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SUMMARY Objective: This study aims to evaluate the primary signs and symptoms in patients diagnosed with breast cancer and meningeal carcinomatosismeningeal carcinomatosis, assess the prognostic role of these symptoms at the time of diagnosis, and correlate them with prognostic factors. Methods: This retrospective study consecutively included breast cancer patients diagnosed with meningeal carcinomatosis. The study collected the symptoms of meningeal carcinomatosis at the time of diagnosis. To assess the prognostic role of symptoms in patients’ overall survival, the Cox regression model was used. Results: A total of 109 patients between the ages of 26 and 79 were included in the study. The most frequently reported symptoms at diagnosis were headache (42.2%), cranial nerve alteration (31.2%), and nausea (30.3%). The study showed a median survival of 2.4 months, with a 95% confidence interval of 1.7–3.0 months. The only symptom found to be associated with a worse prognosis was the presence of cranial nerve abnormalities, with a hazard ratio of 1.78 (95%CI 1.08–2.95, p=0.024). Conversely, the presence of meningeal hyperenhancement on magnetic resonance was related to a better prognosis, with an hazard ratio of 0.58 (p=0.02, 95%CI 0.36–0.92). Conclusion: It can be concluded that meningeal carcinomatosis is a serious condition, and the most common symptoms at diagnosis are headache and nausea. Special attention should be given to patients who present with alterations in cranial nerves, as they belong to a subgroup with a poor prognosis.

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SUMMARY OBJECTIVE: The aim of the study was to assess the predictive value of the triglyceride-glucose index and atherogenic indices for infertility in women with polycystic ovary syndrome. METHODS: This prospective, single-center, non-randomized observational study was conducted on 279 women diagnosed with polycystic ovary syndrome from May to December 2023. Women with polycystic ovary syndrome were grouped into two groups: those with infertility and those without infertility. Demographic, hormonal, and clinical parameters were studied. The statistical study employed IBM SPSS (Statistical Package for the Social Sciences) Statistics 22 to analyze the distribution of variables, assessing normality and comparing categorical and continuous data. Descriptive statistics were computed, with categorical and continuous data compared using appropriate tests (chi-square, Student's t-test, and Mann-Whitney U). Multivariable logistic regression identified independent predictors of infertility, with a significance level set at 0.05. RESULTS: Infertile women with polycystic ovary syndrome had significantly higher plasma levels of dehydroepiandrosterone sulfate (p=0.001), testosterone (p=0.005), insulin (p=0.041), Homeostasis Model Assessment of Insulin Resistance (p=0.029), prolactin (p=0.018), triglycerides (p<0.001), triglyceride/high-density lipoprotein (p=0.001), atherogenic index of plasma (p=0.011), triglyceride-glucose index (p=0.001), and lipoprotein combine index (p=0.007) compared to the fertile women with polycystic ovary syndrome. Correlation analysis showed that the triglyceride-glucose index correlated with the Homeostasis Model Assessment of Insulin Resistance (r=0.402, p<0.001) and total testosterone (r=0.191, p=0.001). Multivariable analysis identified age (OR 1.189, 95%CI 1.122–1.263, p<0.001), prolactin (OR 1.040, 95%CI 1.004–1.077, p=0.029), and triglyceride-glucose index (OR 2.473, 95%CI 1.404–4.177, p<0.001) as independent predictors of infertility. CONCLUSION: This study suggests a more atherogenic lipid profile in infertile women with polycystic ovary syndrome, suggesting a significant link between dyslipidemia and infertility. The triglyceride-glucose index proves to be a reliable, non-invasive marker of insulin resistance and may aid in identifying women at higher risk for infertility, facilitating earlier, targeted interventions.

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SUMMARY OBJECTIVE: Zonulin is a protein, synthesized in intestinal cells, that reversibly regulates the permeability of the intestinal epithelium. Elevated levels of zonulin are associated with increased intestinal permeability. It is shown that some neurological disorders are related to zonulin. We aim to research the possible associations between the zonulin levels and the symptom intensity in restless legs syndrome. METHOD: Demographic data of 43 patients with restless legs syndrome were recorded, and plasma zonulin levels were compared with 43 healthy controls using the enzyme-linked immunosorbent assay test. In the study, 66% of all participants were female and 20% were male. The mean age of the study group was 57.4±14.3 years. The average duration of the disease was 9.3±7.4 years, while the severity of the disease was 24.3±7.6. A p<0.05 was considered statistically significant. RESULTS: There was no significant difference between plasma zonulin levels in the control group and patients, but there were more individuals in the patient group in the high category of Zonulin levels, while the control group was dominant in the low level. In the patient group, zonulin levels were higher in the overweight and obese groups according to body mass index. CONCLUSION: Our study indirectly supports the hypothesis that central factors play a more significant role in the pathophysiology of restless legs syndrome rather than immunoresponsiveness in the gut and intestinal permeability.

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SUMMARY OBJECTIVE: Cesarean scar pregnancy poses significant risks, including uterine scar rupture and increased postpartum hemorrhage. Effective diagnosis and treatment are critical to improving clinical outcomes. This study aimed to analyze the risk factors for cesarean scar pregnancy and evaluate the efficacy and safety of hysteroscopic diagnosis and treatment, providing a theoretical basis for clinical management. METHODS: A total of 122 patients with cesarean scar pregnancy, diagnosed via vaginal ultrasound, were included in the study group and treated with hysteroscopic surgery. A total of 90 pregnant women with prior cesarean sections and normal intrauterine pregnancies were selected as the control group. RESULTS: Logistic regression identified significant cesarean scar pregnancy risk factors: the number of uterine operations, the number of cesarean sections, and a time interval of ≤5 years since the last cesarean (p<0.05). After hysteroscopic treatment, the mean operation time, intraoperative bleeding, and surgical failure rate were 22.31±6.26 min, 57.23±9.12 mL, and 8.03%, respectively. Surgical failure was associated with gestational age, gestational sac position, gestational sac size, diverticulum angle, and blood β-human chorionic gonadotropin levels (p<0.05). Hysteroscopy demonstrated superior diagnostic accuracy over ultrasound for type II and type III cesarean scar pregnancy cases (p<0.05). CONCLUSION: Hysteroscopic surgery improves treatment outcomes in cesarean scar pregnancy patients. Key risk factors for surgical failure include gestational age, gestational sac position, gestational sac size, diverticulum angle, and blood β-human chorionic gonadotropin levels. Early identification and management of these factors can enhance clinical outcomes and reduce complications.

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SUMMARY OBJECTIVE: The objective of this study was to investigate the association between breastfeeding, the introduction of specific foods in the first year of life, and asthma symptoms at 6 years of age. METHODS: A longitudinal study was conducted involving 956 children in southern Brazil. Asthma symptoms were assessed through the International Study of Asthma and Allergies in Childhood questionnaire. Information regarding breastfeeding and the introduction of complementary foods during the first year of life was obtained through interviews with mothers conducted at home. A multivariate analysis was performed using Poisson regression, and relative risks were estimated to assess the magnitude of the associations. RESULTS: Among the 956 children included in the study, 18.7% exhibited asthma symptoms. Male children had a 3% higher incidence [RR=1.03 (95%CI 1.01–1.06); p=0.023]. Children with a family history of asthma showed a 9% higher incidence [RR=1.09 (1.06–1.13); p<0.001] compared to those without such a history. Nonbreastfed children had an 8% higher incidence [RR=1.08 (95%CI 1.02–1.15); p=0.015]. Moreover, children who were introduced to wheat flour during the first year of life had a 4% higher incidence [RR=1.04 (95%CI 1.01–1.06); p=0.020] of asthma symptoms. CONCLUSION: Significant and independent associations were observed between asthma symptoms at 6 years of age and male sex, family history of asthma, breastfeeding, and the introduction of wheat flour during the first year of life.

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SUMMARY OBJECTIVE: The objective of this study was to assess the risk factors for neonatal death in newborns with gastroschisis. METHODS: Hospital-based secondary analysis of a retrospective cohort study was performed in a single reference center between January 2014 and December 2023. The following variables were evaluated: maternal characteristics, obstetric aspects, habits, and labor and delivery data. Information on neonatal and hospitalization was also included. RESULTS: A total of 48 newborns with gastroschisis were delivered, with 27 (56%) being discharged from the hospital, 5 (10%) being transferred to another hospital, and 16 (33%) dying. Maternal origin was associated with neonatal death, with a 4.2 times greater chance of death if the pregnant women came from the interior. Newborns who died started prenatal care significantly earlier than the survivors. Newborns with complex gastroschisis had a 4.05 times higher risk of death, while the lack of primary closure in the first approach increased this risk by a factor of 7.0. Duration of parenteral nutrition, admission to the neonatal intensive care unit, and total hospital stay were significantly shorter in the cases of death, indicating that longer periods were associated with a 5, 6, and 6% reduction in the risk of death, respectively. On the other hand, not wearing the oxygen hood helmet increased the risk of death by 6.94 times. Newborns who spent more days on mechanical ventilation were 9% more likely to die. CONCLUSION: In conclusion, the only significant variable was the longer time on mechanical ventilation, which was associated with mortality in newborns with gastroschisis.

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SUMMARY OBJECTIVE: The aim of this study was to validate the structural and criterion validity of the short version of the Upper Limb Functional Index with 10 items in Brazilian patients with musculoskeletal dysfunction in the upper limb. METHODS: The structure of the Upper Limb Functional Index with 10 items and with one domain was tested using confirmatory factor analysis with model fit evaluated using comparative fit index, Tucker-Lewis index, root mean square error of approximation, standardized root mean square residual, and chi-square/degree of freedom. Criterion validity was assessed using Spearman's correlation coefficient (rho) to correlate the Brazilian versions of Upper Limb Functional Index with 25 items and Upper Limb Functional Index with 10 items. RESULTS: We included 150 patients, mostly women, with an average age of 52.21±12.09 years, diagnosed with chronic musculoskeletal dysfunction in the upper limbs. The Upper Limb Functional Indexwith 10 items showed sufficient fit indices (CFI=0.970, TLI=0.962, RMSEA=0.054, SRMR=0.078, chi-square/DF=1.43). Criterion validity showed an excellent correlation between Upper Limb Functional Indexwith 25 items and Upper Limb Functional Index with 10 items, with rho=0.900 (p<0.001). CONCLUSION: The Upper Limb Functional Index with 10 items demonstrated sufficient unidimensional structure and high correlation with the original version. We recommend the use of Upper Limb Functional Index with 10 items for assessing upper limb functioning in Brazilian patients with chronic musculoskeletal dysfunction.

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SUMMARY OBJECTIVE: Findings in the literature indicate that women often have incorrect or incomplete knowledge about the concepts of microbiota, microbiome, probiotics, prebiotics, and their relationship with women's health, pregnancy, childbirth methods, and breast milk. In this regard, designing educational programs that contribute to preventing reproductive system infections, achieving positive fertility outcomes, and supporting the health processes of women and newborns through the microbiota of the female body can contribute to the current situation. In line with this aim, in this study, the development and evaluation of a microbiota education program for women were conducted. METHODS: The research was conducted with 151 female participants in a pre-test and post-test, single-group, quasi-experimental design. The trainings were conducted for 2 days, with a total of 4 h for each group, 2 h each day. The microbiota knowledge test applied before the training was repeated as a post-test after 4 weeks. SPSS 25.0 was used for data analysis. RESULTS: It was determined that there was a statistically significant difference between the pre-training and post-training knowledge scores of the participants, with the post-training knowledge scores being higher than the pre-training scores (p<0.05). It was found that there was an increase in intra-group means for age, education level, occupation, number of pregnancies, number of births, and method of delivery after the training. CONCLUSION: As a result of the evaluations, it was concluded that the microbiota education program developed and implemented for women addressed all female participants.

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SUMMARY OBJECTIVE: Recurrent pregnancy loss is characterized as a disorder characterized by two or more miscarriages, and its etiology is unclear. Recent research has focused on microRNA and recurrent pregnancy loss; however, single-nucleotide polymorphisms of microRNA in recurrent pregnancy loss need to be better understood. The aim of the study was to assess if there is any relationship between the miR499b A>G gene polymorphism and recurrent pregnancy loss in Turkish women. METHODS: The work has 267 participants, including 153 patients in the recurrent pregnancy loss and 114 participants in the control group. DNA isolation from peripheral blood was conducted using a kit-based approach, followed by the implementation of polymerase chain reaction and restriction fragment length polymorphism methods as outlined in the procedure. RESULTS: The rates of recurrent pregnancy loss were determined as 32.7% for the AA genotype, 51.6% for the AG genotype, and 15.7% for the GG genotype. When the AA genotype type was taken as a reference, the risk of recurrent pregnancy loss was 0.922 times higher (95%CI 0.513–1.655; p=0.785) in the AG type and 0.354 times lower (95%CI 0.178–0.705; p=0.003) in the GG type. In the recurrent pregnancy loss patient group, the GG genotype was lower than the expected value. The GG genotype was found to be less susceptible to recurrent pregnancy loss development. CONCLUSION: Based on our results, GG genotype frequencies, which are the recessive model of the miR499b A>G gene polymorphism, may be a protective genotype in susceptibility to recurrent pregnancy loss in Turkish women. The results obtained from this study represent the first data to be established for the Turkish population.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate serum B-type natriuretic peptide levels in pregnant women with hyperemesis gravidarum and compare them with healthy pregnant women. METHODS: In this prospective cross-sectional study, sample size calculation using G*Power determined a minimum of 40 participants per group, totaling 80 participants. The study included 43 pregnant women with hyperemesis gravidarum and 43 healthy pregnant controls. Hyperemesis gravidarum diagnosis was based on clinical and laboratory criteria, including weight loss, ketonuria, and electrolyte imbalance. Exclusion criteria included pre-existing cardiovascular or systemic diseases, multiple pregnancies, and smoking. Serum B-type natriuretic peptide levels and various biochemical parameters were measured using standard laboratory techniques. Statistical analyses were performed using the Statistical Package for the Social Sciences software, with a p-value of <0.05 considered statistically significant. RESULTS: B-type natriuretic peptide levels were significantly higher in the hyperemesis gravidarum group compared to the control group (HG: 9.6±2.5 pg/mL [95%CI 8.9–10.3]; control: 8.1±1.8 pg/mL [95%CI 7.5–8.6]; Cohen's d=0.70, p=0.016). No significant differences were found between the groups in terms of age, body mass index, and other biochemical parameters, including hemoglobin, electrolytes, and inflammatory markers. B-type natriuretic peptide levels were not significantly correlated with gestational week, maternal age, body mass index, or hemoglobin levels. CONCLUSION: In this study, we found that B-type natriuretic peptide levels are elevated in hyperemesis gravidarum, and we believe that this may be associated with increased cardiac stress. B-type natriuretic peptide may serve as a potential biomarker for monitoring cardiovascular changes in hyperemesis gravidarum. Further research is warranted to validate these findings and explore the role of B-type natriuretic peptide in the clinical management of hyperemesis gravidarum.

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SUMMARY OBJECTIVE: The aim of the study was to examine the mediating role of depression, stress, and anxiety in the relationship between smartphone addiction and sleep quality. METHODS: Data were collected from 514 university students using validated self-report measures. Correlation and mediation analyses were performed to examine the relationships between variables. FINDINGS: Smartphone addiction is negatively associated with sleep quality and positively related to depression, stress, and anxiety. Depression, stress, and anxiety are negatively correlated with sleep quality. The analysis revealed that these three factors partially mediate the relationship between smartphone addiction and sleep quality. CONCLUSION: The findings indicate that interventions targeting smartphone addiction could potentially alleviate its adverse effects on sleep quality, particularly by addressing underlying psychological factors such as depression, stress, and anxiety. These results obtained during the research process were discussed in relation to similar studies in the literature.

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SUMMARY OBJECTIVE: Recent data have shown that patients with epilepsy experience reduced quality of life and poor sleep quality, which are also closely related to heart rate variability. For the first time, we investigated the relationship between heart rate variability and quality of life and sleep in patients with epilepsy. METHODS: Twenty-seven patients with medically controlled epilepsy, 23 patients with drug-resistant epilepsy, and 36 healthy subjects were included in this cross-sectional prospective study. Heart rate variability analysis was conducted using a 24-h rhythm Holter device in all cases. The quality of life in epilepsy-31 questionnaire and Pittsburgh Sleep Quality Index questionnaire were used for patients with epilepsy. RESULTS: Compared to the control group, patients with epilepsy had lower heart rate variability parameters, including standard deviation of normal-to-normal, standard deviation of normal-to-normal index, standard deviation of the averages of the normal-to-normal, root mean square of successive differences, and percentage of NN Intervals >50 ms (pNN50) values (p<0.001). Heart rate variability parameters and sleep scores were similar between the drug-resistant epilepsy and medically controlled epilepsy subgroups (p>0.05). In addition, quality of life in epilepsy-31 subscores were significantly lower in drug-resistant epilepsy than in medically controlled epilepsy in the subdomains of seizure worry (p=0.001), overall quality of life (p=0.004), emotional well-being (p=0.005), and cognitive functioning (p=0.007). There was a significant positive correlation between standard deviation of the averages of the normal-to-normal and cognition (r=0.335; p=0.017); maximum QT and emotional well-being (r=0.286; p=0.046); and maximum QTc and emotional well-being (r=0.292; p=0.042) in patients with epilepsy. CONCLUSION: We found that low heart rate variability was more common in patients with epilepsy. Quality of life was also highly impaired in drug-resistant epilepsy, and low heart rate variability correlated with low cognition and emotional well-being in patients with epilepsy.

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SUMMARY OBJECTIVE: The aim of this study is to investigate the relationship between risk scores and immune-inflammatory indices with prognosis and mortality in community-acquired pneumonia. Additionally, we aim to examine the association between mortality and the Acute Phase Reactant Index, which we developed using C-reactive protein, procalcitonin, and albumin levels. METHODS: This retrospective study was conducted with 417 patients diagnosed with community-acquired pneumonia who presented to the emergency department of a tertiary care hospital between 2022 and 2023. The patients’ demographic data, imaging findings, blood parameters, site of care, and 30-day mortality status were recorded. Risk scores, immune-inflammatory indices, and the Acute Phase Reactant Index were calculated. The risk scores and indices were compared with treatment outcomes and 30-day mortality results. RESULTS: In the receiver operating characteristic analysis, Acute Phase Reactant Index was found to be as effective as other risk scores in predicting mortality. Among them, Acute Phase Reactant Index had the highest area under the curve value. Additionally, in patients transferred from the ward to the ıntensive care unit, when the Acute Phase Reactant Index score cut-off value was set at 1.32, it accurately predicted mortality in 9 out of 13 patients (69.2%). CONCLUSION: It was determined that Acute Phase Reactant Index is a better predictor of mortality than all other scores and inflammatory indices in community-acquired pneumonia. This suggests that the Acute Phase Reactant Index may be used as a prognostic factor in high-mortality lung diseases such as cancer.

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SUMMARY INTRODUCTION: The aim of the present study was to gain insight into how age may influence the outcomes of adolescent pregnancies and to gain a better understanding of the proportion of immigrants in adolescent pregnancies. METHODS: This retrospective study was conducted in a perinatology clinic between 2021 and 2024. The patients were divided into two categories such as adolescents and adults. The adolescent cohort was then divided into two subgroups according to age. Demographic characteristics, pregnancy follow-up, and postnatal outcomes were reported and compared between groups. RESULTS: A total of 123 adolescent pregnancies compared with 123 adult pregnancies. There were 27 patients in the 14–15 age group and 96 patients in the 16–17 age group. The adult group exhibited significantly higher age (p<0.01), gravidity (p<0.01), parity (p<0.01), gestational age at birth (p<0.01), neonatal weight (p<0.01), and both antepartum (p=0.017) and postpartum (p<0.01) hemoglobin values compared to the adolescent group. The decline in hemoglobin levels in the peripartum period was significantly higher in the 14–15 age group (p<0.01). A significant difference was observed between adolescent and adult pregnant groups in terms of early pregnancy follow-up. The proportion of immigrants was much higher in the adolescent group at 49.6% and in the adult group at 4.8% (p<0.01). CONCLUSION: Adolescent pregnancies represent a significant public health concern. The risks in this regard are amplified with a reduction in the age of the patient. The prevalence of adolescent pregnancies among refugees appears to be a matter of significant concern.

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SUMMARY OBJECTIVE: The aim of the study was to conduct a meta-analysis of studies on the effect of reflexology on blood pressure and heart rate in patients with cardiovascular disease. METHOD: The study collected data from PubMed, ScienceDirect, MEDLINE, Web of Science, Google Scholar, and Cochrane Library databases. The study had randomized-controlled, non-randomized-controlled, and quasi-experimental designs. Patients aged >18 years with coronary artery disease, coronary angiography, percutaneous coronary intervention, open-heart surgery, or coronary bypass were included. All analyses were performed using Comprehensive Meta-Analysis. RESULTS: This study included 1,041 patients aged 18–75 years from 12 studies. According to the random-effects model, reflexology significantly reduced systolic blood pressure (95%CI, Hedges’ g=-0.41, Z=-2.27, p=0.02) and diastolic blood pressure (95%CI, Hedges’ g=-0.38, Z=-2.69, p=0.01). However, reflexology did not affect the heart rate (95%CI, Hedges’ g=0.16, Z=-1.54, p=0.12). CONCLUSION: The results suggest that reflexology has a positive effect on the systolic and diastolic blood pressures of cardiovascular patients, but no significant effect on the heart rate was observed.

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SUMMARY OBJECTIVE: The aim of this study was to investigate the relationship between anticholinergic drug burden and clinical frailty in patients with urinary incontinence. METHODS: This prospective cross-sectional study included 197 patients who were aged ≥60 years old and admitted to Family Medicine and Urology Departments of Kırıkkale Faculty of Medicine between May 2024 and August 2024. Anticholinergic burden was calculated using anticholinergic burden calculator, frailty was assessed using the clinical frailty scale, and these patients were assigned a frailty score ranging from 1 (very fit) to 9 (terminally ill). RESULTS: The mean age of the 197 participants in our study was 67.71±6.85 and 92 (46.7%) were female. The mean anticholinergic burden score was 2.43±1.77 and clinical frailty scale score was 4.75±1.05. There was a statistically significant difference between age groups, gender, marital status, educational status, anticholinergic burden status, and clinical frailty scale score (p<0.001, p=0.001, p=0.033, p<0.001, and p<0.001, respectively). There was also a statistically significant distance between age groups, gender, marital status, educational status, and anticholinergic aurden score (p=0.001, p=0.023, p=0.013, p=0.042, respectively). A strong, positive, and significant correlation was found between anticholinergic burden and frailty (r=0.728, p<0.01). CONCLUSION: The findings of this study highlighted that it is useful to evaluate the anticholinergic burden and reconsider treatment options when prescribing to elderly patients with urinary incontinence.

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SUMMARY OBJECTIVE: The aim of this study was to determine the effects of Reiki applied to women in the postmenopausal period on menopausal symptoms and depression levels. METHODS: This randomized controlled study was conducted with postmenopausal women registered in a family health center. The sample of the study consisted of 82 women (Reiki=41, control=41). While four sessions of Reiki were applied to the women in the Reiki group, once a week for 4 weeks. All participants in the control group received routine care provided by health professionals at the family health center. The Menopause Rating Scale and Beck Depression Inventory were used to collect data. The data were analyzed using SPSS 25.0, with independent and dependent t-tests, and effect sizes were calculated using Cohen's d. The analysis was conducted using the per-protocol approach, where only participants who fully completed the intervention and adhered to the protocol were included in the analysis. RESULTS: The mean scores of menopausal complaints (17.31 vs. 21.73; p<0.01), somato-vegetative complaints (2.70 vs. 3.85; p<0.01), and psychological complaints (10.07 vs. 12.60; p<0.05) were significantly reduced in the Reiki group compared to the control group. Similarly, the mean score of depression (9.63 vs. 15.90; p<0.001) was significantly decreased in the Reiki group compared to the control group. CONCLUSION: Reiki practice significantly reduced menopausal symptoms and depression levels in postmenopausal women. These findings suggest that Reiki may be an effective complementary treatment option for women going through menopause.

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SUMMARY OBJECTIVE: The aim of this prospective cross-sectional study was to determine serum D-dimer and fibrinogen concentrations in pregnant women with hyperemesis gravidarum and compare them with those of healthy pregnant women. METHODS: The study group consisted of 50 patients diagnosed with hyperemesis gravidarum. The control group consisted of 50 healthy pregnant women. Maternal characteristics such as age, gestational age, body mass index, gravida, and parity were recorded. Following a 12-h fasting period, venous blood samples of 10 cc were collected. The blood samples were centrifuged, and serum was stored at −80°C until assay. Blood count, coagulation profiles, and biochemical analyses were performed, and the results were analyzed using appropriate statistical tests. RESULTS: The data of 45 patients in the hyperemesis gravidarum group and 47 patients in the control group were analyzed. Serum levels of hemoglobin, white blood cell and platelet counts, prothrombin time, activated partial thromboplastin time, fibrinogen, D-dimer, and international normalized ratio were similar between groups (p>0.05). There was a positive association between serum D-dimer levels and serum fibrinogen levels (p=0.039, r=0.215). Also, a positive association was observed between serum D-dimer levels with the degree of ketonuria (p=0.008, r=0.274) and the number of vomitings per day (p=0.02, r=0.346) in hyperemesis gravidarum patients. CONCLUSION: Serum D-dimer levels were not different in patients with hyperemesis gravidarum versus healthy women during the first trimester of pregnancy. Pregnant women tend to have higher D-dimer concentrations as hyperemesis gravidarum severity increases. Serum D-dimer levels cannot be used for the evaluation of potential venous thromboembolism in patients diagnosed with hyperemesis gravidarum.

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SUMMARY OBJECTIVE: Although many genes associated with prostate cancer have been identified, there are still many cases of prostate cancer whose genetics have not been identified. The urokinase-type plasminogen activator gene is thought to play a key role in cancer invasion and metastasis. The Pro141Leu polymorphism may be involved in the development of prostate cancer, although genetic evidence is lacking. METHODS: We used the real time polymerase chain reaction based TaqMan assay to investigate whether the urokinase-type plasminogen activator gene Pro141Leu polymorphism is associated with prostate cancer patients and healthy controls. urokinase-type plasminogen activator, urokinase-type plasminogen activator receptor, and prostate-specific antigen antigens were assayed by the enzyme-linked immunosorbent assay method. RESULTS: We found no significant differences between the cancer and control populations in terms of genotype distribution (CC, CT, and TT). Furthermore, we found no association between the urokinase-type plasminogen activator gene Pro141Leu polymorphism and cancer risk in prostate cancer patients. CONCLUSION: This is the first study to investigate the association between the rs2227564 polymorphism and prostate cancer. Although the urokinase-type plasminogen activator gene Pro141Leu polymorphism has been reported to be a risk factor for some cancers, our findings suggest that the urokinase-type plasminogen activator gene Pro141Leu polymorphism is not an important genetic risk factor for prostate cancer.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate the conditioned pain modulation of patients with fibromyalgia and compare it to that of healthy individuals before and after 3 months of strength training. METHODS: This is a prospective experimental study consisting of two independent, non-randomized groups: fibromyalgia (n=10) and healthy control (n=10). The research was conducted in person at the Unidade Saúde Escola of the Federal University of São Carlos, Brazil, during the period of June 2023–June 2024. The conditioned pain modulation test was administered to all patients in both groups. Twice a week (for 3 months), patients with fibromyalgia performed three sets of each exercise, with 10 repetitions, 40 s of muscle tension, and a 60-s interval between the sets. Subsequently, we compared the conditioned pain modulation test using the Student's t-test. RESULTS: Significant between-groups differences (p≤0.05) and large effect sizes (d≥0.8) that were observed at baseline (at times 2, 3, and 4) were not observed after 3 months of strength training, indicating that the intervention was able to improve the conditioned pain modulation in patients with fibromyalgia. Although the within-group comparisons (pre- and posttreatment) showed an absolute difference of 6.35 in central sensitization, this was not statistically significant (p≥0.05) and had a small effect size (d=0.27). CONCLUSIONS: The conditioned pain modulation of fibromyalgia patients appears to become similar to that of healthy individuals after 3 months of strength training.

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SUMMARY OBJECTIVE: This study aims to investigate the relationship between vascular endothelial growth factor gene polymorphisms and Crimean–Congo hemorrhagic fever METHODS: A total of 130 serum samples were analyzed, including 60 patients diagnosed with Crimean–Congo hemorrhagic fever and 70 healthy controls. Genetic analyses were performed using polymerase chain reaction and restriction fragment length polymorphism techniques. RESULTS: Significant differences were observed between patient and control groups in terms of vascular endothelial growth factor −460 C/T and -ID (18 bp) polymorphisms. CONCLUSION: Vascular endothelial growth factor gene polymorphisms may contribute to genetic susceptibility to Crimean–Congo hemorrhagic fever. Further studies with larger sample sizes are recommended to support these findings.

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SUMMARY BACKGROUND: Rheumatoid arthritis is a chronic inflammatory disease that often necessitates combination therapy. The presence of comorbidities, frequently observed in rheumatoid arthritis patients, can further increase the number of medications required, raising the risk of drug-to-drug interactions. OBJECTIVE: This study aimed to analyze the prevalence of polypharmacy and identify potential drug-to-drug interactions in rheumatoid arthritis patients using the MedScape® digital platform. METHODS: A retrospective analysis was conducted on 370 rheumatoid arthritis patients. Data on epidemiological characteristics, comorbidities, and the number of medications used during treatment were collected. The MedScape® platform was employed to assess potential drug-to-drug interactions. RESULTS: Polypharmacy was observed in 81.1% of the patients, with a higher prevalence among older individuals and those with multiple comorbidities. The MedScape® platform identified 2,018 potential drug-to-drug interactions in the sample, of which 27.5% were mild, 54.4% moderate, and 17.8% severe. Severe interactions frequently involved combinations of antirheumatic drugs. CONCLUSIONS: Polypharmacy is highly prevalent in rheumatoid arthritis treatment, particularly in patients with comorbidities, increasing the risk of clinically significant drug-to-drug interactions. Physicians should remain vigilant in monitoring for potential interactions and adopt strategies to mitigate the risks, such as regular medication reviews and utilizing digital platforms to support clinical decision-making. This approach is critical to optimizing patient safety and treatment outcomes in rheumatoid arthritis care.

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SUMMARY OBJECTIVE: Robotic surgery has been gaining attention because of the physical and metabolic morbidity of the conventional open technique. The systemic immune-inflammation index has emerged as a recent and more reliable biomarker. In our single-center retrospective cohort study, we investigate systemic immune-inflammation index in robotic gastrectomy in order to show the advantageous effect on the immune system, which we think is the first study in the literature. METHODS: The study involved patients from a high-volume center for 32 months. The patients were allocated into three groups: patients with robotic (1), laparoscopic (2), and open surgery (3). Venous blood was derived on the postoperative 24th hour. The systemic immune-inflammation index scores were compared in three groups in terms of Group 1 vs. Groups 2 and 3, Groups 1 and 2 vs. Group 3, and compared with platelet-lymphocyte ratio, neutrophil–lymphocyte ratio scores. RESULTS: Robotic surgery was performed in 55 patients, laparoscopic surgery in 13 patients, and open surgery in 248 patients. In the comparison of minimally invasive surgery (Groups 1+2) vs. open surgery (Group 3), systemic immune-inflammation index, platelet-lymphocyte ratio, and neutrophil–lymphocyte ratio were found to be significantly lower in the minimally invasive surgery group (p<0.05). The comparison between robotic surgery patients (Group 1) and patients with laparoscopy/open surgery (groups 2 and 3) showed that systemic immune-inflammation index, platelet-lymphocyte ratio, and neutrophil–lymphocyte ratio were significantly lower in Group 1 (p<0.05). neutrophil–lymphocyte ratio, platelet-lymphocyte ratio, and systemic immune-inflammation index values were analyzed by receiver operating characteristic curve test, and the area under curve value of systemic immune-inflammation index was found to be higher in minimally invasive surgery group (robotic+laparoscopic) (p<0.05). CONCLUSION: The study reveals the superiority of robotic gastrectomy as a more feasible and high-quality procedure over conventional techniques in terms of better preservation of immune system function using a reliable and noninvasive serum biomarker.

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SUMMARY OBJECTIVE: This study aimed to evaluate whether the increased use of exome sequencing as a primary next-generation sequencing test provides a higher diagnostic yield compared to multi-gene panels for various clinical indications within a Brazilian cohort. METHODS: We retrospectively analyzed test results from 3,025 patients who underwent single-gene tests, multi-gene panels, and exome sequencing in our laboratory. The results were categorized as positive, inconclusive, or negative, with clinical indications including neurodevelopmental, late-onset neurological, neuromuscular, syndromic, skin/hair, hematological/immunologic, ophthalmologic, inborn errors of metabolism, skeletal, cardiovascular, reproductive planning, cancer, genitourinary, gastrointestinal, and hearing disorders. RESULTS: Of the 3,025 next-generation sequencing-based tests, 420 were single-gene tests, 1,158 were multi-gene panels, and 1,447 were exome sequencing. Although multi-gene panels were initially the most frequently ordered test, exome sequencing currently represents 62% of all next-generation sequencing-based tests performed in our laboratory. Exome sequencing had the highest detection rate (32.7%), but also the highest inconclusive rate. Among the clinical indications, when stratified by exome sequencing, skeletal and hearing disorders had the highest diagnostic yield, corresponding to 55 and 50%, respectively. CONCLUSION: This study emphasizes the diagnostic usefulness of exome sequencing for complex genetic disorders in postnatal diagnosis. However, the expansion of exome sequencing also presents challenges, including an increased rate of inconclusive results due to variants of uncertain significance. Broader availability of exome sequencing must be accompanied by additional resources to address these challenges effectively.