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SUMMARY OBJECTIVE: To identify risk factors for hyperglycemia and evaluate the impact on outcomes among pediatric patients with acute lymphoblastic leukemia undergoing chemotherapy. METHODS: We conducted a retrospective cohort study involving 188 pediatric patients treated for acute lymphoblastic leukemia at a Brazilian cancer referral center between 2004 and 2017. Hyperglycemia was assessed during the induction and consolidation phases of chemotherapy. Associations with patient and disease characteristics were examined through multivariate analysis. Outcomes analyzed included severe infections, relapse, and mortality. RESULTS: Hyperglycemia occurred in 43.6% of patients, predominantly during the induction phase. Pubertal status at diagnosis, younger age, and high relapse risk classification were independently associated with increased hyperglycemia risk. Puberty conferred a nearly 8-fold increased risk. However, hyperglycemia was not associated with increased risk of infections, relapse, or mortality. Higher mortality was observed among patients with overweight/obesity and those with pancreatitis or recurrent infections. CONCLUSION: Hyperglycemia was a frequent early adverse event in pediatric acute lymphoblastic leukemia treatment, particularly among pubertal patients and those at high relapse risk. Despite its high incidence, hyperglycemia was not associated with worse clinical outcomes in this cohort. These findings underscore the importance of early identification and monitoring, particularly during high-risk treatment phases.

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SUMMARY OBJECTIVE: The relationship between sleep quality in pregnancy, which is associated with adverse pregnancy outcomes, and healthy life behaviors is unclear. The aim of the study was to investigate the relationship between healthy life behaviors and sleep quality during pregnancy. METHODS: This study was conducted as a descriptive and correlational study. This study included 282 pregnant women. The study "Healthy Lifestyle Behaviors in Pregnancy Scale" was used to determine women's healthy lifestyle behaviors and "Pittsburgh Sleep Quality Index" was used to evaluate sleep problems. In this study, PATH analysis was used to test the model (p<0.050). RESULTS: The mean age of the participants was 27.43±5.54 years, and the mean gestational age was 24.32±10.4 weeks. Healthy Lifestyle Behaviors in Pregnancy Scale total mean score was 109.62±16.46, and Pittsburgh Sleep Quality Index total mean score was 6.90±3.37. According to the results of path analysis, there was no statistically significant relationship between Pittsburgh Sleep Quality Index and Healthy Lifestyle Behaviors in Pregnancy Scale total and sub-dimension scores (p>0.050). CONCLUSION: The results of this study suggest that there is no association between healthy lifestyle behaviors and sleep quality during pregnancy, but poor sleep quality is common during pregnancy. Therefore, studies investigating the longitudinal associations of sleep with objectively measured lifestyle behaviors during pregnancy are recommended.

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SUMMARY OBJECTIVE: The aim of the study was to assess the prognostic potential of high-density lipoprotein cholesterol levels in predicting survival for patients with epithelial ovarian cancer. METHODS: This is a retrospective observational study. The cutoff value for high-density lipoprotein cholesterol was determined through receiver operating characteristic analysis, revealing a value of 45 mg/dL. Patients in Group I had high-density lipoprotein cholesterol values <45 mg/dL, while patients in Group II had high-density lipoprotein cholesterol values ≥45 mg/dL. RESULTS: A total of 219 patients participated in the study, including 78 (36%) in group I and 141 (64%) in group II. high-density lipoprotein cholesterol (HR 0.44, 95%CI 0.27–0.73, p=0.001), age ≥65 (HR 3.02, 95%CI 1.87–4.58, p<0.001), and stage (HR 3.68, 95%CI 1.07–12.67, p=0.038) were identified as independent prognostic factors for overall survival in the multivariate analysis. High-density lipoprotein cholesterol (HR 0.44, 95%CI 0.27–0.72, p=0.001) and N1b (HR 2.32, 95%CI 1.33–4.03, p=0.003) were independent prognostic factors for disease-free survival in the multivariate analysis. CONCLUSIONS: In epithelial ovarian cancer, high-density lipoprotein cholesterol levels were prognostic for both overall survival and disease-free survival.

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SUMMARY OBJECTIVE: Primary hyperparathyroidism is considered the third most common endocrine disorder. Moreover, persistently elevated levels of parathyroid hormone occur in up to 30% of patients undergoing parathyroidectomy. The aim of this study was to determine the prevalence of persistently elevated parathyroid hormone levels after parathyroidectomy and analyze its associated factors. METHODS: An anonymized medical record query was conducted, filtering patients who underwent parathyroidectomy at a tertiary hospital center in Southern Brazil from 2010 to 2019. Clinical, laboratory, and sociodemographic data were collected. The analyzed period ranged from 3 months prior to surgery and up to 18 months after surgery. RESULTS: A total of 261 patients with an average age of 56 (45–65) years and a body mass index of 25.53 (22.19–28.86) kg/m2 were included. Patients with normal parathyroid hormone levels after 18 months of surgery were compared to those with high parathyroid hormone levels in the same period. The latter had lower levels of median parathyroid hormone, minimum achieved parathyroid hormone, and higher values of vitamin D. The two groups showed no difference in terms of age, body mass index, parathyroid hormone before parathyroidectomy, calcium before and after parathyroidectomy, and glomerular filtration rate. The multivariate linear regression model showed a negative association between body mass index, glomerular filtration rate, and total calcium after parathyroidectomy with parathyroid hormone variation. Patients with reduced glomerular filtration rate had higher levels of parathyroid hormone before parathyroidectomy, with no significant difference after the procedure between glomerular filtration rate groups. CONCLUSION: Persistently elevated levels of parathyroid hormone occurred in more than half of the patients subjected to parathyroidectomy. The observed variation in parathyroid hormone was significantly higher in patients with reduced glomerular filtration rate.

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SUMMARY BACKGROUND: Malaria remains a major public health concern in tropical regions, especially among pregnant women. It increases the risk of maternal anemia, low birth weight, preterm delivery, and infant mortality. OBJECTIVE: The aim of this study was to assess the hematological effects of malaria during pregnancy and evaluate the diagnostic value of blood count parameters, particularly platelet distribution width, as a potential biomarker. METHODS: In this retrospective study, 174 pregnant women were included: 78 with confirmed malaria and 96 malaria-negative controls. Hematological parameters such as hemoglobin, white blood cell count, platelet count, platelet distribution width, and mean platelet volume were compared between the groups. Statistical analyses included univariate and multivariate logistic regression and receiver operating characteristic curve analysis. RESULTS: There were no significant differences between the groups in terms of age, gestational week, gravida, parity, abortion, white blood cell, or mean platelet volume. However, body mass index, hemoglobin, platelet, and platelet distribution width were significantly lower in the malaria group (p<0.05). While all the four parameters predicted malaria status in univariate analysis, only platelet distribution width remained significant in multivariate analysis. Platelet distribution width demonstrated the highest diagnostic accuracy (area under the curve=0.857). CONCLUSION: Platelet distribution width may serve as a reliable and accessible hematological marker for malaria in pregnancy, particularly in resource-limited settings. Routine evaluation of complete blood count parameters could support early diagnosis and improve maternal–fetal outcomes.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate the impact of preoperative niche size on the success of hysteroscopic surgery in symptomatic isthmocele patients. METHODS: All patients who underwent hysteroscopic surgery for symptomatic isthmocele were recruited for this retrospective study. The dimensions of the niche, the apex of the niche to the uterine serosa (residual myometrial thickness), the depth of the wedge-shaped niche, and the width of the niche were measured before hysteroscopic repair of the isthmocele by ultrasonography. The present study assessed the correlation between preoperative niche dimensions and postoperative symptom resolution in a cohort of patients diagnosed with symptomatic isthmocele. RESULTS: Of the 29 patients evaluated, 72.4% (n=21) complained of postmenstrual spotting, while 27.5% (n=8) had both postmenstrual spotting and pelvic pain. Myometrial thickness was thinner in the postmenstrual spotting+pelvic pain group than in the postmenstrual spotting-only group (9.76±1.87 and 6.25±1.28, respectively, p≤0.001). After surgery, 75.8% of the patients were cured: 79.3% in the postmenstrual spotting-only group and 17.24% in the pelvic pain group were symptom-free. The residual myometrial thickness was greater both in the group that achieved total cure (9.50±2.02, p=0.002) and in the group with only postmenstrual spotting (9.39±2.04, p=0.005). CONCLUSION: This study demonstrated that patients with greater residual myometrial thickness had a higher success rate in hysteroscopic surgery for isthmocele-related symptoms. Preoperative niche measurements were considered a potential predictor of surgical outcomes.

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SUMMARY OBJECTIVE: Total knee arthroplasty is a common procedure for advanced knee osteoarthritis, aiming to reduce pain and restore function. However, the impact of patellar resurfacing and tibial insert types (fixed vs. mobile) on clinical outcomes remains debated, with limited comparative studies. METHODS: This retrospective cohort study included total knee arthroplasty patients (2012–2018) with ≥5 years of follow-up, divided into four groups based on insert type and resurfacing status. Clinical outcomes were assessed using visual analog scale, Western Ontario and McMaster Universities Osteoarthritis Index, timed up and go, and range of motion. Shapiro-Wilk tests were used to assess normality, and group comparisons were conducted using non-parametric statistical methods. RESULTS: Non-resurfacing groups had significantly higher pain scores (p<0.001). Mobile inserts provided better flexion range of motion and Western Ontario and McMaster Universities Osteoarthritis Index functional scores than fixed inserts (p<0.001). The best functional outcomes were observed in the mobile insert with the resurfacing group. A significant correlation was found between timed up and go and Western Ontario and McMaster Universities Osteoarthritis Index total scores in the fixed insert without resurfacing group (r=0.424, p=0.008), while no such correlation was observed in other groups. CONCLUSION: Patellar resurfacing and mobile tibial inserts enhance pain relief, mobility, and function in total knee arthroplasty patients. However, due to the retrospective nature of the study and group heterogeneity, prospective multicenter trials are warranted to validate these findings. These findings emphasize the importance of individualized implant selection, warranting further prospective, multicenter studies.

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SUMMARY OBJECTIVE: The aim of the study was to present estimates of mortality from noncommunicable diseases attributable to low physical activity in Brazil in 2019. METHODS: An epidemiologic and descriptive study. We retrieved the data during the month of September 2023. Two independent researchers accessed the indicators in the Global Burden of Disease database: (i) number of cases and (ii) mortality from cardiovascular diseases, diabetes, kidney diseases, and neoplasms, and (iii) level of physical activity in Brazilian individuals for the year 2019. Data were extracted by two researchers independently for the states of Brazil, stratified by sex (male and female), age groups (15–49 years, 50–69 years, and 70 or more years), cause of death and corresponding mortality (cardiovascular diseases, diabetes and kidney diseases, and neoplasms) and classified by regions according to geographic and administrative distribution in North, Northeast, Southeast, South, and Central-West. The number of deaths, age-standardized mortality, and years of life lost due to the disease were extracted, gross and in rates per 100,000 inhabitants. RESULTS: Mortality from noncommunicable diseases associated with low levels of physical activity in Brazil in 2019 was 293.39 deaths per 100,000 inhabitants, highest in Maranhão, with 407.98 deaths per 100,000 inhabitants, and lowest in the Distrito Federal and Minas Gerais, respectively. CONCLUSIONS: Cardiovascular disease was the most prominent risk factor among the results of this study.

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SUMMARY OBJECTIVE: Urinary incontinence is more common in women than men; additionally, prevalence rises in elderly women. This study was conducted to compare the 10-year results of tension-free transvaginal tape and transobturator tape operations in terms of urinary incontinence and quality of life in women. METHODS: Women who underwent transvaginal tape and transobturator tape operations in the urogynecology department at Istanbul Kanuni Sultan Süleyman Training and Research Hospital between January and December 2013 were retrospectively screened. The Urogenital Distress Inventory-6 and King's Health Questionnaire were applied to volunteers who could be reached via phone between January 2023 and July 2023 to evaluate urinary incontinence and quality of life. RESULTS: Of the 117 volunteers who were included in the study, 28 underwent transvaginal tape and 89 underwent transobturator tape operations. A statistically significant difference in favor of transvaginal tape was found between the two groups in terms of relief from postoperative stress urinary incontinence and pelvic pain (p<0.05). When transvaginal tape and transobturator tape groups were compared according to Urogenital Distress Inventory-6 and King's Health Questionnaire, no statistically significant difference was found (p>0.05). Although it is not statistically significant, it can be thought that transvaginal tape is superior than transobturator tape in terms of quality of life, by patient satisfaction with minimal clinically important difference. CONCLUSION: Although there is no long-term statistical difference in terms of quality of life between transvaginal tape and transobturator tape surgery, the transvaginal tape procedure was more successful in the long term, subjectively, in terms of stress urinary incontinence and postoperative pelvic pain among women.

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SUMMARY OBJECTIVE: The aim of this study was to investigate the long-term effects of tenofovir alafenamide, tenofovir disoproxil fumarate, and entecavir on fibrotic burden and to compare the virological clearance and biochemical improvement times achieved with these drugs. METHODS: The study was designed with treatment-naive, hepatitis B e-antigen-negative chronic hepatitis B patients who started tenofovir alafenamide, tenofovir disoproxil fumarate, or entecavir at a tertiary care hospital. The aspartate aminotransferase-to-platelet ratio index and the fibrosis index based on four factors were used to determine the fibrotic burden. RESULTS: Age, gender, baseline aspartate aminotransferase-to-platelet ratio index and fibrosis index based on four factors values, and fibrosis grades obtained by the biopsy of patients treated with tenofovir alafenamide (n=45), tenofovir disoproxil fumarate (n=65), and entecavir (n=56) were similar (p>0.05 for all). Significant fibrosis regression was observed during the 5-year antiviral therapy period in the tenofovir alafenamide, tenofovir disoproxil fumarate, and entecavir groups. CONCLUSION: Significant regression in aspartate aminotransferase-to-platelet ratio index and fibrosis index based on four factors was observed during tenofovir alafenamide, tenofovir disoproxil fumarate, and entecavir therapy within the first 2 years, and this regression remained stable up to the 5th year. None of the three drugs showed superiority over each other in terms of the pattern of fibrosis regression reflected by aspartate aminotransferase-to-platelet ratio index and fibrosis index based on four factors, average virological response time, and biochemical improvement time.

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SUMMARY OBJECTIVE: The aim of this study was to assess the immunohistochemical expression of second-generation neuroendocrine markers such as insulin gene enhancer protein 1, insulinoma-associated protein 1, and secretagogin in pheochromocytoma and their prognostic value. METHODS: The study included 30 operated pheochromocytoma patients. The tissue preparations were re-evaluated by two pathologists, and Pheochromocytoma of the Adrenal Gland Scaled Score score and Grading System for Adrenal Pheochromocytoma and Paraganglioma score were given. Four μm-thick paraffin block sections were stained with insulinoma-associated protein 1, insulin gene enhancer protein 1, and secretagogin antibodies to obtain staining intensity score, staining percentage, and H-score. RESULTS: The mean age at diagnosis was 50.5 (±15.9) years. The most common complaint was high blood pressure. A total of four patients (13.3%) had a nonfunctioning adenoma. The lesions were mostly localized in the right adrenal gland, and the median tumor size was 45.0 (35.0–54.2) mm. The median Ki67 proliferation index was 2.0% (0.9–3.0). According to the Pheochromocytoma of the Adrenal Gland Scaled Score score, nine (30.0%) patients showed the benign clinical behavior (score <4), while according to the Grading System for Adrenal Pheochromocytoma and Paraganglioma score, only four (13.3%) patients were in the well-differentiated-type (0–2 points) group. insulinoma-associated protein 1 and insulin gene enhancer protein 1 were positive in 21 (70%) and 26 (86.7%) of the patients, respectively. However, secretagogin was positive only in six patients (20%). Among the second-generation neuroendocrine immunohistochemical markers, insulin gene enhancer protein 1 had the highest H-score. Correlation analysis showed a negative correlation between insulin gene enhancer protein 1 and tumor Hounsfield unit and a positive correlation between insulinoma-associated protein 1 and Ki67 proliferation index. CONCLUSIONS: Insulinoma-associated protein 1, insulin gene enhancer protein 1, and secretagogin, which are second-generation neuroendocrine immunohistochemical markers, can be used in the differential diagnosis of pheochromocytoma. Notably, insulinoma-associated protein 1 may also have prognostic significance.

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SUMMARY OBJECTIVE: The relationship between the number of lymph nodes removed and survival was investigated in patients undergoing radical gastrectomy and D2 lymph node dissection for gastric cancer. METHODS: Patients who underwent gastrectomy and D2 lymph node dissection were analyzed. The cases were evaluated based on age, sex, tumor stage, number of removed lymph nodes, operation duration, presence of comorbidities, tumor status at the surgical margin, lymphovascular invasion, and perineural invasion. Survival analyses at 1 and 3 years were conducted. RESULTS: The 1-year survival rate was 73%, and the 3-year survival rate was 40.4%. Factors associated with 1-year survival included age ≥70 years, the number of removed lymph nodes <35, and the presence of lymphovascular invasion, which negatively impacted survival. Age ≥70 years reduced survival by 3.7 times, the number of lymph nodes removed <35 reduced survival by 3.3 times, and the presence of lymphovascular invasion reduced survival by 4.6 times. For 3-year survival, age affected survival by 4.1 times, and tumor presence at the surgical margin affected survival by 2.85 times. A positive correlation was found between the number of removed lymph nodes and survival (p=0.006). CONCLUSION: Lymph node dissection should be performed according to guidelines, and efforts should be made to increase the number of removed lymph nodes.

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SUMMARY OBJECTIVE: Low kisspeptin levels are observed in those with reproductive difficulties. This study was designed to examine and compare kisspeptin levels in women with infertility and miscarriages. Moreover, the aim of this study was to evaluate the possible relationship between kisspeptin levels and the C677T and A1298C polymorphisms of the methylenetetrahydrofolate reductase gene, as well as certain biochemical parameters in these two groups. METHODS: A total of 76 women, including 46 infertile women and 30 women with a history of miscarriages, were included in the study. In addition to kisspeptin levels, thyroid-stimulating hormone, free triiodothyronine, free thyroxine, ferritin, vitamin B12, folate, prolactin, and homocysteine levels were analyzed in individuals in both groups. The distribution of the C677T and A1298C polymorphisms of the methylenetetrahydrofolate reductase gene was also evaluated. RESULTS: Women with infertility had lower kisspeptin levels (p=0.019, Cohen's d=0.62) and higher vitamin B12 levels (p=0.018, Cohen's d=0.50) than women with miscarriages. Thyroid-stimulating hormone, free triiodothyronine, free thyroxine, ferritin, folate, prolactin, and homocysteine levels were not different between the two groups. There was no difference in the genotype distribution of methylenetetrahydrofolate reductase C677T and A1298C gene polymorphisms between the groups. There was no correlation between kisspeptin levels and other parameters in both groups. No difference was found between kisspeptin levels of individuals with different methylenetetrahydrofolate reductase C677T and A1298C gene polymorphism genotypes. CONCLUSION: Kisspeptin levels were lower in women with infertility compared to women with a history of miscarriages, suggesting a possible association between low kisspeptin levels and reproductive difficulties and warranting further investigation.

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SUMMARY OBJECTIVE: The receptors and cell membrane channels found in breast cancer in high numbers have been promising for drugs in the past and in the future. In addition, analyses of proliferation indices play an essential role in predicting the success of these treatments. METHODS: Gamma-aminobutyric acid type A receptor subunit π and minichromosome maintenance-3 expressions were studied by immunohistochemical staining from tissue samples obtained by trucut biopsy from epidermal growth factor receptor 2-negative breast cancer patients who received neoadjuvant chemotherapy. RESULTS: The study included 101 patients. Almost 96.0% of the breast tumor tissues expressed gamma-aminobutyric acid type A receptor subunit π. The median value for gamma-aminobutyric acid type A receptor subunit π was calculated as 30% (19 patients) and the median for minichromosome maintenance-3 as 80% (13 patients). When neoadjuvant chemotherapy response was evaluated, pathological complete response was achieved in 23.8% of patients (n=24). Pathological complete response was achieved in 16.4% of patients for hormone receptor positivity and in 38.2% of patients for triple-negative breast cancer. When the factors predicting pathological complete response were evaluated with univariate analysis, age (p=0.044), molecular subtype (p=0.017), menopausal status (p=0.032), Ki-67 increase (p<0.001), estrogen receptor decrease (p<0.006), progesterone receptor decrease (p<0.002), and grade (p<0.001) predicted treatment response. There was no relationship between gamma-aminobutyric acid type A receptor subunit π (p=0.945) and minichromosome maintenance-3 (p=0.985) and treatment response. CONCLUSION: Our study found that gamma-aminobutyric acid type A receptor subunit π is highly expressed in breast cancer cells but absent in normal breast tissue, making it a potential therapeutic target. Additionally, we determined that minichromosome maintenance-3 is not a reliable proliferation index or predictor of treatment response.

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SUMMARY OBJECTIVE: The coronavirus disease pandemic has significantly impacted maternal and neonatal health outcomes. METHODS: This retrospective study compared the health outcomes of 1,556 pregnant women and their newborns who gave birth before and during the pandemic at a tertiary university hospital. Demographic and clinical data were collected from hospital medical records. The primary outcome was the association between coronavirus disease and neonatal intensive care unit admission rates, while the secondary outcomes included birth weight, gestational age at delivery, 5th-min APGAR scores, and maternal complications. RESULTS: During the pandemic, screening test rates (58.9 vs. 33.2%, p<0.001), gestational diabetes mellitus prevalence (9.8 vs. 4.2%, p<0.001), and neonatal intensive care unit admission rates (8 vs. 4.4%, p=0.003) were significantly higher than those in the pre-pandemic period. Preterm birth rates were lower during the pandemic (12.5 vs. 25.1%, p<0.001). Logistic regression analysis revealed that infants born during the pandemic had a significantly higher likelihood of neonatal intensive care unit admission (OR 1.910, 95%CI 1.237–2.949, p=0.004). CONCLUSION: These findings highlight the need for health systems to be prepared and resilient to public health crises, ensuring uninterrupted health services for pregnant women and newborns.

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SUMMARY OBJECTIVE: The aim of this study was to compare the frequency and severity of depressive symptoms between adults diagnosed with Crohn's disease and a demographically matched group of healthy individuals. Depressive symptoms were assessed using the Beck Depression Inventory, a validated self-report instrument. DESIGN AND SETTING: The study employed a comparative and exploratory case–control design to evaluate whether patients with Crohn's disease report significantly higher levels of depressive symptomatology than healthy controls. Patients were recruited from various regions in southern Spain. METHODS: A total of 84 participants were included, comprising 42 individuals with Crohn's disease and 42 matched controls. Assessment of depressive symptoms was performed using the Beck Depression Inventory, a validated instrument for quantifying depression severity. As the data did not meet normality assumptions, non-parametric methods were applied for statistical analysis. RESULTS: Crohn's disease patients demonstrated significantly higher depression scores compared to controls (Beck Depression Inventory: 15.55±9.99 vs. 5.76±4.18; p<0.001). The prevalence of depression (Beck Depression Inventory ≥10) was 32.1% in the Crohn's disease group versus 9.5% in the control group. Notably, severe depression was observed exclusively among Crohn's disease patients, highlighting the substantial psychological burden associated with the disease. CONCLUSION: These results highlight the significant psychological burden associated with Crohn's disease, with patients experiencing higher rates and greater severity of depression compared to healthy individuals.

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SUMMARY OBJECTIVE: Methotrexate remains the most commonly used agent for the medical management of ectopic pregnancy. The aim of this study was to develop a novel scoring system to predict the efficacy of single-dose methotrexate treatment in ectopic pregnancy. METHODS: In this retrospective study, information on patients diagnosed with ectopic pregnancy between January 2012 and December 2023 was obtained from the hospital information system. Notably, 156 patients received a single dose of methotrexate for ectopic pregnancy treatment and met the study criteria. Almost 117 of those who were successful in single-dose methotrexate treatment constituted the successful methotrexate treatment group. The other 39 cases who failed single-dose methotrexate treatment constituted the failed methotrexate treatment group. A new scoring system was developed based on six parameters, including serum human chorionic gonadotropin level, gestational week, and ultrasound findings. RESULTS: According to the scoring system, the total score was significantly higher in the group in which methotrexate treatment failed compared to the group with successful treatment (4 points versus 2 points, respectively, p<0.001). In receiver operating characteristic analysis, the optimal cut-off value for the scoring system was determined as 2.5, with 92% sensitivity and 78% specificity (AUC=0.804, 95%CI 0.731–0.877). The overall success rate of single-dose methotrexate treatment was 75%. However, when only patients with a score below the cut-off value of 2.5 were considered, the success rate of single-dose methotrexate treatment in ectopic pregnancy increased to 90.5%. CONCLUSION: This new scoring system significantly enhances the ability to predict outcomes of methotrexate therapy, allowing for faster decision-making regarding surgical intervention.

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SUMMARY OBJECTIVE: The aim of this retrospective study was to evaluate early clinical outcomes and inflammatory responses associated with the use of open and closed cardioplegia sets in patients undergoing cardiac surgery with cardiopulmonary bypass. METHODS: A total of 123 adult patients who underwent elective cardiac surgery with cardiopulmonary bypass between 2023 and 2024 were included. Patients were divided into two groups based on the cardioplegia system used: Group 1 (open system, n=63) and Group 2 (closed system, n=60). Demographic features, intraoperative variables, and preoperative and postoperative biochemical parameters (white blood cell count, C-reactive protein, glucose, and liver and renal function tests) were analyzed. Statistical significance was set at p<0.05. RESULTS: Preoperative characteristics and most laboratory parameters were comparable between the groups (p>0.05). Postoperatively, white blood cell (12.64±3.47 vs. 8.43±4.43, p=0.031), C-reactive protein (28.00±32.28 vs. 8.42±6.37, p<0.0001), glucose (150.66±82.40 vs. 174.19±51.89, p=0.043), aspartate aminotransferase (p=0.001), and gamma-glutamyl transferase (p<0.0001) levels were significantly lower in the closed system group. Extubation time was longer in the closed group (8.56±3.18 vs. 5.15±0.66 h, p<0.0001), while urine output was significantly lower (554.16±401.50 vs. 916.34±709.58 mL, p=0.001). No differences were observed in hospital or intensive care unit stay. CONCLUSION: Closed cardioplegia systems may offer better control of inflammatory and hepatic responses during cardiac surgery with cardiopulmonary bypass. Despite favorable biochemical outcomes, the longer extubation time and reduced urine output observed in the closed system group warrant further investigation. Future prospective randomized studies are required to validate these findings and assess long-term clinical outcomes such as morbidity and mortality.