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SUMMARY OBJECTIVE: The aims of this study were to determine whether the six-minute walk test predicts muscular fatigability in ambulant children with congenital myasthenic syndrome and to examine the relationship between the six-minute walk test and mobility tests. METHODS: Eight children (four girls and four boys) with congenital myasthenic syndrome (mean age: 11.75±3.54 years) were included. Five children had COLQ variants. The distance of each minute for the six-minute walk test was determined to evaluate fatigability. The mobility tests included the 10-m walk/run test, rising from the floor, and climbing up and down four stairs. RESULTS: The mean six-minute walk test distance was 463.38±132.59 m. There was no difference between the first and last minute, between the first and last two minutes, and between any of the minutes during the six-minute walk test (p>0.05). The mean times for performing the 10-m walk/run test, rising from the floor, and climbing up and down four stairs were 8.59±3.36, 6.38±4.49, 4.38±5.07, and 3.35±3.69 s, respectively. The strong correlations were determined between six-minute walk test and all the mobility tests, except for climbing down four stairs (p< 0.05, rs=-0.72 to -0.83). CONCLUSION: The six-minute walk test did not provide sufficient evidence to predict muscular fatigability. However, this preliminary study suggested that the six-minute walk test may be used by clinicians and researchers to assess mobility in congenital myasthenic syndrome.

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SUMMARY OBJECTIVE: The aim of this study was to investigate the change of Doppler measurements among late-onset intrauterine growth restriction and appropriate for gestational age fetuses and to estimate the neonatal adverse outcome in late-onset intrauterine growth restriction during longitudinal Doppler assessments. METHODS: This study was conducted at a tertiary referral hospital with 50 appropriate for gestational age and 50 late-onset intrauterine growth restriction fetuses. Late-onset intrauterine growth restriction was defined as the detection and diagnosis of growth restriction from the 32nd week of gestation. Doppler assessments were performed longitudinally for the uterine arteries, umbilical artery, and middle cerebral artery from 32 weeks of gestation until delivery. The cerebroplacental ratio was calculated for each analysis. Neonatal outcomes were recorded after delivery. Statistical analysis was performed, and a p<0.05 was considered statistically significant. RESULTS: Compared with appropriate for gestational age, umbilical artery pulsatility index and adverse neonatal outcomes were higher in late-onset intrauterine growth restriction (p<0.001, p<0.001), while term middle cerebral artery pulsatility index and term cerebroplacental ratio were lower (p=0.013, p<0.001). According to adverse neonatal outcomes in late-onset intrauterine growth restriction, term uterine arteries pulsatility index and pre-term umbilical artery pulsatility index were higher (p=0.002, p=0.013); middle cerebral artery pulsatility index and term cerebroplacental ratio were lower but without statistical significance. CONCLUSION: Umbilical artery pulsatility index, term middle cerebral artery pulsatility index, and cerebroplacental ratio are significantly different between appropriate for gestational age and late-onset intrauterine growth restriction fetuses; however, only increased uterine arteries pulsatility index on term Doppler scans may be useful in detecting adverse neonatal outcomes in late-onset intrauterine growth restriction.

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SUMMARY BACKGROUND: YouTube, a video-sharing platform, aids health information sharing, and while social media’s role in heart failure care remains unclear, it can enhance interaction, education, and engagement, fostering patient-centered care and encouraging treatment adherence and active health management. OBJECTIVE: The aim of the study was to evaluate the quality and usability of heart failure-related YouTube videos as a source of information for patients. METHODS: A total of 100 English-language YouTube videos on heart failure were analyzed. Videos were categorized based on uploader identity (healthcare vs. non-healthcare professionals) and assessed using quality criteria for consumer health information, Global Quality Scale, Journal of the American Medical Association criteria, and Video Power Index. Quantile regression analysis was performed to identify independent predictors of video quality. RESULTS: Of the videos analyzed, 69% were uploaded by healthcare professionals. The mean quality criteria for consumer health information score was 21, Global Quality Scale was 3, and Journal of the American Medical Association was 3. Videos from professionals and longer videos had significantly higher quality scores. Quantile regression showed that video duration predicted high Global Quality Scale values at the 75th and 90th percentiles, while professional source was a consistent predictor across most quantiles. CONCLUSION: The overall quality of YouTube videos on heart failure was found to be low to moderate, with substantial room for improvement. Videos uploaded by healthcare professionals, however, consistently demonstrated higher quality across evaluation metrics. Longer videos tend to have higher quality, but popularity does not correlate with content reliability. Efforts should be made to improve video content for better patient education.

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SUMMARY OBJECTIVE: The aim of this study was to assess the changes in the sociodemographic profile and maternal healthcare associated with adolescent deliveries in Brazil in 2000, 2011, and 2022. METHOD: Cross-sectional study by search on the Live Births Data System. Analyzed variables from mothers aged 10–19 years in Brazil: age, education, ethnicity, marital status, prenatal consultations, mode of delivery, and the country’s region. RESULTS: In 2000, there were 750,537 adolescents’ live births to adolescents in Brazil, and in 2022, there were 315,606 (58% reduction). There was a decrease in the number of married adolescent mothers, from 48 to 29.7% in 2011 and 25.5% in 2022. Regarding ethnicity, 231,369 (75%) pregnant adolescents in 2022 were Black and Brown, compared with 47.4% in 2000; the Indigenous adolescent deliveries have tripled (from 0.8 to 2.4%), with 7,526 births in 2022. Education improved substantially (30.3% in 2000 to 53.0% in 2011 and 80.6% in 2022) with at least 8 years of study. Adolescents with no prenatal care decreased from 6% in 2000 to 2% in 2022. There was an increase in cesarean births from 26.4 to 41.5%. Regionally, the age-specific fertility rate from 15 to 19 years in 2000 was higher in the North (111.7/1,000) and lower in the Southeast (71.4/1,000), in 2022, there was a decrease to 61.7/1,000 and 29.1/1,000, respectively. CONCLUSION: There was a decrease in the number of married adolescent mothers and an increase in the education level of adolescent mothers. However, the rise in cesarean births and racial disparities, with Black and Brown adolescents comprising ¾ of pregnancies in 2022, highlights ongoing challenges for health policies.

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SUMMARY OBJECTIVE: The aim of this study was to analyze trends in avoidable mortality due to circulatory system diseases and ischemic heart diseases among individuals aged 30–69 years across the health macro-regions of Rio Grande do Sul, Brazil, from 2000 to 2023. METHODS: An ecological time-series study was conducted using data from the Mortality Information System and Department of Informatics of the Unified Health System, with calculation of age- and sex-adjusted mortality coefficients. RESULTS: A reduction in mortality from circulatory system diseases and ischemic heart diseases was observed among women in almost all macroregions, except for the Central-West. Among men, decreasing trends in mortality from circulatory system diseases were identified, except in the Vales macro-region and in the state overall. Mortality was higher among men and increased with age, with the highest coefficients observed in the South, Central-West, and Metropolitan macro-regions. CONCLUSION: A downward trend in mortality was observed despite population aging, which may be attributed to health policies that strengthened the Unified Health System, including the expansion of the Family Health Strategy, the Hypertension and Diabetes Mellitus Care Reorganization Plan, and the Popular Pharmacy Program, as well as measures for chronic disease control and health promotion.

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SUMMARY OBJECTIVE: The aim of this study was to compare the return of spontaneous circulation and survival to discharge of patients who experienced in-hospital cardiac arrest assisted by a rapid response team during the day versus night and weekdays versus weekends. METHODS: This retrospective observational study was conducted at a tertiary teaching hospital. Patients aged 18 years or older who experienced a cardiac arrest in the wards between March 2018 and December 2021 were included. Patients with an express order of “natural death permission” were excluded. Data regarding the period of in-hospital cardiac arrest occurrence, return of spontaneous circulation, and survival to discharge were collected from medical records. In addition, data related to nursing staff leave were collected. RESULTS: A total of 387 patients were included in the analysis. The mean age was 65.4±14.8 years, and 53.7% were men. In the multivariate logistic regression, in-hospital cardiac arrest during the day versus night was not associated with return of spontaneous circulation. However, in-hospital cardiac arrest during weekdays versus weekends showed a significant association with return of spontaneous circulation (odds ratio=2.073; 95%CI 1.206–3.564; p=0.008). No differences were found in survival to discharge between daytime versus nighttime or weekdays versus weekends. CONCLUSION: There is no difference in return of spontaneous circulation rates between in-hospital cardiac arrest events occurring during the day versus night. However, a significant difference in return of spontaneous circulation rates was observed between weekdays and weekends, although this difference did not extend to in-hospital survival rates.

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SUMMARY OBJECTIVE: Natural medicines are considered an effective strategy for treating burns. A preclinical study of a new natural ointment, “Yubivaks,” was conducted to study acute dermal toxicity and irritant properties to ensure its safety. METHODS: The study investigated the acute dermal toxicity, local irritant effect on the skin and mucous membranes of eyes, and the sensitizing activity of the ointment. Adult nonlinear white rats and rabbits of both sexes were used in the experiment. The rats were randomly divided into three groups, each consisting of 10 animals: group I received recommended therapeutic dose (0.003 kg/day), group II received a “conditionally toxic” dose (0.020 kg /day), and group III served as the control group. RESULTS: There were no deaths or signs of intoxication in the acute dermal toxicity study. No local irritant, resorptive, or sensitizing effect and positive immunological tests were observed at the therapeutic dose. Treatment of experimental burns with “Yubivaks” reduced the wound surface by half on the 7th day (59.6%); on the 15th day, the restoration of the histostructure of the epidermal tissue was 99.8%; and by the 25th day, the burn area was completely restored (100%) compared to “Levomekol”: 43.6, 51.1, and 95.8%, respectively. Comparison with “Levomekol” was made based on its wide use as a recognized traditional medicine with complex action. CONCLUSION: At the recommended therapeutic dose, the ointment can be considered as an alternative medication due to accelerated regenerative processes, pronounced anti-inflammatory properties, and safety proven in experimental studies. A limitation of the study was that it was only conducted on rats and rabbits, without using guinea pigs or pig models for several reasons.

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SUMMARY OBJECTIVE: The aim of this study was to “determine post-pandemic impact on activities of daily living and instrumental activities of daily living factors affecting daily living activities of the elderly.” No difference was identified between the post-pandemic activities of daily living and instrumental activities of daily living levels of the elderly in the two countries. METHODS: The descriptive study was conducted in Ghana and Turkish Republic of Northern Cyprus between February 16 and July 1, 2022. A total of 390 elderly volunteers aged 65 and over living at home participated in this study. The participants were administered the sociodemographic data form, Katz Activities of Daily Living Scale, and Lawton and Brody Instrumental Activities of Daily Living Form. The Slovin formula was used in selecting the study’s sample. Slovin’s formula is used to calculate the sample size necessary to achieve a certain confidence interval when sampling a population. RESULTS: According to the activities of daily livings and instrumental activities of daily livings, they can continue their lives without being dependent on others, and the scale scores of women compared to men are statistically significant, and it can be said that women are less dependent than men. CONCLUSION: The study revealed that the pandemic had a negative impact on activities of daily livings and instrumental activities of daily livings. Participants’ physical activity since the pandemic had a negative impact on activities of daily livings and instrumental activities of daily livings. It may be recommended to develop appropriate policies so that elderly individuals can live without being dependent on others. In addition, it is recommended that a variety of scales measuring activities of daily living be adopted and adapted, which, when adapted, will provide more reliable results. Since this study was conducted as a cross-sectional study in only one region in two countries, it cannot be generalized to both countries.

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SUMMARY Ensuring cancer patients and their families receive high-quality care at the very end of life is of paramount importance. The manner a family member dies has a profound impact on the bereaved. One way to assess this care is by using a post bereavement questionnaire. OBJECTIVE: The aim of the study was to translate into Brazilian Portuguese, conduct cross-cultural adaptation, validate and use a post-bereavement tool, “Care of the Dying Evaluation”. METHODS: An observational, international, cross-sectional multicenter study in seven countries, through 2018 to 2020. In Brazil, participants were recruited from two hospitals, Hospital Estadual Sumaré and Hospital das Clínicas, and had been admitted for a minimum of 3 days before death. Translation of CODETM in keeping with international principles, and pre-testing using patient and public involvement and cognitive interviews with bereaved relatives. RESULTS: The survey involved 235 bereaved family members, mostly female (70.6%), with 40% being sons and daughters of the deceased. Validity of the CODETM tool was assessed using confirmatory factor analysis, internal consistency through Cronbach’s α, and reliability via the Kappa coefficient and Spearman’s correlation. The study compared care quality perceptions between those who received palliative care and others. Findings revealed that 50.7% were informed about the dying process, and over 60% expressed that clarification of expected symptoms would have been beneficial. CONCLUSION: The study confirms that the CODETM questionnaire is a valid and reliable tool for evaluating the quality of end-of-life care within the Brazilian Portuguese context.

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SUMMARY OBJECTIVE: The aim of the study was to evaluate inflammatory markers after 1 year of antiretroviral therapies use in persons living with human immunodeficiency virus. METHODS: This is a retrospective, observational, and multicenter study. The study included adult, comorbid disease-free patients who received antiretroviral therapies with a diagnosis of human immunodeficiency virus infection. Multi-inflammatory index, multi-inflammatory index obtained by various formulations of complete blood count, C-reactive protein, neutrophil count, lymphocyte count, and platelet count, systemic immune-inflammatory index, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, C-reactive protein/lymphocyte ratio, cluster of differentiation 4 (CD4) T lymphocyte percentage, and CD4/CD8 ratio data were compared with pretreatment data. RESULTS: A total of 391 persons living with human immunodeficiency virus, including 241 (61.6%) women, were included in the study. When pretreatment human immunodeficiency virus ribonucleic acid, neutrophil count, lymphocyte count, platelet count, C-reactive protein level, CD4 percentage, CD8 percentage, CD4/CD8 ratio, multi-inflammatory index-1, multi-inflammatory index-2, and systemic immune-inflammatory index data were compared with the 48th week of treatment, a statistically significant difference was found except for neutrophils (p<0.05). When the 48th week post-treatment data were evaluated, human immunodeficiency virus ribonucleic acid, C-reactive protein, multi-inflammatory index-1, multi-inflammatory index-2, and systemic immune-inflammatory index values decreased; lymphocyte, platelet, CD4, CD8, and CD4/CD8 ratio values increased. Among the pretreatment markers, systemic immune-inflammatory index, platelet/lymphocyte ratio, and neutrophil/lymphocyte ratio predicted CD4/CD8 ratio ≤1 or >1 at the end of 48 weeks at the highest rate (60.7, 60, and 59.6%, respectively). CONCLUSION: Multi-inflammatory markers were found to regress after antiretroviral therapies use in persons living with human immunodeficiency virus. In the long term, these patients should be monitored for the effects of chronic inflammation.

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SUMMARY OBJECTIVE: Juvenile idiopathic arthritis is the most common chronic arthritis in children and adolescents. Nitric oxide mediates autoimmune responses and plays a role in the etiology of numerous rheumatic diseases. Endothelial nitric oxide synthase regulates nitric oxide levels through catalyzing its production. Here, we evaluated the effect of eNOS rs1799983 and variable number tandem repeat variants on disease occurrence and clinical findings in Turkish juvenile idiopathic arthritis patients. METHODS: One hundred and eight participants, including 58 juvenile idiopathic arthritis patients and 50 healthy controls, were included in the study. eNOS rs1799983 and variable number tandem repeat variants were genotyped using polymerase chain reaction and/or restriction fragment length polymorphism. The genotype distribution of the patients was investigated according to their clinical and laboratory results. The results of the analyses were evaluated for statistical significance. RESULTS: The eNOS genotype distributions did not differ between juvenile idiopathic arthritis patients and controls. Within the patient population, those carrying the rs1799983 GT/TT genotypes had higher body mass index, whereas those with the VNTR 4b/4b genotype had lower sedimentation rate. CONCLUSION: Our study results suggest that the eNOS rs1799983 and variable number tandem repeat variants may play a role in juvenile idiopathic arthritis patients’ clinical findings. These data need to be confirmed in different ethnic and larger sample groups.

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SUMMARY OBJECTIVE: The aim of the study was to determine whether vaccinating older adults with PCV13 (pneumococcal conjugate vaccine) and/or PPSV23 (pneumococcal polysaccharide vaccine) and/or the influenza vaccine can reduce pneumonia-related hospitalizations and all-cause death. METHODS: Retrospective cohort of subjects ≥60 years who attended an outpatient clinic in Minas Gerais, Brazil (May 1, 2021 to April 26, 2024). Data regarding pneumonia hospitalizations, all-cause death, pneumococcal and influenza vaccination, demographic, and clinical characteristics were collected from an electronic health record (data in the cloud were available upon request). Only patients with valid data were included and were divided into groups based on their vaccination history, pneumococcal vaccinations (PVC13 and/or PPSV23), influenza vaccination, pneumococcal+influenza vaccinations, and unvaccinated, to calculate the association of vaccination with pneumonia hospitalizations and all-cause death by Cox proportional hazard models, adjusted for demographic and clinical factors. RESULTS: A total of 12,268 older adults were analyzed, with a median age of 79 (interquartile range 72–86), and 73% were female. Vaccination rates were 56% for influenza, 29% for pneumococcal vaccines, and 24% for both influenza and pneumococcal vaccines. Neither pneumococcal nor influenza vaccination alone showed a protective effect against pneumonia hospitalization. The combination of pneumococcal and influenza vaccines was associated with a 35% reduction in pneumonia hospitalization (HR 0.65; 95%CI 0.51–0.83). There was no association between vaccination and allcause death, although the influenza vaccine tended to reduce this risk (HR 0.68; 95%CI 0.46–1.00; p-value 0.053). CONCLUSION: Despite low vaccination rates, the combination of influenza and pneumococcal vaccines reduces pneumonia hospitalizations among older adults by 35%.

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SUMMARY OBJECTIVE: Thiol–disulfide homeostasis is a marker of oxidative stress. The aim of the study was to compare the effects of low-flow desflurane and sevoflurane anesthesia on perioperative changes in thiol–disulfide balance in patients undergoing thyroidectomy. METHODS: In this randomized controlled trial, 50 ASA I–II patients were assigned to receive low-flow desflurane (n=25) or sevoflurane (n=25). Blood samples were collected before and after surgery. The primary outcomes were between-group comparisons of perioperative changes in total and native thiol levels. Secondary outcomes included changes in disulfide concentrations and thiol–disulfide ratios. RESULTS: For the primary outcomes, the magnitude of reduction in total thiol (86.4±159.7 vs. 151.5±104.9 μmol/L; p=0.095) and native thiol (79.3±130.1 vs. 115.1±86.3 μmol/L; p=0.257) did not differ significantly between the desflurane and sevoflurane groups. For the secondary outcomes, disulfide levels significantly decreased in the sevoflurane group (67.5±19.9 vs. 48.4±18.1 μmol/L; p=0.001), whereas no significant change was observed in the desflurane group (60.2±23.2 vs. 52.5±34.5 μmol/L; p=0.300). Between-group comparisons of disulfide/total thiol, native thiol/total thiol, and disulfide/native thiol ratios revealed no significant differences. CONCLUSION: Low-flow desflurane and sevoflurane anesthesia demonstrated similar effects on perioperative thiol–disulfide homeostasis in thyroidectomy patients.

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SUMMARY BACKGROUND: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy are promising treatments for colorectal cancer-related peritoneal metastases. The learning curve may influence surgical outcomes. OBJECTIVE: The aim of the study was to compare outcomes of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy during the learning curve versus after surgical proficiency at a gastrointestinal cancer center. METHODS: A retrospective study of 83 patients treated between 2018 and 2023. Group 1 (n=42) included initial cases; Group 2 (n=41) represented the experienced phase. Operation time, organ resections, morbidity, transfusion needs, and survival were compared. RESULTS: Severe morbidity (Clavien-Dindo grade 3–4) was similar in both groups (G1: 21.4%, G2: 29.2%; p=0.947). No 30- or 90-day mortality occurred. Transfusions of ≥3 units were more frequent in G1 (p=0.003). Mean operative time was longer in G1 (8.5 vs. 7.2 h). More patients in G2 had multiple organ resections (p<0.001). CONCLUSION: The learning curve significantly influences perioperative outcomes in cytoreductive surgery and hyperthermic intraperitoneal chemotherapy procedures. As surgical experience increases, intraoperative transfusion requirements and operative time decrease, while the extent of resection improves. However, these improvements do not appear to translate into a survival benefit.

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SUMMARY OBJECTIVE: The aim of this study was to develop and validate the Severity of the Complaints Related to Polycystic Ovary Syndrome Scale. METHODS: This methodological study employed exploratory factor analysis and confirmatory factor analysis. Internal consistency was assessed through item–total correlations and the test–retest method. RESULTS: Exploratory factor analysis revealed a four-factor structure explaining 57.416% of the variance. Confirmatory factor analysis results confirmed a good model fit (χ2/df=3.094, RMSEA=0.065, CFI=0.913, GFI=0.910). The overall Cronbach’s alpha coefficient was 0.897. In the test–retest reliability analyses, significant correlations were found between all items and factor scores across the two administrations (p<0.001). CONCLUSION: The scale is a valid and reliable measure for assessing the severity of complaints related to Polycystic Ovary Syndrome Scale.

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SUMMARY OBJECTIVE: The aim of this study was to analyze and compare the clinical, epidemiological, and laboratory characteristics of male and female patients with kidney disease admitted for hemodialysis. METHODS: This retrospective, observational, cross-sectional study analyzed the clinical, epidemiological, and laboratory data from electronic health records of patients admitted for hemodialysis at a university hospital between January 2022 and November 2023, comparing men’s and women’s profiles. All adult patients were consecutively included, except those with missing data. RESULTS: A total of 163 patients were included: 53.9% of whom were male and 43.4% self-identified as white. Chronic kidney disease was diagnosed at admission in 78.5% of cases, with diabetes mellitus being the leading etiology, affecting 20.4% of men and 26.6% of women. Men had significantly higher serum creatinine (7.9 vs. 6.3 mg/dL; p<0.001), potassium (4.8 vs. 4.6 mEq/L, p=0.039), and phosphorus levels (5.9 vs. 5.0 mg/dL; p=0.004), whereas women had significantly higher high-density lipoprotein cholesterol cholesterol (46 vs. 37 mg/dL; p<0.001), low-density lipoprotein cholesterol cholesterol (120.4 vs. 97.8 mg/dL; p=0.004), and total cholesterol (198 vs. 161 mg/dL; p<0.001). Among patients with diabetes mellitus, women more frequently used statins (67.7 vs. 42.4%; p=0.042) and angiotensin II type 1 receptor blockers (58.1 vs. 27.3%; p=0.013). They also had higher total cholesterol (199 vs. 156 mg/dL; p=0.005) and low-density lipoprotein cholesterol cholesterol levels (117 vs. 92 mg/dL; p=0.043), while men had higher serum phosphorous levels (6.3 vs. 5.0 mg/dL; p=0.028). CONCLUSION: Significant gender-based differences were identified in the clinical, epidemiological, and laboratory characteristics of patients admitted for hemodialysis. Men presented higher serum creatinine, phosphorus, and potassium levels, whereas women showed higher cholesterol fractions and greater use of statins and angiotensin II type 1 receptor blockers.

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SUMMARY BACKGROUND: The prognostic value of TP53 mutations in metastatic colorectal cancer remains unclear owing to inconsistent findings in the literature. Given its central role in tumor biology, clarifying the impact of TP53 status on survival outcomes is clinically relevant. METHODS: This retrospective cohort study included 115 patients with metastatic colorectal cancer who underwent TP53 mutational analysis using next-generation sequencing (KAPA HyperPETE Pan Cancer Panel). Eligible patients were aged ≥18 years, had histologically confirmed metastatic colorectal cancer, and received first-line systemic therapy. Patients with incomplete clinical or molecular data were excluded. Based on mutation profiles, those with RAS or BRAF mutations received anti-VEGF therapy, whereas patients with wild-type tumors received anti-EGFR treatment. Patients were stratified according to TP53 mutation status to evaluate differences in clinical outcomes. RESULTS: Among the 115 patients included, 78 (67.8%) harbored TP53 mutations and 37 (32.2%) had wild-type TP53. The median progression-free survival was significantly longer in the TP53-mutant group (18.6 vs. 10.0 months; p=0.002). The median overall survival was also numerically longer in the TP53-mutant group (32.9 vs. 30.3 months), although this difference was not statistically significant (p=0.114). In the univariate analysis, TP53 mutation was associated with improved progression-free survival (HR 0.479; 95%CI 0.294–0.779; p=0.003). This association remained independently significant in the multivariate analysis (HR 0.477; 95%CI 0.289–0.787; p=0.004). None of the other variables consistently predicted survival. CONCLUSION: TP53 mutations appear to be an independent prognostic marker for prolonged progression-free survival in patients with metastatic colorectal cancer. Although the difference in overall survival was not statistically significant, these findings warrant further validation in prospective studies to confirm the prognostic utility of TP53 in therapeutic stratification.

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SUMMARY OBJECTIVE: The aim of this study was to investigate the effect of gamified breastfeeding education on breastfeeding self-efficacy and infant feeding attitudes of pregnant women. METHODS: A total of 60 primiparous women in the third trimester of pregnancy were randomly assigned to experimental (n=30) and control (n=30) groups. Data were collected using the Sociodemographic and Obstetric Characteristics Form, Breastfeeding Self-Efficacy Scale-Antenatal Form, and the Iowa Infant Feeding Attitude Scale. The experimental group received a gamified breastfeeding education program designed by the researchers and developed based on Werbach and Hunter’s D6 Gamification Framework. The program was delivered via a secure Web 2.0 platform and included the interactive digital game “Discovering Breastfeeding” and an educational escape room-style activity enriched with visual and auditory elements. The intervention aimed to enhance participants’ motivation, engagement, and learning through game mechanics such as goals, feedback, challenges, and rewards. The control group received routine hospital antenatal education. Pretest and posttest data were analyzed using appropriate statistical methods. RESULTS: No significant difference was found between the groups in baseline measurements. However, post-test scores revealed that women in the experimental group showed a significant improvement in both breastfeeding self-efficacy and infant feeding attitudes compared to the control group (p<0.05). Effect sizes indicated a strong impact of the intervention. CONCLUSION: Gamified breastfeeding education based on digital and interactive learning principles effectively enhanced pregnant women’s self-efficacy and attitudes toward infant feeding. Incorporating gamification into maternal health education may increase motivation, promote positive behavioral change, and contribute to better breastfeeding outcomes for mothers and infants. The trial was registered in the clinicaltrials.gov notification system (Clinical Trials Number: NCT06344806).

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SUMMARY OBJECTIVE: Physical changes and scarring after cesarean section may negatively affect women’s body image. Combined with decision regret about the mode of delivery, this may cause psychological problems. The aim of this study was to examine the effects of cesarean scars on decision regret and body image in women with cesarean delivery. METHODS: This descriptive and cross-sectional study was conducted in Turkey between February and May 2025. A total of 219 women with a history of cesarean delivery voluntarily participated through an online survey. Data were collected using a personal information form, the Decision Regret Scale, and the Body Image Scale. Statistical analyses were performed using Statistical Package for the Social Sciences 22.0 software, including descriptive statistics, t-test, analysis of variance, correlation, and regression analyses. RESULTS: The mean age of participants was 34.90±7.96 years, and the mean time since the first cesarean was 9.38±8.31 years. The mean Decision Regret Scale score was 22.46±20.12, and the mean Body Image Scale total score was 50.22±16.71. Decision regret and body image significantly differed according to perceptions of scar appearance and its impact on body perception, social life, and psychological well-being (p<0.05). Regression analysis indicated that negative perceptions of scar appearance were the strongest predictor of decision regret (B=15.42, p<0.001). CONCLUSION: Cesarean section scars may negatively affect women’s body image and increase decision regret regarding the mode of delivery. Healthcare professionals should be aware of these psychosocial consequences and provide appropriate counseling and support services for women after cesarean section.