Objectives: Wrist and forearm deformities are usually due to congenital or post-traumatic causes. These deformities cause progressive pain and limitation of motion and impair quality of life. Acute correction with radius and/or ulna osteotomy and fixation with plate or wire can be applied in treatment, but complications such as vascular/nerve damage, malunion and inadequate correction may be encountered. Treatment with circular external fixators provides correction without residual deformity and is safer because it can provide deformity correction and gradual lengthening both intraoperatively and postoperatively. Computer-assisted circular external fixators (Ca-CEF) facilitate the correction of complex deformities by allowing postoperative deformity planning to be redone. In this study, we analyzed wrist or wrist deformities treated with Ca-CEF.
Methods: The hospital database was searched for patients who underwent surgery for wrist and forearm deformity between 2010 and 2020. Demographic data, radiographic and functional measurements of the patients were evaluated. Preoperative and postoperative forearm supination, pronation, wrist flexion and extension, Visual Analog Scale (VAS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, Mayo Wrist Score and grip strength were measured. Radiological measurements of radius, ulna lengths, radial inclination and volar tilt were performed. Postoperative complications were analyzed. Preoperative and postoperative data of the patients were analyzed statistically.
Results: A total of 14 patients were included in the study. The mean age of the patients was 17.1 years (11-34), 8 were female and 6 were male. The mean follow-up period was 18.4 months (6.8-32.9). The planned anatomical correction was achieved in all patients. The mean differences between preoperative functional and radiographic data and postoperative data were 7.8 (p=0.029) for forearm supination, 14.64 (p<0. 001), 6.17 kg for Grip Strength (p=0.001), 3.07 for VAS (p<0.001), 21 points for DASH Score (p=0.003), and 22.14 points for Mayo Wrist Score (p=0.004), which were statistically significantly better. No major complications were observed in any patient.
Conclusion: The study showed that Ca-CEF provides functional improvement and radiological improvement and is a safe treatment method with low complication rates. This method stands out as an effective option in the treatment of complex deformities.

Objectives: The objective of this study is to examine the safety of percutaneous renal mass biopsy and compare the oncological outcomes between patients who had a renal biopsy prior to nephrectomy procedures and those who did not have a biopsy.
Methods: We evaluated a total of 145 patients who underwent nephrectomy for renal cancer between January 2017 and January 2021. Based on the pretreatment percutaneous renal mass biopsy, we categorized the patients into two groups: the biopsy (-) group and the biopsy (+) group. We performed a comparative analysis of the radiologic and histological characteristics of the tumors in all the groups. We also conducted an examination of the surgical margin outcomes in cases of partial nephrectomy between the two groups. In addition, we did an analysis of the overall survival (OS), recurrence-free survival (RFS), metastasis-free survival (MFS), and disease-free survival (DFS) between each group.
Results: Out of 145 patients meeting inclusion criteria, we analyzed 119 cases. The mean age and tumor diameter were 56.75±11.71 years and 53.77±23.99 mm, respectively. Operative time averaged 176.87±56.46 minutes, with a mean follow-up of 25.67±14.27 months (range: 8–60 months). Partial nephrectomy rates were 35.41% (biopsy (-)) and 43.47% (biopsy (+)), with left kidney tumors in 46/96 (biopsy (-)) and 16/23 (biopsy (+)) cases, respectively. Cystic and exophytic tumors varied significantly between groups (p=0.01 and p=0.03). During follow-up, 16 deaths occurred. Mean overall survival (OS) was 51.38±2.26 months. We noted local recurrence and metastatic progression in 4 and 7 patients, respectively, with lung metastases in all cases. RFS, MFS and DFS times averaged 57.94±1.00, 54.75±1.67, and 53.83±1.75 months, respectively. The biopsy (+) group showed a higher prevalence of papillary and chromophobe RCC subtypes. Pathological parameters and surgical outcomes were comparable between groups. OS, RFS, MFS, and DFS times did not significantly differ (p>0.05).
Conclusion: According to our findings, a percutaneous renal mass biopsy is a safe procedure. It can aid in the diagnostic evaluation of suspected renal masses and mitigate any adverse effects on oncological outcomes. Our opinion is that patients with suspected renal cancer can safely and successfully use routine percutaneous renal mass biopsy.

Objectives: Replantation surgery is one of the most difficult areas of reconstructive surgery. The aim of finger replantation is to restore sensation and adequate function of the amputated part in addition to restoring circulation. It is very crucial to investigate prognostic factors to improve the outcomes of this surgery. The type and severity of the injury, along with the duration between the injury and surgery, are the most significant factors influencing the success of replantation. This study investigates the impact of the type of anesthesia used on the success of replantation and other postoperative factors.
Methods: The finger replantation operations performed in our clinic between December 2018 and December 2023 were retrospectively analyzed. The effects of gender, smoking, type of injury, vein repair, nerve repair, use of vein graft, level of injury, type of anesthesia, preoperative and postoperative hemoglobin values on replantation success were statistically investigated in 192 patients (162 males, 30 females). Ratios in independent groups were compared by chi-square test. Comparisons of numerical variables in the independent groups were conducted using the Mann-Whitney U test, as the assumption of normal distribution was not satisfied.
Results: In the study, among the 192 patients, 91 received anesthesia via axillary nerve block (47.4%), 33 received general anesthesia (17.2%), and 28 received local anesthesia through digital block (14.6%). It was found that the type of anesthesia had no effect on the success of the replantation (p<0.05). A statistically significant difference was observed in the amount of change in hemoglobin levels between preoperative and postoperative measurements, according to the type of anesthesia. In the group receiving axillary nerve block, the decrease in hemoglobin levels was greater compared to the group receiving local anesthesia.
Conclusion: Our study found that smoking status and type of injury had no effect on the success of replantation.

Objectives: 18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG-PET/CT) is a widespread imaging technique for whole-body scanning. Incidental lesions may be detected in thyroid gland and the importance and management of these lesions are still a matter of debate. The aims of this study were the evaluation of the diagnostic success of ultrasonography and FDG-PET/CT for predicting malignancy and contribution of these techniques for the decision of Fine Needle Aspiration Biopsy (FNAB) in incidental thyroid lesions detected in FDG-PET/CT.
Methods: Patients who underwent FDG-PET/CT in Nuclear Medicine Unit in a single institution between January 2018 and December 2022 were screened for thyroid incidentaloma with increased focal FDG uptake. Imaging studies and pathology results of the patients with Focal Thyroid Incidentalomas (FTI) were reviewed retrospectively.
Results: A total of 14.003 FDG-PET/CT reports of 8.259 patients were evaluated. In FDG-PET/CT imaging, 495 (6.0%) patients had increased uptake in thyroid gland, 383 (4.6%) patients had focal and 112 (1.4%) patients had diffuse FDG uptake. The rate of malignancy in FTIs was 19.2%. In the ROC curve analysis, regarding the prediction of malignancy in FTIs with FDG uptake, a SUVmax value of 5.5 and above predicts malignancy with a sensitivity of 71.4% and a specificity of 68.6% (AUC: 0.718, p=0.018, 95%CI: 0.564-0.872). The sensitivity of ACR-TIRADS-5 was 35.7% (95%CI: 14.6-61.7) and sensitivity of the combination of SUVmax>5.5 and ACR-TIRADS-5 was 30.0% (95%CI: 8.5-60.7).
Conclusion: FDG-PET/CT findings can be used for determining malignancy risk and cutoff values such as 5.5 can be threshold for ordering FNAB. In patients with SUVmax less than 5.5, ultrasonographic risk classification criteria should be used for decision-making.

Objectives: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder in which patients with HS experience profound deterioration in their overall well-being, psychological state and quality of life. This study aimed to evaluate the psychological impact of HS and examined its associations with relevant factors, including sociodemographic and disease-related characteristics.
Methods: A prospective, single-center study was conducted involving 80 patients with HS. The demographic and clinical characteristics of patients were recorded. Depression Anxiety Stress Scale-21 (DASS-21), Dermatology Life Quality Index (DLQI), and General Health Questionnaire-12 (GHQ-12) were used to assess the psychosocial impact of HS.
Results: A significant proportion of patients with HS had severe and extremely severe scores in depression, anxiety and stress, with 48.75%, 52.5%, and 48.75% of patients, respectively. Sixty percent of the patients exhibited high psychological disorders while 53.8% experienced severe impairment in their quality of life (QoL). Sociodemographic and clinical factors were evaluated for associations with the scales used in this study. DASS-21 Anxiety (DASS-21A) was significantly positively correlated with lower education levels and higher body mass index (BMI) (p<0.05). There were no significant correlations between the Hurley stages and the other three scales, except for the DASS-21 Stress (DASS-21S) subscale. Patients with a family history had higher DASS-21A, DASS-21 Depression (DASS-21D), DASS-21S, and GHQ-12 (both Likert and traditional scoring) scores compared to those without a family history (p<0.05). Additionally, a positive family history significantly predicted higher scores on DASS-21A, DASS-21D, and DASS-21S (p=0.002; p=0.019; p=0.022, respectively).
Conclusion: Our findings confirm that a significant proportion of patients with HS had high or extremely high levels on all three scales assessing the psychological burden of HS. Patients were negatively affected psychologically at each Hurley stage. Family history proved to be a strong predictive factor contributing to impaired psychosocial status among individuals with HS. Thus, dermatologists should provide extra care, especially for those with family members affected by this condition.

Objectives: Chronic spontaneous urticaria (CSU) is a common disease characterized by wheals and/or angioedema. Since it is a chronic, itch-related disease, it may substantially affect the psychological status and quality of sleep. In this study, it was aimed to evaluate the impact of CSU on depression, anxiety, stress, and quality of sleep, as well as their relation to disease-specific factors.
Methods: This prospective case-control study included 86 patients with CSU and 86 controls. The sociodemographic and clinical characteristics of the patients, such as scores of urticaria activity score (UAS7) and chronic urticaria quality of life questionnaire (CU-Q2oL), were recorded. Depression, Anxiety, and Stress Scales-21 (DASS-21), Pittsburgh Sleep Quality Index (PSQI), and Dermatology Life Quality Index (DLQI) were used to evaluate their psychological status, quality of sleep, and life.
Results: Of 172 participants, the patient group comprised 86 patients with CSU, and the control group comprised 86 age and sex-matched volunteers. Of 86 patients with CSU, 60 (69.8%) were females and 26 (30.2%) males with a median age of 34.5 years. In the patients with CSU, the median scores (interquartile range) for depression, anxiety, and stress, according to DASS-21, were 6 (8), 5 (6.25) and 6 (7), respectively. Additionally, the median scores of PSQI and DLQI were 7 (5) and 5.5 (11), respectively. The median scores for depression, anxiety, and stress according to DASS-21, the median scores of PSQI and DLQI were statistically significantly higher in the patient group than in the control group. According to the PSQI classification, 68 (79.1%) patients had poor sleep quality, while 18 (20.9%) patients had good sleep quality. When the patient group was examined in two groups, those with good and poor sleep quality, UAS7, depression, anxiety, stress, and DLQI/CU-Q2oL scores were statistically significantly higher in the patients with poor sleep quality than in the patients with good sleep quality.
Conclusion: Treatment of urticaria is typically symptomatic and aims to reduce the symptoms of itching and wheals. However, clinicians can contribute to the well-being of patients if they are aware of psychological comorbidities and sleep disturbances.

Objectives: Venom-specific immunotherapy is recognized as the gold standard treatment for honey bee and wasp venom allergies. This study aims to evaluate the clinical characteristics and treatment outcomes of patients diagnosed with honey bee and wasp venom allergies who commenced immunotherapy.
Methods: This study encompasses data from 43 patients who presented with honey bee and wasp venom allergies at Ondokuz Mayis University and initiated venom immunotherapy (VIT). We retrospectively examined the patients' demographic characteristics, history of atopic diseases, allergy history, characteristics of honey bee and wasp venom stings, severity of reactions, laboratory values, administered treatments, and side effects.
Results: Among the 43 patients included in our study, 9 (20.9%) were female, and 34 (79.1%) were male. A history of atopic disease was present in 34.8% of the patients, and a family history in 51.1%. The severity of systemic reactions was evaluated according to Müller's classification, with grade 4 reactions being the most frequent (48.8%). Of the 43 patients who received VIT, 28 (65.1%) were treated for Apis mellifera, 9 (20.9%) for Vespula vulgaris, and 6 (14%) for both species. Twelve patients experienced side effects during VIT, leading to discontinuation in two cases due to patients' reluctance to continue. The remaining 22 patients, who were stung again during or after completing VIT, experienced milder systemic reactions.
Conclusion: This study delineates the demographic and clinical characteristics of patients with honey bee and wasp venom allergies, highlighting the efficacy of VIT treatment. Despite the occurrence of side effects related to VIT, both previous studies and our findings suggest that these side effects are not more severe than systemic reactions resulting from stings. The absence of severe systemic reactions in patients who were stung again during or after receiving VIT underscores the effectiveness of the immunotherapy.

Objectives: Influenza is an infectious disease that primarily affects the respiratory system. It can cause high morbidity and mortality, especially in people with risk factors. This study aimed to epidemiologically analyze influenza PCR-positive patients in the 2014-2015 influenza season and to identify risk factors associated with disease severity and fatality.
Methods: Within the scope of national influenza surveillance program, clinical samples from patients with influenza-like illness (ILI) symptoms are sent to the Turkish Public Health Institution, National Influenza Center for testing, accompanied by case information forms. A retrospective analysis was conducted on the case information forms of patients who tested positive for influenza via PCR during the 2014-2015 influenza season. Demographic data were analyzed, and the presence of risk factors associated with fatality was investigated through further analysis.
Results: A total of 1330 patients were included in the study. 684 (51.4%) of the patients were female. The median age was 42.8 years (IQR: 23-61). Among the patients, 154 (11.9%) died. The median age of deceased patients was 60.2 years (IQR: 39.8-75). Being over 65 years old in deceased patients is 3.4 times more likely compared to survived patients [OR=3.4 (95% CI=2.4-4.9)]. Additionally, deceased patients were 4.8 times more likely to have Influenza A (H1N1) compared to survivors [OR=4.8 (95% CI=3.2-7.2)], and the presence of chronic diseases in deceased patients was also 3.4 times higher than in those who survived [OR=3.4 (95% CI=2.3-5.1)].
Conclusion: Infection with H1N1, being elderly and presence of chronic diseases were found to be associated with increased fatality. To mitigate morbidity and mortality, it is crucial to vaccinate individuals with chronic diseases and the elderly, educate them about contact precautions, and encourage prompt healthcare seeking when symptoms appear.

Objectives: Epidural fibrosis occurs after laminectomy as part of the local repair mechanisms. Adhesion around the nervous tissue could cause pain and disability. In the current study, we investigated the possible antifibrotic effects of the plasminogen activator inhibitor 1 (PAI-1) antagonists in a rat laminectomy model.
Methods: The rats were randomly assigned to the control, the TM5441, and the TM5484 groups (n=6 per group). In the control group, just a laminectomy was performed. In the treatment groups, intragastric administration of PAI-1 antagonists was done after skin closure. Epidural fibrosis was investigated macroscopically and histopathologically four weeks later.
Results: In the TM5441 and TM5484 groups, the macroscopic epidural fibrosis score was less than the control group (p<0.001 for both groups). Microscopic epidural fibrosis score was also decreased in the TM5441 and TM5484 groups (p>0.05 for both groups). Fibroblast cell density classification scores in the TM5441 and TM5484 groups were lower when compared to the control group (p>0.05 for both groups). Fibrosis thickness was lower in the TM5441 and TM5484 groups when compared to the control group (p<0.01 for both groups).
Conclusion: Plasminogen activator inhibitor 1 antagonists could be a treatment alternative for the prevention of epidural fibrosis.

Objectives: Nutritional status significantly impacts outcomes in allogeneic hematopoietic stem cell transplantation (allo-HSCT). Among various indices, the Nutritional Risk Index (NRI), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT) scores hold potential as prognostic tools. This study compares their predictive utility for transplant outcomes.
Methods: A retrospective analysis was conducted on 41 patients who underwent their first allo-HSCT between October 2022 and July 2024. Nutritional scores were calculated using pre-transplant data, and their associations with mortality and non-relapse mortality (NRM) were assessed. Receiver operating characteristic (ROC) curves and multivariable logistic regression were employed to evaluate predictive accuracy.
Results: The high CONUT score demonstrated the highest prognostic accuracy for mortality (AUC: 0.771, p=0.026) and NRM (AUC: 0.806, p=0.047). It was the sole independent predictor of mortality (OR: 2.180, p=0.028). Both the NRI (AUC: 0.737, p=0.040) and PNI (AUC: 0.803, p=0.008) were also associated with mortality but lacked independent predictive value. Higher CONUT scores correlated with increased mortality rates.
Conclusion: The CONUT score emerged as the most effective nutritional scoring system for predicting mortality in allo-HSCT patients. Its simplicity and integration of key clinical parameters make it a valuable tool for early risk stratification and targeted interventions. Further studies with larger cohorts are warranted to validate these findings and refine nutritional management strategies.

Objectives: This study aimed to compare the expression of midkine (MK) in the vitreous of patients with proliferative diabetic retinopathy (PDR) and non-diabetic individuals, elucidating its potential role in the pathogenesis of the disease.
Methods: This prospective cross-sectional study included three groups of patients who underwent pars plana vitrectomy (PPV) surgery. The first group (control) consisted of patients who underwent PPV for epiretinal membrane and macular hole and did not have diabetes mellitus (DM). The second group included patients who underwent PPV for vitreous hemorrhage (VH) and tractional retinal detachment (TRD) secondary to PDR without prior anti-VEGF treatment (No preoperative anti-VEGF application: NPa-VEGF). The third group comprised patients who underwent PPV for VH and TRD secondary to PDR and received a preoperative anti-VEGF injection one week before surgery (preoperative anti-VEGF application: Pa-VEGF). Vitreous samples were collected intraoperatively, and the concentrations of MK, interleukin (IL)-6, and IL-8 were measured using specific Enzyme-Linked Immunosorbent Assay (ELISA) kits.
Results: The study included a total of 49 eyes from 49 patients undergoing PPV. The concentrations of IL-6 and IL-8 in vitreous samples from the NPa-VEGF group (n=15) and the Pa-VEGF group (n=14) were not significantly different compared to the control group (n=20) (p>0.05). However, the vitreous fluid of patients in the NPa-VEGF group exhibited significantly higher MK concentrations compared to the control group (p<0.007). Similarly, MK concentrations were significantly elevated in the Pa-VEGF group compared to the control group (p<0.046). No significant difference in MK levels was detected between the NPa-VEGF and Pa-VEGF groups (p>0.05).
Conclusion: These findings suggest that increased MK expression in the vitreous may be associated with the pathogenesis of PDR. Further studies are warranted to elucidate the precise mechanisms underlying this association and to explore the potential of MK as a therapeutic target for PDR management.

Objectives: This study aimed to investigate the relationship between smartphone use and musculoskeletal pain among health-care workers of different occupations. The research sought to examine the connection between smartphone habits and the prevalence and severity of musculoskeletal pain, with a focus on work-related and personal smartphone use, physical activity, temporomandibular dysfunction and neck disability.
Methods: The study utilized a cross-sectional survey design conducted via Google Forms targeting healthcare workers affiliated with Sisli Hamidiye Etfal Training and Research Hospital. The survey comprised 99 questions assessing demographic and professional information, health conditions, smartphone addiction, physical activity level, musculoskeletal pain, and pain-related disability.
Results: A total of 207 hospital staff members' responses were included in the analysis. Participants with higher smartphone addiction scores exhibited a significantly younger mean age and increased smartphone usage post-pandemic. No significant differences were found in physical activity levels between groups. However, those with higher addiction scores reported more frequent pain in the jaw and elbows, greater neck disability score, and a higher prevalence of temporomandibular dysfunction. The study also revealed a significant association between smartphone addiction and multi-site musculoskeletal pain.
Conclusion: The findings indicate that smartphone addiction among healthcare workers is associated with specific patterns of musculoskeletal pain, particularly in the jaw and elbows, and increased neck disability scores. The study highlights the need for targeted interventions to promote healthier smartphone habits and mitigate musculoskeletal pain among healthcare professionals.

Objectives: The primary aim of this study was to evaluate the effects of nocturnal enuresis (NE) on Health-Related Quality of Life (HRQoL) in children with a special emphasis on the domains of HRQoL.
Methods: This was a case-control study in which consecutive children with NE were recruited along with their parents. Age and sex-matched children without enuresis served as controls. Age-appropriate children and proxy versions of the German Quality of Life Questionnaire (KINDL) were used to evaluate HRQoL and its domains. The clinicodemographic characteristics and family data were collected. HRQoL and the domain scores were compared between the patients and the control subjects.
Results: 100 children (50 of whom are males) with enuresis along with their parents were included in the study. 100 children served as the control group. The mean age of the patients was 9.58±2.77 years, and was no different from that of the control group. 55% of the children were receiving treatment for NE. The most common treatment was the nighttime waking (40%). The most commonly used drug was desmopressin. The median score of the health-related quality of life was 78.8 [69.2–83.3] in children with NE versus 90 [86.7–91.7] in the control group (p<0.001). In all domains, the median scores were significantly lower in children with NE compared with the controls.
Conclusion: Turkish children with NE had a significantly lower HRQoL score compared with children without NE. All the domain scores were also significantly lower in children with NE compared with the control subjects.

Objectives: Primary central nervous system lymphoma (PCNSL) is a rare and aggressive form of non-Hodgkin lymphoma (NHL). This study aimed to investigate the characteristics, treatment approaches, and outcomes of patients with PCNSL in a single institution.
Methods: We retrospectively analyzed 11 patients with PCNSL treated at our institution between October 2022 and July 2024. Patient demographics, clinical characteristics, treatment modalities, and outcomes were evaluated.
Results: The median age of the patients was 65 years, with male predominance (63.64%). The median follow-up duration was 10 months. All patients were immunocompetent, and 90.91% had diffuse large B-cell lymphoma. At diagnosis, 81% of the patients were considered fit to receive HDMTX treatment. R-MPV was the most common first-line treatment (45.45%). The complete response rate to initial treatment was 80%. The treatment-related mortality was 9.09%. Autologous stem cell transplantation (ASCT) was performed in 72.73% of the patients, with rituximab-thiotepa-carmustine as the predominant conditioning regimen (62.50%). Treatment-related toxicities occurred in 50% of patients, and 87.50% of patients experienced transplant-related complications. The transplantation-related mortality rate was 25%. The relapse rate was 25% among the patients undergoing ASCT. The mortality rate was 36.36%, and cerebellar involvement was significantly associated with a higher mortality rate (p=0.045).
Conclusion: This study demonstrated the efficacy of methotrexate-based regimens and ASCT in the treatment of PCNSL and achieved high complete response rates. However, the significant incidence of treatment-related toxicities and mortality underscores the persistent challenges of managing this disease. In addition, the association between cerebellar involvement and increased mortality requires further investigation. Larger prospective studies are needed to validate these findings.

Objectives: Aluminum accumulates in the body, disrupts mental development, affects bone mineral structure and causes cholestasis in the liver. Aimed to investigate parenteral nutrition and aluminum transmission in preterm infants.
Methods: Our study was designed as a single-center prospective study. And 45 babies were included during pregnancy weeks ≤32 and/or under 1500 grams. Cord blood samples were taken at birth from all infants. And blood levels of aluminum on the 14th day compared with cord blood levels of aluminum.
Results: Aluminum levels evaluated from patients’ cord blood were 3.35±1.73 g/L (18-9.7 g/L), while levels reported on day 14 were 4.79±3.54 (1.6-18.6 g/L). Aluminum levels increased by 1.44±3.86 (0.28-2.60) f/L, which was statistically significant (p=0.021). The increase in aluminum levels was highly associated with number of days that furosemide was administered (p=0.012). The increase in serum aluminum levels of patients receiving parenteral feeding for more than 10 days was found to be significantly higher. But there was no statistically significant difference. When the contents of parenteral solutions were examined, it was discovered that there was an important positive correlation between calcium and magnesium levels administered in the first seven days and serum aluminum levels on the fourteenth day (p=0.044 and p=0.008, respectively).
Conclusion: The increase in serum aluminum levels in preterm infants fed parenteral nutrition was found to be statistically significant. Longer parenteral nutrition was associated with a greater increase in serum aluminum levels.

Objectives: Clinicians are uncertain about the nutrition of patients diagnosed with hypoxic-ischemic encephalopathy due to the risk of necrotizing enterocolitis and feeding intolerance. The nutritional protocols of these patients are still unclear. We aimed to investigate the time of starting nutrition and related conditions in these patients receiving therapeutic hypothermia (TH) treatment.
Methods: This retrospective single-center study evaluated patients hospitalized at our unit and receiving TH between January 2022 and June 2023. Those who started nutrition during TH and after TH were defined as the early enteral nutrition (EEN) and late enteral nutrition (LEN) groups, respectively. Analyses were performed between the two groups.
Results: Our study evaluated 91 patients, of whom 40 were in the EEN group and 51 were in the LEN group. The reaching birth weight time in the LEN group was delayed (10 [5-22] vs. 7.5 [5-25] days, respectively, p<0.001), the transition time to full enteral nutrition was longer (10 [6-20] vs. 7 [5-18] days, respectively, p<0.001), and the hospitalization time was longer (13 [8-43] vs. 9 [7-35] days, respectively, p<0.001) compared with those of the EEN group.
Conclusion: TH is not an obstacle to starting nutrition. Starting nutrition in these patients at an early stage does not increase nutritional complications and shortens their discharge time.

Objectives: This study aimed to assess the predictive value of the Diastolic Deceleration Area (DDA), a novel Doppler ultrasound parameter, in detecting adverse neonatal outcomes in fetuses with late-onset fetal growth restriction (FGR). While Doppler parameters such as cerebroplacental ratio (CPR), umbilicocerebral ratio (UCR), and cerebralplacentaluterine ratio (CPUR) are commonly used for fetal monitoring, their predictive power varies. Given the importance of cerebral blood flow redistribution in fetal adaptation to hypoxia, we investigated whether DDA could serve as a reliable indicator of fetal distress and adverse perinatal outcomes.
Methods: This prospective case-control study was conducted between January 2024 and July 2024, including 90 pregnant women: 45 diagnosed with late-onset FGR and 45 gestational age-matched healthy controls. Doppler ultrasound measurements, including umbilical artery, uterine artery, middle cerebral artery Doppler indices, CPR, UCR, CPUR, and DDA, were performed. The primary outcome was the prediction of adverse neonatal events, such as neonatal intensive care unit (NICU) admission, neonatal sepsis, respiratory distress, low APGAR scores, and low cord blood pH. Receiver Operating Characteristic (ROC) curve analysis was used to determine the predictive ability of the Doppler indices.
Results: DDA values were significantly higher in the FGR group compared to controls (p<0.001). At a cut-off value of >7.23, DDA demonstrated 50% sensitivity and 88% specificity, making it the most specific Doppler parameter for predicting adverse neonatal outcomes. In comparison, CPR (cut-off ≤2.11), UCR (cut-off >0.46) and CPUR (cut-off ≤1.36) had higher sensitivity (96%, 96%, 54%) but lower specificity (32%, 31% and 85% respectively).
Conclusion: DDA is a promising Doppler parameter for identifying fetuses at risk in late-onset FGR. Its high specificity suggests it could be a valuable supplementary tool alongside traditional Doppler indices for better risk assessment and clinical decision-making. Further studies are needed to validate its role in perinatal care.

Objectives: This study aimed to evaluate the etiology, clinical characteristics, and outcomes of mesenteric lymphadenopathy (ML) in children, with an emphasis on its clinical significance and management strategies.
Methods: This cross-sectional, single-center study was conducted between July 2016 and May 2017 and included pediatric patients aged 1 month to 18 years diagnosed with ML via abdominal ultrasonography. Patients with malignancies, acute infections, ongoing corticosteroid or antibiotic treatment, or incomplete follow-up were excluded. Data collection included demographic, clinical, and laboratory findings. Statistical analyses were performed using IBM SPSS Statistics version 25. The Mann–Whitney U test was used for comparisons of numerical variables between groups, while the chi-square and Fisher’s exact tests were applied for categorical variables. A p-value less than 0.05 was considered statistically significant.
Results: A total of 106 patients were included with a median age of 7.4 years (range: 8 months–16.4 years), of whom 55.7% were male. The majority (63%) were aged 6–11 years. Abdominal pain was the most common symptom (64.2%), and 99.1% of the ML cases were localized in the right lower quadrant. At 1-month follow-up, lymph node sizes regressed to normal in 71.7% of cases, while 28.3% remained pathological. Antibiotic use did not significantly affect lymph node regression. At 6 months, no new symptoms or diagnoses were reported in the 91 patients contacted. ML was most often idiopathic (76.4%), with secondary causes including gastrointestinal and respiratory infections, acute abdomen, and Familial Mediterranean Fever.
Conclusion: In children, ML is predominantly benign and self-limiting, and in most cases, it resolves without medical intervention. Although its association with symptoms such as abdominal pain may cause anxiety in parents, careful monitoring of patients can prevent unnecessary interventions. This study underscored the importance of conservative management and highlighted the need for further research with larger cohorts and extended follow-up periods to explore rare etiologies and long-term outcomes.

Congenital morphological disorders of the vascular bed, especially located on the main arteries and veins of the extremities, can cause chronic venous insufficiency and venous claudication, creating exacerbated symptoms for the patient and which require intervention. In cases where interventional radiology is insufficient, surgical approaches should be prioritized. Sixty-five years old male patient admitted to our clinic with increased bilateral lower extremity swelling which revealed to be chronic venous insufficiency secondary to congenital disorders. Sapheno-femoral veno-venous bypass (Palma operation) was performed, and patient was discharged on post-operative day 15 without further complaints. Palma Operation is an effective surgical treatment option in venous malformations of lower extremity where interventional radiology is not sufficient.

Congenital hyperinsulinism (HI) is the leading cause of persistent hypoglycemia in infants and children. Focal pancreatic lesions account for 30-40% of cases with congenital HI. With early diagnosis, these patients can be treated by resection of the lesion, making long-term medical care unnecessary. In this case, a 5-day-old newborn boy presented with convulsion due to severe and persistent hypoglycemia at his hospitalization in neonatal intensive care unit. Laboratory studies revealed very low levels of ketone bodies with inappropriately normal insulin levels during hypoglycemia. The patient was unresponsive to diazoxide treatment. The molecular genetic analysis revealed a heterozygous pathogenic variant in the ABCC8 gene. 18F-DOPA-PET/CT scan showed increased uptake of 18F-DOPA consistent with focal lesion at the tail of the pancreas. A focal pancreatectomy operation was performed when he was three months old. Histopathological evaluation confirmed focal endocrine cell hyperplasia. Hypoglycemia did not recur after the operation. CHI patients with ABCC8 / KCNJ11 mutation are not easy to manage with pharmacotheraphy. In the case of an identifiable focal lesion associated with CHI, surgery is the most preferred option. In focal CHI, as in our case, the lesion may not be visually evident and requires a surgeon experienced in CHI.