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Objective Calcium plays an important role in almost all cellular processes. Measurement of ionized calcium levels is more important in demonstrating calcium metabolism. Tight control of calcium metabolism is impaired during sepsis. However, the prognostic significance of ionized calcium levels in patients admitted to the intensive care unit (ICU) due to sepsis is not fully known. The aim of our study was to evaluate the prognostic significance of ionized calcium levels in patients admitted to the ICU due to sepsis. Material and methods A total of 228 patients who were admitted to the emergency department of the university Faculty of Medicine and admitted to the emergency ICU with a diagnosis of sepsis between January 2020 and December 2021 were included in the study. Demographic characteristics, vital signs, Sequential Organ Failure Assessment (SOFA), Rapid Sequential Organ Failure Assessment (qSOFA), ionized calcium and total serum calcium levels, blood gas, hemogram and biochemistry parameters, hospital outcome, and 7-day mortality status were retrospectively screened and analyzed. Results The mean ionized calcium level of the cases was 1.07 ± 0.20 mmol/L, and the albumin-corrected calcium level was 9.20 ± 1.06 mg/dL. While the 7-day mortality rate was 25.4%, the hospital mortality rate was up to 57.9%. ROC analyses showed that ionized calcium concentrations were not the sole predictors of 7-day mortality (AUC=0.561, 95% CI 0.494-0.626, p=0.188) and hospital outcome (AUC=0.525, 95% CI 0.458-0.591, p=0.517). Ionized calcium levels were also not correlated with SOFA score, ICU length of stay, and hospital length of stay, which were significant predictors of mortality. Conclusion Ionized calcium may provide more accurate information than corrected total serum calcium levels in determining calcium levels. The frequency of hypocalcemia is quite high in sepsis cases. However, the prognostic value of ionized calcium is limited in patients admitted to the ICU due to sepsis.

Aim: Anaplastic thyroid carcinoma (ATC) is one of the most aggressive and lethal forms of thyroid malignancies, accounting for approximately 1-5% of all thyroid cancers. Despite multimodal treatment approaches, prognosis remains poor, with a median survival of approximately six months. A significant portion of patients die during postoperative follow-up before being discharged after the initial surgical treatment. Materials and Methods: This retrospective study analyzed 13 patients diagnosed with ATC who underwent surgical treatment at Necmettin Erbakan University Faculty of Medicine over the past 20 years (2004-2024). Patient demographics, tumor characteristics, treatment modalities, and survival outcomes were evaluated. Statistical analyses were performed using SPSS software. Results: The median age of the patients was 77.23 years (range: 69-89), with a male-to-female ratio of 7:6. The median survival time was 140 days (range: 10-700 days), with no significant difference between male and female patients (p=0.595). Additionally, no significant correlation was found between age and survival duration (p=0.26). The comparison between stage 4B and stage 4C patients revealed no statistically significant difference in survival (151.3 vs. 103 days, p=0.45). Patients who received chemotherapy or radiotherapy had significantly longer survival compared to those who did not (367 vs. 72 days, p=0.017). Conclusion: ATC remains a highly aggressive malignancy with limited treatment options and poor survival outcomes. Although chemotherapy and radiotherapy appear to improve survival, the small sample size limits definitive conclusions. While it is seen that surgery was the most important treatment option in old cases, it is seen that chemotherapy, radiotherapy and immunotherapy options are used more as we approach the present day. Future studies with larger cohorts and molecular analyses, including BRAF mutation and immunotherapy trials, are needed to identify more effective treatment strategies.

Objective: The Ankle-Brachial Index (ABI) serves as an indicator for the diagnosis of peripheral arterial disease and general atherosclerosis. Framingham risk score (FRS) is among the validated measures used to evaluate 10-year cardiovascular risk. This study aimed to assess the ABI and FRS in patients who presented outpatient clinic for periodic health examinations. Methods: This retrospective study examined the medical files of 580 patients aged ≥18 who presented to the Family Medicine outpatient clinic between June 25, 2013, and June 25, 2016, for any reason. The FRS was calculated automatically using a computer-based tool. Two distinct FRS values, FRS1 (LDL-based) and FRS2 (total cholesterol-based), were generated by utilizing both LDL cholesterol and total cholesterol levels. The ABI was calculated as the ratio of ankle systolic blood pressure to brachial systolic blood pressure. Results: Of the 580 patients, 58.3% (n=338) were female, and 41.7% (n=242) were male. The mean value of ABI in our study was 1.13±0.10. A low ABI (≤0.97) was identified in 15 patients (2.6%). A statistically significant association was determined between ABI and both FRS1 and FRS2 (p<0.001, p<0.001). A statistically significant relationship was found between FRS1 and Body Mass Index (BMI) (p=0.002). A comparison of FRS1 and FRS2 by gender demonstrated a significantly higher cardiovascular risk in men than in women (p<0.001). Conclusion: The current study determined that the risk of coronary artery disease (CAD) was significantly higher in individuals with ABI ≤0.97 compared to those with ABI >0.97. The findings of this study demonstrated that the ABI score with FRS can be utilized as a cost-effective and effective marker for assessing cardiovascular risk during periodic health examinations in primary care within our country.

Aim: The efficient use of the prefrontal cortex (PFC) plays a crucial role in athletes' mastery of technical and tactical skills, enabling them to perform at a high level by making sound decisions during competitive encounters. However, the effects of dual-task paradigms on the PFC in athletes remain unclear in the literature. The aim of this study was to investigate the effects of dual-task (cognitive + motor) paradigms presented at varying levels of difficulty on PFC hemodynamic responses. Methods: This study included 14 athletes (mean age = 12 ± 1.56 years), randomized to the "Dual Task" paradigm (P1: motor task; P2: cue task; P3: complex cue task). Dual task performance was measured using the Fitlight system, where participants extinguished 25 lights at varying difficulty levels. In P1, participants extinguished randomly lit lights; in P2, they did so faster as the next light appeared in the same color region; in P3, a more complex cue indicated the light region, requiring altered motor control. Hemodynamic responses in the prefrontal cortex (HbO, HbR, HbT) were assessed using fNIRS during task performance. Results: Significant differences were observed in the competition time of the test between the P1 and P2 tasks (p < 0.001), as well as between the P1 and P3 tasks (p < 0.001). fNIRS data demonstrated a higher level of cortical activation in the prefrontal cortex during the P3 task compared to other tasks; however, this difference was not statistically significant (p = 0.257). A strong and statistically significant positive correlation was identified between the hemodynamic responses and the P1, P2, and P3 tasks (p < 0.001). Conclusion: Task protocols with higher cognitive load resulted in an increase in HbO, HbR, and HbT values, which were proportional to task difficulty in prefrontal activation. Keywords: dual-task, cognitive load, prefrontal cortex, fNIRS

At the beginning of the 21st century, with the rapid advancement of globalization, the concepts of international promotion and global health diplomacy underwent a significant transformation. Global health diplomacy, once the sole responsibility of states and international money, has evolved into a complex and multidimensional process intertwined with numerous interdisciplinary fields such as human rights, foreign policy, national security, development policies, and global governance. In this context, health diplomacy plays a critical role in global politics, not only in responding to health crises but also in reshaping interstate cooperation and institutions. COVID-19 pandemic has been recorded as one of the most comprehensive and devastating health crises experienced by globalization, transcending regions and affecting the entire world. The effects of the pandemic have not only led to profound changes in general health sector policies, international politics, economic structures, social dynamics, and global security. This process has highlighted the need for interdisciplinary approaches and strengthened the link between international trade and health sciences. During the pandemic, collaborative work in these two fields has grown, and global health diplomacy has become a daily topic of academic research.This study conducts a bibliometric analysis of the global health diplomacy literature, systematically presenting regional development processes, research programs, academic collaborations, and key themes. Bibliometric dissemination conveys the aesthetic and qualitative characteristics of publications in the field and provides important tools for identifying research perspectives and interdisciplinary relationships. The resulting data will serve as a valuable guide for evaluating academics, policymakers, and existing knowledge in the field, as well as developing future strategies. And this study aims to deepen knowledge of health diplomacy studies and support interdisciplinary collaboration and policy-making processes. This will contribute to both the enrichment of the academic literature and the development of more effective operations and policy solutions to global health crises.

Aim:The Sistrunk procedure is the most commonly used technique in the treatment of thyroglossal duct cysts(TDCs). A surgical drain is placed with the concerns of hematoma, edema, and seroma, resulting in airway compromise. There has recently been a general tendency to reduce hospital stay time in many surgical procedures. This study aimed to discuss the feasibility and safety of outpatient Sistrunk procedures without drain. Methods: The hospital records of the patients operated on were retrospectively reviewed by a single surgeon in terms of patients’ demographics, performed operations, and complications. Results: Of 49 patients, 27(55.1%) were boys, and 22(44.9%) were girls. The average age was 6.3±3.7years in the study group (min:13months-max:17years). The most common complaint was swelling in the middle region of the neck. In the patient group, 42 had TDCs and seven had thyroglossal cyst fistulas. Of all TDC cases, 81.6%(n=40), 12.2%(n=6), and 6.2%(n=3) were determined to be localized in the infrahyoid, suprahyoid, and suprasternal regions, respectively. While 15 of our cases were followed up postoperatively (min-max:16-24hours), the other 34 patients were discharged on the same day after the operation (min-max:3-6hours). Whereas the mean hospital stay was 4.7±1.1hours for those discharged on the same day, the time was 18.8±4.3hours for those hospitalized. No complication was observed in the patients undergoing the Sistrunk procedure without drain placement, except for one recurrence. Conclusion: TDCs should be kept in mind in patients presenting with neck swelling. We consider that the drain placement is not mandatory as long as there are no compulsive conditions, such as immune deficiency or coagulopathy, and that meticulous hemostasis during the operation is more significant. Furthermore, the outpatient Sistrunk procedure is safe and well-tolerated for the routine treatment of TDCs. Contact information and specific instructions about the potential complications should also be given to the parents or relatives.

Idiopathic granulomatous mastitis is a rare, chronic, benign inflammatory disease of the breast that tends to be unilateral. It differs from other granulomatous breast diseases in that it lacks a definitive underlying etiology. However, lactation, hormonal changes, trauma, infections, and autoimmunity have been implicated in the etiology. Idiopathic granulomatous mastitis can mimic a wide spectrum of benign and malignant conditions, including bacterial mastitis, sarcoidosis, tuberculosis, vasculitic diseases, diabetic mastopathy, and inflammatory breast cancer; therefore, accurate diagnosis requires clinical, radiological, and pathological correlation. The diagnosis of idiopathic granulomatous mastitis is more often a diagnosis of exclusion. A woman of reproductive age, who has undergone lactation, and presents with a palpable breast mass and concomitant inflammatory findings (such as pain, fever, erythema) is the most common presentation. Radiological findings can be evaluated together with histopathological findings to arrive at a correct diagnosis. The radiological findings of idiopathic granulomatous mastitis can be nonspecific. However, radiological findings are quite helpful in establishing a preliminary diagnosis, determining the extent of the disease, and distinguishing it from malignant lesions. On mammography, the most common findings are an irregularly bordered mass or an asymmetrically increased opacity; on ultrasonography, hypoechoic tubular structures and an accompanying irregularly bordered hypoechoic mass; and on magnetic resonance imaging, the most common findings are segmentally distributed non-mass-like enhancing areas, a heterogeneous enhancing mass, and lesions representing a well-circumscribed, rim-like enhancing abscess. If idiopathic granulomatous mastitis is suspected clinically and radiologically, histopathological confirmation can be used to support the preliminary diagnosis. Currently, core needle biopsy is often preferred due to its less invasive nature and high diagnostic yield compared to excision. Histopathologically, it is seen as an inflammation involving the breast lobules and the fatty tissue surrounding the lobules, with sterile granulomas accompanied by Langerhans-type giant cells and epithelioid histiocytes.