difference in work performance sub-scale of MHQ (p=0.135) whereas a significant difference was observed in bilateral activities of daily living task (p=0.006) and pain (p=0.010) the sub-scales of MHQ in favor of osteosynthesis group.
DISCUSSION AND CONCLUSION: In the osteosynthesis group, it was found that the shoulder functions and bilateral activities of daily living task were better than the hemiarthroplasty group. Also the perceived pain in the hemiarthroplasty group was higher. Further studies with large sample size are needed to confirm the existence of differences between these surgical techniques.

INTRODUCTION: Defining the characteristics of pediatric trauma injuries is essential for providing specialized care. We aimed to clarify and determine the frequency of admission to the emergency department due to any traumatic injury to the musculoskeletal system, its characteristics, and related factors in pediatric age groups.
METHODS: We reviewed data through a retrospective analysis of pediatric trauma visits from our emergency unit records. Data analyzed included demographic properties, hospital admission hours, trauma etiologies, trauma site (upper-lower extremity), and the rates and numbers of injury types.
RESULTS: A total of 2,627 patients admitting to the pediatric emergency unit due to musculoskeletal trauma in a university hospital from January 2019 to December 2020 were evaluated. The highest rate of admission was in the 16-20 years among all age groups. The most common etiology was a fall from the same level in all age groups. The number of patients with upper extremity injury (n = 2110) was higher than those with lower extremity injury (n = 517). Ninety percent (2382) of the children evaluated for these injuries were treated conservatively. The highest number of admissions due to trauma was observed in July, September, and August.
DISCUSSION AND CONCLUSION: This single-center study will help clinicians determine musculoskeletal injury patterns in the pediatric population, along with their characteristics and related factors in pediatric age groups.

INTRODUCTION: The study aimed to evaluate both the traditional metrics and the altmetric scores (AS) of the most cited 100 articles regarding keratoconus published between 2010-2020 in ophthalmology journals.
METHODS: The word “keratoconus” was searched in the Web of Science database. The articles published in ophthalmology journals between 2010 and 2020 were filtered. The traditional metric and altmetric data of the most cited 100 articles were evaluated according to the subject of the articles, the type of the article, publication year, and the journals they were published in. The correlation between metric and altmetric data was also investigated
RESULTS: While there was a weak positive correlation between AS and average citation per year and the publication year, there was a weak negative correlation between AS and number of years since publication.
DISCUSSION AND CONCLUSION: AS cannot be used as a substitute for traditional metric data, but can be considered as a complement to them.

INTRODUCTION: The aim of the study is to determine the preoperative blood values that can predict the presence of additional deep infiltrating endometriosis (DIE) in patients operated for ovarian endometrioma (OMA).
METHODS: This retrospective cohort study was conducted with 149 patients who had undergone surgery for OMA. While 43 of these patients had DIE, 106 did not have DIE.
RESULTS: In the group of patients with DIE, HB (hemoglobin) value was lower (p=0.014), PLR (platelet-to-lymphocyte ratio), CA125, CA19-9, CA15-3 values were higher (p=0.028, p=0.000, p=0.004, p=0.003, respectively). There was no significant difference between groups in terms of thyroid stimulating hormone (TSH), neutrophil count, lymphocyte count, platelet count, NLR (neutrophil-to-lymphocyte ratio), c-reactive protein (CRP), prothrombin time, (PT), activated partial thromboplastin time (APTT), International standardized ratio (INR), and CEA values (p> 0.05 for all). The diagnostic efficacy of HB, PLR, CA125, CA15-3, CA19-9 values and the three combination models in the diagnosis of DIE in patients with OMA were also evaluated. ROC curves showed that HB, PLR, CA125, CA15-3, CA19-9, Combination 1 (CA125, CA15-3, CA19-9), Combination 2 (PLR and CA125) and Combination 3 (PLR, CA125, CA15-3, CA19-9) had AUC (area under the curve) of 0.629, 0.615, 0.701, 0.650, 0.656, 0.705, 0.698 and 0.759, respectively.
DISCUSSION AND CONCLUSION: HB values tend to decrease and PLR, CA125, CA15-3 and CA19-9 values tend to increase in patients with OMA in the presence of DIE. The combination of PLR, CA125, CA15-3, and CA19-9 values may help detect the presence of DIE preoperatively in patients with OMA.

INTRODUCTION: Cancer patients with comorbidities often require multiple pharmacological treatments in addition to their oncological therapies. This situation can lead to potential drug-drug interactions (PDDIs), increasing morbidity and mortality. The study aims to identify PDDIs in oncology patients.
METHODS: The records of 250 cancer patients from a Medical Oncology clinic who were either receiving chemotherapy for the first time or had a change in their drug protocol were reviewed. The medications were analyzed for PDDIs using 2020 data from the Medscape and Drugs.com databases. PDDIs were classified by clinical significance (major, moderate, minor) and mechanism (pharmacodynamic, pharmacokinetic). Drugs with major interactions and those prolonging the QT interval were listed.
RESULTS: A high rate of polypharmacy was observed. Of the patients, 55.6% were male, and 44.4% were female. PDDIs were identified in 223 (85.2%) and 238 (95.2%) patients according to Medscape and Drugs.com, respectively. Major interactions were found in 28 (11.2%) and 67 (26.8%) patients, respectively. A total of 99 drug pairs prolonged the QT interval. According to Medscape, 77 interactions were seen in 52 (20.8%) patients, while Drugs.com identified 298 interactions in 136 (54.4%) patients. An increase in the number of medications for comorbidities significantly raised the PDDI risk (P<0.05).
DISCUSSION AND CONCLUSION: The rate of major PDDIs and the number of QT-prolonging drugs in this study are comparable to other studies. However, certain frequently prescribed drugs pose preventable risks. Caution is needed when prescribing these medications, and close monitoring by clinicians is advised when alternatives are unavailable.

INTRODUCTION: Aortic stenosis (AS) is the most common primary valve lesion in Europe and North America, often requiring surgical or transcatheter intervention. Due to increased afterload left ventricular hypertrophy (LVH) occurs. Fragmented QRS (fQRS) on an electrocardiogram (ECG) is defined by specific alterations in the QRS morphology and is associated with myocardial fibrosis, ischemia, and poor cardiovascular outcomes. This study aimed to investigate the relationship between fQRS and left ventricular mass index (LVMI) in patients with symptomatic severe AS.
METHODS: This retrospective study included 209 patients diagnosed with severe AS between January 2018 and December 2023, after exclusion criterias. Patients underwent ECG and echocardiography to assess the presence of fQRS and LVH parameters, including LVMI. Statistical analyses compared variables between patients with and without fQRS, and logistic regression identified predictors of high LVMI.
RESULTS: Patients were divided into two groups based on the presence of fQRS. The fQRS group had significantly greater interventricular septal thickness (IVST), LV posterior wall thickness (LVPWT), LVMI, and peak aortic velocity. According to regression analyses COPD, low glomerular filtration rate (GFR), increased systolic pulmonary artery pressure (sPAP), and the presence of fQRS was found as independent predictors of high LVMI. The LVMI value of 131.7 was found to predict the presence of fQRS on ECG with 62.5% sensitivity and 62% specificity in the general population of the study.
DISCUSSION AND CONCLUSION: The presence of fQRS on ECG is a significant marker of higher LVMI in patients with severe AS. Identifying fQRS on ECG can help predict LVH severity in these patients.

INTRODUCTION: The morbidity rate after Whipple operation is quite high (40-50%). We aimed to evaluate the efficacy of preoperative biochemical, inflammatory and nutritional biomarkers used as predictors for morbidity and mortality in patients undergoing this procedure, as well as the effect of perioperative biliary drainage and anastomosis technique on the postoperative period.
METHODS: This retrospective clinical study was conducted by extracting data from hospital computer databases or archive files of patients who underwent pancreaticoduodenectomy between 23.07.2010 and 22.12.2021.All patients who underwent Whipple procedure and achieved R0 surgical resection were included in the study. Demographic data (age and gender), presence of stent, preoperative hemoglobin, platelet, neutrophil, lymphocyte, total bilirubin, direct bilirubin, albumin blood test values were recorded retrospectively. Preoperative neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and prognostic nutritional index (PNI) were calculated for all patients.
RESULTS: A total of 153 patients were included in the study. The mean values of total bilirubin and direct bilirubin were significantly different between cases with and without bleeding and complications. Gender, presence of stent, anastomotic technique, albumin, PLR and PNI did not significantly affect mortality. Age, hemoglobin, NLR, total bilirubin and direct bilirubin affected mortality. However, further analysis revealed that age was the only risk factor for mortality
DISCUSSION AND CONCLUSION: High bilirubin levels were associated with perioperative bleeding in the analyses. While age, hemoglobin, bilirubin and NLR were prominent in predicting mortality, further analysis revealed that only age was strongly associated with early postoperative mortality.

INTRODUCTION: The aim of this study was to assess the knowledge, attitudes, and practices of family physicians in Türkiye regarding scabies diagnosis and treatment.
METHODS: A cross-sectional survey was conducted among 160 family physicians in Türkiye. The survey included questions on demographics, clinical experience, scabies management, practices, and knowledge of scabies transmission and treatment.
RESULTS: Permethrin cream was the most frequently reported first-line treatment (80.6%). Repeat treatment was recommended by most of the physicians (71.25). Nearly all physicians (98.12%) treated close contacts and 93.75% of the physicians provided hygiene advice. However, misconceptions existed regarding zoonotic transmission (46.25%) and unnecessary laboratory tests were sometimes requested (9.37%). Knowledge gaps were identified concerning the use of magistral preparations. The most common reason for referral to dermatologists was diagnostic uncertainty (75.6%).
DISCUSSION AND CONCLUSION: Family physicians in Türkiye demonstrate some strengths like diagnostic success and family therapy, in scabies management, but knowledge gaps and inconsistencies exist. Educational interventions are needed to improve diagnostic accuracy, optimize treatment practices, and enhance scabies control strategies.

INTRODUCTION: Awareness of lipedema is still low among medical professionals. Pain is a prevelant symptom of lipedema, it is crucial to increase awareness among physical medicine and rehabilitation (PMR) physicians. The primary objective of this study is to evaluate the level of knowledge and awareness about lipedema among PMR physicians and to identify the factors influencing these.
METHODS: A cross-sectional survey was conducted using an online questionnaire administered to PMR physicians, including both residents and specialists, practicing in Turkey. A total of 151 PMR residents and specialists aged 24-64 years participated in the study. The survey consisted of two parts. The first part included demographic and profession-related information. The second part consisted of 14 questions focusing on assessing knowledge and awareness of lipedema.
RESULTS: The majority of the 151 participants(80.1%) were female. The median age of the participants was 38 years. Knowledge scores ranged from 0 to 14, with a median of 8. Scores of 0 to 8 indicated insufficient knowledge, while scores of 9 to 14 indicated sufficient knowledge. Of the participants, 45.7%(N=69) had sufficient knowledge (Group 1) of lipedema's definition, pathogenesis, diagnostic tools, differential diagnosis, and treatments, while 54.3%(N=82) had insufficient knowledge(Group 2). Group 1 participants with sufficient knowledge had significantly ≤10 years of experience proportion compared to Group 2(p<0.05). Group 1 had a significantly higher proportion of participants under the age of 40 compared to Group 2(p<0.05).
DISCUSSION AND CONCLUSION: The awareness of lipedema among PMR physicians tends to be low. Interestingly, younger physicians tend to have higher levels of awareness about lipedema.

INTRODUCTION: Hepatitis B virus(HBV) can be prevented with vaccination. Some individuals fail to elicit an adequate antibody response despite appropriate vaccination. In this study, we aimed to assess the vaccine response to the HBVvaccine in subjects who tested negative for HBsAg, Anti-HBc, and Anti-HBs at our vaccination center, and to identify the factors influencing this response.
METHODS: The study included 170 individuals over the age of 18 who visited our clinic between 01/March/2021 and 31/August/2024. All participants who received three doses of standard vaccination had their Anti-HBs levels checked 30 days after the third dose. Demographic data and potential factors influencing the vaccine response were analyzed retrospectively through the hospital information system.
RESULTS: Of the 170 individuals included in the study, 93(54.7%) were male, with a mean age of 42.02 years. A vaccine response was observed in 87%(n=148) of the cases following vaccination. The mean age of the non-responsive group was 50.5 years, compared to 40.8 years in the responsive group(p<0.001). The vaccine response rate was 57.7% in individuals living with HIV, compared to 92.4% in the HIV-negative group(p<0.001). Among individuals on immunosuppressive therapy, the vaccine response was 40%, while it was 91.6% in those not on such therapy(p<0.001). In logistic regression analysis, being over 50 years old increased the risk by 3.72 times, having HIV by 40.73 times, and receiving immunosuppressive therapy by 94 times.
DISCUSSION AND CONCLUSION: It has been evaluated that the vaccine response may be lower in patients over 50 years of age, those using immunosuppressive drugs, and those who are HIVpositive.

Kounis syndrome is an acute coronary syndrome due to activation of mast cells after exposure to an allergen. The most important step in the diagnosis of Kounis syndrome is to consider that the appearance of the picture as a result of chest pain and ECG changes may be due to a hypersensitivity reaction. We aimed to present a case of Kounis Syndrome due to the use of succinylated gelatin-based colloid, which is used as a volume expander, and our treatment approach in the light of the literature.

Only a very few cases of splenic lymphangiomatosis have been published in the literature to date. Herein,
we report the case of splenic lymphangiomatosis with unique characteristics. A woman in her 70s was
referred to us due to worsening of her pre-existing pancytopenia. Abdominal computed tomography scan
revealed an enlarged spleen (17 cm) and some hypodense lesions in the splenic parenchyma. These lesions
were evaluated as benign cystic lesions. Then, splenectomy was performed. The lesions were diagnosed as
lymphangiomatosis. Her thrombocytopenia, neutropenia, and lymphopenia were resolved postoperatively.
Her anemia regressed but persisted likely due to underlying chronic illnesses. Lymphangiomatosis should
be considered a rare cause in the differential diagnosis of hypersplenism and pancytopenia. Other potential
causes of hypersplenism and pancytopenia should also be thoroughly investigated to arrive at an accurate
diagnosis.

Cervicogenic headache (CH) is a headache associated with greater occipital nerve (GON) and/or third occipital nerve (TON). GON and/or TON block is frequently preferred in cases of CH, which have resistance to medical treatment. In this case report, we aimed to present a case with systemic toxicity of local anesthesia, following GON+ TON block due to CH. A 34-year-old female weighing 70 kg with ASA I risk classification, underwent a block of GON+ TON for cervicogenic headache treatment. The block has performed with 2.5 ml 0.5% bupivacaine + 8 mg dexamethasone + 0.5 ml saline mixture after being assured that there was no blood or cerebrospinal fluid in negative aspiration under ultrasonography (USG). In the first minute after the procedure, dysarthria and perioral numbness have developed. A 10% lipid solution has started for treatment. We concluded that the use of USG and frequent negative aspiration in peripheral block applications did not eliminate the risk of inadvertent intravascular injection of the local anesthetic agent. Besides, we believe that the risk of inadvertent intravascular injection has increased in procedures in the cervical region where vascular structures are excessive and close to the skin surface.

Background: Protracted febrile myalgia syndrome (PFMS) is a rare condition in patients with familial Mediterranean fever (FMF), characterised by severe muscle pain and fever. We present a case of protracted febrile myalgia in the setting of pyelitis in a patient with undiagnosed FMF.
Case description: A seven-year-old patient was admitted with abdominal pain, high fever, dysuria and high acute phase reactants. The patient had an ultrasound imaging finding of pyelitis, persistent fever despite antibiotic therapy. The patient developed generalised myalgia, edema of the muscles and activity limitation. She was diagnosed with FMF followed by PFMS and detection of M694V homozygous mutation.
Conclusýon: Protracted febrile myalgia syndrome should be considered in cases of severe myalgia, fever and elevated acute phase reactants.

In this case report, we shared the anesthesia management of a patient concurrently diagnosed with Behçet's Disease and Multiple Sclerosis (MS). A 60-year-old female patient underwent lumbar spine surgery for stabilization. The patient's history of cerebrovascular events, mucosal ulcers due to Behçet's disease, and neuroinflammation due to MS made this case difficult and required special attention. Accordingly, we thought that the case was interesting for anesthesiologists. She was operated under the umbrella of steroid therapy to minimize inflammation and regulate the surgical stress response. Care was taken to choose a smaller endotracheal tube in order to reduce the pressure on the mucous membranes. The preference for general anesthesia was aimed at avoiding neuroinflammation, and approaches in similar or different cases from the literature were discussed. The patient did not experience perioperative complications and was discharged in good health at the end of the operation period.