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SUMMARY OBJECTIVE: The aim of this study was to examine the relationship between chronic pain, spasticity, and maternal burnout in children with spastic cerebral palsy, and to determine whether pain and muscle tone independently predict caregiver exhaustion. METHODS: This cross-sectional study included 126 mother–child dyads with spastic cerebral palsy aged 6–18 years. Pain was assessed using the Faces Pain Scale-Revised and revised Face, Legs, Activity, Cry, Consolability; spasticity using the Modified Ashworth Scale; and functional status by Gross Motor Function Classification System. Maternal burnout was evaluated with the Parental Burnout Assessment, and anxiety/depression with the Hospital Anxiety and Depression Scale. RESULTS: Mean pain score was 4.1±1.7, Modified Ashworth Scale 2.6±0.8, and maternal Parental Burnout Assessment 56.7±13.9. Burnout correlated significantly with pain (r=0.52), spasticity (r=0.44), Gross Motor Function Classification System level (r=0.39), caregiving hours, and Hospital Anxiety and Depression Scale-depression (all p<0.001). In regression analysis, pain (β=0.37), maternal depression (β=0.31), spasticity (β=0.24), Gross Motor Function Classification System level, caregiving time, and epilepsy were independent predictors of burnout (adjusted R2=0.56). CONCLUSION: Pain and spasticity are key contributors to maternal burnout in spastic cerebral palsy. Integrating pain and tone management into family-centered care may improve both child outcomes and caregiver well-being.

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SUMMARY OBJECTIVE: The aim of this study was to examine the associations between positive/negative religious coping, fear of childbirth, and pregnancy-related distress among pregnant women. METHODS: A descriptive correlational design was used at a training and research hospital (June 2023–March 2024). A total of 155 pregnant women completed a demographic form, the Religious Coping Scale, the Tilburg Pregnancy Distress Scale, and the Wijma Delivery Expectancy/Experience Questionnaire. Analyses included descriptive statistics, Pearson correlations, t-tests, analysis of variance, and multiple regression. RESULTS: Participants reported higher positive than negative religious coping. Fear of childbirth was moderate, and pregnancy-related distress was low. In adjusted regression analyses, negative religious coping was associated with higher fear of childbirth and pregnancy-related distress (p<0.05), while positive coping was not significantly associated. CONCLUSION: Assessing religious coping in prenatal care may help identify women reporting greater childbirth fear and pregnancy-related distress. Spiritually sensitive support may be considered within holistic antenatal care. Longitudinal studies are needed to clarify the direction of these associations.

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SUMMARY OBJECTIVE: Very few clinical studies have been done to evaluate the potential clinical benefit of utilizing early colposcopy in women with normal Pap smear cytology but positive for high-risk human papillomavirus types other than human papillomavirus 16 or human papillomavirus 18 in a screening population for cervical cancer. The aim of this study was to compare two follow-up strategies and assess the need for colposcopy at the initial visit, based on cytology, human papillomavirus testing, and colposcopic findings at 1 year, among study participants. METHODS: In total, 122 women who had negative Pap smears and were positive for high-risk types of human papillomavirus (not human papillomavirus 16/18) were randomly allocated to two groups via simple computer-generated randomization. Notably, one group had a colposcopic examination when they were first diagnosed (61), and the other group had standard Pap/human papillomavirus follow-up without a colposcopic examination (61). All women in both groups had repeat Pap and human papillomavirus testing and a colposcopic examination after 1 year. RESULTS: Rates of loop electrosurgical excision procedure application were similar between groups (11.5 and 8.2%; p=0.343). So early colposcopy has enabled the treatment of high-grade squamous intraepithelial lesion lesions without increasing the number of loop electrosurgical excision procedures. CONCLUSION: In women who had negative cytology yet positive high-risk human papillomavirus types other than human papillomavirus 16/18, there was no statistically significant difference in either high-risk human papillomavirus persistence, abnormal cytology rates, or loop electrosurgical excision procedure requirements at a 1-year follow-up after having their colposcopy performed early vs. delayed assessments. This suggests that these patients can be appropriately managed with risk-based follow-up care.

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SUMMARY BACKGROUND: Artificial intelligence represents a rapidly advancing innovation in healthcare with the potential to revolutionize the field of clinical nutrition. OBJECTIVE: The aim of this study was to evaluate ChatGPT's potential to support the clinical decision-making process regarding nutrition in older adults. METHODS: Twelve questions and three clinical vignettes addressing fundamental concepts of malnutrition, including general information, diagnosis, follow-up, and treatment, were created and asked to ChatGPT. Three geriatricians independently examined ChatGPT's responses. The quality of the responses was assessed using the Quality Analysis of Medical Artificial Intelligence tool. RESULTS: The inter-rater reliability among the authors was calculated, and an excellent intraclass correlation coefficient of 0.84 (95%CI 0.77–0.89; p<0.001) was found. The total mean Quality Analysis of Medical Artificial Intelligence score for the ChatGPT-generated responses to questions related to malnutrition was 26.60, indicating very good quality. In evaluating the clinical scenarios, the lowest scores were observed in source use. The total Quality Analysis of Medical Artificial Intelligence, accuracy, relevance, and use of sources scores for the clinical scenario involving the patient with a hip fracture were statistically significantly lower compared to other scenarios. CONCLUSION: Our study highlighted that ChatGPT has the potential to generate correct answers related to complex clinical scenarios about malnutrition. ChatGPT can help clinicians make more informed decisions regarding patients’ nutritional requirements and management by utilizing more up-to-date medical resources and guidelines.

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SUMMARY OBJECTIVE: The aim of this study was to identify factors associated with difficulty in establishing vascular access during the transradial approach for neurointerventional therapy. METHODS: We retrospectively analyzed consecutive patients who successfully underwent transradial approach neurointerventional therapy at Fudan Zhongshan Xiamen Hospital (July 2021–July 2024). Patients were categorized as "difficult" or "easy" according to whether vascular access establishment required >15 min. Collected variables included difficulty in radial artery puncture/sheath insertion, feasibility of routinely forming a Simmons-2 catheter, aortic arch type (II–III), tortuosity of the brachiocephalic trunk, brachiocephalic trunk–target common carotid artery angle (<30°), and tortuosity of the C2–C4 internal carotid artery. Multivariate logistic regression was performed to identify independent factors. RESULTS: Among 277 patients, 199 were in the easy group and 78 were in the difficult group. Compared with the easy group, the difficult group more frequently had difficult radial puncture/sheath insertion, brachiocephalic trunk tortuosity, a sharp brachiocephalic trunk–target common carotid artery angle (<30°), C2–C4 internal carotid artery tortuosity, and failure to routinely form a Simmons-2 catheter (all p<0.05). Hypertension, diabetes, hyperlipidemia, and type III aortic arch were not significantly different between groups (all p>0.05). On multivariate analysis, difficult radial puncture/sheath insertion, inability to routinely form a Simmons-2 catheter, brachiocephalic trunk tortuosity, a brachiocephalic trunk–target common carotid artery angle <30°, and C2–C4 internal carotid artery tortuosity were independent factors associated with access difficulty (all p<0.001). CONCLUSION: Both access-site difficulty and unfavorable supra-aortic/internal carotid artery anatomy were independently associated with prolonged vascular access establishment during transradial approach neurointerventional therapy.

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SUMMARY OBJECTIVE: Individuals who are cognizant of microbiota and exercise connections may come to understand that exercise not only benefits their physical health but also has favorable effects on their internal balance and microbiota. In this context, the aim of this educational study was to illustrate how the balance between exercise and microbiota functions for the promotion of a healthy life. METHODS: The training sessions were conducted for 2 h per week and took place face-to-face over a period of 4 weeks. The data collection instruments used in the study included the Microbiota Awareness Scale, the Exercise Benefits/Barriers Scale, and the International Physical Activity Questionnaire-Short Form to assess participants’ current levels of physical activity. All scales, except for the International Physical Activity Questionnaire-Short Form, were administered to the participants during both the pre-test and post-test. Statistical Package for the Social Sciences 25.0 was used for data analysis. RESULTS: A total of 47 students participated in the education. The average age of the participants was 23±1.6 years. The students were found to be very active, with a mean physical activity level score of 8,685.36±6,684.09 Metabolic Equivalent-min/week. The average score of students in the microbiota knowledge pre-test was 42.5±1.4 out of 100, while the average score in the post-test was determined to be 87.5±3.2. The average score of the Exercise Benefit/Barrier Scale before the training was 86±24.97, while after the training it was 90.18±22.10. CONCLUSION: It has been determined that the applied microbiota and exercise training helped participants establish a balance between exercise and microbiota for a healthy life.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate the clinical, ultrasonographic, and elastographic parameters in the risk stratification of malignancy for thyroid nodules with indeterminate cytology according to The Bethesda System for Reporting Thyroid Cytology. METHODS: This retrospective, single-center study analyzed 838 thyroid nodules from 716 consecutive patients for six years. The diagnostic performance of nodule size, Doppler ultrasonography features, American Thyroid Association risk of malignancy guidelines, and Tsukuba elasticity scores via strain elastography was assessed. A multinomial logistic regression analysis was employed to compare indeterminate categories (III, IV, and V) with benign cytology (II) to identify independent predictors of malignancy. RESULTS: Indeterminate nodules exhibited larger mean diameters compared to benign ones (20.83±9.89 vs. 18.65±9.08 mm; p<0.05), and significant associations were identified between III, IV, and V categories and increased peripheral/central vascularization, higher-risk American Thyroid Association risk of malignancy classifications, and elevated Tsukuba elasticity scores (4 and 5). Histopathological malignancy rates were higher in indeterminate groups (p<0.05), whereas patient age and nodule location demonstrated no significant predictive value. CONCLUSION: Integrated assessment of nodule size, Doppler vascularity, American Thyroid Association risk stratification, and strain elastography significantly enhances the predictive accuracy for malignancy in nodules with indeterminate cytology. These multiparametric indices provide essential guidance for optimizing surgical indications and clinical management in cases of diagnostic uncertainty.

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SUMMARY OBJECTIVE: The aim of this study was to compare the performance of different fetal growth reference standards—Hadlock, INTERGROWTH-21st, and World Health Organization—in pregnancies complicated by systemic lupus erythematosus. METHODS: This retrospective cohort study was conducted at a tertiary referral center and included singleton pregnancies delivered at ≥22 weeks of gestation. Pregnant women were classified into two groups: those with systemic lupus erythematosus, defined by ≥4 American College of Rheumatology criteria, and controls without autoimmune disease. Estimated fetal weight obtained from routine obstetric ultrasonography was converted into gestational age-specific percentiles using the Hadlock, INTERGROWTH-21st, and World Health Organization reference standards. Correlations between ultrasound-based fetal weight percentiles and birth weight percentiles were assessed using Spearman's rank correlation coefficient. RESULTS: Of 225 initially identified pregnancies, 179 fetuses were included in the final analysis, comprising 124 from women with systemic lupus erythematosus (69.3%) and 55 from controls (30.7%). Data distribution was non-normal. Across all growth standards, fetuses from women with systemic lupus erythematosus demonstrated lower mean weight percentiles than those from controls. Mean percentiles for controls versus the systemic lupus erythematosus group were 47.1% versus 38.4% using Hadlock, 63.3% versus 55.2% using INTERGROWTH-21st, and 51.7% versus 42.6% using World Health Organization. No statistically significant differences were observed among the three reference standards; however, INTERGROWTH-21st consistently yielded higher percentile values in both groups. CONCLUSION: Although fetal weight classification varied according to the growth standard used, pregnancies complicated by systemic lupus erythematosus consistently exhibited lower fetal weight percentiles. Awareness of systematic differences among commonly used growth references is essential, as these may influence the detection of fetal growth restriction.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate the use of dienogest in the treatment of deep endometriosis and ovarian endometrioma. METHODS: This retrospective cohort study included 59 women diagnosed with ovarian endometrioma at a tertiary hospital between 2013 and 2018. Pain scores and endometrioma size were evaluated after 12 months of dienogest use, along with the women's sociodemographic characteristics. RESULTS: The mean age of the participants was 35.7±6.9 years. Unilateral endometrioma was observed in 38.9% of cases. There was a significant reduction in dysmenorrhea (p=0.011) with dienogest use, but no reduction in other pain symptoms. A reduction in left ovarian volume (p=0.009), mean left endometrioma size (p=0.01), and lesion size in the anterior cul-de-sac (p=0.047) was observed after dienogest treatment. A positive correlation was found between dyschezia and lesions in the posterior cul-de-sac before initiation of dienogest treatment. CONCLUSION: Dienogest appears to reduce pain in women with deep endometriosis. Our findings support dienogest as an effective therapeutic option.

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SUMMARY OBJECTIVE: The aim of this study was to examine the effects of pacifier use alone and combined with human milk on vital signs, feeding duration, and gastric residue in preterm infants during orogastric tube feeding. METHODS: In total, 90 preterm infants (gestational age 29+0 to 34+0 weeks) were randomly assigned to three groups: pacifier group, pacifier with human milk group, and control group. During feeding, the pacifier group received only a pacifier, while the pacifier with human milk group received a pacifier with 1–2 mL of human milk. The control group received no intervention. RESULTS: Groups were homogeneously distributed based on descriptive characteristics. Feeding duration was significantly shorter in both intervention groups compared to the control group. Additionally, heart and respiratory rates measured after feeding were significantly lower in these groups than during feeding. CONCLUSION: These findings suggest that pacifier use, with or without human milk, may be associated with more stable physiological responses after feeding and more efficient feeding in preterm infants. Clinical Trial Registration Number: This study was prospectively registered at ClinicalTrials.gov, registration NCT05530733.

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SUMMARY OBJECTIVE: Perineural invasion is a well-established adverse prognostic factor in several malignancies, yet its prognostic role in breast cancer remains controversial. METHODS: We retrospectively analyzed 400 breast cancer patients treated with neoadjuvant chemotherapy between 2012 and 2025 who had residual disease (non-pCR) at surgery. Clinicopathological variables, recurrence-free survival, and overall survival were evaluated using Cox proportional hazards models. RESULTS: Perineural invasion was identified in 42.5% of the cohort and associated with larger tumor burden, lymphovascular invasion, and nodal metastasis (p<0.01). Perineural invasion-positive status correlated with significantly inferior median recurrence-free survival (100.5 vs. 120.4 months; HR 1.77, p=0.008) and overall survival (108.5 vs. 133.6 months; HR 3.11, p<0.001). Multivariate analysis confirmed perineural invasion as a robust independent predictor of shorter recurrence-free survival and overall survival. The adverse impact was evident across all molecular subtypes, particularly HR+/HER2- and HER2+ groups. CONCLUSION: Perineural invasion is a strong independent prognostic factor for recurrence-free survival and overall survival in breast cancer patients with residual disease after neoadjuvant chemotherapy. Reporting perineural invasion status in routine pathology evaluations may aid in risk stratification for this high-risk population.

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SUMMARY OBJECTIVE: The aim of this retrospective study was to evaluate the relationship between renal artery morphometry and renal artery plaque formation and location using multislice computed tomography angiography images. METHODS: The study was conducted retrospectively using multislice computed tomography angiography data from a cohort of 130 patients. Specific measurements included abdominal aortic diameter, contrast material density, right and left renal artery diameters, lengths, angles of aortic separation, and their vertebral levels. Plaque locations in the renal artery and abdominal aorta were recorded. The statistical analysis utilized independent samples t-tests, analysis of variance, and Pearson’s correlation. RESULTS: A moderate positive correlation (r=0.308, p<0.01) was found between plaque formation and abdominal aortic diameter. An abdominal aortic diameter of ≥20.5 mm was determined as a significant risk threshold for plaque formation in the renal artery (sensitivity: 0.69, specificity: 0.68). The mean arterial length with plaque was significantly longer than that without plaque (difference: 6.97 mm, p=0.029), a relationship that was particularly evident in the right renal artery. In women, a significant association was observed between plaque formation and increased renal artery diameter (difference: 2.10±0.67 mm, p=0.017) and increased renal artery separation angle (difference: 27.44±10.04°, p=0.042). In renal arteries with plaque, both abdominal aorta and renal artery density values were lower than those without plaque (p<0.01). CONCLUSION: Our findings suggest that the size of the abdominal aorta diameter and the length of the renal artery are important anatomical factors contributing to plaque formation in the renal artery.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate the contribution of routine four-quadrant re-excision performed during breast-conserving surgery in detecting de novo tumor foci and ensuring negative surgical margins in patients with breast cancer. METHODS: A retrospective analysis was conducted on 44 female patients who underwent breast-conserving surgery between April 2021 and April 2023. In all cases, routine re-excision was performed in the superior, inferior, medial, and lateral quadrants during the same operative session. Based on pathological findings, patients with additional tumor foci in the re-excision specimens were classified as Group 1, while those without were classified as Group 2. RESULTS: The mean age of the patients was 54.2±11.6 years, with an average follow-up period of 21.5±8.3 months. Additional tumor foci were identified in seven patients (15.9%). There were no statistically significant differences between the groups in terms of age, tumor size, hormone receptor status, or histopathological characteristics (p>0.05). CONCLUSION: Routine four-quadrant re-excision may aid in the identification of microscopic de novo tumor foci even when clear surgical margins are achieved. However, larger multicenter studies with longer follow-up periods are warranted to determine its potential impact on local recurrence and long-term outcomes.

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SUMMARY BACKGROUND: Infertility affects 10–15% of couples worldwide. Although assisted reproductive technologies such as in vitro fertilization are effective, they are invasive, costly, and not without risks. Nutraceutical supplementation has gained importance as a non-invasive option to support natural conception. OBJECTIVE: The aim of this study was to evaluate whether combined nutraceutical supplementation improves natural pregnancy rates in subfertile couples with a relative indication for in vitro fertilization while awaiting treatment. METHODS: This retrospective study included 213 couples followed for 6 months (119 in the supplementation group; 94 controls). In the treatment group, both partners received combined nutraceutical supplementation (PROfertil® female/male). Controls received folic acid for women only, while men received no treatment. All couples were on an in vitro fertilization waiting list without an absolute indication for immediate assisted reproductive technologies. Those with oligoasthenozoospermia II/III or bilateral tubal occlusion were excluded. The primary endpoint was a natural pregnancy within 6 months. RESULTS: Natural conception occurred more often in the supplementation group than in controls (66.4 vs. 39.4%, p<0.001). Multivariate logistic regression showed a 4.13-fold higher odds of pregnancy with supplementation (95%CI 2.12–8.04, p<0.001). CONCLUSION: Combined nutraceutical supplementation significantly increased natural pregnancy rates in couples awaiting in vitro fertilization. Randomized trials are needed to confirm these findings and assess live birth outcomes.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate knowledge and attitudes regarding human papillomavirus infection and vaccination among medical students and to examine differences according to gender and academic year. METHODS: This cross-sectional study was conducted during the 2024–2025 academic year among medical students enrolled at Muğla Sıtkı Koçman University Faculty of Medicine. Data were collected through a voluntary online questionnaire. The human papillomavirus Knowledge Scale (33 items; theoretical range 0–33) was used to assess knowledge. Results are presented as median (minimum–maximum). Group comparisons were performed using non-parametric tests, and multiple linear regression analysis was conducted to identify independent predictors of knowledge. RESULTS: A total of 372 students participated (56.5% female; mean age 21.5 years). The median total human papillomavirus knowledge score was 20.5 (0–31). Female students demonstrated significantly higher knowledge scores than male students (p<0.001). Knowledge increased significantly with the advancing academic year (p<0.001), with first- and second-year students exhibiting the lowest scores across all subscales. Multiple linear regression analysis revealed that academic year and prior awareness of human papillomavirus testing were the strongest independent predictors of total knowledge (R2=0.411, p<0.001), followed by female gender, academic year, and alcohol use. CONCLUSION: Although the overall level of human papillomavirus awareness was found to be satisfactory, knowledge levels were lower among male students, those in the early years of medical education, and individuals with unfavorable health behaviors (such as alcohol use). Providing comprehensive education from the early years of training may enhance future physicians’ capacity to deliver effective preventive counseling.

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SUMMARY OBJECTIVE: Malnutrition in older adults drives functional decline, higher morbidity, and rising healthcare costs. Although family medicine specialists are well placed to manage community nutritional risk, their clinical engagement is often limited. The aim of this study was to evaluate their attitudes toward the clinical nutrition care process and identify professional factors influencing these views. METHODS: We conducted a national cross-sectional survey among family medicine specialists in Turkey using the Turkish-validated 12-item Attitude Scale for the Clinical Nutrition Care Process. The scale evaluates two primary dimensions: Physician duties (Factor 1) and Non-physician duties (Factor 2), with total scores ranging from 12 to 60. Professional characteristics, including work setting, clinical nutrition training, and self-perceived competence, were also assessed. Statistical associations were explored using Welch’s t-test, Welch analysis of variance, and Pearson correlation. RESULTS: Overall, 410 specialists participated (65.6% female; mean age 37.0±5.9 years). Although 71.2% (n=292) had clinical nutrition training, only 30.0% (n=123) used nutrition screening tools, and 32.4% (n=133) reported self-perceived competence in malnutrition management. The mean total attitude score was 40.76±6.48, moderately positive. Work setting affected attitudes (p=0.025): home health scored higher than outpatient clinics (42.23±6.09 vs. 40.04±6.88). Screening-tool use and self-perceived competence were significantly associated with more favorable attitudes toward interprofessional duties (Factor 2) (p=0.008; p=0.016). CONCLUSION: Despite generally positive attitudes, a major gap remains between clinical perception and delivering nutritional care in primary practice. Low use of screening tools and limited perceived competence indicate an urgent need for interventions that combine hands-on training with institutional support to improve community nutritional management.

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SUMMARY OBJECTIVE: Exclusive breastfeeding for 6 months is essential for infant health. Various factors, as well as early breastfeeding performance assessed by the LATCH score, may influence exclusive breastfeeding duration, but their predictive value remains unclear. We aimed to evaluate whether early postpartum LATCH scores and other clinical or sociodemographic factors predict exclusive breastfeeding at 6 months in a Baby-Friendly Hospital. METHODS: The single-center prospective observational study was conducted at a Baby-Friendly Hospital in Istanbul, Türkiye. LATCH scores were assessed within the first 48 h postpartum by the same lactation consultant. At 6 months, follow-up interviews were conducted via phone to determine the infant's feeding status, bottle and pacifier use, and return to work. RESULTS: Of the 301 mother-infant pairs included, 54.8% maintained exclusive breastfeeding at 6 months. Higher early LATCH scores were significantly associated with vaginal delivery, previous breastfeeding experience, and exclusive breastfeeding during the first 48 h. However, LATCH scores were not significantly linked to exclusive breastfeeding at 6 months. In multivariate analysis, bottle use was strongly associated with reduced likelihood of exclusive breastfeeding at 6 months (OR 16.672, 95%CI 8.875–31.318, p<0.001). CONCLUSION: Since bottle use is the most important factor affecting exclusive breastfeeding at 6 months, preventing bottle use is a critical intervention in maintaining breastfeeding. Furthermore, the LATCH score is insufficient in predicting exclusive breastfeeding in the long term.

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SUMMARY OBJECTIVE: The Hemoglobin–Albumin–Lymphocyte–Platelet score has shown prognostic value across various cancers; however, its utility in predicting cytoreductive outcomes in advanced epithelial ovarian cancer remains unclear. The aim of this study was to determine whether the preoperative Hemoglobin–Albumin–Lymphocyte–Platelet score predicts maximal cytoreduction at primary cytoreductive surgery. METHODS: In this single-center study, we analyzed data from 140 patients with epithelial ovarian cancer who underwent primary cytoreductive surgery at our clinic. Patients were categorized by residual disease: maximal cytoreduction (no macroscopic residual disease, n=104), optimal cytoreduction (n=19), and suboptimal cytoreduction (n=17). Preoperative Hemoglobin–Albumin–Lymphocyte–Platelet, CA-125, and clinical variables were compared across groups. Discrimination for maximal cytoreduction was assessed using receiver operating characteristic analysis. RESULTS: The maximal cytoreduction group had higher preoperative hemoglobin and lymphocyte counts, lower platelet counts, and lower CA-125 levels (p<0.005). Median Hemoglobin–Albumin–Lymphocyte–Platelet was significantly higher in maximal cytoreduction vs. optimal cytoreduction vs. suboptimal cytoreduction (35.37 vs. 21.10 vs. 20.19; all p<0.001). For predicting maximal cytoreduction, the Hemoglobin–Albumin–Lymphocyte–Platelet cutoff of 24.96 yielded a sensitivity of 71.4% and a specificity of 71.4% (area under the curve: 0.792; p<0.001). A CA-125 cutoff of 260.50 IU/mL provided a sensitivity of 71.4% and a specificity of 65.7% (area under the curve: 0.758; p<0.001). CONCLUSION: The preoperative Hemoglobin–Albumin–Lymphocyte–Platelet score demonstrates good discrimination for predicting maximal cytoreduction in advanced epithelial ovarian cancer and appears to perform at least comparably to CA-125. Given that patients selected for neoadjuvant chemotherapy were excluded, these performance estimates apply to a surgically selected population. Given its low cost and universal availability, Hemoglobin–Albumin–Lymphocyte–Platelet may support preoperative selection and counseling before cytoreductive surgery.

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SUMMARY OBJECTIVE: The aim of this study was to describe the clinical-epidemiological profile and outcome in patients under 15 years of age with differentiated thyroid cancer diagnosed at a state pediatric referral service in Santa Catarina, Brazil, from 2011 to 2020. METHODS: Retrospective cohort study analyzing the medical records of 16 patients with differentiated thyroid cancer. The variables analyzed were gender, age, year of diagnosis, previous exposure to radiation, personal and family medical history, symptoms/signs at diagnosis, histological type, staging, therapy, surgical complications, remission rate, and vital status. RESULTS: Differentiated thyroid cancer occurred in females and adolescents in 62.5% of cases, respectively. Previous radiotherapy was reported in 25% of cases. On physical examination, 56% had a thyroid nodule. Papillary carcinoma was diagnosed in 81.25% of cases. Four patients (25%) were classified as high risk and three never achieving remission. All five low-risk patients and four of the five intermediate-risk patients were in remission. Total thyroidectomy, with or without lymph node resection, was indicated in all cases. Transient hypoparathyroidism occurred in 25%. Radioiodine therapy with I-131 was used in 68.75% of cases, including two low-risk patients treated before 2015. The remission rate was 75%. There were no deaths. CONCLUSION: Papillary carcinoma is the most common histological type, predominantly in adolescents and females. Previous radiotherapy is a risk factor for differentiated thyroid cancer. The most frequent presentation is a thyroid nodule. Total thyroidectomy is the standard procedure. Radioiodine therapy is not indicated for low-risk patients after 2015. Transient hypoparathyroidism is the most common surgical complication. The remission rate for differentiated thyroid cancer is high.

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SUMMARY OBJECTIVE: The aim of this study was to identify the places of death of patients with solid cancer under follow-up by a Palliative Care team and to recognize factors that influence the place of death. METHODS: Retrospective study of cancer patients whose deaths occurred between January 1, 2022, and January 1, 2024, followed up by a Palliative Care team in a Portuguese public hospital. Demographic and clinical data were reviewed through clinical file consultation and were analyzed by Statistical Package for the Social Sciences® v.29, considering a p<0.05 as statistically significant. RESULTS: The sample included 413 cancer patients; 60.5% were male, and 72.9% were Eastern Cooperative Oncology Group 3–4. The median age was 75 years, and the median follow-up duration in Palliative Care was 40 days. Death in a hospital setting occurred in 64.4% of the patients. The most common types of cancer were gastrointestinal/hepato-bilio-pancreatic (41.6%) and lung cancers (18.6%). Death due to cancer progression was the main cause of death (88.4%). In a multivariate logistic regression, factors associated with higher odds of hospital death were age <75 years (OR 1.88, 95%CI 1.22–2.90) and follow-up duration in Palliative Care <30 days (OR 2.59, 95%CI 1.66–4.04). Death due to cancer progression was associated with lower odds of hospital death (OR 0.03, 95%CI 0.004–0.21). CONCLUSION: Death in a hospital setting was predominant in this sample, which is in line with outcomes from international studies. These findings highlight the need for early palliative care referral and advance care planning to support patients’ preferences for place of death.

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SUMMARY OBJECTIVE: Vaccine hesitancy continues to be a significant global public health issue, and our understanding of how vaccine literacy influences immunization attitudes is incomplete. The aim of this study was to evaluate vaccine literacy and attitudes toward immunization among adults in Central Anatolia, Turkey, and to examine the association between vaccine literacy dimensions and immunization attitudes. METHODS: A cross-sectional study was conducted between February and May 2025 among 928 adults attending Family Health Centers in Kırşehir. Data were collected through face-to-face interviews using a structured sociodemographic questionnaire, the Health Literacy about Vaccination in Adults Scale, and the Attitudes Toward Immunization Scale. Nonparametric tests, Spearman correlation analyses, and multiple linear regression were applied. RESULTS: Participants showed moderate levels across all vaccine literacy domains and moderately positive immunization attitudes. Correlations between Health Literacy about Vaccination in Adults Scale subscales and Attitudes Toward Immunization Scale scores were generally weak. Communicative vaccine literacy showed a weak but important negative relationship with the overall Attitudes Toward Immunization Scale score (r=-0.077, p=0.018) and the belief/opinion part (r=-0.121). In regression analysis, none of the vaccine literacy subscales significantly predicted immunization attitudes, and the model explained only 0.4% of the variance (Adjusted R2=0.004, p=0.090). CONCLUSION: Vaccine literacy alone has limited explanatory value for immunization attitudes. These findings indicate that attitudes are shaped by factors beyond cognitive literacy and suggest that interventions should extend beyond information provision.

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SUMMARY OBJECTIVE: Idiopathic colitis is a chronic disorder, and the pain, fatigue, and anxiety associated with this condition may promote the evolution of kinesiophobia, a fear of movement that limits physical activity and worsens quality of life. However, this relationship has been understudied. Therefore, the aim of this research was to compare kinesiophobia scores in ulcerative colitis subjects to those in healthy controls. METHODS: In this case-control study, 106 subjects participated; 53 healthy participants were selected from private podiatry clinics; and 53 patients with ulcerative colitis were selected from the Virgen Macarena University Hospital and the Association of Crohn's and Ulcerative Colitis Patients of Seville (ACCU) Seville association. Each participant received the abbreviated Spanish version of the Fear of Movement Scale, known as Tampa Scale for Kinesiophobia. RESULTS: Subjects with ulcerative colitis had higher total Tampa Scale for Kinesiophobia scores compared to healthy subjects (24.98 ± 8.01 vs. 21.94 ± 6.18; p=0.016). Moderate to severe kinesiophobia was present in 49.1% of the ulcerative colitis patients, compared with 30.2% in the control group. The ulcerative colitis group had a significantly higher percentage of participants with severe kinesiophobia (11.3 vs. 1.9%). CONCLUSION: These findings highlight the importance of early assessment of fear of movement to support interventions aimed at improving physical activity participation, functional capacity, and overall quality of life in this population.