Background: Occupational diseases are often underestimated and overlooked among orthopedic surgeons. This study aimed to investigate the prevalence of occupational injuries and their impact on orthopedic surgeons in Türkiye.
Methods: A modified version of the physical discomfort Web-based anonymous survey and the Short Form-36 (SF-36) were sent via email to all members of the Turkish Association of Orthopedics and Traumatology (TOTBID) mailing list. The data were collected and analyzed.
Results: A total of 217 orthopedic surgeons completed the survey. The most common musculoskeletal disorders were low back pain (73%), wrist tendinitis (36%), lateral epicondylitis (29%) and shoulder pain (28%). Additionally, 98% of surgeons had experienced needle stick or sharp instrument injuries at least once, and fewer than one-third of them received special treatment from their institutions. The behavior of not using any protective equipment was found to be associated with the surgeon's age (p=0.03).
Conclusion: This study highlights the high prevalence of occupational health injuries among orthopedic surgeons in Türkiye. The findings of this study may raise awareness among orthopedic surgeons about occupational health injuries and encourage the implementation of prevention strategies, early recognition of these injuries, and timely, definitive interventions.
Key Words: Occupational disease, orthopedic surgeons, musculoskeletal disorders, low back pain.

Background: As artificial intelligence (AI) continues to advance, its integration into medical education and clinical decision making has attracted considerable attention. Large language models, such as ChatGPT-4o, Gemini, Bing AI, and DeepSeek, have demonstrated potential in supporting healthcare professionals, particularly in specialty training examinations. However, the extent to which these models can independently match or surpass human performance in specialized medical assessments remains uncertain. This study aimed to systematically compare the performance of these AI models with orthopedic residents in the Specialty Training Development Exams (UEGS) conducted between 2010 and 2021, focusing on their accuracy, depth of explanation, and clinical applicability.
Methods: This retrospective comparative study involved presenting the UEGS questions to ChatGPT-4o, Gemini, Bing AI, and DeepSeek. Orthopedic residents who took the exams during 2010-2021 served as the control group. The responses were evaluated for accuracy, explanatory details, and clinical applicability. Statistical analysis was conducted using SPSS Version 27, with one-way ANOVA and post-hoc tests for performance comparison.
Results: All AI models outperformed orthopedic residents in terms of accuracy. Bing AI demonstrated the highest accuracy rates (64.0% to 93.0%), followed by Gemini (66.0% to 87.0%) and DeepSeek (63.5% to 81.0%). ChatGPT-4o showed the lowest accuracy among AI models (51.0% to 59.5%). Orthopedic residents consistently had the lowest accuracy (43.95% to 53.45%). Bing AI, Gemini, and DeepSeek showed knowledge levels equivalent to over 5 years of medical experience, while ChatGPT-4o ranged from to 2-5 years.
Conclusion: This study showed that AI models, especially Bing AI and Gemini, perform at a high level in orthopaedic specialty examinations and have potential as educational support tools. However, the lower accuracy of ChatGPT-4o reduced its suitability for assessment. Despite these limitations, AI shows promise in medical education. Future research should focus on improving the reliability, incorporating visual data interpretation, and exploring clinical integration.

Objectives: The aim of this study is to evaluate and compare the minimum 2-year functional outcomes, clinical scores and complications of patients in whom we performed open volar and dorsal ganglion cyst excision.
Methods: Patients were divided into two groups based on cyst location: dorsal and volar. The surgical outcomes were analyzed, encompassing the size and localization of the cyst, wrist ROM (range of motion), VAS (visual analogue scale) for pain, QDASH (quick disability arm shoulder hand) questionnaire, and PRWE (patient rated wrist evaluation) scale. Additionally, complications and recurrence rates were examined.
Results: A total of 53 patients were evaluated in the study, including 34 dorsal ganglion cysts (19 women, 56%) and 19 volar ganglion cysts (15 women, 79%). The mean age of the patients was 34.1 years (range: 18 to 68), and the mean follow-up period was 73.8 months (range: 26 to 136). The surgical duration was longer for volar cysts (P = 0.01). For extension, the change in ROM was 3.9 ± 6.3 degrees in volar cysts (P=0.01), whereas in dorsal cysts, this change was measured as 2.0 ± 6.0 degrees (P=0.05). The increase in wrist flexion in the postoperative period was significantly higher in volar ganglion cysts (P<0.01). There were no statistically significant differences between the two groups for QDASH, PRWE, and VAS scores (P>0.05). Recurrence and complication rates were approximately 2-fold higher in volar cysts.
Conclusion: Open surgical excision is a successful treatment method for wrist ganglion cysts based on middle and long-term outcomes, with high patient satisfaction and low recurrence and complication rates.

Objective: In this study, it is aimed to examine the effects of septoplasty, functional endoscopic sinus surgery and septorhinoplasty on the acoustics of Turkish nasal consonants.
Methods: The prospective study was conducted by taking voice recordings of 72 patients preoperative, 1st and 3rd months postoperative and based on changes in nasalance values. Patients were asked to read aloud the predetermined speech materials. The speech materials were recorded and analyzed using the Praat Assisted Nasalance Meter (PANM) system. The effect of the type of surgery was investigated for the change of nasalance values in the 1st and 3rd months after surgery compared to the preoperative value.
Results: Septoplasty and functional endoscopic sinus surgery groups showed significant increases in nasal consonants and nasal sentence nasalance values in both male and female after surgery compared to the preoperative value. (p<0.05) In the septorhinoplasty group, no significant changes were observed in the values after surgery compared to the preoperative value in male patients (p>0.05). In the female septorhinoplasty group, nasalance values decreased after surgery compared to the preoperative value, but no significant differences were detected. (p>0.05)
Conclusion: Comprehensive information about the potential for resonance changes following rhinological surgery should be provided to professional voice users. Clear communication of results can support more informed decision making, manage patient expectations, and reduce the risk of postoperative dissatisfaction with voice quality.

Background: This study aims to determine the prevalence of cold agglutinins (CA) in patients undergoing cardiac surgery in the Turkish population, to draw attention to the importance of preoperative diagnosis, and to increase clinicians' awareness of cold hemagglutinin disease (CHD).
Method: 4273 patients who underwent elective cardiac surgery between 2012-2022 were examined. All patients were routinely screened for CA. Patients were divided into two groups: 18-49 years old (Group 1) and over 50 years old (Group 2). Prevalence analysis was performed by comparing these age groups and genders.
Result: Among all patients, CA was positive in 390 (9.12%). There was no difference between group 1 and group 2 in all patient groups and women. However, CA was found to be higher in group 2 in men compared to group 1 (n=154 (8.9%) and n=65 (6.6%), respectively), p=0.47). CA was found to be higher in women compared to men (n=171 (10.9%), n=219 (8.07%), respectively), p=0.015).
Conclusion: We found that CAs were considerably high in patients undergoing cardiac surgery in the Turkish population. CA is important for cardiac surgery where hypothermia is used, and we believe that this pathology should be routinely screened in the preoperative period. Due to these rates that cannot be ignored, the clinical awareness of the heart team about CHD should be increased.

Objective: Hypoxic-ischemic encephalopathy (HIE) continues to be a predominant cause of morbidity and mortality in neonates. Therapeutic hypothermia (TH) is the only method with proven neuroprotective effects, and the aim of this study was to evaluate the short-term results of patients treated with TH.
Methods: Demographic, clinical characteristics, laboratory and aEEG results of patients who received TH treatment with a diagnosis of Stage II or Stage III HIE according to modified Sarnat staging in the Neonatal Intensive Care Unit were analyzed retrospectively.
Results: A total of 101 patients were included in the study. The mean gestational age of the patients was 38.8±1.5 weeks, the mean birth weight was 3215±499.5 g, and 40.6% were female. According to the modified Sarnat staging, 50.5% of the patients were evaluated as Stage II, and the others as Stage III HIE. The most common peripartum risk factors were meconium delivery (25.7%) and prolonged or difficult labor (20.7%). Mortality rates in patients with Stage II and Stage III HIE were 5.9% and 26%, respectively. One of the patients who died, the 6th hour aEEG background activity was moderately abnormal, and in 15 patients there was a severely abnormal voltage pattern. Acute kidney injury was found to be the most effective factor in mortality.
Conclusions: In our study, it was concluded that the mortality rate of newborns diagnosed with Stage III HIE was higher, the most impact factor on mortality was acute kidney injury, and 6th hour voltage activity in aEEG monitoring was useful in predicting prognosis.

Objectives: Isotretinoin-mediated apoptosis is considered the main cause of anti-acne side effects of isotretinoin. The aim of this study is to investigate the effects of oral isotretinoin therapy on the skin and serum levels of forkhead box transcription factor (FoxO)-3, tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), p53 and metabolic parameters and examining the relationship between these parameters.
Methods: Sixteen acne vulgaris patients who were administered the appropriate cumulative dose of oral isotretinoin were enrolled in this prospective study.
Results: The decreases in the values of body mass index, waist circumference, systolic blood pressure, CRP, and ferritin from the baseline to the end of the treatment were statistically significant (p=0.028, p=0.029, p=0.008, p=0.046, and p=0.003, respectively). The increases in the levels of serum low density lipoprotein-cholesterol (LDL-C), triglyceride (TG), total cholesterol, gamma glutamyl transferase (GGT), and FoxO3 from the baseline to the end of the treatment were statistically significant (p=0.001, p=0.004, p<0.001, p=0.010, p=0.007, respectively). In terms of changes from the baseline to the end of the treatment, serum FoxO3 levels were positively correlated with the changes in serum TRAIL levels (r=0.674, p=0.004). The changes in serum FoxO3 levels were positively correlated with the changes in fasting blood glucose levels (r=0.540, p=0.031). The changes in serum TRAIL levels were positively correlated with the changes in the values of systolic BP (r=0.552, p=0.027) and diastolic BP (r=0.511, p=0.043). The changes in serum p53 levels and serum LDL-C levels were also positively correlated (r=0.499, p=0.049).
Conclusion: Isotretinoin therapy caused an increase in skin and serum levels of FoxO3 and TRAIL and a decrease in serum and skin p53 values. However, only the increase in serum FoxO3 levels was statistically significant. The observed reduction in p53 levels implies that the isotretinoin-related side effects may not rely on p53-mediated apoptosis, and it may be considered that its safety profile is better than expected. The correlations between the changes during isotretinoin therapy in metabolic parameters and TRAIL, p53, and FoxO3 values suggest that isotretinoin's metabolic side effects may involve these molecules.

Objective: Chronic spontaneous urticaria (CSU) is characterized by recurrent wheals and/or angioedema lasting more than 6 weeks. The disease is marked by unpredictable, severe itching attacks, significantly impacting patients' quality of life and often prompting them to seek medical treatment. This study aimed to evaluate the efficacy of omalizumab in patients with CSU and identify the factors that determine its effectiveness.
Methods: This retrospective descriptive study analyzed registered data of 159 patients with CSU who received omalizumab at a tertiary dermatology clinic. The study recorded patient demographics, allergic conditions, omalizumab dosage, treatment response time, efficacy, duration of use, and additional medications. It also included assessments of total IgE levels.
Results: Of 159 patients with CSU, 112 (70.4%) were females, and 42 (29.6%) were males with a median age of 43 years (IQR = 20). Among the patients, 156 (98.1%) received a 300 mg dose of omalizumab, while 3 (1.9%) received 450 mg. Additionally, 41 (25.8%) required antihistamines and corticosteroids in addition to omalizumab, while 118 (74.2%) were treated with omalizumab alone. The median response time was 3 months, with 116 (73%) showing complete responses and 39 (24.5%) showing partial responses. Four patients (2.5%) showed no response. When patients were categorized into two groups—those receiving only omalizumab and those on combination therapy, the median response time to omalizumab was statistically significantly longer in the combination therapy group (mean=2.53±0.76, median=3, IQR=1 vs mean=3.49±1.63, median=3, IQR=0). When patients were categorized into two groups based on a total IgE cut-off value of 20 IU/ml, the group with IgE levels greater than 20 had a significantly higher proportion of full responders.
Conclusions: The majority of patients with CSU in this study responded well to omalizumab, with a significant proportion achieving complete responses. Additionally, higher IgE levels (>20 IU/ml) were associated with a greater likelihood of full response to treatment. These findings suggest that omalizumab is an effective agent for CSU, with the possibility of enhanced response in patients with elevated IgE levels.

Objective: Parkinson's disease (PD) is a neurodegenerative disorder with both motor and non-motor symptoms, including depression and anxiety, which significantly impact patients' quality of life. The predictors of these psychiatric symptoms remain incompletely understood. This study aims to evaluate the prevalence and potential predictors of depression and anxiety in PD.
Methods: A prospective study was conducted on 99 idiopathic PD patients. Depression and anxiety were assessed using the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) scale. A range of clinical and demographic variables, including motor symptoms, sleep disturbances, and quality of life, were analyzed using regression models.
Results: Of the patients, 57.5% had depression, 48.4% had anxiety, and 36.3% had both. Significant predictors of depression included the use of apomorphine, which was associated with lower PHQ-9 scores (p=0.031), and the presence of restless legs syndrome (RLS), which was linked to higher depression scores (p=0.037). For anxiety, younger age was a significant predictor (p=0.007). Both depression and anxiety scores correlated with lower quality of life (p<0.001 for both).
Conclusion: This study highlights the high prevalence of depression and anxiety in PD, with significant predictors including RLS for depression and younger age for anxiety. Apomorphine use appears protective against depression. Both depression and anxiety disrupt quality of life. These findings underscore the importance of routine psychiatric screening and comprehensive management of depression and anxiety in PD, aiming to improve patient outcomes.

Objective: Brucellosis is a prevalent zoonotic disease in developing countries, as well as Turkey. The objective of this study was to investigate the prevalence of brucellosis in the Hakkari province of Turkey over a period of 1 year.
Methods: A retrospective cross-sectional study was conducted using serum samples since 12,742 patients in Hakkari’s three main hospitals from January to December 2023. Demographic data, results of serological tests, admission time and clinics were collected and recorded. To identify seropositivity for brucellosis, the Rose Bengal Test (RBT) and Standard Tube Agglutination (STA) tests were performed.
Results: Of the samples, 6.6% tested positive for RBT, and 3.2% were confirmed to be seropositive for brucellosis with an STA titer of ≥1/320. The highest prevalence of brucellosis seropositivity was observed in August, with a greater prevalence among women, particularly those aged 25-44. Most patients were admitted to internal medicine clinics, and the highest seroprevalence was observed in infectious diseases clinics. Seroprevalence was statistically significant across age, gender, and clinics (p<0.05).
Conclusion: The present study showed that the seroprevalence of brucellosis in Hakkari province was 3.2% in 2023. Brucellosis is still endemic in our province and public health measures are needed to reduce brucellosis transmission. We believe that the results of this study will provide data for epidemiological studies in the region.

Background: Alcohol consumption is a major risk factor for liver cirrhosis and chronic pancreatitis (CP). The interplay between pancreatic changes and alcoholic cirrhosis remains poorly understood due to limited diagnostic tools. Endosonography (EUS) offers high sensitivity for detecting pancreatic morphological changes, even in early fibrosis stages.
Methods: Between February 2010 and February 2017, 71 male patients diagnosed with alcoholic cirrhosis based on clinical, biochemical, and imaging findings were enrolled. Cirrhosis and pancreatitis from other causes were excluded. EUS, performed under midazolam and propofol sedation using a radial probe, classified pancreatic morphology per Rosemont criteria: normal, indeterminate for CP, suggestive of CP, or consistent with CP. Clinical data, including alcohol and smoking history, liver function, and portal hypertension markers, were recorded.
Results: EUS identified normal pancreatic morphology in 28 patients (39.4%), indeterminate findings in 18 (25.4%), and CP-consistent or suggestive changes in 25 (35.2%). Logistic regression revealed no significant association between pancreatic changes and age, smoking, alcohol intake, BMI, spleen size, INR, platelet count, diabetes mellitus (DM), or compensated cirrhosis. Kaplan-Meier analysis showed no survival difference between normal (3.9 years) and abnormal morphology groups (3.1 years; p=0.792). One patient (1.4%) with normal morphology developed pancreatic cancer after 3.3 years. Hepatic and extrahepatic malignancy incidence reached 18% over five years, with hepatocellular carcinoma (HCC) at 4.3%, yet no link to pancreatic changes emerged (p=0.639). Portal hypertension severity and mortality showed no correlation with pancreatic findings.
Conclusion: EUS proves valuable for assessing pancreatic changes in alcoholic cirrhosis, illuminating the complex relationship between alcohol consumption and pancreatic morphology.

Objectives: Epicardial fatty tissue volume (EFV) is regarded to be an important parameter in the evaluation of coronary artery disease (CAD). The aim of our study was to investigate the prognostic value of EFV measurements related to age, gender, coronary artery calcium score (CCS) and CAD severity through coronary computed tomography angiography (CCTA).
Methods: We retrospectively evaluated a total of consecutive 688 patients who were either asymptomatic but had a positive family history, or had typical or atypical symptoms suggesting the presence of CAD. They all underwent CCTA examination with multiplanar reformat (MPR), maximal intensity projection (MIP), and myocardial three dimensional (3D) volume rendering (VRT) images were obtained. We calculated CCS, coronary artery plaque stenosis degrees, the number of main coronary arteries involved and the EFVs for each patient. Finally, the relationship between the EFVs and all other parameters were analyzed by performing the Pearson and Spearman correlation analysis.
Results: We found a statistically significant difference between the genders of the patients where males presented higher EFVs than females (p=0.001; p<0.01). The correlation between the presence of CAD and the number of main vessels involved with EFVs was also statistically significantly higher in the analysis performed with the student t- test (p=0.001; p<0.01). There was a statistically significant but weak positive correlation between the ages of the patients (r=0.271; p=0.001; p<0.01), calculated total CCSs (r=0.149; p=0.001; p<0.01) and the degree of vessel stenosis determined based on coronary artery disease reporting and data system (CAD RADS) (r=0.347; p=0.001; p<0.01) and their EFV measurements.
Conclusion: We assume that, the quantification of EFV performed by the CCTA technique is a potential novel method and hence, can guide clinicians in predicting the presence and severity of CAD.

Objective: Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious hyperinflammatory complication of COVID-19 in which cardiovascular abnormalities are frequently detected. In the context of MIS-C, it remains uncertain which patients will develop cardiac dysfunction and which will experience coronary artery abnormalities (CAAs). To investigate this, patients were categorized into four distinct groups based on the presence or absence of myocardial dysfunction and/or CAAs. We aimed to determine whether there were any differences in demographic, echocardiographic, laboratory results, outcome, and COVID-19 variants between the groups.
Methods: Between July 2020 and August 2022, 135 MIS-C diagnosed patients were divided into 4 groups according to their cardiovascular involvement.
Results: The mean age of the patients was 104 months (9-209 months) and the male/female ratio was 1.45. Thirty-eight percent of the patients had decreased LVEF and 44% had signs of CAAs. Fifty-nine percent (80/135) of the patients were admitted to the pediatric intensive care unit (PICU). Patients admitted to the PICU were older patients with cardiac dysfunction. The severity of cardiac involvement ranged from severe to mild in Group 1, Group 2, Group 3, and Group 4, respectively. Group 1 was older (median age 146 months, p=0.008), albumin was lower (p=0.015) and CRP was higher than Group 4 (p=0.007). PICU admission/stay time and CRP elevation were significant in the groups with decreased LVEF (groups 1 and 2). More MIS-C patients were observed in the alpha wave compared to other waves, but there was no difference in the severity of cardiac involvement (p=0.25). Cardiac dysfunction and improvement in CAAs were observed in patients. The case fatality rate was 1.48%.
Conclusion: D-dimer, CRP, ferritin levels were higher, lymphocyte, platelet and albumin levels were lower in elderly patients with cardiac dysfunction who were followed up in the PICU.

Objective: Streptococcus anginosus (SAG) group, also known as the Streptococcus milleri group, consists of Streptococcus anginosus, Streptococcus intermedius and Streptococcus constellatus. Skin and soft tissue infections, intra-abdominal infections, skeletal infections and ear-nose-throat (ENT) and cervical infection are the most common presentations. This study aimed to evaluate Streptococcus anginosus group (SAG) infections in children.
Methods: A retrospective review was conducted on patients aged 0-18 years who had cultures positive for S. anginosus, S. intermedius, or S. constellatus between January 1, 2019, and March 1, 2024.
Results: Streptococcus anginosus group (SAG) bacteria were cultured in 113 patients. SAG was identified as the causative agent of infection in 93 patients. Of a total of 93 patients, 39 were female (41.9%) and 54 were male (58.1%). The median age of the patients at the time of diagnosis was 14 years (IQR: 9-17). Among these, S. constellatus was found in 46 patients (49.5%), S. anginosus in 36 patients (38.7%), and S. intermedius in 11 patients (11.8%). The infections presented primarily as skin and soft tissue infections (63 patients), head and neck infections (23 patients), and intra-abdominal abscesses (7 patients). Additionally, two patients had concomitant bacteremia. Predisposing factors for the development of infection were identified in 52 patients (55.3%). Surgical drainage was required for 70 patients (74.4%).
Conclusion: Streptococcus constellatus was the most frequently isolated species among the Streptococcus anginosus group (SAG), followed by S. anginosus and S. intermedius. The most common site of infection was skin and soft tissue, with a significant proportion of patients requiring surgical drainage. The overall incidence of bacteremia was low S. intermedius was more frequently isolated from deep tissue infections.

Intracardiac glomus tumors are very rare neoplasms arising from mesenchymal cells. Solitary glomus tumors are usually benign and mostly seen in the skin of limbs. Still, exceptional cases of noncutaneous visceral glomus tumors have been reported at sites other than the limbs. We present a case of glomangioma that was surgically removed from the right ventricle and briefly pointed to the importance of differential diagnosis of cardiac tumors. A 57-year-old woman was referred to our hospital for dyspnea and recurrent arrhythmia attacks. We performed a three-dimensional transthoracic echocardiogram, and contrast chest CT, which revealed a mass in the right ventricle. She was successfully treated with cardiac surgery. After pathological studies, the tumor was finally diagnosed as benign intracardiac glomangioma.

Awake thoracic surgery utilizing thoracic epidural anesthesia has shown significant advantages over general anesthesia, especially in patients with comorbidities. This case report presents three cases of critically ill patients who successfully underwent awake thoracic surgery using thoracic epidural anesthesia. The first case involved an 81-year-old male with advanced Chronic obstructive pulmonary disease who underwent thoracotomy with decortication for mesothelioma. The second case involved a 73-year-old male with a history of hypertension, coronary artery bypass graft surgery, laryngeal cancer, and permanent tracheostomy who underwent video-assisted thoracic surgery for the lung tumor. Finally, the third case involved a 41-year-old female with a history of hypertension, tuberous sclerosis, epilepsy, and interstitial lung disease. All patients were managed with epidural anesthesia and conscious sedation, resulting in perioperative hemodynamic stability and effective pain control without the need for additional opioids. These cases highlight the efficacy and safety of thoracic epidural anesthesia for facilitating pain-free, uneventful thoracic surgeries in high-risk patients, suggesting that thoracic epidural anesthesia is a viable alternative to general anesthesia in selected cases.

Argyria can be described as the deposition of silver in the skin taken orally or through direct skin inoculation, causing discoloration of the skin and mucosa. In recent years, the increasing trend of people towards complementary medicine and marketing the colloidal form of silver is causing a resurgence of cases of argyria. Therefore, we aim to report a 16-year-old male patient who applied to our outpatient clinic and highlight the uprising trend through the patient. In the presented case, discoloration of the skin is much more pronounced on sun-exposed area as in the literature, with the catalytic effect of sunlight on silver. In order to avoid this permanent situation, the authorities should take measures such as restricting the sale of products containing silver or limiting the silver content of products. Expanding awareness is highly recommended as a must.

In recent years, the use of AQUAfilling® filler has become widespread, particularly in breast and gluteal augmentation, which are among the most common aesthetic surgical procedures. Although AQUAfilling® filler is claimed to be biocompatible with human tissue, the number of complications associated with it continues to increase. The invasion of AQUAfilling® filler into the parenchyma, as well as the toxicity and oncogenicity of its main component, polyacrylamide, remain uncertain and require further investigation. In this study, we present three female patients with a history of AQUAfilling® filler injection for breast and gluteal augmentation who experienced long-term major complications. We aim to emphasize the significance of long-term complications of AQUAfilling® filler material and contribute to the reconstruction options in managing these complications.

Drug-induced esophagitis (DIE) is a rare condition and doxycycline is responsible for more than 50% of the cases. Most cases can be prevented and treated conservatively. In this case series, four patients with DIE that treated at our center will be presented.
Four adolescents, aged 14, 16, 16, and 17 years, presented to the clinic with complaints of dysphagia and odynophagia. All patients had a history of oral doxycycline use for acne vulgaris. Upper GI endoscopy revealed erosions and ulcers in the thoracic esophagus in two cases and in the distal esophagus in the other two cases. All patients were managed conservatively, and follow-up endoscopy showed no development of strictures.
DIE should be considered in the differential diagnosis of adolescents presenting with dysphagia and odynophagia. Proper education about medication use can reduce the risk of developing esophagitis.

Among the agents used for self-defense, O-chlorobenzylidene malononitrile (CS) is the most commonly used substance. It has been suggested that CS use is characterized by rapid onset of action, short duration of action, and minimal side effects. When the clinical situations and case series resulting from exposure to CS were examined, we saw that no cases of exposure during the neonatal period were identified. A male baby born at 40 weeks, weighing 3260 grams, was brought to the emergency room on the 24th postnatal day with bruising and respiratory distress due to a stranger spraying CS into his mouth. There was a widespread hyperemic erosive lesion in the mouth, tongue exfoliation, and leg ecchymosis. Widespread edema and hyperemia were observed in the vocal cords, and the patient was intubated and followed up. An epithelial defect involving the corneal limbus and conjunctiva was detected in the upper and lower eyelid membranes. Endoscopy revealed a grade 2 burn in the esophagus, and normal pseudomembrane and gastric mucosa in some areas. It was observed that the lesions around the patient's mouth and tongue completely resolved. After discharge, the esophagus-stomach-duodenum radiograph showed no suspicion of obstruction. At the 3rd-month post-discharge check-up, his eye examination was normal, and his stridor and wheezing at rest continued. This case, in which we have shown that CS used for self-defense or riot suppression, seriously threatens the life of a newborn patient for the first time and may perhaps cause permanent morbidities during follow-up, suggests the need to restrict access to such substances.