Search Results (225)

Background and Objectives: Inadvertent perioperative hypothermia is a common and clinically significant complication during laparoscopic surgery, leading to pain, agitation, shivering, and delayed recovery. This randomized controlled trial evaluated the effect of peri-induction active warming with an electric resistive blanket on postoperative pain and agitation—the primary outcomes—compared with passive insulation. Materials and Methods: This study was registered at ClinicalTrials.gov (Identifier: NCT06022926; date of registration: 15 August 2023) prior to the enrollment of the first patient. One hundred and thirty-two American Society of Anesthesiologists I–II adults undergoing laparoscopic cholecystectomy were randomly allocated (1:1) to two groups: one received active warming with a resistive carbon fiber underbody blanket (Group 1), and the other received passive insulation (Group 2). The tympanic core temperature was measured at four perioperative time points (TT1–TT4). Postoperative agitation (Riker Sedation–Agitation Scale, RSAS) and pain (Numerical Rating Scale, NRS) were assessed 20 min after extubation in the post-anesthesia care unit (PACU). Secondary outcomes included intraoperative and postoperative temperature, postoperative shivering, adverse events (bradycardia, tachycardia, hypotension, hypertension, postoperative nausea and vomiting, and respiratory depression), and the PACU length of stay. Results: Baseline core temperatures (TT1) were similar between the groups (36.5 ± 0.55 °C vs. 36.6 ± 0.54 °C; p = 1.00). However, mean core temperatures at TT2, TT3, and TT4 were significantly higher in the active warming group compared with the control group (TT2: 36.7 ± 0.53 °C vs. 36.5 ± 0.54 °C; TT3: 36.6 ± 0.49 °C vs. 36.4 ± 0.54 °C; TT4: 36.6 ± 0.51 °C vs. 36.2 ± 0.52 °C; all p < 0.001). Active warming markedly reduced postoperative agitation (RSAS ≥ 5: 3.1% vs. 19.4%, p = 0.004) and pain (NRS ≥ 4: 15.4% vs. 49.3%, p < 0.001). The incidence of shivering was lower (20.0% vs. 46.3%, p = 0.006), and the PACU stay was shorter (24 [23–28] min vs. 35 [30–40] min, p < 0.001) with active warming. No significant differences in adverse events were observed between groups. Logistic regression identified the intraoperative fentanyl dose as a predictor of agitation and identified shivering and the PACU duration as predictors of pain. Conclusions: Peri-induction active warming effectively maintained normothermia and improved recovery quality by reducing postoperative agitation, pain, shivering, and PACU stays without increasing adverse events. It should be considered a standard component of thermal management in short- and medium-duration laparoscopic surgeries. Full article

Background/Objectives: Non-small-cell lung cancer (NSCLC) is a common disease with a high mortality rate and is often treated with immunotherapies; however, prognostic markers are required to identify patients who are most likely to benefit from these treatments. Therefore, we designed this study to assess the prognostic significance of the C-PLAN index, which includes performance status (PS) and C-reactive protein (CRP). Methods: A total of 560 patients were included in this multicenter study. Patients had been diagnosed with NSCLC and had received nivolumab therapy. The C-PLAN index, defined in 2022, is a score derived from the combination of PS, CRP, lactate dehydrogenase (LDH), albumin, and neutrophil–lymphocyte ratio (NLR). Patients were classified into good-, moderate-, and poor-prognosis groups according to the C-PLAN score. Results: The median metastatic overall survival was 25 months in the group with a C-PLAN score < 2 and 6 months in the group with a C-PLAN score ≥ 2 (p < 0.001). The median metastatic progression-free survival was 11 months in the group with a C-PLAN score < 2 and 3 months in the group with a C-PLAN score ≥ 2. Conclusion: This is the first comprehensive study demonstrating that the C-PLAN index can be used for prognostic purposes in immunotherapy. This score, which can be easily, economically, and practically calculated in outpatient clinics, can predict patient prognosis and determine who should receive longer durations of immunotherapy. Full article

Background and Objectives: Monday syndrome refers to a psychosomatic stress response occurring at the beginning of the work week and has been implicated in triggering acute cardiovascular events. This study aimed to evaluate the association between Monday syndrome and the incidence of cardiovascular emergencies. Materials and Methods: Between June 2024 and June 2025, a total of 500 patients aged 18–65 years who presented with acute cardiovascular events at two centers were retrospectively analyzed. Diagnoses included STEMI, NSTEMI, unstable angina, ventricular tachycardia/fibrillation, and hypertensive emergency. The distribution of events by weekday and hour was examined. Poisson regression was used to assess the effect of Mondays on event incidence. Results: Of 500 patients (mean age 49.1 ± 9.7 years, 50.4% male), the most common diagnoses were STEMI (31.8%) and NSTEMI (27.4%). The incidence of cardiovascular events was highest on Mondays (19.6%) and lowest on Sundays (10.6%). The early-morning period (06:00–10:00) showed the most significant clustering of events (p < 0.001). Systolic blood pressure (145 ± 18 vs. 139 ± 17 mmHg, p = 0.008) and heart rate (87 ± 12 vs. 82 ± 13 bpm, p = 0.01) were significantly higher on Mondays. Monday presentation was associated with a 23% higher event rate (incidence rate ratio [IRR] 1.23, 95% CI 1.10–1.38, p = 0.002). Conclusions: Monday syndrome is associated with a significant increase in the incidence of cardiovascular emergencies, especially in the early-morning hours. Increased sympathetic tone, hormonal activation, and psychosocial stress are possible contributors. Full article

Background/Objectives: Eltrombopag, a thrombopoietin receptor agonist, is widely used in the treatment of relapsed or refractory (R/R) immune thrombocytopenia (ITP). This study aimed to compare the efficacy, safety, and tolerability of generic eltrombopag (Rompag^®) with original eltrombopag (Revolade^®) in adult patients with R/R ITP. Methods: In this prospective, multicenter study conducted at 10 centers, 104 adult ITP patients were followed for at least 3 months. A total of 35 (33.7%) patients received Rompag^® and 69 (66.3%) received Revolade^®. The primary endpoint was platelet (PLT) response, defined as achieving a PLT count ≥50 × 10⁹/L and at least a twofold increase from baseline, without the need for rescue therapy or transfusion. Secondary endpoints included bleeding rates, fatigue-related quality of life, adverse events (AEs), and rescue therapy requirements. Results: PLT response was achieved in 94.2% of patients in the Revolade^® group and 85.7% in the Rompag^® group (p = 0.16). Bleeding rates decreased significantly in both groups (Revolade^®: 56.5% to 2.9%, p < 0.001; Rompag^®: 62.9% to 2.9%, p < 0.001). Although overall AE rates were similar (30.4% in the Revolade^® group and 42.9% in the Rompag^® group; p = 0.22), arthralgia (28.6% vs. 7.2%, p = 0.01) and vomiting (11.4% vs. 0%, p = 0.008) were more frequent with Rompag^®. Conclusions: Both generic and original eltrombopag demonstrated no statistically significant difference in efficacy in achieving PLT response, reducing bleeding, and improving fatigue-related quality of life in adult patients with R/R ITP. Although minor differences in AE profiles were observed, particularly arthralgia and vomiting, both formulations showed acceptable safety and tolerability. Full article

Background/Objectives: Rosacea increasingly appears to involve systemic immune and metabolic disturbances rather than isolated cutaneous inflammation. To evaluate inflammatory, platelet, and oxidative–metabolic biomarkers in rosacea and explore their interrelations. Methods: 90 patients with rosacea and 90 healthy controls were evaluated for hematologic inflammatory indices—neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune–inflammation index (SII), pan-immune–inflammation value (PIV), mean platelet volume (MPV), and C-reactive protein (CRP)—along with oxidative–metabolic regulators including sirtuin 1 (SIRT1), sirtuin 3 (SIRT3), visfatin, and irisin. Logistic regression and receiver operating characteristic (ROC) analyses were used to identify independent predictors of rosacea, while inter-marker associations were evaluated using Spearman’s rank correlation. Results: Rosacea patients showed higher NLR, PLR, SII, PIV, MPV, CRP, and LDL cholesterol (p < 0.05) and lower SIRT1, SIRT3, visfatin, and irisin (p < 0.01). MPV independently predicted rosacea (OR = 7.24; AUC = 0.827), whereas SIRT1 inversely correlated with disease risk. SIRT1, SIRT3, and visfatin showed inverse correlations with HbA1c and waist-to-height ratio, while fasting glucose and HOMA-IR remained within normal ranges. Conclusions: Rosacea exhibits dual systemic activation, an inflammatory–platelet and an oxidative–metabolic axis bridging immune dysregulation, mitochondrial stress, and vascular dysfunction. Recognition of these pathways highlights the potential of redox-targeted and metabolic interventions beyond symptomatic treatment. Full article

Quercetin (Q), a bioactive flavonoid, exerts potent antioxidant and redox-modulating effects by activating the nuclear factor erythroid 2-related factor 2/antioxidant response Element (Nrf2/ARE) pathway and upregulating endogenous antioxidant defenses, including enzymatic antioxidants such as superoxide dismutase (SOD) and catalase (CAT), as well as non-enzymatic glutathione (GSH) and lipid peroxidation (MDA). Gemcitabine (Gem), a widely used antimetabolite chemotherapeutic, often shows limited efficacy under hypoxic and oxidative stress conditions driven by hypoxia-inducible factor 1-alpha (HIF-1α) and vascular endothelial growth factor (VEGF)-mediated angiogenesis. This study investigated the redox-mediated synergistic effects of Q and Gem in MDA-MB-231 human breast cancer cells. Combination treatment significantly reduced cell viability beyond the expected Bliss value, indicating a synergistic interaction and enhanced apoptosis compared with single-agent treatments. Increased reactive oxygen species (ROS) production was accompanied by depletion of GSH and accumulation of MDA, establishing a pro-apoptotic oxidative stress environment. Q alone enhanced SOD and CAT activities, whereas the combination induced exhaustion of antioxidant defenses under oxidative load, reflecting a redox-adaptive response. Molecular analyses revealed downregulation of HIF-1α and VEGF, alongside upregulation of Bax and Caspase-3, confirming suppression of hypoxia-driven survival and activation of the intrinsic apoptotic pathway. Transcriptomic and enrichment analyses further identified modulation of oxidative stress- and apoptosis-related pathways, including phosphoinositide-3-kinase–protein kinase B/Akt (PI3K/Akt), HIF-1 and VEGF signaling. Collectively, these results indicate that Q potentiates Gem cytotoxicity via redox modulation, promoting controlled ROS elevation and apoptosis while suppressing hypoxia-induced survival mechanisms, highlighting the therapeutic potential of redox-based combination strategies against chemoresistant breast cancer. Full article

Background: Preeclampsia (PE) is a hypertensive disorder of pregnancy associated with oxidative stress and mitochondrial dysfunction. NRF1 and NRF2 are transcription factors that regulate mitochondrial activity and antioxidant defense. This study investigated their expression patterns in placentas from preeclamptic and severe preeclamptic pregnancies by immunohistochemical and bioinformatical methods. Methods: Placentas from 40 healthy controls, 40 PE, and 40 sPE patients were analyzed by histological and immunohistochemical techniques. Protein–protein interaction networks for NRF1, NRF2, and PE-related proteins were constructed using Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) and Cytoscape software, followed by Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis performed via ShinyGO, with significance set at false discovery rate (FDR) < 0.05. Results: NRF1 expression was significantly decreased in PE and sPE groups compared to controls, with notably negative staining in syncytial knots and fibrinoid areas. Conversely, NRF2 expression significantly increased, showing intense positivity in syncytiotrophoblasts, stromal cells, and vascular structures. Pathway analysis revealed that decreased NRF1 expression was associated with glutathione metabolism, hypoxia inducible factor-1 (HIF-1) signaling, and AMP-Activated Protein Kinase (AMPK) signaling pathways. Increased NRF2 expression was associated predominantly with inflammatory and immune response pathways, including AGE-RAGE signaling and pathogen–response pathways. Conclusions: Differential expressions of NRF1 and NRF2 in preeclamptic placentas reflect distinct yet interconnected responses to oxidative stress and inflammation. These transcription factors have potential clinical relevance as biomarkers for PE severity assessment and as targets for future therapeutic interventions. Full article

Background: Metastasectomy is a cornerstone of multimodal management in metastatic colorectal cancer (mCRC), yet contemporary real-world data focusing specifically on RAS wild-type (RAS-WT) disease remain limited. We aimed to evaluate survival outcomes and prognostic factors associated with metastasectomy in patients with RAS-WT mCRC using a large national multicentre registry. Methods: This retrospective cohort study utilized data from the ONKO-KOLON Türkiye registry. A total of 1079 patients with pathologically confirmed KRAS/NRAS wild-type mCRC were identified and categorized according to receipt of metastasectomy. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan–Meier method and compared with log-rank tests across multiple clinically relevant time origins, including metastatic diagnosis, initial colorectal cancer diagnosis, and time of metastasectomy. Prognostic factors within the metastasectomy cohort were assessed using univariate Cox proportional hazards models. Serum CEA and CA19-9 were analyzed after log₁₀ transformation. Results: Among 1079 patients, 185 (17.1%) underwent metastasectomy. Patients receiving metastasectomy demonstrated significantly longer OS compared with those managed non-surgically when survival was calculated from the time of metastatic diagnosis (hazard ratio [HR] for death 0.36, 95% CI 0.27–0.47; p < 0.001), as well as improved PFS (HR for progression or death 0.39, 95% CI 0.30–0.52; p < 0.001). The survival advantage remained consistent when OS was measured from the time of initial colorectal cancer diagnosis (HR 0.37, 95% CI 0.25–0.50; p < 0.001). Median OS following metastasectomy was 43 months (95% CI 31.4–45.6). In univariate analyses within the metastasectomy cohort, higher baseline CA19-9 levels were significantly associated with inferior OS when analyzed both as a continuous variable (per log₁₀ increase; HR 1.81, 95% CI 1.20–2.75; p = 0.005) and as a categorical variable (above vs. below threshold; HR 0.37, 95% CI 0.16–0.86; p = 0.021). Other clinicopathologic factors, including age, CEA, tumor sidedness, grade, MSI status, and metastatic burden, were not significantly associated with survival. Conclusions: In this large, real-world national cohort of RAS-WT mCRC, metastasectomy was strongly associated with prolonged survival across multiple clinically relevant time frames. Within surgically treated patients, baseline CA19-9 emerged as the most informative prognostic marker, while traditional clinicopathologic variables showed limited discriminatory value. These findings highlight the importance of careful patient selection and support further prospective studies integrating molecular and biomarker-based strategies to refine prognostication and optimize surgical decision-making in RAS-WT mCRC. Full article

In semi-arid areas like Southeastern Anatolia, where agricultural productivity and water supply are extremely climate-sensitive, drought is a significant environmental and socioeconomic problem. Comprehensive assessment of drought and soil moisture dynamics is fundamental to sustainable agriculture and water security in semi-arid regions. This study analyzes drought patterns across seven provinces in the Southeastern Anatolia (GAP) region of Türkiye (Adıyaman, Diyarbakır, Gaziantep, Kilis, Mardin, Siirt, and Şanlıurfa) from 1963 to 2022, employing four drought indices (SPI, SPEI, CZI, and RDI) at multiple timescales (1-, 3-, and 12-month) to support evidence-based strategies for sustainable water and agricultural resource management. A more thorough evaluation is made possible by this multi-index and multi-scale method, which is rarely used concurrently at the provincial level. Additionally, the drought characterization was validated and enhanced through the analysis of ERA5-Land soil moisture data (1950–2022). According to the findings, the provinces with the lowest median index values and the highest frequency of extreme drought episodes are Diyarbakır and Şanlıurfa. The SPEI-12 (THW) median values showed a neutral long-term drought–wetness balance with seasonal changes, ranging from −0.0714 (Adıyaman) to 0.188 (Şanlıurfa). Particularly after 2009, soil moisture levels decreased to as low as 2–3 mm during the summer, indicating heightened evapotranspiration stress. RDI-12’s reliability in long-term drought evaluation was confirmed by its strongest correlation with other indices (r = 0.87–0.97). According to spatial research, the frequency of moderate droughts in the southwest was as high as 39%, whilst the eastern provinces experienced severe and intense droughts as high as 8%. However, with frequency above 53%, wet occurrences were more common in the east, particularly in Siirt. By clarifying long-term drought and soil moisture patterns, this study provides essential insights for sustainable irrigation planning and agricultural water allocation in the GAP region. Full article

The restoration of endodontically treated teeth remains a clinical challenge, particularly when substantial coronal tissue loss is present. Endocrowns fabricated using CAD/CAM technologies offer a conservative and esthetic alternative to conventional post-core systems; however, their long-term performance may be influenced by age-related mechanical and thermal stresses. This study evaluated the effect of thermomechanical aging on the marginal adaptation and fracture resistance of endocrowns fabricated from three CAD/CAM materials: zirconia-reinforced lithium silicate (ZLS), polyetherether ketone (PEEK), and 3D-printed resin. Sixty extracted human molars were endodontically treated and restored with endocrowns produced from these materials (n = 20 per group) and then subdivided into aged (n = 10) and control (n = 10) subgroups. Thermomechanical aging involved 5000 thermal cycles between 5 °C and 55 °C, and 75,000 mechanical loading cycles at 50 N. Marginal gaps were examined using scanning electron microscopy, and fracture resistance was tested under axial load at a crosshead speed of 0.5 mm/min. Data were analyzed using two-way ANOVA followed by Tukey’s post hoc test (α = 0.05). Thermomechanical aging significantly increased the marginal gaps in all materials (p < 0.05). The smallest marginal discrepancies were observed in the 3D-printed resin group, while the largest occurred in the ZLS after aging, likely due to dimensional changes during crystallization. Fracture resistance decreased in ZLS (−21.2%) and 3D resin (−20.9%) after aging (p < 0.05) but was not significantly affected in PEEK (−5.4%, p = 0.092). Thermomechanical aging adversely affects marginal adaptation across all materials, whereas its impact on strength is material-dependent. PEEK demonstrated the most stable mechanical performance and may represent a promising alternative for long-term endocrown restorations. Full article

Background: We aimed to investigate the diagnostic performance between the oral glucose tolerance test (OGTT) and HbA1c in diagnosing prediabetes and diabetes among obese individuals, and to evaluate the diagnostic performance of HbA1c for detecting OGTT-defined diabetes in obese individuals referred for evaluation of suspected prediabetes. Methods: Individuals with prediabetes were included between 1 January 2020 and 31 December 2022. Participants were categorized as mildly, moderately, morbidly, or super obese based on body mass index (BMI). According to the 75 g OGTT results, patients were classified into three groups: isolated impaired fasting glucose (IFG), combined IFG + impaired glucose tolerance (IGT), and overt type 2 diabetes mellitus (T2DM). The threshold HbA1c value for T2DM diagnosis in obese patients was determined based on OGTT outcomes. Results: Of the 139 prediabetic obese patients included, 115 (82.7%) were female, with a mean age of 45.18 ± 11.74 years. Based on BMI, 34 patients (24.5%) were mildly obese, 41 (29.5%) moderately obese, 49 (35.3%) morbidly obese, and 15 (10.8%) super obese. According to the 75 g OGTT results, 37.4% (n = 52) had isolated IFG, 45.3% (n = 63) had combined IFG + IGT, and 17.3% (n = 24) had overt T2DM. A weak–moderate positive correlation was observed between HbA1c and fasting blood glucose (Spearman’s rho = 0.263, p = 0.002). ROC–AUC analysis showed that HbA1c had significant discriminatory power in detecting T2DM diagnosed by the 75 g OGTT (AUC = 0.881, 95% CI: 0.816–0.946, p < 0.001). The optimal HbA1c cut-off was 6.15%, with 83.3% sensitivity and 80% specificity. The positive predictive value was 46.1%, and the negative predictive value was 95.8%. Conclusions: An HbA1c threshold of 6.15% demonstrated optimal performance for detecting OGTT-defined diabetes in obese individuals with suspected prediabetes. This value should not be interpreted as a population-wide diagnostic threshold. These findings indicate that HbA1c may serve as a useful screening tool to identify obese individuals who warrant confirmatory OGTT testing, rather than as a stand-alone diagnostic criterion. Further large-scale studies are warranted to confirm these results and support future clinical guidelines. Full article

In a standard diffuser system in a membrane bioreactor (MBR), uneven air distribution scouring the membrane surface causes transmembrane pressure to reach its ultimate value earlier, which requires membrane cleaning more frequently. In this study, a Venturi-integrated innovative diffuser design is proposed to improve membrane bioreactor (MBR) technology. The proposed design aims to increase filtration efficiency by creating a homogeneous scouring effect on the membrane surface. To compare the performance of the proposed diffuser configuration (V-MBR) with that of a conventional diffuser (S-MBR), computational fluid dynamics models were established for each of the two configurations. The results showed that the V-MBR model produced about 50% higher average shear stress on the membrane surfaces. Statistical analysis also showed that the V-MBR model generally produced low variance and non-zero shear stress values. Along with shear stress distribution, other parameters such as volume fraction, velocity, turbulent kinetic energy, and turbulent eddy distribution were evaluated to compare the performance of two diffuser system configurations. These parameters also supported the superior performance of the new V-MBR model over the conventional S-MBR. It is concluded that homogeneous shear stress distribution on the membrane surface is an important parameter that increases filtration efficiency by preventing the formation of dead zones. Full article

Background/Objectives: Cervical cancer remains a major global health challenge, and treatment resistance limits the long-term success of chemotherapy. Drug repurposing strategies offer new opportunities for improving therapeutic outcomes by combining existing agents with established chemotherapeutics. Sitagliptin, a DPP-4 inhibitor commonly used in type 2 diabetes, has recently gained attention for its potential anticancer effects. This study aimed to investigate the cytotoxic, apoptotic, and anti-metastatic effects of sitagliptin and doxorubicin, individually and in combination, on human cervical cancer cells (HeLa), and to determine whether their combined use exerts a synergistic anticancer effect. Methods: HeLa cells were treated for 48 h with increasing concentrations of sitagliptin, doxorubicin, or their combination. Cell viability was assessed using the MTT assay. Apoptosis was evaluated by Annexin V-FITC/PI staining and caspase-8/9 activity assays. Synergy was quantified using the Chou–Talalay method, and Combination Index (CI) values were used to determine synergistic interactions. Intracellular ROS levels were measured using the DCFDA assay. Migration and invasion capacities were analyzed using wound healing and Transwell assays. MMP-1, MMP-2, TIMP-1, and TIMP-2 levels were quantified via ELISA with normalization to viable cell counts. Gene expression levels of PI3K/Akt and MAPK/ERK pathway components were measured by qRT-PCR. Bioinformatic analyses (STRING, GeneMANIA, GO, KEGG) were performed to identify common molecular targets and enriched pathways affected by both agents. Results: The combination of sitagliptin and doxorubicin significantly reduced cell viability and demonstrated a synergistic interaction (CI < 1). Combined treatment induced a marked increase in ROS production and significantly elevated apoptosis rates compared to monotherapies. Caspase-8 and caspase-9 activities were also higher in the combination group. Migration and invasion assays revealed substantial suppression of cell motility and invasive capacity. After normalization to viable cell numbers, MMP and TIMP reductions remained significant, confirming true biological inhibition rather than cell-death–related artifacts. qRT-PCR analyses showed downregulation of Akt and ERK expression, indicating suppression of key survival and proliferation pathways. Bioinformatic analyses supported these findings by highlighting enrichment in apoptotic, oxidative stress, and metastasis-related pathways. Conclusions: Sitagliptin enhances the anticancer efficacy of doxorubicin by amplifying ROS-mediated apoptosis, inhibiting migration and invasion, and modulating PI3K/Akt and MAPK/ERK signaling in cervical cancer cells. The combination exhibits a clear synergistic effect and demonstrates strong potential as a supportive therapeutic strategy. These findings warrant further in vivo and clinical-level investigations to evaluate the translational applicability of sitagliptin in cervical cancer therapy. Full article

Background: Thyroid hormone dysregulation is a well-recognized consequence of cardiopulmonary bypass (CPB), particularly in neonates undergoing congenital heart surgery. Triiodothyronine (T3) plays a crucial role in maintaining cardiovascular stability, and an early decline in serum levels may adversely impact clinical outcomes. This study aimed to evaluate perioperative thyroid hormone changes and their association with morbidity and mortality. Methods: We retrospectively analyzed 132 neonates who underwent congenital cardiac surgery with CPB between January 2021 and June 2024. Serum free T3 (FT3), free thyroxine (FT4), and thyroid-stimulating hormone (TSH) levels were measured preoperatively and within one hour after admission to the cardiac intensive care unit. Demographic, clinical, and surgical variables were recorded. Associations between thyroid hormone levels and postoperative outcomes, including in-hospital mortality, ventilation duration, vasoactive-inotropic score (VIS), and length of stay, were assessed using correlation analyses, logistic regression, and receiver operating characteristic (ROC) analysis. Results: Postoperatively, both FT3 and TSH levels declined significantly (p < 0.01), while FT4 levels remained unchanged. Lower postoperative FT3 levels were negatively correlated with prolonged invasive mechanical ventilation (rho = −0.196, p = 0.029) and longer hospital stay (rho = −0.183, p = 0.042). Overall mortality was 7.6% (n = 10). Non-survivors had significantly lower postoperative FT3 levels compared with survivors (p = 0.001). In multivariable logistic regression, postoperative FT3 was independently associated with mortality (OR = 0.22, 95% CI 0.05–1.03, p = 0.048). ROC analysis demonstrated good predictive performance of postoperative FT3 for mortality (AUC = 0.818), with an optimal cutoff of 2.17 pg/mL (sensitivity 72%, specificity 70%). Conclusions: Early postoperative suppression of FT3 is common after CPB in neonates and is independently associated with increased mortality and adverse short-term outcomes. Early assessment of thyroid function, particularly FT3, may provide valuable prognostic information and aid in risk stratification in this high-risk population. Full article

Background/Objectives: Mucormycosis is a rapidly progressive invasive fungal infection that commonly involves the sinonasal region and skull base in patients with systemic comorbidities, yet robust ENT data from middle-income settings are scarce. Methods: We performed a single-center retrospective review of all patients with histopathologically confirmed mucormycosis treated in the Otorhinolaryngology Department of Dicle University between 2010 and 2023, covering a 14-year period. Eligible patients had paranasal sinus computed tomography at presentation and received surgical and/or systemic antifungal therapy. Demographic data, comorbidities, disease subtype, radiological extent, treatment modality and survival were extracted from records. Survival was estimated using Kaplan–Meier analysis, and group differences were tested with chi-square statistics (p ≤ 0.05). Results: Fifty-two patients met the inclusion criteria (mean age 56.5 ± 15.2 years; 57.7% male); 73.1% had at least one systemic comorbidity, most frequently diabetes mellitus (65.4%) and hematological malignancy (19.2%). Disease was sinonasal in 42.3%, rhino-orbital in 28.8% and rhino-orbito-cerebral in 28.8%. Baseline CT showed intracranial extension in 26.9%. Overall survival was 59.6% and differed markedly by subtype, highest in isolated sinonasal disease (81.8%) and lowest in rhino-orbito-cerebral disease (26.7%). Intracranial extension was associated with higher mortality (71.4% vs. 28.9%). Combined surgical debridement plus systemic antifungal therapy, used in 84.6% of patients, yielded lower mortality than antifungal therapy alone (31.8% vs. 87.5%). Conclusions: In this ENT cohort, prognosis was mainly determined by anatomical extent and treatment strategy. Our findings suggest that timely combined surgical and antifungal management, when feasible and in appropriately selected patients, is associated with improved survival outcomes. Full article