INTRODUCTION: Disability impairment rating is a critical medicolegal function requiring precise integration of clinical findings with regulatory tables. Large language models (LLMs) have shown promising capabilities in medicine; however, their ability to perform quantitative disability assessments has not been evaluated. This study aimed to assess the agreement between three commercial LLMs and expert-determined disability ratings.
METHODS: One hundred standardized fictional clinical cases were constructed representing the spectrum of medicolegal disability assessments. Each case was evaluated by a forensic medicine specialist using the Turkish Regulation on Disability Assessment for Adults (2019) as the reference standard. Three LLMs—GPT-5, Gemini 3 Pro, and Claude Opus 4.6—were tested using a zero-shot prompt. A three-model ensemble was also examined. Agreement was assessed using intraclass correlation coefficients (ICC), Bland-Altman analysis, and mean absolute error (MAE).
RESULTS: All three LLMs demonstrated good agreement with the reference standard, with ICC values of 0.875 (Gemini 3 Pro), 0.848 (Claude Opus 4.6), and 0.814 (GPT-5). MAE ranged from 5.1 to 6.0 percentage points. No significant difference was found among models (Friedman p=0.790). The three-model ensemble achieved the highest ICC (0.890) and lowest MAE (4.7 points). Accuracy declined substantially for rates ≥21% (MAE 9.1–11.5). Agreement for temporary work disability duration was moderate (ICC 0.701–0.750), while caregiver need showed poor-to-moderate agreement (ICC 0.497–0.585).
DISCUSSION AND CONCLUSION: Commercial LLMs demonstrate good overall agreement with expert disability ratings but show declining accuracy for complex multi-system cases. A multi-model ensemble approach improves reliability. LLMs may serve as supportive tools in medicolegal disability assessment, although expert oversight remains essential.

INTRODUCTION: This study aimed to evaluate the impact of the preoperative lactate-to-albumin ratio (LAR) and the postoperative ferritin-to-albumin ratio (FAR) on mortality, functional independence, and recanalization outcomes in patients who underwent endovascular thrombectomy (EVT) for acute ischemic stroke (AIS).
METHODS: This retrospective study evaluated 182 adult AIS patients who underwent EVT. Preoperative LAR was determined using blood samples collected within 6 hours prior to the procedure, while postoperative FAR was calculated from samples drawn within the first 24 hours following EVT. The primary endpoints were 90-day functional independence (modified Rankin Scale [mRS] 0–3), overall mortality, and technical recanalization success (modified Thrombolysis in Cerebral Infarction [TICI] ≥2b). We utilized ROC curves and multiple logistic regression to identify independent predictors.
RESULTS: Successful reperfusion was achieved in 90.7% of cases, yet the mortality rate stood at 28.6%, with 63.2% reaching functional independence. ROC analysis revealed LAR as the strongest mortality predictor (AUC=0.874). In multiple models, elevated LAR and FAR were strongly associated with both a higher mortality risk and a markedly reduced chance of 90-day functional recovery. Interestingly, classic predictors like age and admission NIHSS were overshadowed by these composite ratios in the final model. Diabetes was the sole independent predictor of failed recanalization.
DISCUSSION AND CONCLUSION: LAR and FAR emerged as potent, independent indicators of poor clinical outcomes in EVT-treated stroke patients. By capturing both tissue hypoperfusion and systemic inflammation simultaneously, these easily accessible laboratory parameters can help clinicians recognize high-risk cases early in the post-procedural phase and tailor follow-up care accordingly.

INTRODUCTION: Acute parotitis (AP) ranges from mild local inflammation to systemic complications. While some patients can be treated as outpatients, others require hospitalization and intravenous therapy. This study aimed to identify clinical and laboratory predictors of hospitalization and determine optimal cut-off values using receiver operating characteristic (ROC) curve analysis in patients presenting to the emergency department with AP.
METHODS: This retrospective study included 62 patients diagnosed with AP between 2019 and 2025. Demographic characteristics, clinical findings (oral feeding intolerance, purulent discharge from Stensen’s duct, and comorbidities), and laboratory parameters were evaluated. Logistic regression analysis was used to identify independent predictors of hospitalization, and ROC analysis was performed to determine discriminatory performance and optimal cut-off values.
RESULTS: The mean age was 49.90±20.44 years, and 59.6% were female. Hospitalized patients were older and had higher WBC, neutrophil counts, CRP levels, and BUN/creatinine ratios, while lymphocyte counts were lower. Oral feeding intolerance and purulent discharge from Stensen’s duct were more frequent among hospitalized patients. Multivariate analysis identified age (OR: 1.065, 95% CI: 1.018–1.114, p=0.006) and CRP (OR: 1.038, 95% CI: 1.006–1.071, p=0.021) as independent predictors of hospitalization. ROC analysis identified cut-off values of ≥61.5 years for age (AUC=0.843) and ≥22.95 mg/L for CRP (AUC=0.832). The combined model incorporating age and CRP showed good discriminatory performance (AUC=0.887).
DISCUSSION AND CONCLUSION: Older age and elevated CRP levels were independently associated with hospitalization in patients with AP. ROC-derived cut-off values and the combined predictive model may support clinical decision-making in the emergency management of AP.

INTRODUCTION: Anorectal malformations (ARM), including anal atresia, represent a heterogeneous group of congenital anomalies with variable anatomy, frequent associated malformations, and long-term functional consequences. Despite advances in surgical techniques such as posterior sagittal anorectoplasty (PSARP), functional outcomes remain influenced by malformation type and associated anomalies. This study aimed to evaluate the surgical and pediatric management outcomes of patients with ARM in a single-center experience.
METHODS: This retrospective single-center study included patients diagnosed with anal atresia and treated between January 2015 and January 2026. Demographic data, associated anomalies, Krickenbeck classification, surgical approaches, and early and late outcomes were analyzed. Patients underwent systematic evaluation, including echocardiography, renal ultrasonography, and spinal imaging when indicated. Statistical analysis was performed using appropriate parametric and non-parametric tests.
RESULTS: A total of 52 patients were included; 57.7% were male. Associated anomalies were present in 53.8% of patients. High-type malformations were most common (40.4%). Fistulas were detected in 73.1% of cases. Primary repair was performed in 32.7%, and staged surgery in 67.3%. PSARP was the most frequently used definitive procedure (88.5%). Early postoperative complications occurred in 17.3% of patients. Good continence was achieved in 65.4%, while 11.5% had significant incontinence. Functional outcomes were significantly associated with malformation type and spinal anomalies (p<0.05).
DISCUSSION AND CONCLUSION: PSARP-based surgical management of ARM is safe and effective with acceptable functional outcomes. However, high-type malformations and associated spinal anomalies negatively affect continence. Multidisciplinary management and structured long-term follow-up are essential for optimal outcomes.

INTRODUCTION: Abiraterone acetate and enzalutamide are widely used androgen receptor-targeted therapies for metastatic prostate cancer (mPCa). Although both agents have demonstrated survival benefits in randomized trials, comparative real-world evidence remains limited. This study aimed to compare survival outcomes associated with abiraterone and enzalutamide and to evaluate the prognostic impact in patients with mPCa.
METHODS: This retrospective single-center study included 230 patients with mPCa treated with abiraterone (n=109) or enzalutamide (n=121). Overall survival (OS) and progression-free survival (PFS) were calculated from treatment initiation using the Kaplan–Meier method and compared with log-rank tests. Multivariable Cox proportional hazards regression analyses were performed adjusting for age, ECOG performance status, PSA level at treatment initiation, metastatic burden, treatment line, and hormone sensitivity status
RESULTS: The median follow-up duration was 21.1 months (IQR, 12.9–31.1 months). Patients receiving abiraterone were older and had higher PSA levels, poorer ECOG performance status, and greater metastatic burden than those receiving enzalutamide. In unadjusted analyses, enzalutamide was associated with longer OS (33.4 vs. 26.7 months, p=0.019) and PFS (53.6 vs. 17.5 months, p=0.006). Hormone-sensitive patients demonstrated superior OS (36.6 vs. 26.8 months, p=0.013) and PFS (36.6 vs. 14.4 months, p=0.001) compared with hormone-resistant patients. In multivariable Cox regression analysis, enzalutamide was not independently associated with improved OS (HR 0.85, 95% CI 0.54–1.33, p=0.468), but remained independently associated with improved PFS (HR 0.62, 95% CI 0.39–0.98, p=0.042).
DISCUSSION AND CONCLUSION: In this real-world cohort, enzalutamide remained independently associated with improved PFS after adjustment for baseline prognostic factors, whereas the difference in overall survival was no longer statistically significant.

INTRODUCTION: Primary hyperparathyroidism (PHPT) is an endocrine disorder with systemic effects, including potential oxidative stress. Although thiol–disulfide homeostasis and ischemia-modified albumin (IMA) assess oxidative processes, their connection with PHPT remains limited. This study evaluated thiol–disulfide homeostasis and IMA levels in PHPT patients compared to healthy controls.
METHODS: Forty PHPT patients and 40 controls were included. Serum thiol–disulfide and IMA levels were measured spectrophotometrically. Intergroup comparisons used Student’s t-test, Mann-Whitney U, and chi-square/Fisher’s exact tests. Pearson correlation assessed intervariable relationships. Analysis of covariance (ANCOVA) adjusted for age.
RESULTS: Age, PTH, and calcium were significantly higher in the PHPT group, while IMA was lower (all p≤0.003). Unadjusted analyses showed no thiol differences; however, age-adjusted ANCOVA revealed significant differences for native (p=0.035) and total thiol (p=0.031). Correlation analysis revealed significant negative relationships between age and thiols, and between PTH, phosphorus, and bone mineral density. Preoperative PTH correlated positively with thiol levels.
DISCUSSION AND CONCLUSION: PHPT is associated with altered oxidative status, characterised by unexpectedly low IMA levels and age-dependent thiol disruptions. These lower IMA levels differ from typical elevations in other oxidative stress conditions, indicating a distinctive metabolic influence. Significant thiol differences emerging only after age adjustment highlights that demographic imbalances can mask these associations. The positive correlation between PTH and thiols may represent a compensatory antioxidant response to increased calcium load. Overall, oxidative stress dynamics in PHPT are complex, highlighting the importance of strictly considering confounding factors like age.

INTRODUCTION: To evaluate the diagnostic performance of large language models (LLMs) with FDG PET-derived Z-score profiles and structured clinical information in patients with suspected neurodegenerative diseases (NDs).
METHODS: This retrospective study included patients who underwent FDG-PET imaging of the brain for suspected NDs. FDG PET brain imaging Z-score derived from a database and anonymized structured clinical information were provided to four LLMs (ChatGPT, Grok, Gemini, and DeepSeek). Each model generated a single diagnosis among Alzheimer’s disease, frontotemporal dementia, dementia with Lewy bodies, vascular dementia, primary progressive aphasia, or normal/nonspecific. A multidisciplinary consensus diagnosis served as the reference standard. LLM outputs were stratified into subgroups: overall, high diagnostic confidence (HC; ≥85%), epicenter concordance (EC), and combined (HC + EC). Diagnostic agreement was assessed using Cohen’s kappa (κ).
RESULTS: A total of 80 patients (42 females, 38 males) were included. All LLMs showed significant agreement with the diagnosis. ChatGPT had the highest agreement (κ=0.760), followed by Grok (κ=0.648) and DeepSeek (κ=0.639). In the HC subgroup, agreement improved across all models, with ChatGPT reaching κ=0.872, followed by DeepSeek (κ=0.789), Grok (κ=0.711), and Gemini (κ=0.676). In the EC subgroup, ChatGPT (κ=0.828) and Grok (κ=0.799) show substantial concordance, and DeepSeek (κ=0.682) and Gemini (κ=0.542) demonstrate moderate agreement. In the combined HC + EC subgroup, ChatGPT achieved the strongest performance (κ=0.860), followed by Grok (κ=0.824) and DeepSeek (κ=0.786), while Gemini reached moderate agreement (κ=0.652).
DISCUSSION AND CONCLUSION: LLMs showed moderate-to-high agreement with multidisciplinary consensus diagnoses in patients with suspected NDs. Agreement was higher in cases with high diagnostic confidence and epicenter concordance.

INTRODUCTION: Insulin resistance (IR) is a central metabolic feature of polycystic ovary syndrome (PCOS). Although metformin improves insulin sensitivity, its adverse effects limit long-term use, prompting interest in herbal alternatives. The present study aimed to investigate the effects of Cichorium intybus L. ethanolic extract on PCOS-associated IR in a letrozole-induced rat model, compared with metformin.
METHODS: Twenty-four female Sprague–Dawley rats were divided into four groups: healthy control (H), PCOS-associated IR (IR), metformin-treated (MET), and Cichorium intybus ethanolic extract–treated (C.I) groups. PCOS was induced by oral letrozole administration (1 mg/kg/day) for 21 days. Following confirmation of IR by estrous cycle disruption and oral glucose tolerance test (OGTT), treatments were administered orally for 15 days. Metabolic parameters, serum insulin, glucose, lipid profile, sex hormones, and HOMA-IR index were evaluated. Skeletal muscle tissues were examined histopathologically and by immunohistochemical analysis of insulin receptor (INSR), insulin receptor subsrate 1 (IRS1), and insulin receptor subsrate 2 (IRS2) expression.
RESULTS: PCOS-associated IR rats showed impaired glucose tolerance, hyperinsulinemia, increased HOMA-IR, dyslipidemia, and hormonal imbalance. C. intybus ethanolic extract treatment significantly improved glucose tolerance, insulin levels, HOMA-IR, and lipid profile, with effects comparable to metformin. While metformin markedly restored INSR, IRS1, and IRS2 expression in skeletal muscle, C. intybus produced only moderate improvements
DISCUSSION AND CONCLUSION: C. intybus ethanolic extract improved metabolic, hormonal, and biochemical parameters in PCOS-associated IR. However, its effects on skeletal muscle insulin signaling markers were less pronounced than metformin, suggesting a complementary therapeutic role mainly through systemic metabolic regulation.

INTRODUCTION: Referrals to rheumatology outpatient clinics have increased worldwide, contributing to prolonged waiting times and challenges in accessing specialized care. A substantial proportion of referred patients ultimately do not receive a rheumatologic diagnosis, often due to nonspecific complaints or inappropriate referral indications. This study aimed to evaluate referral patterns, diagnostic yield, and clinical outcomes according to referral source in a rheumatology outpatient clinic.
METHODS: This retrospective single-center observational study included 400 patients over a nine-month period. Demographic characteristics, referral reasons, referral sources, laboratory parameters and final diagnoses were recorded. Comparative statistical analyses were performed between referral groups. Firth’s penalized logistic regression analysis was additionally used to address quasi-complete separation in multivariable analysis.
RESULTS: Overall, 79.3% of patients received a rheumatologic diagnosis. Internal medicine accounted for the majority of referrals (75.8%) and demonstrated a significantly higher diagnostic yield compared with primary care referrals (91.4% vs. 53.1%, p < 0.001). Crystal-induced arthropathies represented the most frequent diagnostic category, followed by spondyloarthritis spectrum disorders and rheumatoid arthritis. ANA positivity was significantly associated with rheumatologic diagnosis. Using Firth’s penalized logistic regression, referral from internal medicine remained independently associated with rheumatologic diagnosis (OR 5.03, 95% CI 2.38–10.61, p < 0.001), while ANA positivity was also independently associated (OR 3.28, 95% CI 1.15–9.34, p = 0.026).
DISCUSSION AND CONCLUSION: Referral source is associated with substantial differences in diagnostic yield in rheumatology outpatient care. These findings likely reflect variations in pre-referral evaluation rather than intrinsic differences in diagnostic accuracy. Structured referral strategies and standardized triage approaches may help optimize specialist resource utilization.

INTRODUCTION: Female gender is negatively associated with carpal tunnel syndrome (CTS). Therefore, it is logical to hypothesize that female gender may also be associated with postoperative CTS complaints. This study aimed to investigate the relationship between female gender and postoperative clinical outcomes in CTS.
METHODS: In this study, 65 patients with carpal tunnel release surgery (CTRS) were included (16 males and 49 females). The males and females were compared in terms of clinical outcomes after CTRS. The Boston Carpal Tunnel Questionnaire scores were used to assess symptomatic and functional status. In this questionnaire, the higher scores indicate more severe symptoms and dysfunction.
RESULTS: The two groups were similar in age (p=0.105), BMI (p=0.118), comorbidity (p=0.137), operated side (p=0.767), and postoperative duration (p=0.909). Postoperative symptom and function scores were significantly lower than preoperative ones in both males and females (p<0.001). For both symptom and function, the two groups were similar in the scores of pre-treatment, post-treatment, and mean difference.
DISCUSSION AND CONCLUSION: The findings obtained in this study suggest that CTRS is an effective treatment in both sexes, but the female gender is not associated with CTRS outcomes. These findings should be considered when managing preoperative counseling and, thus, postoperative expectations.

INTRODUCTION: Objective: Boxing is a contact sport associated with repetitive head impacts that may lead to visual disturbances. This study aimed to evaluate subclinical visual pathway function in elite amateur boxers using visual evoked potentials (VEP).
METHODS: Materials and Methods: Twenty-four amateur boxers and 24 age- and sex-matched healthy controls were prospectively evaluated. Visual pathway conduction was assessed using pattern-reversal VEP recordings obtained separately from each eye. Peak latencies of waveform components and interocular latency differences were analyzed.
RESULTS: Results: P100 latency values were significantly prolonged in both the right and left eyes of boxers compared with controls (p < 0.05). Interocular P100 latency differences greater than 8 ms were observed in a subset of participants. No significant differences were found in N75 or N135 latencies. Additionally, no significant correlation was observed between boxing duration and P100 latency.
DISCUSSION AND CONCLUSION: Conclusion: Amateur boxing may be associated with mild alterations in optic nerve conduction detectable by VEP. However, the lack of association with boxing duration suggests that exposure time alone may not explain these changes. These findings highlight the potential of VEP as a non-invasive tool for detecting early functional alterations in the visual system.

INTRODUCTION: Recent evidence points out that alterations in gut microbiome may be associated with pain modulation in fibromyalgia (FM). The objective was to review the associations between microbiome diversity and FM or chronic widespread pain (CWP), to identify microbial taxa consistently altered in affected individuals and to quantify the alpha diversity change in fibromyalgia.
METHODS: In systematic search conducted through PubMed, Scopus and Google Scholar for studies published between 2010 and September 2025 using synonyms of “fibromyalgia”, “chronic pain syndrome” and “microbiome” was undertaken. Eligible studies reporting microbiome diversity metrics with Shannon index or alpha diversity in adult FM/CWP patients compared with healthy controls were selected. Random-effects meta-analysis was performed for alpha diversity outcomes using standardized mean differences (SMD). Heterogeneity and risk of bias were assessed using established methods.
RESULTS: Overall, nine studies met inclusion criteria and Shannon-diversity index was extracted from seven studies (2233 participants). FM patients exhibited significant reduction in gut microbiota diversity with compared with controls (SMD -0.40, 95% CI -0.55 to -0.25; p < 0.001), with between the study heterogeneity was low (I² = 13.8%). Qualitative synthesis revealed consistent depletion of butyrate-producing taxa, including Faecalibacterium and Coprococcus, and enrichment of taxa linked to pro-inflammatory and neuroactive pathways, such as Parabacteroides merdae and Clostridium scindens.
DISCUSSION AND CONCLUSION: FM is associated with consistent reduction in gut microbiome alpha diversity. There are consistent shifts in important microbial taxa. Findings from this review support the potential role of microbiome dysbiosis in FM pathophysiology and highlight the potential role of microbiome based biomarkers and therapeutic strategies.

INTRODUCTION: Glioblastoma multiforme (GBM) remains the most aggressive primary brain tumor with poor prognosis. Accurate survival analysis is essential for treatment planning and prognostic assessment. This study evaluates the application of corrected Kaplan-Meier and Cox regression methods in analyzing survival outcomes of GBM patients.
METHODS: A retrospective analysis was conducted on 203 GBM patients treated at XXX University Faculty of Medicine Hospital between 2005 and 2011. Patient demographics, clinical characteristics, tumor localization, and treatment protocols were recorded. Survival analysis was performed using classical and corrected Kaplan-Meier methods, and Cox proportional hazards regression was applied to identify independent prognostic factors.
RESULTS: The mean survival time was 20.9 months with a median survival of 17.0 months. Multivariate Cox regression analysis identified age, Karnofsky Performance Status (KPS), tumor localization, and adjuvant treatment protocols as independent prognostic factors. Temporal and parietal lobe localizations were associated with better prognosis. Combined Temozolomide (TMZ) + Altuzan/bevacizumab (ALT) therapy demonstrated a significant survival advantage. Male gender and low postoperative KPS scores increased mortality risk, while high KPS and TMZ+ALT treatment improved survival outcomes.
DISCUSSION AND CONCLUSION: Corrected Kaplan-Meier and Cox regression methods provide reliable tools for survival analysis in GBM patients. These statistical approaches support clinical decision-making and enable more accurate prognostic estimation, particularly when dealing with censored data.

INTRODUCTION: Diabetic neuropathic pain (DNP) is an important complication of diabetes. EGCG is known to have antioxidant, anti-inflammatory, and antidiabetic effects. TRPV1 channel and iNOS are pain-related pathways. Our study aimed to investigate the effects of EGCG on the sciatic nerve and the role of the TRPV1 channel and İNOS in the experimental DNP.
METHODS: Animals were divided into 4 groups (n=7): Control, EGCG, DNP, DNP+EGCG. Throughout the study (days 0, 3, 8, 14, 17), the average weight change of the groups, average blood sugar levels, hot plate, and tail dipping tests were performed. Sciatic nerve samples were examined with stereological, histopathological, and immunohistochemical methods.
RESULTS: According to the findings of the study, the hot plate and tail dipping times were significantly shortened in the DNP group. The hot plate, tail dipping times were longer in the DNP+EGCG group. Axonal degeneration was detected in the DNP group. DNP+EGCG was found to have less deterioration in axons compared to DNP. While intense TRPV1 and INOS expression was observed in the DNP group, low TRPV1 and İNOS expression was observed in the Control, EGCG, and DNP+EGCG groups. No significant difference was observed between the groups in terms of sciatic nerve area. While the number of axons significantly decreased in the DNP group, EGCG treatment prevented the decrease in axons.
DISCUSSION AND CONCLUSION: The results of this study showed that EGCG treatment can modulate pain tolerance by reducing TRPV1 and İNOS expressions, blood glucose levels, alleviating sciatic nerve deterioration, and modulating the hot plate and tail dipping times.

INTRODUCTION: To evaluate whether Breast Imaging Reporting and Data System (BI-RADS) categories can be determined using diffusion-weighted imaging (DWI) alone through a new evaluation model, and to compare DWI-based BI-RADS categorization with multiparametric magnetic resonance imaging (MP-MRI) assessments and available histopathological findings.
METHODS: Anonymised DWI datasets of 400 consecutive patients were retrospectively reviewed, and 354 patients were involved in the final analysis using a newly developed classification model comprising lesion morphology and diffusion restriction patterns. For each patient, the highest BI-RADS category based on DWI was recorded. DWI-based BI-RADS categories were compared with the categories reported on MP-MRI and, when available, with histopathological results. Normalized apparent diffusion coefficient (nADC) values were calculated, and their diagnostic performance in distinguishing benign from malignant lesions was assessed.
RESULTS: Using MP-MRI as the reference standard, the DWI-based model achieved a sensitivity of 64%, specificity of 98%, positive predictive value (PPV) of 90%, negative predictive value (NPV) of 89%, and an overall accuracy of 89.5%. When histopathology was used as the reference, sensitivity, specificity, PPV, NPV, and accuracy were 87%, 68%, 70%, 86%, and 77%, respectively. Malignant lesions demonstrated significantly lower nADC values than benign lesions. An nADC threshold of 0.784 yielded a sensitivity of 68% and specificity of 73% for benign–malignant discrimination.
DISCUSSION AND CONCLUSION: A DWI-based standalone evaluation model incorporating diffusion patterns and morphological features demonstrates acceptable diagnostic performance for BI-RADS categorization and may provide practical guidance when DWI must be interpreted independently.

INTRODUCTION: Hymenoptera venom allergy is a major cause of IgE-mediated anaphylaxis. Optimal management includes prompt adrenaline administration, referral to an allergy specialist, prescription of an adrenaline autoinjector, and initiation of venom immunotherapy (VIT). Despite well-established international guidelines, adherence to recommended practices in real-world settings remains suboptimal.
METHODS: Medical records of 238 patients diagnosed with bee venom allergy at the our clinic between 1999 and 2010 were reviewed. Collected data included demographic characteristics, sting location, reaction severity (Mueller classification), acute emergency management (adrenaline administration and specialist referral), diagnostic testing (skin prick test and venom-specific IgE), adrenaline autoinjector prescription, and VIT-related outcomes (initiation, safety, and efficacy).
RESULTS: Systemic reactions occurred in 92.4% of patients, with 76.4% classified as severe (Mueller grades 3–4). Neck stings were significantly associated with severe reactions (95% grade 3–4; p = 0.011). Adrenaline was administered in 43% of acute reactions, 24% were referred to an allergy specialist, and 35.5% received an autoinjector prescription. Venom sensitization was confirmed in 86.5%. Although VIT was recommended for 163 patients, only 50.9% initiated therapy. During VIT, 31% had mild-to-moderate injection reactions, with no severe systemic events. No systemic reactions occurred after re-sting in patients who completed VIT.
DISCUSSION AND CONCLUSION: The management of Hymenoptera venom allergy in Türkiye remains suboptimal, primarily due to underuse of adrenaline, low referral rates to allergy specialists, and limited uptake of VIT. Strategies aimed at improving physician education, standardizing emergency management protocols, and enhancing access to VIT are essential to optimize patient outcomes and ensure guideline-concordant care.

INTRODUCTION: Anhedonia is increasingly recognized as a transdiagnostic construct associated with multiple dimensions of psychopathology. However, its relationship with somatic symptom burden in adolescents, independent of core internalizing symptoms such as depression and anxi-ety, remains unclear. This study aimed to examine the association between anhedonia and somatic symptoms in adolescents and to de-termine whether this relationship persists beyond depressive and anxiety symptom severity.
METHODS: A total of 242 adolescents aged 12–18 years referred to a child and adolescent psychiatry outpatient clinic were included. Psychiatric diagnoses were established using a semi-structured clinical interview. Depression severity was assessed with a clinician-rated instru-ment, while anhedonia, anxiety symptoms, and somatic symptoms were evaluated using validated self-report measures. Hierarchical regression analyses were conducted in three steps: Model I included age and sex; Model II added depression and anxiety; and Model III included anhedonia.
RESULTS: Clinically significant anhedonia was identified in 27.7% of participants. Adolescents with anhedonia exhibited higher somatic symp-tom severity (p<0.001). Somatic symptom scores were positively correlated with depression and anxiety severity and negatively corre-lated with hedonic capacity (p<0.001). In hierarchical regression analyses, female sex (β=0.295), depression (β=0.410), and anxiety (β=0.370) were significant predictors of somatic symptoms. In the final model, anhedonia remained an independent predictor (β=–0.184, p=0.003), explaining additional variance beyond core internalizing symptoms.
DISCUSSION AND CONCLUSION: Anhedonia is independently associated with somatic symptom burden in adolescents. These findings suggest that somatic symptoms should be conceptualized not only as manifestations of internalizing psychopathology but also in relation to dysfunctions in reward–motivation systems and interoceptive processing.

INTRODUCTION: The primary objective of this investigation was to determine the efficacy of the gamma-glutamyl transferase-to-albumin ratio (GAR) and the gamma-glutamyl transferase-to-platelet ratio (GPR) in diagnosing preeclampsia and their capacity to differentiate between early-onset and late-onset disease phenotypes.
METHODS: In this retrospective cohort study, 201 singleton pregnancies managed between 2019 and 2025, comprising 100 cases of preeclampsia and 101 normotensive controls, were analyzed.: Preeclamptic participants were categorized into two subgroups according to gestational age at clinical presentation: early-onset (<34 weeks; n=26) or late-onset (≥34 weeks; n=74). Demographic, clinical, and laboratory parameters at diagnosis were recorded, and GPR and GAR were calculated from routine tests. Group comparisons were performed using non-parametric methods, and discriminative performance was assessed using ROC curve analysis.
RESULTS: The study cohort comprised 201 participants, showing baseline homogeneity for maternal age and routine blood markers (p>0.05). Mean arterial pressure remained consistent across preeclampsia subtypes but was markedly higher than normotensive controls (p<0.001). Albumin levels dropped sequentially across groups, reaching minimum concentrations in the early-onset subtype (p<0.001). GAR varied significantly among cohorts (p=0.003), peaking in early-onset cases, while GPR showed no such differentiation (p=0.094). GAR identified preeclampsia with an AUC of 0.599 (p=0.014, threshold 0.246), whereas GPR was non-significant (p=0.199). For subtype stratification, GAR provided superior discrimination (AUC=0.679, p=0.008) compared to the non-significant GPR (p=0.102).
DISCUSSION AND CONCLUSION: Unlike GPR, the GAR index offers a modest but significant diagnostic performance, particularly for predicting early-onset preeclampsia, and holds potential as a complementary parameter for clinical risk stratification.

INTRODUCTION: Respiratory bronchiolitis-associated interstitial lung disease (RB-ILD) is an extremely rare condition classified as smoking-related interstitial pneumonia. The purpose of this study was to investigate the demographic, radiological, and pulmonary function characteristics of patients diagnosed with RB-ILD based on radiological findings. In this study, we aimed to investigate the co-occurrence of lung cancer and non-lung cancers in patients with RB-ILD.
METHODS: Radiological images consistent with RB-ILD presentation (centrilobular opacity, ground glass areas, and air trapping) who attended the our center, were included in the study. Included patients were age 18 years and older, had a history of smoking (active or ex-smoker), and presented radiological evidence of RB-ILD. Demographic data, such as age, sex, cigarette packs smoked and history (pack-years), occupation, comorbidities, cancer frequency, and pulmonary function parameters were assessed.
RESULTS: The study included 60 patients of which 91.7% were male. The mean age was 60.9±12.5 years, and the mean cigarette pack-year history was 33.7±12.0. Pulmonary function tests indicated small airway obstruction. Malignancy was present in 51.7% of patients with RB-ILD, with the most common types being small-cell lung cancer, colon cancer, gastric cancer, and prostate cancer. Patients were assigned into groups based on the presence of malignancy, with no significant differences found in gender, age, cigarette pack-years, and pulmonary function test values.
DISCUSSION AND CONCLUSION: This study is the first nationwide investigation reporting the coexistence of RB-ILD and malignancy in a selected population of smokers. Besides smoking cessation, close monitoring for lung and extrapulmonary cancer development is advised for patients with RB-ILD.

Bloch–Sulzberger Syndrome (BSS), also known as Incontinentia Pigmenti (IP), is a rare X-linked dominant neurocutaneous disorder affecting the skin, central nervous system, eyes, teeth, and hair. It predominantly affects females, as hemizygous male embryos are usually nonviable. Survival in males is exceptionally rare and often associated with chromosomal abnormalities or somatic mosaicism. We report a full-term male neonate born to a non-consanguineous primigravida mother with no relevant family history. The infant developed recurrent seizures and characteristic cutaneous lesions shortly after birth, including vesiculobullous eruptions over the scalp with alopecia and linear hyperpigmentation along Blaschko lines on the trunk and limbs. Ocular abnormalities were also present. Diagnostic evaluation fulfilled major criteria with stage 1 (vesicular), stage 2 (verrucous), and stage 3 (hyperpigmented) lesions, along with minor neurological, ocular, and hair involvement. Peripheral eosinophilia and eosinophils in vesicular fluid supported the diagnosis. Differential diagnoses, including neonatal herpes simplex and other linear pigmentary disorders, were excluded clinically and histopathologically. Molecular testing for IKBKG mutation and neuroimaging were advised but not performed due to financial constraints. Despite supportive management, the infant succumbed to refractory seizures. A literature review using PubMed and Google Scholar was conducted to summarise current evidence on the genetics, pathogenesis, clinical manifestations, diagnosis, and management of Bloch–Sulzberger Syndrome. This case underscores the rarity and severity of BSS in males. Early recognition of staged dermatologic findings and systemic involvement is crucial for multidisciplinary care, genetic counselling, and improved clinical outcomes.