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SUMMARY OBJECTIVE: The aim of the study was to evaluate the incidence of early-onset neonatal sepsis and other perinatal adverse outcomes associated with not screening for group B beta-hemolytic Streptococcus. METHODS: A retrospective cohort study was conducted by searching electronic medical records from 2018 to 2022. Group B beta-hemolytic Streptococcus culture was performed after routine collection of vaginal and anal swabs from pregnant women at any time of pregnancy.. RESULTS: A total of 968 pregnant women were included; 69.3% (675/968) were screened for group B beta-hemolytic Streptococcus, and 30.3% were not screened for group B beta-hemolytic Streptococcus. Of the pregnant women who were screened, 30.5% (206/675) had positive cultures and 69.5% (469/675) had negative cultures for group B beta-hemolytic Streptococcus. Pregnant women who underwent group B beta-hemolytic Streptococcus screening had a lower prevalence of preterm birth (p<0.0001), neonatal intensive care unit (NICU) admission (p=0.001), and neonatal death within 48 h (p=0.002). Group B beta-hemolytic Streptococcus screening was an independent predictor of preterm birth (p<0.0001). The best model for neonatal death in the first 48 h included group B beta-hemolytic Streptococcus screening (p=0.035) and NICU admission (p=0.016). Antibiotic use (p=0.040), preterm birth (p<0.0001), premature rupture of ovular membranes (p=0.047), premature delivery (p<0.0001), and chorioamnionitis (p=0.001) were associated with an increased risk of early-onset neonatal sepsis. CONCLUSIONS: Screening for group B beta-hemolytic Streptococcus was not significantly associated with early-onset neonatal sepsis, but it was an independent predictor of preterm birth.

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SUMMARY OBJECTIVE: The aim of this study was to assess the relationship between hypophosphatemia and osteoporosis in people living with HIV on antiretroviral therapy, and to identify risk factors associated with both conditions. METHODS: This was a cross-sectional, analytical study of 96 patients at a clinic in Belém-PA. Data collection included serum phosphorus, calcium, vitamin D, parathyroid hormone, renal parameters, and bone mineral density (T-score). Student's t-test, Mann-Whitney U test, chi-square test, or Fisher's exact test was applied, as well as multiple logistic regression for hypophosphatemia and osteoporosis. RESULTS: Of the 96 patients, 24 (25%) had hypophosphatemia, with a male predominance (75%). There was a statistically significant association (p<0.05) between hypophosphatemia and longer duration of infection and use of antiretroviral therapy, as well as a higher prevalence in men. Regimens containing tenofovir disoproxil fumarate showed an increased risk of hypophosphatemia, although logistic regression did not confirm significance at the 5% level. As for osteoporosis, there was an association with female gender and age but no direct relationship with hypophosphatemia. CONCLUSION: Hypophosphatemia was significantly associated with male gender, prolonged infection, and the use of antiretroviral therapy, especially regimens with tenofovir disoproxil fumarate. There was no statistical correlation between hypophosphatemia and osteoporosis, but female gender and advanced age were risk factors for the latter. These findings highlight the importance of monitoring bone and kidney parameters in people living with HIV, especially those on long-term tenofovir disoproxil fumarate, with a view to more effective preventive and therapeutic strategies.

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SUMMARY BACKGROUND: Postoperative care after McKeown esophagectomy remains challenging. The aim of this study was to evaluate retrograde gastric decompression and feeding as an alternative to nasogastric decompression and nasogastric-jejunal feeding. METHODS: This retrospective study analyzed 142 esophageal cancer patients undergoing McKeown esophagectomy (between June 2020 and August 2022): retrograde gastric decompression and feeding (n=74) vs. nasogastric-jejunal (n=68). Outcomes included operative parameters, complications, and recovery metrics. RESULTS: Retrograde gastric decompression and feeding required longer operative time (183.0±41.7 vs. 169.4±32.6 min, p=0.031) but showed comparable blood loss, R0 resection rates (95.9 vs. 97.1%), and lymph node yield. Gastric tube retention was shorter with retrograde gastric decompression and feeding (3.2±1.6 vs. 3.6±1.4 days). Complication rates (anastomotic leak: 10.8 vs. 10.3%; respiratory: 16.2 vs. 16.2%) and in-hospital mortality (1.4 vs. 1.5%) were similar. Tube-related complications trended lower with retrograde gastric decompression and feeding (5.4 vs. 10.3%, p=0.276). CONCLUSION: Retrograde gastric decompression and feeding is a safe, effective method for enteral nutrition and decompression post-esophagectomy.

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SUMMARY OBJECTIVE: The aim of this study was to develop a mobile application for the management of overactive bladder by means of urinary diaries. The application was designed to enhance usability and user satisfaction, with the Analyze, Design, Develop, Implement, Evaluate model serving as the overarching systematic framework. METHODS: The Analyze, Design, Develop, Implement, Evaluate model guided the development process, starting with analyzing patient and professional needs. User-centered mockups were designed, leading to a functional prototype. The app was developed, tested through assigned tasks, and evaluated for usability using scales, qualitative data, and feedback. RESULTS: Most healthcare professionals and patients found the tasks "very easy" or "easy." Average completion times were 13 min for patients and 9 min for professionals. Participants gave positive feedback, describing the application as intuitive and easy to use. No critical errors were identified, and satisfaction levels were high. CONCLUSION: The mobile app showed high usability and user satisfaction, demonstrating its potential to enhance overactive bladder management and improve patient care efficiency.

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SUMMARY OBJECTIVE: The aim of the study was to research the effective factors on decision-making process to terminate or continue the pregnancy in trisomy 21. METHODS: A total of 103 patients who had a confirmed trisomy 21 diagnosis in a tertiary center were involved in this study. Demographic data, obstetric history, educational status, family income, and maternal employment were compared between termination of pregnancy and continuation of pregnancy (non-termination of pregnancy) groups. Also, possible effective factors on parents’ decisions were evaluated by a questionnaire. RESULTS: Maternal age, number of miscarriages, number of living children, maternal and paternal educational status, family income, maternal working status, and detected fetal anomalies were not found to be effective on the decision-making process. Early diagnosis was correlated with a higher termination of pregnancy ratio. Psychological and economic factors, concerns of having less time and energy for other children, and career concerns were significantly effective in the termination of pregnancy group. While in the non-termination of pregnancy group, religious factors were the main concern. CONCLUSION: Gestational age at diagnosis, psychological factors, economic status, and religious concerns seem to be the possible factors behind deciding termination of pregnancy in pregnancies with trisomy 21.

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SUMMARY OBJECTIVE: Endometrial hyperplasia is a precursor lesion that may progress to endometrial carcinoma, particularly in cases with atypia. Early and accurate diagnosis is essential for timely intervention. The aim of the study was to evaluate the diagnostic performance of shear wave elastography in differentiating normal endometrium, non-atypical hyperplasia, and atypical hyperplasia in premenopausal women with abnormal uterine bleeding. METHODS: This prospective study included 235 premenopausal women over 45 years of age with abnormal uterine bleeding. All patients underwent transvaginal ultrasonography and shear wave elastography using a Toshiba Aplio 500 system. Five regions of interest were placed within heterogeneous endometrial areas, and mean shear wave elastography (mean-SWE) and highest shear wave elastography (highest-SWE) values were recorded. Histopathological evaluation was performed via probe curettage, and patients were categorized into three groups: normal endometrium, non-atypical hyperplasia, and atypical hyperplasia. Receiver operating characteristic curve analysis and logistic regression were conducted. RESULTS: Mean-SWE and highest-SWE values were significantly higher in the hyperplasia groups compared to the normal endometrium group (p=0.021, p=0.001). Highest-SWE had the highest diagnostic accuracy (cut-off: 37.71 kPa, sensitivity: 85.9%, specificity: 48.0%). Logistic regression identified body mass index, uterine free fluid, mean-SWE, and highest-SWE as independent predictors of endometrial hyperplasia (p<0.05). CONCLUSIONS: Shear wave elastography demonstrated significant potential as a non-invasive tool for diagnosing endometrial hyperplasia. Mean-SWE and highest-SWE were independent predictors, supporting shear wave elastography as a complementary method to transvaginal ultrasonography. Future research should optimize shear wave elastography protocols for gynecological assessments.

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SUMMARY OBJECTIVE: Chronic edema in the lower extremities leads to significant negative effects on the quality of life, body image perception, satisfaction, self-confidence, and self-esteem of affected individuals. The aim of this study was to evaluate body image, quality of life, and related factors in patients with chronic lower extremity edema due to lymphedema and lipedema. METHODS: This cross-sectional study included 14 lymphedema and 12 lipedema patients receiving treatment at the lymphedema unit. Individuals aged 18–65 years with a confirmed diagnosis were enrolled; those with active infections, malignancies, or systemic diseases were excluded. Body image, dysfunctional thoughts about appearance, and quality of life were evaluated using the Body Cathexis Scale, Beliefs About Appearance Scale, and Lymphedema Quality of Life scale. Circumference measurements of the lower extremities were taken before and after 20 sessions of manual lymphatic drainage therapy. Quantitative data were analyzed to compare the two groups and assess correlations between clinical and psychosocial parameters. RESULTS: No significant differences were observed between the lymphedema and lipedema groups in terms of age, body mass index, or pre-treatment Body Cathexis Scale, Beliefs About Appearance Scale, and Lymphedema Quality of Life scale scores (p>0.05). After 20 sessions of manual lymphatic drainage therapy, both groups showed reductions in limb circumference measurements (p<0.05). Reductions in limb size were moderately associated with improvements in Body Cathexis Scale and Lymphedema Quality of Life scale scores (p<0.05). Post-treatment improvements in body image and quality of life scores were observed in both groups. CONCLUSIONS: This study highlights that patients with lower extremity lymphedema and lipedema experience significant body image disturbances and reduced quality of life. Manual lymphatic drainage therapy improves limb circumference, body image, and quality of life.

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SUMMARY OBJECTIVE: The present research was conducted to determine the empathic skills and self-compassion of midwifery students entering clinical practice. METHODS: This study was designed as descriptive and cross-sectional. This study was performed with all midwifery students studying in the midwifery department of a public university and entering clinical practice between January 15 and March 15, 2024. The aim of this study was to reach the whole population (n=420) and 280 people constituted the sample (66.7%). The study data were collected face-to-face using the "Personal Information Form," "Empathic Tendency Scale," and "Self-Compassion Scale." RESULTS: Of the midwifery students participating in the study, 56.1% stated that they entered their department willingly, and 71.1% indicated that they were satisfied with the department they studied in. The mean score of midwifery students on the Empathic Tendency Scale was 142.25±18.74, and their mean score on the Self-Compassion Scale was 76.65±14.76. A statistically significant difference was identified between students’ grade level and their empathic skills and self-compassion levels (p<0.05). Second-year students scored significantly higher in empathy (p<0.001), suggesting curricular influences. Despite moderate self-compassion, high self-criticism subscale scores may reflect cultural norms. Findings highlight the need for empathy-supportive training, particularly in later clinical years. CONCLUSION: This study found that midwifery students entering clinical practice had moderate empathic skills and self-compassion and concluded that education affected empathic skills and self-compassion.

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SUMMARY OBJECTIVE: Mediastinal neoplasms are relatively rare tumors that require surgical or non-surgical treatment, and they harbor a wide variety of cell types. The aim of this study was to evaluate the surgical outcomes and prognosis of patients who underwent surgery for mediastinal masses. METHODS: The age, gender, symptoms, comorbid factors, radiological findings, preoperative diagnostic steps, surgical procedure, mortality, complications, length of hospital stay, histopathological diagnosis, and survival of 118 patients with mediastinal masses operated on for diagnosis and treatment between January 2013 and December 2018 were retrospectively analyzed. RESULTS: When the mediastinal masses were evaluated according to compartments, the most common mass was found in the anterior mediastinum (n=72, 61%). While 83.3% of malignant lesions were located in the anterior mediastinum, no malignant lesion was detected in the posterior mediastinum. There was a significant correlation between the compartment where the mass was located and its malignancy. A significant increase in the malignancy rate was observed among male patients. The likelihood of malignancy increased with increasing tumor size (p=0.002). Complications were shown to significantly extend the length of hospitalization (p=0.018). Overall survival was found to be at an average of 71.46±2.1 months. The 5-year survival rate was found to be 88.1%. There was a significant difference in survival between genders, in favor of the female sex (p=0.02). CONCLUSION: Considering the low morbidity and mortality rates of mediastinal masses, surgical intervention should be performed promptly for the diagnosis and treatment of mediastinal masses. With videothoracoscopy, adequate biopsies can be obtained from unresectable masses and complete excision of benign lesions can be achieved safely.

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SUMMARY OBJECTIVE: Musculoskeletal disorders are highly prevalent among healthcare workers due to physically demanding tasks and stressful work conditions. These disorders contribute to decreased work performance, pain, and impaired quality of life. Sleep quality is an essential factor in overall health and has been linked to pain perception and musculoskeletal health. However, the relationship between musculoskeletal disorders and sleep quality remains unclear. The aim of this study was to investigate the prevalence of musculoskeletal disorders among healthcare workers, identify associated risk factors, and examine the relationship between musculoskeletal disorders and sleep quality. METHODS: This cross-sectional study was conducted in a state hospital in Kırşehir, Turkey, with 249 healthcare workers. Participants completed a sociodemographic questionnaire, the Cornell Musculoskeletal Disorders Questionnaire to assess musculoskeletal disorders, and the Pittsburgh Sleep Quality Index to evaluate sleep quality. Statistical analyses included Pearson's correlation test, t-test, and analysis of variance to examine associations between musculoskeletal disorders, sleep quality, and other risk factors. RESULTS: A significant relationship was found between musculoskeletal disorders and sleep quality (p<0.001). Healthcare workers with poor sleep quality reported higher Cornell Musculoskeletal Disorders Questionnaire scores. Additionally, musculoskeletal disorder prevalence was significantly associated with working hours (p=0.018) and income level (p=0.047). Nurses had the highest musculoskeletal disorder scores among occupational groups. CONCLUSION: Musculoskeletal disorders in healthcare workers are influenced by sleep quality, working hours, and income level. Ergonomic interventions and policies to improve sleep quality may help reduce musculoskeletal disorder prevalence and enhance overall well-being in this workforce.

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SUMMARY OBJECTIVE: Studies reporting the outcomes of patients after surgical repair of uterine isthmoceles usually have small patient populations. Therefore, the aim of the study was to contribute to the literature by reporting the outcomes of surgical repair of uterine isthmoceles in Turkish women. METHODS: This retrospective study included 41 patients who underwent surgical repair for symptomatic uterine isthmoceles. The patients were divided into two groups: those who underwent vaginal operative hysteroscopy and those who underwent abdominal laparoscopy and laparotomy. RESULTS: Surgical repair was performed vaginally in 29 patients (70.7%) using operative hysteroscopy and abdominally (laparotomy and laparoscopy) in 12 patients (29.3%). The isthomocele sac size, mean operative time, and median hospital stay were significantly shorter in the hysteroscopically repaired group (p<0.01, p=0.03, and p<0.01, respectively). Six months after surgery, the rate of persistent isthmocele sac was higher in the hysteroscopically repaired group (p<0.01). The myometrial thickness in the area of the repaired isthmocele sac was thicker in the abdominally repaired group (p<0.01). Among the 12 patients who desired pregnancy and underwent surgical repair, 58.3% (n=7) conceived spontaneously. Of these pregnancies, 71.4% were intrauterine and 28.6% were cesarean scar. CONCLUSION: Hysteroscopic repair of uterine isthmoceles is advantageous, as it contributes to a shorter operative time and shorter hospital stay. However, complete removal of the isthmocele sac via the abdominal route appears to be more beneficial in terms of live birth rates in future pregnancies. Therefore, we recommend laparoscopic or laparotomic isthmocele repair in patients with fertility desires.

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SUMMARY OBJECTIVE: The aim of the study was to evaluate the role of body composition parameters measured via computed tomography before and after neoadjuvant chemoradiotherapy in predicting pathological response in patients with locally advanced rectal cancer. METHODS: Eighty-four patients with locally advanced rectal cancer who underwent neoadjuvant chemoradiotherapy followed by curative surgery were retrospectively analyzed. Computed tomography images obtained before and after neoadjuvant chemoradiotherapy were used to assess total adipose area, visceral adipose tissue, subcutaneous adipose tissue, adipose tissue density, psoas muscle area, psoas muscle density, and mesorectal adipose volume and density at the level of the L3 vertebra. Pathological response was determined using the Ryan Tumor Regression Grade system. Baseline values and percentage changes (Δ) during treatment were compared between response groups. RESULTS: Of the 84 patients, 31 (36.9%) showed a pathological response. There were no significant differences in demographic or clinical features between the groups. Among baseline body composition metrics, only psoas muscle density was significantly higher in the response group (p=0.015). Post-treatment analysis revealed a significant difference only in the percentage change in psoas muscle density (ΔPMD) (p=0.023). No other baseline or percentage change values for total adipose area, subcutaneous adipose tissue, visceral adipose tissue, mesorectal adipose volume, or psoas muscle area were significantly associated with pathological response (p>0.05). CONCLUSION: In patients with locally advanced rectal cancer, neither abdominal adipose composition nor mesorectal adipose volume nor psoas muscle area was predictive of response to neoadjuvant chemoradiotherapy. However, psoas muscle density, a potential indicator of muscle quality, may serve as a promising biomarker for predicting pathological response based on both baseline value and treatment-induced changes.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate the effectiveness of cerebral pulse oximetry in improving early results (30 days) of surgical outcomes and patient safety during carotid endarterectomy, focusing on its role in guiding selective shunt use and reducing procedure-related complications. METHODS: A retrospective review was conducted on 179 patients who underwent carotid endarterectomy at a cardiovascular surgery clinic (2010–2020). The study emphasized adherence to ethical standards, rigorous data analysis, and stringent participant inclusion criteria and evaluated the impact of cerebral pulse oximetry on surgical outcomes. RESULTS: Cerebral pulse oximetry significantly influenced intraoperative decisions. Mean total operative time and cross-clamp duration were significantly reduced in the group cerebral pulse oximetry (66.96±8.21 vs. 57.41±7.24 min and 28.68±4.20 vs. 18.63±3.91 min, respectively). Routine shunt placement was also lower in this group, with usage reported in only 0.9 vs. 47.2%. CONCLUSION: Cerebral pulse oximetry during carotid endarterectomy may reduce the necessity for routine shunt placement, minimizing associated risks and enhancing operative efficiency.

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SUMMARY OBJECTIVE: The aim of this study was to determine the knowledge and attitudes of pregnant women about endocrine disruptors. METHODS: This cross-sectional and descriptive study was conducted with 313 pregnant women who visited the obstetrics clinic of a state hospital. Data were collected through face-to-face interviews using a Personal Information Form and the Endocrine Disruptors Attitude Scale. Data analysis was performed using SPSS 25.0, with a significance level of p<0.05. RESULTS: The average age of the pregnant women was 28.52±4.52 years. It was found that 62% of the pregnant women had more than 8 years of education, only 20.8% had prior knowledge about endocrine disruptors, and 30.7% of these obtained more information from social and visual media. Pregnant women scored an average of 76.26±9.33 on the Endocrine Disruptors Attitude Scale and were found to have a moderate protective attitude toward endocrine disruptors. It was determined that women who did not consume alcohol during pregnancy and were previously knowledgeable about endocrine disruptors scored significantly higher on the Endocrine Disruptors Attitude Scale (p<0.05). CONCLUSION: In this study, it was determined that the attitudes of pregnant women toward endocrine disruptors were generally at a moderate level, and that the level of knowledge about endocrine disruptors during pregnancy could have an effect on the attitude.

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SUMMARY OBJECTIVE: The aim of this study was to determine the effect of the Health Belief Model-based training provided to women via WhatsApp on their health beliefs about mammography, self-efficacy levels, and regular mammography behavior. METHODS: This randomized controlled experimental trial was conducted with 81 women (41 experimental and 40 control), aged 40–69 years, who were literate, able to use WhatsApp, and had no communication barriers, and had no history of breast cancer. Participants were recruited from a Cancer Early Diagnosis, Screening, and Education Center in eastern Turkey. The experimental group was sent training content via WhatsApp once a week for 7 weeks, individual counseling was provided, and the training video was shared in the last week. Data were collected using the "Questionnaire on Descriptive Characteristics," "Health Belief Model Scale for Breast Cancer Screening," and "Mammography Self-Efficacy Scale." RESULTS: The demographic characteristics of the two groups were similar (p>0.05). After the training, it was determined that women in the experimental group had significantly higher averages in all sub-dimensions of the Health Belief Model Scale for Breast Cancer Screening and Mammography Self-Efficacy Scale compared to the control group (p<0.05). It was also observed that 70% of the women in the experimental group underwent mammography after the training. CONCLUSION: Health Belief Model-based education delivered via WhatsApp positively affected women's health beliefs and mammography behaviors, demonstrating the effectiveness of education delivered through digital platforms.

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SUMMARY BACKGROUND: Prolonged hospitalization increases the risk of adverse events and resource overuse. In dual public-private systems like Brazil's, it is unclear how much hospital length of stay reflects clinical needs versus systemic delays. OBJECTIVE: The aim of the study was to quantify clinical and non-clinical contributions to length of stay in medical inpatients and compare patterns between public (Unified Health System [SUS]) and privately insured patients. METHODS: We conducted a prospective multicenter cohort study including 5,423 adults admitted via the emergency department to internal medicine wards in three Brazilian hospitals (2009–2022). Physicians recorded daily whether ongoing hospitalization was clinically necessary or due to delays (e.g., tests, specialist input, administrative or social issues). Statistical analyses included multivariate models adjusted for comorbidities and frailty. RESULTS: The mean length of stay was 11.8±5.2 days, but only 38% (4.5±2.6 days) were clinically justified. The remainder resulted from non-clinical delays, particularly in diagnostics (2.9±3.1 days) and specialist input (1.9±1.5 days). SUS patients had longer stays than those privately insured (13.2 vs. 10.1 days; p<0.001), despite similar clinical complexity. These differences remained significant after adjustment. SUS patients were more likely to stay ≥12 days (OR 1.76), wait ≥3 days for tests (OR 1.89), and ≥2 days for specialist evaluations (OR 1.67). CONCLUSION: Most hospital days were not due to clinical needs. Diagnostic and specialist delays, especially in the public system, were key contributors to prolonged length of stay, highlighting structural inefficiencies and the need for system-wide reforms.

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SUMMARY OBJECTIVE: Since a significant number of professionals in Brazil did not hold a specialist title, the aim of this study was to describe and analyze the supply of Lato Sensu Postgraduate courses in medicine. METHODS: Lato Sensu Postgraduate courses offered between February and May 2024 were surveyed using the e-MEC platform (Ministry of Education) and the websites of the offering institutions. The variables considered were medical specialty, number of places, workload, price, teaching modality, and public or private nature. Descriptive analyses and statistical tests of association were performed. RESULTS: A total of 2,148 Lato Sensu Postgraduate courses aimed at doctors were identified and offered by 373 institutions, the majority (60.7%) of which were located in the Southeast, with half having a total workload of up to 420 h. The average duration was 13.3±7.4 months; there were 30.6±59.6 vacancies on offer, and the average total price was R$15,782.44±35,372.88. Approximately 90% were paid for, and 41.2% were distance-learning courses, the latter of which had a shorter duration, lower cost, and more places than other types of education. CONCLUSION: Lato Sensu Postgraduate courses in medicine in Brazil reflect a heterogeneous, predominantly private universe with great variation in the characteristics of the courses on offer. This dispersion indicates the need for better regulation of Lato Sensu Postgraduate supply and marketing in Brazil, and in this way, the current study has important implications for education improvement.

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SUMMARY OBJECTIVE: The aim of this study was to estimate the prevalence of electronic cigarette use and to explore the perceptions and beliefs of university students regarding their use. METHODS: This is a cross-sectional study involving 437 students from higher education institutions of Guanambi, Bahia. A questionnaire based on five previous studies on electronic cigarette perceptions among students was applied, consisting of 25 questions addressing student characteristics, knowledge, and experimentation with electronic cigarettes. Bivariate analyses were performed to assess the relationship between electronic cigarette use, age, perceptions, and beliefs, using the chi-square test. RESULTS: The prevalence of electronic cigarette use was 39.2%, with no statistically significant difference between genders. The age of initiation was related to the places of use, predominantly parties and socialization environments. Individuals who used electronic cigarettes believed that they were more socially acceptable than conventional cigarettes and viewed them as a tool for smoking cessation. CONCLUSION: The results indicate a significant prevalence of electronic cigarette use among university students, with varied perceptions of its risks and benefits.