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SUMMARY OBJECTIVE: The objective of this study was to compare anthropometric data and pulmonary and extrapulmonary physical functional outcomes of short- and long-term use of inhaled corticosteroids in adults with asthma. METHODS: This cross-sectional study with retrospective analysis included clinically stable adults with asthma. Anthropometric data, exacerbation history, pulmonary function, disease control, dyspnea in daily life, quality of life, anxiety, depression, functional exercise capacity, performance in daily activities, body composition, physical activity level, respiratory muscle strength, lower limb strength, and handgrip strength were assessed and compared. Participants were separated into two groups based on the current duration of inhaled corticosteroids use below (short-term) or above (long-term) 3 years (≤3 years [n=37] and >3 years [n=30]) for comparative analysis. RESULTS: A total of 67 participants were analyzed (69% female, 49±14 years, body mass index 29±6 kg/m², FEV1 2.21±0.79 L). The group ≤3 years presented statistically higher spirometric values and exercise capacity compared to the group >3 years even after analysis of covariance adjustments for age, body mass index, disease control, and treatment duration (forced vital capacity 3.39 [3.09–3.70] L vs. 2.93 [2.59–3.26] L, p=0.048; FEV1 2.40 [2.17–2.63] L vs. 2.00 [1.75–2.25] L, p=0.023; 6-min walk test 567 [536–599] vs. 519 [484–554] m, respectively, p=0.048). All the other variables were similar between groups (p>0.05 for all). CONCLUSION: Participants who used inhaled corticosteroids for more than 3 years exhibited worse pulmonary function and exercise capacity. Despite this, exacerbation history, disease control, quality of life, anxiety, depression, and dyspnea in daily life, among other physical functional outcomes, were similar between short- and long-term use of inhaled corticosteroids in adults with asthma.

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SUMMARY INTRODUCTION: Children diagnosed with congenital Zika syndrome often experience stomatognathic disorders that may compromise caloric intake via oral feeding OBJECTIVE: The aim of this study was to assess the effects of gastrostomy on the growth and nutritional parameters of children with congenital Zika syndrome. METHODS: This prospective cohort study included children with congenital Zika syndrome who underwent gastrostomy and were followed up by the Center of Support for Children with Microcephaly in the state of Paraiba, in northeast Brazil. The study was conducted between April 2019 and May 2023. Children were assessed for growth and nutritional parameters using anthropometric measurements (weight, length, and body mass index) and body composition (body fat) around 1 year before gastrostomy (T0), up to 3 months before gastrostomy (T1), and around 1 year after gastrostomy (T2). RESULTS: A total of 18 children with a mean age of 47.2±18.7 months at the time of gastrostomy were assessed. Significant improvements were observed in weight-for-age (T1=-3.0±1.3 and T2=-2±1.9; p<0.05) after gastrostomy. However, 11.1 and 38.9% of the children remained below or very below the expected weight-for-age, respectively. CONCLUSION: Although gastrostomy may increase the anthropometric measures of children with congenital Zika syndrome, this increase may not be enough to achieve adequate weight.

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SUMMARY OBJECTIVE: The aim of this study was to investigate the diagnosis of sarcopenia in chronic liver disease by opportunistic computed tomography screening using the Psoas Muscle Index method as a predictor of mortality after liver transplantation. METHODS: We systematically searched PubMed, Scopus, and Cochrane Central Register of Controlled Trials from July 2014 to July 2024. We restricted inclusion in this meta-analysis to observational studies and clinical trials on adult patients with chronic liver disease diagnosed with sarcopenia by computed tomography undergoing liver transplantation or on a waiting list. We included the one with a larger sample size for studies with overlapping populations. We excluded studies with therapeutic interventions, animal experiments, cell-line studies, editorial pieces, commentaries, review articles, and case reports. RESULTS: After the removal of duplicate records and ineligible studies, 163 remained and were thoroughly reviewed based on inclusion criteria. Of these, a total of 11 studies were included in qualitative synthesis and four studies were included in quantitative analysis (meta-analysis), comprising 382 patients. Patients with muscle mass loss after liver transplantation diagnosed by computed tomography scan using the Psoas Muscle Index method had a 4.1 times higher risk of death than non-sarcopenic patients (random-effects model: OR 4.1386; 95%CI 2.4215–7.0730; p<0.0001). Interpretatively, a scale with an I2 value close to 0% indicates no heterogeneity. The other criteria also did not reject the hypothesis of homogeneity among the articles. CONCLUSIONS: Patients with muscle mass loss diagnosed by computed tomography using the Psoas Muscle Index method had a fourfold increased mortality risk after transplantation. The findings reinforce the need to identify sarcopenic patients preoperatively to optimize liver transplantation outcomes. Using the Psoas Muscle Index, an opportunistic diagnosis by computed tomography scan can be helpful in this setting.

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SUMMARY OBJECTIVE: The aim of this study was to investigate the relationship between the severity of hyperemesis gravidarum disease and subclinical inflammatory factors such as platelet crit, hemoglobin-to-red cell distribution width ratio, neutrophil-to-lymphocyte ratio, which are known to be closely associated with inflammation in patients with hyperemesis gravidarum. METHODS: This retrospective case–control study was conducted between December 2020 and December 2021. A total of 215 pregnant women, 102 with hyperemesis gravidarum and 113 healthy pregnant women, were included in the study. Hyperemesis gravidarum patients were divided into three groups according to the modified Pregnancy-Unique Quantification of Emesis and nausea classification as mild (n=38), moderate (n=32), and severe (n=32). RESULTS: Platelet crit, hemoglobin-to-red cell distribution width ratio, and neutrophil-to-lymphocyte ratio values were found to be statistically significantly higher in the hyperemesis gravidarum group compared to the control group (p<0.05). There was a mild-to-severe increase in platelet crit, hemoglobin-to-red cell distribution width ratio, and neutrophil-to-lymphocyte ratio values in hyperemesis gravidarum patients (p<0.05). Logistic regression analysis revealed that a one-unit increase in platelet crit, hemoglobin-to-red cell distribution width ratio, and neutrophil-to-lymphocyte ratio resulted in a 2.14-, 1.41-, and 2.36-fold increase in hyperemesis gravidarum risk, respectively. CONCLUSIONS: Platelet crit, hemoglobin-to-red cell distribution width ratio, and neutrophil-to-lymphocyte ratio are inflammatory markers that increase in patients with hyperemesis gravidarum and have predictive value for the development of hyperemesis gravidarum. In our study, we suggested the use of a new prognostic marker for patients with hyperemesis gravidarum. We believe that our study will be a source for future studies on hyperemesis gravidarum.

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SUMMARY OBJECTIVE: The aim of this study was to retrospectively investigate the musculoskeletal problems and health perceptions of women who applied to the orthopedic clinic after cesarean delivery. METHODS: This study used a descriptive and cross-sectional design. It was conducted with 243 women who sought treatment in an orthopedic clinic between January 2023 and May 2024. Women who agreed to participate in the study, who had a cesarean section for the first time, who did not have any musculoskeletal problems before the cesarean section, who had musculoskeletal problems for a year or more after the cesarean section, and who sought treatment in the orthopedics and traumatology outpatient clinic were included in the study. Data were collected through the "Personal Information Form," the "Extended Nordic Musculoskeletal Questionnaire," and the "Nottingham Health Profile." RESULTS: The average age of the participating women was 32.61±6.89 years. Of all the women, 44.8% experienced pain mostly in the back and lower back region within the last year following cesarean delivery. Nottingham Health Profile scores were negatively affected by several variables such as age, weight gained during pregnancy, BMI, and musculoskeletal disorders (p<0.050). An analysis of the effect sizes showed that Cohen's d values for back and lower back regions according to pain experience within the last year were 1.07 and 1.07, respectively, indicating a high effect size. CONCLUSIONS: Musculoskeletal problems, particularly in the back and lower back regions, negatively affect women's overall health perception after cesarean delivery.

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SUMMARY OBJECTIVE: This study aims to examine the relationship between pregnant women's perception of traumatic birth and their preference for the mode of delivery. METHODS: This cross-sectional study was conducted between April 12, 2023, and June 22, 2023, in the obstetrics and gynecology clinic of a state hospital in Turkey. The study population consisted of pregnant women who applied to the clinic during the study period. The inclusion criteria were being 18 years or older, having a singleton pregnancy between the 20th and 40th gestational weeks, and having no high-risk pregnancy conditions. The exclusion criteria included pregnancy through assisted reproductive techniques and the presence of intellectual disabilities. Participants meeting the inclusion criteria were selected through a non-probability random sampling method. Data were collected using a sociodemographic questionnaire, the traumatic childbirth perception scale, and the belief scale for normal delivery. RESULTS: Among the participants, 71.8% preferred cesarean section over vaginal delivery. A significant negative correlation was found between the perception of traumatic birth and the belief in and preference for vaginal delivery (r=-0.427, p<0.001). Pregnant women with a higher perception of traumatic birth were more likely to choose cesarean delivery. CONCLUSION: The findings suggest that a higher perception of traumatic birth is associated with a decreased preference for vaginal delivery. Addressing these concerns may help support informed decision-making regarding childbirth.

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SUMMARY OBJECTIVE: The aim of this study was to determine the predictors of body awareness in pregnant women. METHODS: A cross-sectional study was conducted with 149 women in their second and third trimesters of pregnancy in Turkey between August and November 2024. Participants completed a sociodemographic form, the Body Awareness Questionnaire, and the International Physical Activity Questionnaire-Short Form. Multiple linear regression was used to analyze the effects of age, number of pregnancies, gestational weeks, and physical activity levels on body awareness. RESULTS: Participants had a mean age of 27.69±4.82 years, a mean body mass index of 26.59±3.49, and a mean gestational week of 31.97±6.95. The average body awareness score was 92.52±15.48, and the mean physical activity level was 1,084.56±671.93 metabolic equivalent of task-minutes/week. Regression analysis showed that gestational weeks significantly predicted body awareness (β=-0.327, p<0.001), with decreased body awareness observed as the pregnancy progressed. No significant associations were found with age, number of pregnancies, or physical activity levels (p>0.05). CONCLUSION: Gestational weeks negatively influence body awareness in pregnant women. These findings highlight the importance of developing interventions to enhance body awareness during advanced stages of pregnancy.

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SUMMARY OBJECTIVE: Rhizobium spp. strains (formerly classified as Agrobacterium based on 16S rDNA analysis) are aerobic, motile, oxidase-positive, non-spore-forming gram-negative bacilli. Clinical manifestations associated with Rhizobium radiobacter infections vary widely, with bacteremia typically linked to intravenous catheter use. METHODS: This study analyzes the clinical and laboratory characteristics of 11 pediatric hematology and oncology patients at a tertiary referral hospital who had Rhizobium radiobacter-associated bloodstream infections over a 3-month period. RESULTS: Nine of the patients were male, and hematologic malignancy was the primary diagnosis in seven patients. Common risk factors included hospitalization within the last month, chemotherapy treatment, and the presence of an indwelling central venous catheter in all cases. Rhizobium radiobacter growth was detected an average of 13.5±16.6 days (range 1–54 days) after hospital admission, with 36% of patients being neutropenic at the time of culture positivity. Rhizobium radiobacter growth was detected in both catheter and peripheral blood cultures in six patients, whereas the microorganism was isolated exclusively from catheter cultures in four patients. Ten patients received antibiotic lock therapy, predominantly with amikacin (90%). Systemic antibiotic treatment involved a combination of beta-lactam and aminoglycoside antibiotics in 10 patients. Culture sterility was achieved in nine patients by the third day of antibiotic treatment. There were no cases of catheter extraction, thrombophlebitis, cardiac vegetation, reproductive complications, or mortality. CONCLUSION: In this first pediatric case series utilizing antibiotic lock therapy, effective treatment, strict isolation, and surveillance screenings led to favorable clinical outcomes for Rhizobium radiobacter-associated bloodstream infections in children with hematologic and oncologic conditions.

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SUMMARY OBJECTIVE: Cardiovascular mortality in schizophrenia and bipolar disorder patients is more than double that of the general population. There appears to be a dual effect between cardiovascular diseases and schizophrenia and bipolar disorder. Inflammation and increased oxidative stress cause cardiac remodeling and increase the severity of psychiatric illness. METHODS: Echocardiographic imaging was performed simultaneously with serum samples obtained for asymmetric dimethylarginine, symmetric dimethylarginine, monomethyl-L-arginine, arginine and its metabolites, and galectin 3 levels in 80 patients with bipolar disorder who were euthymic for at least 8 weeks and 69 patients with schizophrenia undergoing treatment. RESULTS: Monomethyl-L-arginine and arginine levels were significantly higher in bipolar disorder patients compared to schizophrenia patients. Galectin 3 level was significantly higher in bipolar disorder patients with psychotic symptoms compared to schizophrenia patients. There was no significant difference between the groups in terms of other parameters. Statistically significant differences were found between bipolar disorder and schizophrenia patients in terms of diastolic diameter (mm), systolic diameter (mm), interventricular septum (mm), left atrium (mm), and posterior wall (mm) values. CONCLUSION: Arginine and its metabolites, asymmetric dimethylarginine, symmetric dimethylarginine, and galectin 3, may be important biomarkers of cardiovascular diseases risk. In this study, changes in biochemical parameters and cardiac structure could not be explained by disease severity.

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SUMMARY OBJECTIVE: The aim of the study was to assess serum heat shock protein 90 alpha levels as a marker in preeclampsia. METHODS: This cross-sectional study was carried out in 2015 at Istanbul Cerrahpasa University, University Hospital for Obstetrics and Gynecology. The mild (n=60) and severe (n=60) preeclampsia groups were compared with healhty, uncomplicated pregnancies, matched for gestational age within ±1 week (n=120). The main inclusion criteria were women between 18 and 40 years old who had a singleton pregnancy. Pregnant women with any known medical diseases (chronic hypertension, renal diseases, inflammatory diseases, or infections), regular contractions with cervical changes, and premature rupture of membranes were excluded from the study. RESULTS: Median serum heat shock protein 90 alpha was significantly elevated in mild preeclamptic women compared to women in the gestational age-matched control group [3.41 vs. 2.62 ng/mL, p<0.001]. The mean serum heat shock protein 90 alpha levels were significantly elevated in the severe preeclampsia group compared to their gestational age-matched control group [3.94 vs. 2.55 ng/mL, p<0.001]. Mean serum heat shock protein 90 alpha levels were comparable between the mild and severe preeclampsia groups (3.41 vs. 3.94 ng/mL, p=0.407) and mild early-onset and severe early-onset groups (p=0.104). Serum heat shock protein 90 alpha showed a weak positive correlation with both systolic and diastolic arterial blood pressure. CONCLUSION: Heat shock protein 90 alpha level was elevated in preeclamptic patients. The level of heat shock protein 90 alpha in serum may be suitable for evaluating endothelial dysfunction.

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SUMMARY OBJECTIVE: The aim of this study was to compare the perinatal outcomes of pregnancies with intermittently absent end-diastolic umbilical artery Doppler flow and persistently absent flow, focusing on their implications for clinical management. METHODS: This retrospective cohort study was conducted at Basaksehir Cam and Sakura City Hospital between 2020 and 2023, and included 137 pregnancies diagnosed with either intermittently absent end-diastolic umbilical artery Doppler flow (n=38) or persistently absent flow (n=99). Demographic data, pregnancy complications, delivery details, and neonatal outcomes were analyzed. RESULTS: The mean latency from diagnosis to delivery was statistically significantly longer in the intermittently absent end-diastolic umbilical artery Doppler flow group (15.6 days) than in the persistently absent flow group (7.88 days; p<0.0001). The intermittently absent end-diastolic umbilical artery Doppler flow group demonstrated better outcomes, with a higher gestational age at delivery and improved Apgar scores. Notably, although the difference was not statistically significant, all stillbirths (n=4) occurred in the persistently absent flow group. No intergroup differences were found in terms of intensive care unit admission or neonatal intubation. CONCLUSION: This study highlights an important prognostic distinction between intermittently absent end-diastolic umbilical artery Doppler flow and persistently absent flow, with intermittently absent end-diastolic umbilical artery Doppler flow representing a less severe form of placental insufficiency. These findings provide valuable insights for optimizing antenatal surveillance strategies, suggesting that intermittently absent end-diastolic umbilical artery Doppler flow cases may be candidates for outpatient management, whereas persistently absent flow cases require more intensive monitoring.

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SUMMARY OBJECTIVE: The aim of this study was to identify the risk factors and potential causes of myocardial infarction with non-obstructive coronary arteries in patients presenting with acute coronary syndrome. METHODS: This retrospective case series study was conducted at the coronary intensive care unit of our hospital between January 2019 and December 2023. Of 3,107 acute coronary syndrome patients, 195 diagnosed with myocardial infarction with non-obstructive coronary arteries were included. Clinical characteristics, risk factors, laboratory test results, and electrocardiographic, echocardiographic, and coronary angiography findings were analyzed. Additionally, vitamin D, homocysteine, folate, and vitamin B12 levels were compared between myocardial infarction with non-obstructive coronary arteries patients and controls with non-occlusive coronary artery disease without acute coronary syndrome. RESULTS: Among a total of 3,107 acute coronary syndrome patients, 195 (6.28%) were diagnosed with myocardial infarction with non-obstructive coronary arteries. Their mean age was 53.9 years, and 83% of the patients were male. Hypertension (45%), diabetes mellitus (33%), and smoking (70%) were prominent risk factors. Myocardial bridge was the most common cause of myocardial infarction with non-obstructive coronary arteries (11.2%). The left anterior descending artery was the most frequent single vessel responsible for acute coronary syndrome (26%). Vitamin D, B12, and folate levels were statistically significantly lower in myocardial infarction with non-obstructive coronary arteries patients compared to controls (p<0.05). CONCLUSIONS: Smoking and hypertension were prominent risk factors for myocardial infarction with non-obstructive coronary arteries. Myocardial bridge was the most commonly identified cause, and vitamin D deficiency was significantly associated with myocardial infarction with non-obstructive coronary arteries.

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SUMMARY OBJECTIVE: Polycystic ovary syndrome, a prevalent endocrine disorder in reproductive-age women, is characterized by polycystic ovaries, oligoanovulation, and hyperandrogenemia. Epiregulin is a member of the epidermal growth factor (EGF) family, playing a crucial role in processes such as cell growth, differentiation, and proliferation. It is also known to be involved in reproductive system-specific mechanisms, including ovulation and oocyte maturation. This study aimed to investigate the role of epiregulin, an EGF family member implicated in ovulation and oocyte maturation, in women with polycystic ovary syndrome. METHODS: Serum epiregulin levels were analyzed in 39 women with polycystic ovary syndrome and 28 healthy controls. Associations between epiregulin and clinical/metabolic parameters such as body mass index, insulin resistance, and androgen levels were assessed. RESULTS: Women with polycystic ovary syndrome exhibited significantly lower epiregulin levels compared to controls (p<0.001). Epiregulin levels showed a negative correlation with polycystic ovary syndrome status and were inversely associated with body mass index, waist circumference, Homeostatic Model Assessment Insulin Resistance, triglycerides, fasting insulin, fasting glucose, and testosterone. CONCLUSION: Reduced epiregulin levels may contribute to the pathophysiology of polycystic ovary syndrome, highlighting its potential as a biomarker and therapeutic target. Further studies are needed to explore the underlying mechanisms and clinical implications.

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SUMMARY OBJECTIVE: The aim of this study was to investigate the relationship between smartphone usage and neck extensor muscle thickness through ultrasonographic evaluation. METHODS: A prospective cross-sectional study was conducted with 75 participants aged 18–40 years. Demographic data, smartphone usage patterns, and neck extensor muscle thickness were assessed. Smartphone addiction was evaluated using the short version of the Smartphone Addiction Scale. Statistical analyses included appropriate tests, with p<0.005 being considered statistically significant. RESULTS: Participants with smartphone addiction demonstrated statistically significantly higher Neck Disability Index scores compared to their non-addicted counterparts (p=0.001). Although no statistically significant differences were observed in muscle thickness between the addicted and non-addicted groups, smartphone usage duration negatively correlated with dominant trapezius thickness (ρ=-0.362, p=0.028). The age of smartphone use onset was positively correlated with the thickness of several muscles, including the splenius capitis on both the dominant (ρ=0.358, p=0.030) and non-dominant sides (ρ=0.487, p=0.002), and the average thickness of the splenius capitis (ρ=0.442, p=0.006) and semispinalis cervicis muscles (r=0.349, p=0.034). Regression analysis confirmed significant relationships between the age of onset and neck extensor muscle thickness. CONCLUSIONS: Prolonged smartphone use, especially when initiated at an early age, is associated with changes in neck extensor muscle morphology. Ultrasonographic evaluation revealed correlations between usage patterns and muscle thickness, highlighting the importance of preventive measures and ergonomic interventions to mitigate potential musculoskeletal risks associated with excessive smartphone use.

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SUMMARY OBJECTIVE: The aim of this study was to compare the effectiveness of exercise, transcutaneous electrical nerve stimulation, and manual therapy on pain intensity, maximum mouth opening, and masticatory muscle activity-during chewing of the masseter and temporalis anterior in myogenous temporomandibular disorders. METHODS: A total of 51 myogenous temporomandibular disorders patients were randomly assigned to three groups: exercise group, transcutaneous electrical nerve stimulation group, and manual therapy group. For 6 weeks, exercise group received exercise only, transcutaneous electrical nerve stimulation group received exercise+transcutaneous electrical nerve stimulation, and manual therapy group received exercise+manual therapy. At baseline and after 6-week treatment, pain intensity was assessed using a visual analog scale, maximum mouth opening using a millimeter ruler, and masticatory muscle activity-during chewing of the masseter and temporalis anterior using surface electromyography. RESULTS: After treatment, significant improvements in pain intensity, maximum mouth opening, and masticatory muscle activity-during chewing values were found in all the three groups. The greatest improvements were seen in manual therapy group. The decreases in pain intensity and increases in masticatory muscle activity-during chewing values were statistically significantly higher in transcutaneous electrical nerve stimulation group than in exercise group (p<0.05). The increases in maximum mouth opening were similar in transcutaneous electrical nerve stimulation group and exercise group. CONCLUSION: Exercise is an effective method for improving pain intensity, maximum mouth opening, and masticatory muscle activity-during chewing in myogenous temporomandibular disorders. Combining exercise with manual therapy may provide the highest therapeutic effect on these parameters. Combining exercise with transcutaneous electrical nerve stimulation may also lead to further improvements in pain intensity and masticatory muscle activity-during chewing.

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SUMMARY OBJECTIVE: The aim of the study was to compare the hand function (grip strength and grip endurance, manual dexterity, and perceived hand functional disability) of participants with gout, rheumatoid arthritis, and healthy control. METHODS: Grip strength and grip endurance were assessed using a hand dynamometer, while manual dexterity was evaluated through the Nine-Hole Peg Test. Perceived hand functional disability was measured using the Duruöz Hand Index. RESULTS: The grip strength was similar between gout and healthy control (p>0.05). Dominant and non-dominant grip endurance in gout were lower than healthy control (p=0.008, p=0.001). The dominant placing, removing, and total Nine-Hole Peg Test time of gout compared to healthy control were higher (p=0.001, p<0.001, and p<0.001). The non-dominant placing, removing, and total Nine-Hole Peg Test time of gout were higher than healthy control (p=0.002, p=0.004, and p=0.002). The Duruöz Hand Index in gout was higher than healthy control (p=0.002), but lower than rheumatoid arthritis (p=0.008). CONCLUSION: Our findings indicate that individuals with gout experience impairments in grip strength, manual dexterity, and perceived hand function. Assessing hand function during clinical examinations of patients with gout should be considered.

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SUMMARY OBJECTIVE: The Nottingham Prognostic Index, Ki-67 Prognostic Index, and combination of platelet count and lymphocyte-to-monocyte ratio have shown prognostic significance in breast cancer. This aim of the study was to compare combination of platelet count and lymphocyte-to-monocyte ratio with Nottingham Prognostic Index and Ki-67 Prognostic Index in early-stage breast cancer. METHODS: A retrospective cohort study included 321 women aged ≥18 years diagnosed with early-stage breast cancer (2010–2020) who did not receive neoadjuvant chemotherapy. Data were extracted from records, with laboratory values collected preoperatively, postoperatively, and at 6-month and 1-year intervals. Regression and survival analyses evaluated the predictive value of combination of platelet count and lymphocyte-to-monocyte ratio, Nottingham Prognostic Index, and Ki-67 Prognostic Index for disease-free survival and overall survival. RESULTS: The mean age at diagnosis was 53.3 years. The mortality rate was 6.2%, and recurrence occurred in 9.3% of patients. Univariate regression showed age as the sole factor influencing overall survival (HR 1.063, p<0.001). Factors associated with disease-free survival included Luminal-B subtype (HR 3.790, p=0.029), estrogen receptor negativity (HR 15.710, p=0.007), human epidermal growth factor receptor 2 positivity (HR 4.833, p<0.001), Nottingham Prognostic Index (HR 1.967, p=0.009), and Ki-67 Prognostic Index stage (HR 1.908, p=0.008). Multivariate analysis identified age as the only significant predictor for overall survival, while human epidermal growth factor receptor 2-negativity was the sole independent factor for disease-free survival. CONCLUSION: Combination of platelet count and lymphocyte-to-monocyte ratio did not show significant prognostic value in early-stage hormone receptor-positive breast cancer. However, Nottingham Prognostic Index and Ki-67 Prognostic Index were strong predictors, particularly for disease-free survival.

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SUMMARY OBJECTIVE: Colorectal cancer is a common and often fatal malignancy, and predicting survival can help guide treatment decisions. This study aimed to investigate the impact of clinicopathological characteristics and nutritional status on survival in patients with metastatic colorectal cancer receiving first-line treatment with 5-fluorouracil in combination with monoclonal antibodies (bevacizumab, cetuximab, or panitumumab). METHODS: This prospective, non-interventional, observational, single-center study included 150 adult patients with metastatic colorectal cancer undergoing first-line therapy. Demographic data, cancer-related characteristics, laboratory parameters, and nutritional status assessed via the Mini Nutritional Assessment–Short Form were recorded prior to treatment initiation. Mini Nutritional Assessment–Short Form scores of 12–14, 8–11, and 0–7 were used to define normal nutritional status, risk of malnutrition, and malnutrition, respectively. RESULTS: The mean ages of patients without and with malnutrition were 60±11 and 62±11 years, respectively. Median progression-free survival and overall survival were 12 and 22 months, respectively. Multivariate analysis identified alcohol history (HR=2.83; 95%CI 1.27–6.34; p=0.011) and Mini Nutritional Assessment–Short Form≤7 (HR=1.93; 95%CI 1.09–3.45; p=0.025) as significant predictors of shorter progression-free survival. Mini Nutritional Assessment–Short Form ≤7 (HR=2.96; 95%CI 1.80–4.89; p<0.001) was also significantly associated with decreased overall survival. CONCLUSION: Among patients with metastatic colorectal cancer receiving first-line therapy, malnutrition (Mini Nutritional Assessment–Short Form≤7) and a history of alcohol use were associated with poorer survival outcomes. These findings underscore the importance of routine nutritional assessment and support the need for further prospective multicenter studies to validate these results.

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SUMMARY OBJECTIVE: Multidisciplinary treatment is the standard of care for patients with cancer of the rectum. Neoadjuvant therapy decisions rely on the local carcinoma stage's magnetic resonance imaging assessment. However, the reliability of magnetic resonance imaging in evaluating mesorectal lymphadenopathy remains highly questionable. METHODS: A prospective clinical study was conducted to assess the accuracy of preoperative magnetic resonance imaging in assessing T-stage and N-stage rectal carcinoma. The magnetic resonance imaging findings were compared with those of a detailed histopathological examination of rectal specimens in each patient. RESULTS: The study included 48 patients with cancer of the rectum who had undergone rectal resection with total mesorectal excision. The magnetic resonance imaging assessment of the T-stage was accurate in 26 out of the 48 cases (54.2%). Overstaging of the T-stage was recognized in 18 patients (37.5%), and 4 (8.3%) were understaged. According to preoperative magnetic resonance imaging (using Horvat's criteria), 56 suspicious/malignant lymph nodes were identified. However, only 13 (23.2%) of these lymph nodes were proved malignant on histopathology examination. The sensitivity of magnetic resonance imaging for nodal involvement assessment was 52.0% and specificity was 93.6%. Of the 646 magnetic resonance imaging-negative lymph nodes, 12 (1.9%) were false negatives (histopathology revealed metastatic lymph nodes). Of note, 20 study patients with malignant lymphadenopathy (according to magnetic resonance imaging) were detected. The magnetic resonance imaging diagnosis of malignant lymphadenopathy was correct in only 30.0% of these patients. CONCLUSION: The accuracy of magnetic resonance imaging in evaluating mesorectal lymph nodes for cases with cancer of the rectum is remarkably low. Therefore, neoadjuvant therapy indications should be based primarily on the magnetic resonance imaging description of the depth of carcinoma invasion.

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SUMMARY OBJECTIVE: The aim of this study was to compare the characteristics of pregnancies that resulted in fetal death before and during the COVID-19 pandemic in a private maternity hospital in Rio de Janeiro, Brazil. METHODS: This retrospective cohort study considered all pregnancies that ended in fetal death in a private maternity hospital in Rio de Janeiro, Brazil, from January 2018 to December 2021. Maternal and fetal characteristics were compared between the periods before the pandemic and during the pandemic. Data were extracted from electronic medical records, and statistical analyses included Student's t-test, chi-square test, and Fisher's exact test where applicable. RESULTS: Among 41,162 deliveries at Casa de Saúde Perinatal, 88 (0.21%) resulted in fetal death, with 38 (43.2%) occurring pre-pandemic (2018–March 2020) and 50 (56.8%) during the pandemic (March 2020–2021). Maternal demographics, comorbidities, and prepartum complications showed no statistically significant differences between groups. COVID-19 infection was identified in 12% of the pandemic-group pregnancies, but no significant disparities in fetal death causes or abnormalities were found. CONCLUSIONS: No significant differences were observed in maternal or fetal characteristics, prepartum complications, or fetal mortality rates between the pre-pandemic and pandemic periods in this private hospital setting. However, this does not reflect the broader Brazilian healthcare reality, where disparities in access and resources may have influenced outcomes differently.