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SUMMARY OBJECTIVE: Excessive screen exposure is associated with musculoskeletal discomfort, postural alterations, visual fatigue, and increased anxiety among young adults. This study investigated the effects of a virtually delivered multimodal exercise program integrating sensorimotor, oculomotor, and postural components on postural awareness, musculoskeletal complaints, visual fatigue, and anxiety among screen-exposed university students and staff. METHODS: Fifty-seven participants (mean age: 23.35±1.2 years) with ≥6 h of daily screen use completed an 8-week program consisting of twice-weekly live virtual sessions and daily video-guided exercises. Outcomes included the Postural Habits and Awareness Scale, Cornell Musculoskeletal Discomfort Questionnaire, Rapid Office Strain Assessment, ASTHENOPIA Eye Fatigue Scale, and State-Trait Anxiety Inventory. Pre–post differences were analyzed using paired-sample t-tests and Wilcoxon signed-rank tests. RESULTS: Significant improvements were observed in Postural Habits and Awareness Scale Factor 1 and Factor 3 (p<0.05), accompanied by reduced musculoskeletal discomfort across all Cornell Musculoskeletal Discomfort Questionnaire sections (p<0.05). Visual fatigue decreased substantially (z=-4.185; p<0.001), whereas Rapid Office Strain Assessment scores showed no significant change (p>0.05). State anxiety increased slightly (p<0.05), while trait anxiety remained stable. CONCLUSION: This preliminary single-group study suggests that virtual multimodal exercise programs may be effective, accessible preventive strategies for reducing musculoskeletal symptoms, enhancing posture awareness, and alleviating visual fatigue among individuals with high daily screen exposure. Controlled trials with larger and more diverse populations are recommended to establish causal effectiveness.

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SUMMARY OBJECTIVE: The aim of this study was to assess the quality and readability of ChatGPT and Gemini's responses to frequently asked questions about early intervention for individuals with at-risk infants. METHODS: Ten frequently asked questions about early intervention were selected by three researchers (a child development specialist, a physiotherapist, and a midwife) from a list generated by ChatGPT and Gemini. Questions were sent to ChatGPT version 4.0 and Gemini 1.5, and initial responses were recorded without follow-up queries. Ten independent experts (two special education specialists, two child development specialists, two physiotherapists, two midwives, and two pediatricians) The quality of ChatGPT and Gemini's responses was assessed using a four-grade rating system. Readability levels were analyzed using the Flesch-Kincaid Grade Level through WordCalc software. RESULTS: One of the answers given by ChatGPT was of higher quality than Gemini (p=0.025), while one answer given by Gemini was of higher quality than ChatGPT (p=0.033). The answers to the other questions were of similar quality, with Gemini having a lower level. CONCLUSION: This study compares the quality and readability of the answers given by artificial intelligence-based language models to demonstrate their potential to appeal to different user groups. While the models generally provided answers of similar quality, quantitative differences in readability were observed, suggesting potential suitability for different audiences. These findings contribute to understanding the role of AI tools in health communication.

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SUMMARY OBJECTIVE: Pediatric solid tumors require accurate imaging for staging, treatment planning, and follow-up. Whole-body magnetic resonance imaging has emerged as a promising radiation-free alternative to positron emission tomography-computed tomography, offering superior soft tissue contrast. This study compares the diagnostic performance of whole-body magnetic resonance imaging and positron emission tomography-computed tomography in detecting primary tumors, metastases, and recurrences in pediatric solid tumors. METHODS: This retrospective study included 47 pediatric patients (27 boys and 20 girls; age range: 3–18 years; mean age: 11.3±3.5 years) with suspected or confirmed solid tumors who underwent both whole-body magnetic resonance imaging and positron emission tomography-computed tomography between 2017 and 2020. Lesional and per-patient agreement between modalities was evaluated using positron emission tomography-computed tomography as the reference. Statistical analysis was performed to assess inter-modality agreement. RESULTS: Positron emission tomography-computed tomography detected pathological findings in 35 patients (74.4%), including 27 primary tumors (57.4%), 18 metastases (38.2%), and one recurrence (2.1%). Whole-body magnetic resonance imaging showed high diagnostic concordance, detecting all primary tumors and the recurrence, and 16 of 18 metastatic cases. Per-lesion analysis revealed 66 lesions on positron emission tomography-computed tomography and 64 on whole-body magnetic resonance imaging, with two metastatic lesions (an ossified pulmonary metastasis and an osteoblastic femur lesion) missed by magnetic resonance imaging. Cohen's kappa (κ) for abnormality detection was 0.89, indicating almost perfect agreement (95%CI 0.75–1.00). McNemar's test showed no statistically significant difference between the modalities (p=0.479). CONCLUSION: Whole-body magnetic resonance imaging demonstrates excellent agreement with positron emission tomography-computed tomography for evaluating pediatric solid tumors, offering a radiation-free alternative, particularly advantageous in long-term follow-up. While limitations remain in detecting sclerotic metastases, whole-body magnetic resonance imaging is a primary alternative in specific scenarios.

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SUMMARY OBJECTIVE: The aim of this study was to determine the effectiveness of tranexamic acid in improving intraoperative visual clarity in patients undergoing arthroscopic repair of rotator cuff tears. METHODS: This prospective, randomized, double-blinded clinical trial was conducted in Brazil, between July 2020 and September 2022, including patients who underwent surgery for arthroscopic repair of rotator cuff tears. RESULTS: In total, 20 patients were included in each group: control, oral, and intravenous. There were no statistically significant differences between groups regarding intraoperative interventions, including duration of surgery, anesthesia time, number of ablations, increase in irrigation pump pressure, or total volume of irrigating solution used. Likewise, no differences were observed between groups in the assessment of visual clarity, either subjective (initial, final, and median) or objective, although the groups that received tranexamic acid had slightly lower average turbidity compared to the control group. CONCLUSION: Tranexamic acid use did not demonstrate benefits concerning the objective/subjective visual clarity between the evaluated groups.

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SUMMARY OBJECTIVE: The success of anterior cruciate ligament reconstruction depends on anatomical tunnel placement. The aim of this was to compare the effects of 30° and 70° arthroscopes on femoral and tibial tunnel positioning and their relationship with clinical outcomes. METHODS: This retrospective study analyzed 55 patients who underwent anterior cruciate ligament reconstruction between 2020 and 2024 (30° arthroscope, n=28; 70° arthroscope, n=27). All procedures were performed by the same surgeon using hamstring tendon grafts with suspensory femoral fixation and bioabsorbable tibial screws. Femoral and tibial tunnel positions were evaluated on postoperative computed tomography using the Bernard-Hertel and Staubli-Rauschning methods, respectively, with measurements performed by four orthopedic surgeons; clinical outcomes were assessed at ≥6 months using the International Knee Documentation Committee score. RESULTS: Femoral tunnels were significantly more posterior and distal in the 70° group (depth 29.4 vs. 38.7%; height 33.7 vs. 43.1%; both p<0.001). Tibial tunnel placement showed no significant difference (p=0.49). International Knee Documentation Committee scores were higher in the 70° group (89.2±5.4 vs. 84.6±6.8; p=0.02). Correlation and regression analyses confirmed femoral tunnel position as an independent predictor of functional outcome. Receiver operating characteristic curve analysis showed area under the curve values of 0.75 (95%CI 0.69–0.79) for depth and 0.71 (95%CI 0.67–0.78) for height. CONCLUSION: Use of a 70° arthroscope in anterior cruciate ligament reconstruction enables more anatomical femoral tunnel placement and improves functional outcomes, while tibial tunnel positioning is unaffected. Arthroscopic viewing angle should be regarded not only as a technical factor but also as a determinant of clinical success.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate the performance and perception of a 360-degree video as an educational tool for medical students in the management of premature rupture of membranes. METHODS: A prospective interventional study was conducted with fifth-year medical students. Participants watched a 10-min, 360-degree video simulating a complete premature rupture of membranes case, from anamnesis to prescription. Student perceptions were assessed using a questionnaire with a five-point Likert scale, covering technical quality, comprehension of clinical procedures, and pedagogical impact. A subgroup analysis compared outcomes based on the viewing device (mobile phone vs. computer). RESULTS: A total of 60 medical students were included in this study. The video intervention received a highly favorable evaluation. Students reported high rates of comprehension for key clinical decision-making elements, including the indication for hospital admission (60 students, 100%) and the rationale for antibiotic therapy (59 students, 98.3%). The experience positively influenced student motivation (53 students, 88.3%) and heightened their interest in obstetrics (45 students, 75.0%). No statistically significant (p>0.05) differences were found between the proportion of positive responses (agree and strongly agree) according to the device used to watch the 360-degree video: mobile phone (n=34, 56.7%) vs. computer (n=26, 43.3%). CONCLUSION: The use of 360-degree video is an effective and well-received pedagogical tool for teaching complex obstetric scenarios. Its comparable effectiveness on both mobile and computer platforms underscores its potential as an accessible and scalable resource to better prepare students for the practical challenges of the obstetrics and gynecology clerkship.

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SUMMARY OBJECTIVE: Systemic inflammation is closely associated with acute exacerbations of chronic obstructive pulmonary disease and may reflect the risk of future exacerbations. Blood-based inflammatory biomarkers represent simple and practical tools for identifying patients at increased risk. The aim of this study was to evaluate the association between systemic inflammatory biomarkers measured during stable chronic obstructive pulmonary disease and overall exacerbation burden across Global Initiative for Chronic Obstructive Lung Disease stages. METHODS: This retrospective cohort study included 132 patients with chronic obstructive pulmonary disease followed for at least 2 years. Clinical, functional, and laboratory data obtained during clinically stable periods were analyzed. Systemic inflammatory indices (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, systemic inflammation response index, aggregate index of systemic inflammation, and modified Glasgow prognostic score) were calculated. Exacerbation frequency was defined as the annualized number of moderate-to-severe exacerbations. Patients were classified according to Global Initiative for Chronic Obstructive Lung Disease groups A, B, and E, and associations between inflammatory biomarkers and clinical outcomes were evaluated using appropriate statistical methods, including receiver operating characteristic curve analyses. RESULTS: Elevated levels of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, aggregate index of systemic inflammation, modified Glasgow prognostic score, and C-reactive protein were significantly associated with increased exacerbation frequency and hospitalization rates in the overall cohort (all p<0.05), whereas systemic inflammation response index showed no significant association. Receiver operating characteristic analyses demonstrated moderate discriminative ability of C-reactive protein and inflammatory indices for predicting frequent exacerbations. CONCLUSION: Systemic inflammatory biomarkers were associated with adverse clinical outcomes in patients with chronic obstructive pulmonary disease and were significantly related to exacerbation frequency and severity. These findings suggest that systemic inflammatory markers may be useful for overall clinical assessment and identifying patients at increased risk of exacerbations, rather than for stage-specific risk stratification.

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SUMMARY OBJECTIVE: Juvenile idiopathic arthritis is the most prevalent chronic rheumatic disease of childhood. Ferroptosis is a distinct, regulated form of cell death that is iron-dependent and driven by the accumulation of lipid peroxides on cell membranes. The aim of this study was to measure the soluble transferrin receptor and malondialdehyde levels as ferroptosis markers in Turkish children with Juvenile idiopathic arthritis. We also evaluated the laboratory findings in the patients. METHODS: Thirty children diagnosed with Juvenile idiopathic arthritis and 30 healthy children were included in the study. The sTfR1 and the malondialdehyde levels were measured by enzyme-linked immunosorbent assay. RESULTS: The mean age of the patient group was 10.13±3.98, and the mean age of the control group was 10.67±3.21. Blood soluble transferrin receptor and malondialdehyde levels did not differ between the patient and control groups (p>0.05). In contrast, the p-value for the malondialdehyde results was statistically borderline. In the patient group, sedimentation rates were found to correlate with serum amyloid A, C-reactive protein levels. In addition, the highest malondialdehyde levels were found in systemic Juvenile idiopathic arthritis, and the highest soluble transferrin receptor levels were found in psoriatic arthritis subtypes. Both malondialdehyde and soluble transferrin receptor levels were lowest in those treated with methotrexate. CONCLUSION: Although our findings show that soluble transferrin receptor and malondialdehyde levels did not differ between patient and control groups, larger-scale studies are needed to evaluate more specific biomarkers and/or targeted tissue sampling in different subtypes, controlling for confounding factors such as treatment. This could open new horizons for therapies targeting ferroptosis.

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SUMMARY OBJECTIVE: Predicting in-hospital mortality rates following tricuspid valve surgery is imperative, especially in light of the recent advancements in treatment modalities. The Naples prognostic score serves as an indicator of systemic inflammation, malnutrition, and prognostic outcomes across a spectrum of medical conditions. In this investigation, we sought to assess the efficacy of the Naples prognostic score in predicting in-hospital mortality among patients undergoing tricuspid valve surgery. METHODS: A total of 360 consecutive patients diagnosed with severe tricuspid valve disease, who underwent tricuspid valve surgery, were included in this retrospective study. The study population was categorized based on the Naples prognostic score classification into two groups: low (0–1–2) and high (3–4). RESULTS: The study's primary outcome—in-hospital mortality—was significantly higher in patients with a high Naples prognostic score group than in those with a low Naples prognostic score group (35 [28.2%] vs. 8 [5.1%], p<0.001). In the receiver operating characteristic analysis, the Naples prognostic score optimal cut-off value of >2 predicted in-hospital mortality with 81.4% sensitivity and 62.5% specificity (area under the curve: 0.782 [95%CI 0.729–0.829, p<0.0001]). CONCLUSION: The findings of this study indicate that the Naples prognostic score serves as an independent predictor of in-hospital mortality among patients undergoing tricuspid valve surgery.

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SUMMARY OBJECTIVE: The use of large language models is increasing in healthcare. The aim of this study was to evaluate and compare the responses provided by ChatGPT (OpenAI) and Gemini (Google) to frequently asked questions about stroke and its treatment by caregivers, in terms of clarity, empathy/tone, actionability, information risk/safety, and accuracy. METHODS: This study used a qualitative content analysis to evaluate responses generated by large language models to stroke-related caregiving questions. Ten frequently asked questions were identified through a review of the literature on stroke caregiving. These questions were presented to the free versions of ChatGPT and Gemini, and responses from each model were recorded. The recorded responses were independently evaluated by 10 experts from neurology, physiatry, and physiotherapy using a structured Likert-scale instrument across five predefined categories: clarity, empathy/tone, actionability, information risk/safety, and accuracy. RESULTS: Generalized estimating equation analyses indicated that the overall trends in response scores did not differ significantly between ChatGPT and Gemini across all evaluated categories (p>0.05). In contrast, response score trends varied primarily in clarity and empathy/tone, with limited variation in actionability (p<0.05). Intraclass correlation coefficient values were below 0.50 for both ChatGPT and Gemini. CONCLUSION: Although both models generally performed well, question-level variations and low inter-rater reliability limit generalizability, and even small shortcomings in information risk may have important implications for stroke caregivers and, indirectly, for patients with stroke.

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SUMMARY OBJECTIVE: Non-muscle invasive bladder cancer is a common urological malignancy characterized by high recurrence and progression rates. There is a critical need for non-invasive biomarkers to support early detection and disease monitoring. Raftlin, a lipid raft-associated scaffold protein involved in immune regulation and signal transduction, has recently gained attention in cancer biology. The aim of this study was to investigate serum Raftlin levels and the rs690037 polymorphism of the Raftlin gene in non-muscle invasive bladder cancer patients. METHODS: A case-control study was conducted, including 30 patients diagnosed with non-muscle invasive bladder cancer and 50 healthy controls. Serum Raftlin levels were measured using enzyme-linked immunosorbent assay, and the rs690037 polymorphism was analyzed using real-time polymerase chain reaction. Gender-stratified analysis and receiver operating characteristic curve analysis were performed. Clinical and pathological characteristics including tumor stage, grade, and European Organisation for Research and Treatment of Cancer risk groups, were analyzed. RESULTS: Serum Raftlin levels were significantly elevated in non-muscle invasive bladder cancer patients compared to healthy controls (p<0.001). Gender-stratified analysis confirmed this association was independent of gender (males: p<0.001; females: p<0.001). Receiver operating characteristic curve analysis demonstrated an area under the curve of 0.987 (95%CI 0.966–1.000), with an optimal cut-off of 5.28 ng/mL providing 96.7% sensitivity and 98.0% specificity. Trends toward higher Raftlin levels were observed in more aggressive disease features. No significant association was found between the rs690037 polymorphism and disease presence. CONCLUSION: This pilot study suggests that serum Raftlin levels are significantly elevated in non-muscle invasive bladder cancer and show high discriminatory ability. While preliminary findings suggest potential as a non-invasive biomarker, validation in larger, independent cohorts is required before clinical implementation.

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SUMMARY OBJECTIVE: Exclusive breastfeeding for 6 months and continued breastfeeding for 24 months remain low due to various challenges. The aim of this study was to examine the impact of mothers’ infant feeding attitudes and parenting styles, as modifiable factors, on breastfeeding duration. METHODS: This cross-sectional descriptive study was conducted at Akdeniz University Faculty of Medicine Hospital between April 1, 2023, and April 1, 2024. The sample comprised 224 mothers of children aged 2–3 years who attended the child health follow-up clinic. Data were obtained through face-to-face interviews using the Introductory Information Form, Child Nutrition Questionnaire, Iowa Infant Feeding Attitudes Scale, and Parenting Styles Scale. Group differences were examined with t-tests and analysis of variance, correlations with Pearson's coefficient, and categorical data with chi-square tests. A binary logistic regression evaluated the effects of parenting style and feeding attitudes on breastfeeding beyond 2 years. RESULTS: While 98.7% of participants breastfed at least once, only 38.8% exclusively breastfed for the first 6 months, and 40.6% continued breastfeeding for 24 months or longer. It was found that a one-unit increase in the Iowa Infant Feeding Attitudes Scale score increased the probability of breastfeeding beyond 24 months by 5.4%, while each unit increase in the authoritarian attitude decreased it by 9.7%. Formula feeding duration was also positively correlated with authoritarian and overprotective parenting styles. CONCLUSION: Parenting styles and mothers’ infant feeding attitudes are two important factors affecting the rates of exclusive breastfeeding for the first 6 months and continuing breastfeeding beyond 24 months.

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SUMMARY OBJECTIVE: Chat Generative Pre-trained Transformer is an artificial intelligence chat system that is pre-trained on a large dataset of language data, providing detailed answers to user inquiries. The aim of this study was to evaluate the accuracy and consistency of the model's answers to frequently asked patient questions about human papillomavirus infection. METHODS: The questions prepared for input into Chat Generative Pre-trained Transformer were sourced from globally recognized associations and organizations and were divided into four categories: basic knowledge, diagnosis, treatment, and preventive medicine. The evaluation levels consisted of comprehensive, correct but inadequate, some correct and some incorrect, and completely incorrect. Three independent reviewers evaluated the responses. RESULTS: A total of 123 questions about human papillomavirus infection were prepared. Of the questions prepared for entry into Chat Generative Pre-trained Transformer related to human papillomavirus infection, 52% were categorized as preventive medicine, 28.5% as basic knowledge, 13.8% as diagnosis, and 5.7% as treatment. The model provided "comprehensive" answers to 115 out of 123 (93.5%) questions. When examined by category, the model provided comprehensive answers to 94.3% of the questions related to "basic knowledge," 88.2% of the questions about "diagnosis," 100% of the questions about "treatment," and 93.8% of the questions about "preventive medicine." Additionally, the model provided reproducible answers to 120 (97.6%) questions. CONCLUSION: Chat Generative Pre-trained Transformer performed well by providing accurate and consistent answers to frequently asked questions about human papillomavirus infection risk factors, transmission, diagnosis, impacts, associated cancers, prevention methods, and vaccination. The model may be considered a valuable informational resource for patients when used in conjunction with care provided by healthcare professionals.

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SUMMARY OBJECTIVE: The aim of this study was to investigate the relationship between intrahepatic cholestasis of pregnancy and maternal nutritional intake, and to evaluate the impact of maternal nutritional status on maternal and fetal outcomes. METHODS: This prospective case-control study enrolled 38 women with intrahepatic cholestasis of pregnancy and 76 age- and body mass index-matched controls between 2022 and 2023. Dietary intake was assessed using 24-h recall interviews and a 60-item food frequency questionnaire. Nutrient adequacy was calculated relative to age- and pregnancy-specific Dietary Reference Intakes. Maternal anthropometrics and gestational weight gain were recorded, alongside maternal and neonatal outcomes. RESULTS: Women with intrahepatic cholestasis of pregnancy had significantly lower energy intake (p=0.004) and gestational weight gain (p<0.001). Nutrient adequacy analyses indicated comprehensive deficiencies, with significantly lower adequacy for energy, protein, fiber, folate, magnesium, potassium, and iron (all p<0.01). Intrahepatic cholestasis of pregnancy was associated with earlier delivery (p<0.001), lower neonatal birth weight (p<0.001), and higher neonatal intensive care unit admission rates (p=0.007). Within the intrahepatic cholestasis of pregnancy group, maternal fasting bile acid levels inversely correlated with gestational age at delivery (ρ=-0.408, p=0.011). Gestational weight gain positively correlated with neonatal birth weight (ρ=0.325, p=0.046). CONCLUSION: Intrahepatic cholestasis of pregnancy is associated with significant maternal nutritional inadequacy and insufficient gestational weight gain. Optimizing maternal nutritional status represents a potentially modifiable pathway for targeted intervention in the comprehensive management of intrahepatic cholestasis of pregnancy.

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SUMMARY OBJECTIVE: The quality of sedation critically affects the success and safety of minor gynecologic surgeries. Ciprofol, a novel analog of propofol, offers rapid onset and recovery with a potentially improved safety profile. This study compared the efficacy and safety of ciprofol and propofol for sedation during minor gynecologic surgery. METHODS: In this single-center, randomized, double-blind trial, 342 patients scheduled for minor gynecologic procedures were assigned to receive either ciprofol or propofol for anesthesia induction and maintenance. The primary outcomes were anesthesia onset time and surgical success rate. Secondary outcomes included recovery time, hemodynamic stability, body movement, injection pain, satisfaction ratings, and adverse events such as respiratory depression and hypotension. RESULTS: Both agents achieved a 100% anesthesia success rate, with comparable onset times (ciprofol: 37.2±10.4 s vs. propofol: 38.7±11.2 s; p=0.214). Ciprofol required a fivefold lower total dose (68.5±31.7 mg vs. 359.6±164.6 mg; p<0.001) and demonstrated superior safety, including fewer body movements (2.4 vs. 15.3%), absence of injection pain (0 vs. 36.5%), and reduced hypotension (10.1 vs. 41.2%; all p<0.001). Satisfaction was higher among surgeons and patients receiving ciprofol. CONCLUSION: Ciprofol provides anesthesia efficacy equivalent to propofol with significantly enhanced safety and tolerance, supporting its use as a preferred agent for outpatient gynecologic surgery.

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SUMMARY OBJECTIVE: The aim of this study was to examine the relationship between breast cancer fear and the level of cyberchondria in women. METHODS: This descriptive and cross-sectional study was conducted with 379 women aged 18 years and older. Data were collected using a Personal Information Form, the Cyberchondria Severity Scale-Short Form, and the Breast Cancer Fear Scale. Statistical analyses were performed using IBM Statistical Package for the Social Sciences version 26.0. RESULTS: The participants’ mean total score on the Cyberchondria Severity Scale-Short Form was 33.73±10.72 (moderate level), while the mean total score on the Breast Cancer Fear Scale was 24.37±9.11 (high level). Significant associations were found between the Cyberchondria Severity Scale-Short Form total score and participants’ educational status, menopausal status, and practice of breast self-examination, as well as between the Breast Cancer Fear Scale total score and history of clinical breast examination (p<0.05). A positive significant correlation was observed between the Cyberchondria Severity Scale-Short Form total score and the Breast Cancer Fear Scale total score (r=0.464; p<0.05). CONCLUSION: Nurses should promote health literacy and guide individuals toward reliable sources, employing an interdisciplinary approach to manage patient fears. By increasing awareness of regular screenings and breast self-examinations, nurses play a key role in mitigating anxiety and fear among high-risk women.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate the impact of sodium-glucose cotransporter-2 inhibitors on haematological parameters and other clinical markers in this patient population. METHODS: We retrospectively analyzed the medical records of 150 diabetic patients with chronic kidney disease who initiated sodium-glucose cotransporter-2 inhibitor therapy, comparing their baseline and 3-month post-treatment laboratory and clinical data. RESULTS: Following 3 months of treatment with sodium-glucose cotransporter-2 inhibitors, mean haemoglobin and haematocrit levels significantly increased, even in patients with an estimated glomerular filtration rate below 60 mL/min/1.73 m2. This therapy also led to significant reductions in the spot urine albumin-to-creatinine ratio, as well as in both systolic and diastolic blood pressure. CONCLUSION: Sodium-glucose cotransporter-2 inhibitor therapy was associated with significant increases in haemoglobin and haematocrit levels in diabetic patients with chronic kidney disease. These findings suggest that sodium-glucose cotransporter-2 inhibitors may represent a potential area requiring further investigation for the treatment of anaemia associated with diabetic chronic kidney disease.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate the association between gestational diabetes mellitus and the severity and impact of lower urinary tract symptoms and urinary incontinence on quality of life in pregnant women. METHODS: This case–control study enrolled 500 pregnant women (251 with gestational diabetes mellitus; 249 healthy controls) between 30 and 38 weeks’ gestation. Women completed the International Consultation on Incontinence Questionnaire-Short Form, Urogenital Distress Inventory-Short Form, Incontinence Impact Questionnaire-Short Form, and Incontinence Severity Index. Sociodemographic, obstetrics, and anthropometric data were also collected. Multivariable logistic regression analyses were performed to examine the independent association between gestational diabetes mellitus and lower urinary tract symptoms and urinary incontinence. RESULTS: The gestational diabetes mellitus group exhibited a significantly higher mean age compared to the control group (p<0.001). Pre-pregnancy body mass index and body mass index during pregnancy were also significantly elevated in the gestational diabetes mellitus group (p<0.001). The median gestational weight gain was significantly greater in the gestational diabetes mellitus group (p=0.027). Women with gestational diabetes mellitus demonstrated significantly elevated scores in International Consultation on Incontinence Questionnaire-Short Form, Urogenital Distress Inventory-6, Incontinence Impact Questionnaire-7, and Incontinence Severity Index (p<0.001 for all). After adjusting for age, pre-pregnancy body mass index, body mass index during pregnancy, and gestational weight gain in multivariable logistic regression models, gestational diabetes mellitus remained independently associated with increased UI risk (adjusted OR 2.34, 95%CI 1.56–3.51, p<0.001). CONCLUSION: Gestational diabetes mellitus is significantly associated with increased severity of lower urinary tract symptoms and urinary incontinence, as well as a greater negative impact on quality of life during pregnancy. Routine systematic screening for lower urinary tract symptoms and urinary incontinence may be considered for all pregnant women with gestational diabetes mellitus, with early implementation of preventive interventions including supervised pelvic floor muscle training programs.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate the prognostic performance of the revised 2023 International Federation of Gynecology and Obstetrics staging system for endometrial cancer compared with the 2009 system, with a particular focus on its ability to discriminate between intermediate- and advanced-stage disease. METHODS: This retrospective cohort study included 400 patients who underwent surgical treatment for endometrial cancer at a tertiary referral center between 2008 and 2018. Patients were reclassified according to both the International Federation of Gynecology and Obstetrics 2009 and 2023 criteria. Clinicopathological variables and survival outcomes were compared across staging systems. Kaplan-Meier curves with log-rank testing and Cox proportional hazards models were used to assess disease-free survival and overall survival. Harrell’s concordance index and the Akaike Information Criterion were calculated to compare prognostic discrimination between staging systems. RESULTS: International Federation of Gynecology and Obstetrics 2023 system demonstrated superior prognostic performance with significantly improved concordance index values for both disease-free survival (C-index 0.681 vs. 0.647, p=0.041) and overall survival (C-index 0.709 vs. 0.672, p=0.037). Five-year disease-free survival rates under International Federation of Gynecology and Obstetrics 2023 were 87.1, 75.9, and 52.3% for Stages I, II, and III–IV respectively, compared with 86.2, 71.8, and 52.3% under International Federation of Gynecology and Obstetrics 2009. Five-year overall survival rates showed similar improvement in Stage II discrimination (92.1, 79.2, and 58.7% for International Federation of Gynecology and Obstetrics 2023 vs. 91.3, 76.5, and 58.7% for International Federation of Gynecology and Obstetrics 2009). CONCLUSION: The 2023 International Federation of Gynecology and Obstetrics staging system provides improved prognostic discrimination compared with the 2009 classification, particularly in delineating intermediate- from advanced-stage endometrial cancer. By incorporating adverse histopathological parameters and allowing integration of molecular classifiers, the revised system enables more accurate risk stratification and individualized treatment planning.

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SUMMARY OBJECTIVE: Bullying is a prevalent issue in medical residency worldwide, yet data from Latin America remain limited. The aim of this study was to assess the prevalence of bullying and its associated factors among medical residents in a public hospital in Brazil. METHODS: A cross-sectional study was conducted with 82 medical residents. Bullying was assessed using the Negative Acts Questionnaire-Revised. RESULTS: There was a prevalence of bullying ranging from 45.1% (Leymann’s criteria) to 51.2% (Einarsen, Hoel, and Notelaers criteria). The overall median Negative Acts Questionnaire-Revised score was 33 (interquartile range: 27–42), with no significant difference between first-year residents and later-year residents (28.0 vs. 34.5; p=0.06). However, first-year residents reported lower median scores for some bullying domains, including “Work-Related Bullying” (p=0.04), “Personal and Professional Disqualification” (p=0.03), and “Physical Intimidation” (p=0.02). Only 7% of residents self-reported feeling bullied. No associations were found between bullying and sex or specialty. CONCLUSION: These findings indicate a high prevalence of bullying in the medical residency programs studied, particularly among more advanced trainees. The large gap between assessed and self-perceived bullying suggests a lack of awareness about what constitutes harassment.

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SUMMARY INTRODUCTION: Surgical procedures are associated with an excess of postoperative cardiovascular events. Risk scores are used for cardiovascular stratification but lack proper validation across diverse populations. OBJECTIVE: The aim of this study was to assess the accuracy of the Revised Cardiac Risk Index, American College of Physicians score, and intuitive clinical judgment in predicting postoperative cardiovascular complications. METHODS: In this prospective, longitudinal study, adults assessed for cardiovascular risk undergoing elective non-cardiac surgery were included. Perioperative clinical variables, Revised Cardiac Risk Index, American College of Physicians, and clinical judgment were evaluated, as well as in-hospital and 30-day postoperative outcomes. Data were analyzed using descriptive statistics, and score performance was assessed by C-statistics. RESULTS: A total of 420 participants, with a mean age of 64.1±12.6 years, were studied, of which 47.1% were female and 71.2% were Black/Hispanic. Among the studied patients, 74.3% had hypertension, 32.9% were diabetics, 13.1% had heart failure, 11.2% had coronary artery disease, and 7.9% had stroke. Preoperative risk levels (low/medium/high) were as follows: Revised Cardiac Risk Index 88%/10.5%/1.4%; American College of Physicians 71.2%/27.4%/1.4%; and clinical judgment 64.5%/33.1%/2.4%. During hospitalization, there were 11 deaths, 3 myocardial infarctions, and 1 acute pulmonary edema. The risk scores showed poor discrimination for death and combined in-hospital cardiovascular outcomes, with area under the receiver operating characteristic curve <0.70. Cardiologist judgment performed slightly better than the scores. Results were similar for major and non-major surgeries, and when evaluating only patients aged 50 years or older. CONCLUSION: Cardiac risk assessment demonstrated low accuracy in predicting in-hospital postoperative cardiovascular outcomes, regardless of surgical magnitude.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate the epidemiological profile of first-trimester pregnant women attending a tertiary reference center in São Paulo, Brazil, and to assess its association with the development of preeclampsia. METHODS: This study involved retrospective and prospective cohorts of pregnant women undergoing first-trimester ultrasound for aneuploidy screening between 11 and 13+6 weeks’ gestation from 2020 to 2023. Maternal, obstetric, and clinical characteristics, including mean arterial pressure, were collected via questionnaire and clinical measurements. Statistical analyses included descriptive statistics and stepwise forward logistic regression to identify factors associated with preeclampsia development. RESULTS: A total of 104 pregnant women were included, with a mean age of 30.9 years. Most were White (48.3%), non-smokers (86.5%), overweight (mean body mass index: 28.5 kg/m2), and had spontaneous pregnancies (100%). Nulliparous and primiparous women accounted for 71.9% of the sample. Low risk for preeclampsia was observed in 84.3% and high risk in 15.7%. History of previous preeclampsia (OR 46.0, 95%CI 3.2–654.2), chronic arterial hypertension (OR 11.2, 95%CI 1.9–64.6), and increased first-trimester mean arterial pressure (OR 1.2, 95%CI 1.1–1.4) were independently associated with higher preeclampsia risk. Other variables, including race, parity, body mass index, and uterine artery Doppler indices, were not significant predictors. CONCLUSION: Prior history of preeclampsia, chronic hypertension, and elevated first-trimester mean arterial pressure were key predictors of preeclampsia development. These findings support the importance of first-trimester risk stratification using maternal history and mean arterial pressure measurement to guide early preventive interventions, particularly in settings where biochemical markers are not routinely available.

Abstract in English:

SUMMARY OBJECTIVE: The aim of this study was to investigate the importance of routine evaluation of cord insertion during the prenatal period. To this end, the perinatal outcomes of marginal and velamentous cord insertions were compared to normal cord insertions. METHODS: We conducted a retrospective cohort study of singleton pregnancies delivered after 24 weeks between 2016 and 2023, comparing marginal and velamentous cord insertions diagnosed on second-trimester ultrasound with normal cord insertions in terms of preterm birth and adverse perinatal outcomes, after excluding cases with fetal anomalies, placenta previa, placental invasion, vasa previa, or multiple gestations. RESULTS: Among 6,675 singleton pregnancies, 367 (5.5%) had marginal cord insertion and 45 (0.7%) had velamentous cord insertion. Marginal cord insertion was associated with a nearly threefold higher risk of preterm birth before 37 weeks, while no significant differences were observed for other adverse outcomes. In contrast, velamentous cord insertion was linked to significantly increased risks of preterm birth, primary cesarean delivery, low Apgar scores, and neonatal intensive care unit admission compared with normal cord insertions. CONCLUSION: Marginal and velamentous cord insertions showed associations with preterm birth and certain adverse perinatal outcomes. Routine evaluation of cord insertion may provide useful information for clinical follow-up. Clinical Trial Registration: This study was retrospectively registered and authorized by the local Ethics Committee of Ankara University (clinical trial date 19.08.2025; number: 1942038).

Abstract in English:

SUMMARY OBJECTIVE: Temporomandibular disorders are among the most common causes of orofacial pain, often leading patients to seek information online. The increasing use of large language models such as chat generative pre-trained transformer in healthcare communication has raised questions about the reliability and readability of artificial intelligence-generated patient information. The aim of this study was to evaluate the accuracy, comprehensiveness, readability, and inter-rater reliability of chat generative pre-trained transformer-generated responses to common patient questions regarding temporomandibular disorders. METHODS: ChatGPT (version 4.0) was prompted to generate 50 potential patient questions about temporomandibular disorders. Ten representative questions were selected and independently evaluated by five experts (two oral and maxillofacial surgeons, two physiotherapists, and one physical medicine specialist). Responses were rated using a four-point quality scale assessing accuracy and completeness. Readability was calculated using the Flesch-Kincaid method, and inter-rater reliability was assessed using the Intraclass Correlation Coefficient. RESULTS: The responses demonstrated variable but generally acceptable quality. The overall Intraclass Correlation Coefficient value was 0.862, indicating good inter-rater agreement. Readability levels ranged from grade 6.2–10.7 (mean 8.0), corresponding to middle-to-high school comprehension. While most responses were rated satisfactory, several lacked sufficient clinical detail, particularly in differentiating professional consultation pathways. CONCLUSION: chat generative pre-trained transformer provides moderately reliable and readable information about temporomandibular disorders, supporting its potential role in patient education. However, reliance on artificial intelligence-generated frequently asked questions introduces methodological limitations and authority bias. Future studies should incorporate real patient data and external fact-checking to enhance clinical relevance.