BACKGROUND: This study aims to show the changes in the liver, lung, kidney, and heart in the liver ischemia-reperfusion model in rats and the effect of quercetin on these changes histopathologically and immunohistochemically.
METHODS: Eighteen Sprague Dawley rats were classified into three groups: Group 1 sham, Group 2 ischemia-reperfusion (IR), Group 3 ischemia-reperfusion + quercetin (IR+Q). For three days, distilled water was given to Group 1, and quercetin was given to Group 3 via gavage. At the end of the third day, abdominal opening-closing was applied to Group 1, and 4 hours of reperfusion was applied to Groups 2 and 3 after 1 hour of ischemia by clamping the hepatoduodenal ligament, and all rats were euthanized. Liver, lung, kidney, and heart tissue samples were stained with Hematoxylin Eosin (HE), Masson Trichrome, Periodic Acid-Schiff (PAS), and TUNEL (Terminal deoxynucleotidyl transferase (TdT) deoxyuridine triphosphate nick end labeling assay) to assess apoptosis and examined histopathologically and immunohistochemically under a light microscope.
RESULTS: In the liver, the damage score was significantly higher in the IR group than in the sham group, while it was significantly lower in the IR+Q group than in the IR group. While there was no significant difference between the groups in semi-quantitative scoring parameters, the Apoptotic Index was significantly higher in the IR group than in the sham group and significantly lower in the IR+Q group than in the IR group. In the lung, no significant difference in lung damage scores between the groups was observed. While the Apoptotic Index was significantly higher in the IR group than in the sham group, it was significantly lower in the IR+Q group than in the IR group. In the kidneys, tubular cell degeneration and intertubular vascular congestion were significantly higher in the IR group than in the sham group. While the Apoptotic Index was higher in the IR group than in the sham and IR+Q groups, it was higher in the IR+Q group than in the sham group. In the heart, there was no difference between the groups in terms of myocardial cell degeneration and vascular damage. The apoptotic index was significantly higher in the IR group than in the sham and IR+Q groups.
CONCLUSION: Our results indicate that histopathological damage occurs in the liver, lung, kidney, and heart in the experimentally created IR model, and quercetin application decreases IR-related damage and apoptosis in these organs.

BACKGROUND: Traumatic brain injury is a global health problem. Infliximab is used daily to treat a variety of inflammatory systemic disorders. The goal of this study was to compare the pathological and biochemical changes induced by dexamethasone and infliximab usage in rats with blunt head trauma.
METHODS: Thirty-two adult rats were used in our study. Groups of eight animals were used, and those with skin incision without any additional trauma were called sham (Group 1); those with skin incision and head trauma were called control (Group 2); those who received 1 mg/kg intraperitoneal dexamethasone immediately after head trauma were called steroid (Group 3); and those who received 5 mg/kg subcutaneous infliximab immediately after trauma were called infliximab (Group 4). The animals were euthanized seven days after the operation.
RESULTS: Brain tissue malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GPx) values of the four groups were compared and a statistically significant difference was shown. However, no significant difference was observed between the infliximab and dexamethasone groups in terms of tissue MDA, SOD, and GPx concentrations. Pathological sections showed that trauma-induced cortical damage, interstitial edema, and perivascular edema were reduced in the infliximab group.
CONCLUSION: Infliximab demonstrates comparable neuroprotective effects to dexamethasone in oxidative stress markers, while providing superior efficacy in edema reduction.

BACKGROUND: This study aims to evaluate the performance of ChatGPT-4o in thoracic trauma management by comparing its responses to established clinical guidelines.
METHODS: Five major thoracic surgery guidelines were reviewed, including the Advanced Trauma Life Support (ATLS) Guidelines 2018, Eastern Association for the Surgery of Trauma (EAST) Guidelines 2020, Evaluation and management of traumatic pneumothorax: A Western Trauma Association critical decisions algorithm 2022, European Trauma Course (ETC) Guidelines 2016, and the National Institute for Health and Care Excellence (NICE) Guidelines for Trauma 2020. Fifty open-ended questions were developed based on these guidelines and submitted to ChatGPT-4o. Five thoracic surgery specialists evaluated the artificial intelligence (AI) responses using a 5-point Likert scale.
RESULTS: ChatGPT-4o achieved an average score of 4.76±0.57 on the 50-question evaluation. ChatGPT-4o excelled in questions derived from well-defined guidelines, demonstrating its ability to synthesize and apply guideline-based medical knowledge. Its performance aligns with previous studies in urological trauma and emergency medicine, which reported similar reliability. However, its reliance on pre-existing data limits its effectiveness in addressing highly nuanced or novel clinical scenarios. These findings underscore its potential as a complementary tool in guideline-driven medical contexts while emphasizing the need for clinical oversight in complex cases.
CONCLUSION: ChatGPT-4o performed strongly in thoracic trauma management questions, demonstrating minimal errors and high reliability. These results suggest it could serve as a valuable support tool for clinical decision-making, particularly in scenarios guided by established protocols. Further exploration into broader medical domains is warranted.

BACKGROUND: This study aims to assess the diagnostic value and problem-solving utility of follow-up abdominopelvic computed tomography (CT) scans performed within 10 days of the initial presentation for acute non-traumatic abdominal symptoms in the emergency department.
METHODS: A retrospective analysis was conducted on patients who presented with acute abdominal symptoms to the emergency department between January 1, 2013 and May 30, 2023, and underwent abdominopelvic CT scans in the acute setting. Among this cohort, 149 patients had repeat abdominopelvic CT scans during the same admission and were classified into five groups based on findings: Group A (no change in diagnosis), Group B (confirmation of suspected initial diagnosis), Group C (disease progression), Group D (disease regression), and Group E (new diagnosis).
RESULTS: The mean age of the cohort was 51.5±18 years (range: 19-92). The average interval between initial and repeat CT scans was 40.9±59.05 hours (range: 0.5-238). The number of patients in each group was as follows: Group A (n=21), Group B (n=60), Group C (n=32), Group D (n=25), and Group E (n=11). Partial bowel obstruction was the most common finding (27%, 41/149), with 72% (18/25) of Group D showing regression on follow-up CT. The "wait and follow-up" approach significantly guided management decisions for partial bowel obstruction (p<0.01).
CONCLUSION: This study emphasizes the importance of the "wait and repeat CT" strategy in enhancing diagnostic accuracy and guiding clinical management for patients with acute non-traumatic abdominal complaints. Follow-up CT scans were particularly effective in identifying conditions such as partial bowel obstruction.

BACKGROUND: This retrospective cohort study aimed to evaluate the safety of hyperbaric oxygen therapy (HBOT) in patients with blunt thoracic trauma, with particular focus on crush injuries sustained during the 2023 Kahramanmaraþ earthquakes.
METHODS: Twenty-five patients with documented thoracic trauma who underwent HBOT at a tertiary care center were included. HBOT was delivered at 2.4 atmospheres absolute (ATA) for two hours per session in a multiplace chamber. Data on demographics, clinical findings, treatment outcomes, and adverse events were analyzed.
RESULTS: The median age was 23 years (range: 10-57), and 64% were female. The median number of HBOT sessions was 11 (range: 2-37). Three patients (12%) died during follow-up due to severe crush injuries, unrelated to HBOT. Five patients (20%) developed respiratory or cardiac symptoms during treatment, including dyspnea (n=2), chest pain (n=1), dyspnea with chest pain (n=1), and arrhythmia with convulsions (n=1). Pneumomediastinum was incidentally detected in one intubated patient post-session and was managed conservatively, allowing HBOT to continue without further complications. One patient experienced a generalized seizure attributed to central nervous system oxygen toxicity; HBOT was discontinued, neurological evaluation was performed, and no permanent sequelae occurred.
CONCLUSION: Although HBOT is generally considered safe, it may cause cardiopulmonary complications in patients with thoracic trauma, especially those with poor clinical reserve or requiring mechanical ventilation. Most complications observed in this cohort were minor and manageable. HBOT can be safely administered in carefully selected thoracic trauma patients when individualized risk assessment and multidisciplinary monitoring are ensured. Future prospective studies with larger cohorts are needed to further clarify safety profiles and risk stratification strategies.

BACKGROUND: Extravasation of non-cytotoxic medications can lead to serious complications such as pain, tissue necrosis, limb loss, and even death. This descriptive cross-sectional study aims to assess the knowledge levels of emergency department (ED) nurses regarding extravasation incidents involving non-cytotoxic medications and to highlight the importance of effective management and prevention.
METHODS: The study was conducted in the EDs of three hospitals in Istanbul, Türkiye, between November 19, 2020 and December 31, 2020. A total of 100 ED nurses participated in the study. Inclusion criteria required nurses to be working full-time in the EDs during the study period and to provide written and verbal consent. The study utilized a survey to assess sociodemographic characteristics, knowledge of non-cytotoxic medications (e.g., epinephrine), symptoms of extravasation, prevention strategies, and intervention practices.
RESULTS: The mean age of the nurses was 29.43 years, with 57% female and 73% holding a bachelor’s degree. Among participants, 52% had 0-3 years of ED experience. Ninety-one percent reported not receiving education on extravasation after graduation, and 82% indicated no extravasation protocol was in place at their workplace. Knowledge about non-cytotoxic medications causing extravasation significantly increased with ED experience (p=0.035). Nurses in units with an extravasation protocol had significantly higher knowledge levels (p=0.007). Female nurses demonstrated better knowledge of extravasation symptoms than male nurses (p=0.012). Nurses with a bachelor’s or higher degree had significantly better knowledge than others (p=0.015). The knowledge rate for the extravasation care protocol was 64%, with the most recognized protocol item being “immediately stop the infusion” (97%) and the least recognized being “aspirate the medication not to exceed 3-5 mL” (33%). Strong correlations were found between non-pharmacological factors and knowledge of non-cytotoxic medications (r=0.601; p<0.001), as well as between knowledge of extravasation care protocols and non-pharmacological factors (p<0.001).
CONCLUSION: The study highlights the need for targeted education and the establishment of institutional protocols for managing and preventing extravasation in EDs. Nurses' knowledge significantly impacts their adherence to prevention and care protocols. To ensure patient safety, it is important to provide ongoing education and implement evidence-based intervention protocols for the management of extravasation in ED settings.

BACKGROUND: This study aimed to determine the reliability and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) in elderly patients compared with younger patients.
METHODS: In this retrospective study, ERCP procedures performed in our endoscopy unit between December 2020 and October 2024 were reviewed. Elderly patients aged ≥80 years (AA group) and younger patients aged <65 years (control group) were included. Their demographics, comorbidities, American Society of Anesthesiologists (ASA) scores, ERCP indications, procedural success, and complications were compared.
RESULTS: There were significant differences in ASA scores, comorbidities, and the use of anticoagulant or antiplatelet drugs between the groups (p<0.05, p<0.01, and p<0.05, respectively). Juxtapapillary diverticula were more common in the AA group than in the control group (21% vs. 5.1%, p<0.01). Regarding indications, choledocholithiasis and obstructive jaundice were the most common in both groups (p=0.456 and p=0.064, respectively). The rate of cannulation success was not significantly different between the groups (p=0.956). Sphincterotomy and stone extraction with balloon or basket were the most frequent interventions in both groups (p=0.22 and p=0.563, respectively). Postprocedural pancreatitis was significantly more common in the control group than in the AA group (p=0.041). No significant differences were found in other complications, including bleeding, perforation, infection, basket impaction, and cardiopulmonary events between the groups (p=0.436, p=0.354, p=0.958, p=0.254, and p=0.289, respectively).
CONCLUSION: Therapeutic ERCP procedures can be performed safely and efficiently in elderly patients, as their outcomes are comparable to those observed in younger patients.

BACKGROUND: This study aims to retrospectively evaluate treatment approaches and clinical outcomes in patients with penetrating abdominal trauma caused by gunshot injuries—one of the most complex and controversial areas in trauma surgery.
METHODS: A total of 101 patients diagnosed and treated for penetrating abdominal trauma due to gunshot injuries between 2015 and 2025 were included in the study. Demographic data (age and sex); vital signs at admission to the emergency department (blood pressure, pulse, respiratory rate, body temperature); level of consciousness (Glasgow Coma Scale); hemodynamic status (stability/instability, need for fluid or inotropic support); intra-abdominal (liver, spleen, small intestine, colon, etc.) and extra-abdominal (thorax, extremities, head, etc.) organ injuries; laboratory findings (hemoglobin, leukocyte count, creatinine, pH level); treatment modality (surgical intervention or conservative management); surgical techniques used; blood and blood product transfusions; and hospital length of stay were retrospectively analyzed. Patients were divided into two groups: those who underwent surgical treatment and those managed conservatively. Factors influencing treatment decisions and variables affecting mortality were evaluated statistically.
RESULTS: Of the patients, 83.2% were male, with a mean age of 28.3±10.5 years. Surgical treatment was performed in 81.2% of cases, while 18.8% received conservative management. No mortality occurred in the conservatively managed group, whereas the surgically treated group had a mortality rate of 15.9%. Mortality among female patients (29.4%) was significantly higher than among males (9.5%) (p=0.026). Hemodynamic instability, intra-abdominal organ injury, presence of free air in the abdomen, and the need for blood product transfusion were associated with both the decision for surgical intervention and higher mortality. Additionally, damage control surgery and multiple organ injuries were linked to increased mortality.
CONCLUSION: Management of abdominal trauma caused by gunshot injuries requires a multidisciplinary approach to ensure appropriate patient selection and treatment planning. In hemodynamically stable patients, selective non-operative management (SNOM) is a safe and effective option, whereas surgical intervention—particularly in cases requiring damage control surgery—is associated with higher mortality. The increased mortality rate among female patients underscores the need for closer monitoring of this subgroup and further investigation into potential additional risk factors. These findings align with current literature and provide practical guidance for clinical decision-making.

BACKGROUND: Epidemiological data are needed to develop pediatric burn prevention strategies and guide interventions in low-and middle-income countries.
METHODS: In this observational retrospective study, the characteristics of 140 consecutive pediatric patients who were hospitalized and treated for burns at the Burns Unit of a hospital in Mogadishu, Somalia, between November 2022 and April 2024 were analyzed.
RESULTS: The patients included 50% males and 50% females, with a mean age of 4.96±4.07 years. The most common burn etiologies were hot water (75.7%), open flame (15.7%), and hot oil (8.6%). Burns involving two or more anatomical regions were observed in 44.2% of the cases. The mean total body surface area (TBSA) affected was 16.2±10.42% (min: 4%, max: 90%). Superficial second-degree burns were present in 50.7% of the patients, and deep second-degree burns in 28.6%. No statistically significant relationship was found between gender and burn degree, burn percentage, or burn etiology (p>0.05). Analysis by age group revealed a statistically significant but weak association (24%) between the 0-4 years age group and burn degree. This was attributed to a higher proportion of more severe burns in children aged 0-4 years compared to those aged 5 years and older. The most common complication was anemia (37.1%), and no mortality was observed. The average hospital stay was 24.1±27.8 days (range: 2-179 days).
CONCLUSION: This study presents the first epidemiological data on in-patient pediatric burn cases in Somalia, a country classified as low-income. The risk of mortality can be eliminated if effective burn management is provided in pediatric burn cases, even in low-resource countries. These findings support the expectation of survival in major pediatric burns. Nurses and all healthcare professionals share responsibility for the protection and promotion of health. Therefore, training on burn injury prevention strategies should be targeted and implemented in areas where the incidence is high.

BACKGROUND: The quick Sequential Organ Failure Assessment (qSOFA) score is widely used for bedside risk stratification in sepsis patients. However, its limited sensitivity may hinder early identification. The lactate-enhanced qSOFA (LqSOFA), which incorporates serum lactate levels into the qSOFA score, may improve prognostic accuracy. This study aimed to evaluate the diagnostic performance of LqSOFA in predicting early (24-hour) and late (30-day) mortality, as well as intensive care unit (ICU) admission, among patients with sepsis.
METHODS: This retrospective descriptive study included patients aged ≥18 years who were diagnosed with sepsis based on Sepsis-3 criteria and admitted to the emergency department (ED) of a tertiary-care teaching hospital between July 1, 2024 and December 31, 2024. Patients were identified through ICD-10 (International Classification of Diseases, 10th Revision) codes, and diagnoses were clinically confirmed. qSOFA and LqSOFA scores were calculated using initial vital signs and venous lactate levels. The primary outcomes were 24-hour and 30-day mortality; ICU admission was assessed as a secondary outcome. Statistical analyses were conducted using SPSS v27 and Jamovi v2.5.7. The diagnostic performance of the scores was evaluated using receiver operating characteristic (ROC) curve analysis. Area under the curve (AUC), sensitivity, specificity, and predictive values were calculated, and AUC comparisons were performed using the DeLong test (p<0.05 considered significant).
RESULTS: A total of 236 patients were included (median age: 75 years; 53% male). The 24-hour and 30-day mortality rates were 20.3% and 36.4%, respectively. LqSOFA demonstrated significantly higher diagnostic accuracy than qSOFA for predicting 24-hour mortality (AUC: 0.709 vs. 0.673; p<0.05). Although LqSOFA also showed a higher AUC for 30-day mortality, the difference was not statistically significant. Nevertheless, LqSOFA exhibited superior specificity and positive predictive value. For ICU admission, LqSOFA demonstrated greater sensitivity than qSOFA (79% vs. 57%).
CONCLUSION: LqSOFA outperforms qSOFA in predicting mortality and ICU admission among sepsis patients in the emergency department. Given its simplicity, objectivity, and ease of implementation, LqSOFA may serve as a practical tool to support clinical decision-making in emergency settings.

BACKGROUND: Predicting return-to-work (RTW) outcomes following upper extremity trauma is crucial for optimizing patient care, guiding rehabilitation, and reducing the socioeconomic burden. Although several disability scoring systems have been proposed to assess injury severity, their ability to estimate RTW status and duration remains underexplored. This study aimed to evaluate the predictive value of the Modified Hand Injury Severity Score (MHISS), Upper Extremity Disability Rate (UEDR), and Total Body Disability Rate (TBDR) for RTW outcomes in patients with hand, wrist, and forearm injuries.
METHODS: A retrospective cross-sectional study was conducted on 69 patients who presented to the Forensic Medicine Department of Ondokuz Mayýs University between 2020 and 2024. Eligible participants were adults with documented hand, wrist, or forearm injuries and complete treatment records, including MHISS scoring. Demographic data, injury characteristics, and disability rates (UEDR, TBDR) were collected. Statistical analyses included Spearman correlation, receiver operating characteristic (ROC) analysis, and logistic regression to assess associations between scoring systems and RTW status and duration.
RESULTS: The median MHISS score was 20.0, with corresponding UEDR and TBDR values of 3.0% and 2.0%, respectively. Occupational injuries, observed in 37.7% of cases, were associated with significantly higher disability scores (p<0.05). ROC analysis demonstrated strong predictive ability for MHISS (area under the curve [AUC]: 0.886), UEDR (AUC: 0.903), and TBDR (AUC: 0.897) in identifying RTW status. While MHISS effectively predicted RTW status, it did not correlate with RTW duration (p=0.082). In contrast, UEDR and TBDR showed weak but statistically significant correlations with RTW duration (r=0.295 and r=0.296, respectively). Multivariate logistic regression did not identify any independent predictors of RTW.
CONCLUSION: Disability scoring systems such as MHISS, UEDR, and TBDR are useful tools for predicting whether patients will return to work following hand and forearm injuries. However, their ability to estimate the duration of work absence is limited. Future research should integrate psychosocial, occupational, and rehabilitation-related variables to develop more comprehensive models for RTW prognosis.

BACKGROUND: This study examines the outcomes of conservative versus surgical treatment for Thoracolumbar Injury Classification and Severity Score (TLICS) 4 thoracolumbar fractures in patients injured during the 2023 Türkiye earthquake. It aims to assess clinical and radiographic outcomes while considering the impact of crush syndrome-related complications on treatment decisions.
METHODS: Twenty-three patients with TLICS 4 spinal injuries were evaluated and divided into surgical (n=12) and conservative (n=11) groups. Clinical parameters, including age, gender, preoperative spinal measurements, and one-year postoperative outcomes, were assessed. The Roland-Morris score was used to evaluate clinical outcomes. Additionally, complications such as cardiac, renal, and respiratory issues, infections, and length of hospital stay were analyzed.
RESULTS: The surgical group had significantly higher Roland-Morris scores (RM: 79.3±12.7 vs. 15.0±8.5, p<0.001). Preoperative acute kidney injury was more common in the conservative group (36.4% vs. 8.3%, p<0.05), whereas preoperative pulmonary complications were more frequent in the surgical group (83.3% vs. 36.4%, p<0.05). No significant differences were found in gender, age, or other complications. Radiological outcomes, including Cobb angle, sagittal index, and anterior central vertebral body height (ACVBH) restoration, showed no significant differences between groups. Length of hospital stay was similar between groups.
CONCLUSION: Our study demonstrates that both conservative and surgical treatments are effective for managing TLICS 4 thoracolumbar fractures in disaster settings. Treatment decisions should be guided by patient-specific factors and available resources.

BACKGROUND: This study aimed to compare the effects of hematoma block (HB) and dexmedetomidine administration on pain control, reduction quality, and physician satisfaction during the reduction of distal radius fractures (DRFs) in the emergency department (ED).
METHODS: A total of 60 patients presenting to the ED with DRFs were enrolled. Patients were randomly assigned to two groups: one received HB, while the other underwent conscious sedation with dexmedetomidine. Pain levels were assessed using the Visual Analog Scale (VAS) at three time points: before the procedure, 10 minutes after administration of the intervention, and post-reduction. Physician satisfaction during reduction was measured using the 5-point Likert Satisfaction Scale (LSS). Post-reduction quality was evaluated on control radiographs using the Sarmiento criteria.
RESULTS: Among the patients included in the study, 28 were female, 19 were male, and 13 were children (<12 years). The mean age was 32.97±20.48 years in the dexmedetomidine group (DG) and 35.25±18.92 years in the hematoma block group (HBG), with no statistically significant difference between the groups (t=-0.448, p=0.65). There was no significant difference in physician satisfaction during reduction between the two groups according to LSS results (χ²=2.296, p=0.512). Pre-procedure VAS scores were comparable between the two groups (t=-0.148, p=0.883). However, VAS scores 10 minutes after the intervention were significantly lower in the DG compared to the HBG (p=0.009, t=-2.773). Post-reduction quality based on the Sarmiento criteria showed no significant difference between the groups (χ²=0.64, p=0.89). No adverse effects related to either method were observed in any of the patients.
CONCLUSION: Dexmedetomidine provides faster and more effective pain management than HB for DRF reduction in the ED. Given its minimal systemic side effects, dexmedetomidine may represent a viable alternative for procedural sedation and analgesia (PSA) in fracture reductions requiring sedation in the ED.

BACKGROUND: Benign and benign-aggressive bone tumors, though non-metastatic, may require surgical intervention due to pain, fracture risk, or functional impairment. In many cases, bone grafting may be required in benign or benign-aggressive bone tumors. Although autografts remain the gold standard, they present disadvantages, especially in pediatric patients. Synthetic alternatives such as bioactive glass (BG) have emerged as viable options. This study aims to evaluate the clinical and radiological outcomes of BG in the treatment of benign bone tumors.
METHODS: This retrospective single-center study evaluated 64 patients (71 procedures) treated with curettage and BG grafting for benign bone tumors between 2004 and 2023. Functional outcomes were assessed using the Musculoskeletal Tumor Society (MSTS) score, and radiological healing was evaluated using the Neer classification.
RESULTS: The mean follow-up was 25.0±12.6 months. Significant improvement was observed in MSTS scores (from 17.6±4.8 to 28.1±2.0; p<0.05). Neer classification indicated high union rates. Complications included tumor recurrence in four patients (five procedures), fractures in nine patients, and superficial infections in four patients. No deep infections or any other material-related adverse effects were reported.
CONCLUSION: Bioactive glass is a safe and effective bone substitute for managing benign bone defects, especially in pediatric populations where autograft options are limited. Its osteoconductive durability, infection resistance, and compatibility with bone remodeling make it a strong alternative to traditional grafting techniques.