Vol. 6 (2025): Journal of Medical and Dental Investigations

Aim: Cadmium (Cd), a toxic metal that accumulates in the environment as a result of industrial and agricultural activities, poses a serious threat to the health of living organisms. Cd is also an important component of environmental pollution. Cd salts dissolve in organs. Therefore, it is one of the heavy metals that can cause toxic effects on the hematological system. The aim of this study was to investigate the morphological changes in blood cells induced by cadmium (Cd) exposure in a rat model. Methods: Fourteen male Wistar Albino rats (8-10 weeks old; 300-350 g) were divided into control and Cd-exposed groups, each consisting of seven rats. Cadmium chloride was administered via intraperitoneal injection. Peripheral blood smear analysis was performed to assess the morphology of blood cells. Morphological abnormalities were identified and recorded using light microscopy. Results: Significant structural alterations were observed in erythrocytes, including target cells, echinocytes, Howell-Jolly bodies, and hypochromia in the Cd-exposed group. Neutrophils showed increased nuclear lobulation and deformation. No significant change in cell morphology was observed in the control group, and normal structural features were preserved in erythrocytes and neutrophils. Conclusion: This study shows that cadmium (Cd) exposure causes significant morphological changes in the hematological system. Erythrocyte deformations, hypochromia, and Howell-Jolly bodies suggest that Cd may increase the risk of anemia by disrupting erythrocyte membrane integrity. These changes may serve as early markers of Cd toxicity.   How to cite this article: Gökdemir GŞ. Morphological changes in blood cells in a rat model of cadmium poisoning. J Med Dent Invest 2025;6:e250165. https://doi.org/10.5577/jomdi.e250165

Aim: The aim of this study was to compare the effectiveness of manual versus mechanical chest compression by using continuous end-tidal carbon dioxide (ETCO 2 ) monitoring in-hospital cardiac arrest patients. Methods: The study included 90 patients meeting the inclusion criteria. Forty-seven (52.2%) patients were male and 43 (47.8%) were female. A prospective observational study of patients who experienced cardiac arrest while being monitored at the emergency department (ED) was conducted at the ED of a tertiary university hospital between April 2018 and September 2019. Demographics, electrocardiography (ECG) rhythm, cardiopulmonary resuscitation (CPR) technique (manual or automatic), laboratory data, the time to return of spontaneous circulation (ROSC), length of stay in the ED, hospitalization, and mortality were compared according to CPR type. Forty-four (48%) patients underwent manual CPR, and 46 (52%) patients underwent automatic CPR. Results: The 15th-minute and 20th-minute oxygen saturation (SaO 2 ) levels, and the 10th-, 15th-, and 20th-minute ETCO 2 levels showed a significant difference between the automatic CPR and manual CPR with all three variables being higher in the automatic CPR group ( p =0.013, p =0.002, p =0.037, p =0.002, p <0.001, respectively). The causes of cardiopulmonary arrest, consultations, POCUS results, post-CPR lifetime, treatment types and neurological conditions were similar in both of the groups. Exitus was more frequent in the manual CPR device group ( p =0,013). Conclusion: Mechanical Chest Compression provides more high-quality CPR than manual Chest Compression in-hospital cardiac arrest, and mid-resuscitation ETCO 2 values equal to or greater than 20 mmHg appear to be a good predictor of ROSC.   How to cite this article Yılmaz Y, Yılmaz F, Yılmaz A, Sönmez BM, Tekkanat S, Kavalcı C, Komut S, Beydilli İ, Zortuk Ö. Comparison of manual versus mechanical chest compression with ETCO 2 value in-hospital cardiac arrest:  A prospective observational study. J Med Dent Invest. 2025;6:e250172.

Aim: Cardiac arrest remains a major cause of mortality despite advances in resuscitation techniques. Identifying early prognostic markers is crucial for optimizing patient management in the emergency department (ED). Eosinophil count, a simple and widely available hematological parameter, has been investigated as a prognostic marker in various critical conditions. However, its role in cardiac arrest patients remains unclear. This study aims to evaluate the prognostic value of eosinophil count in cardiac arrest patients and its association with the return of spontaneous circulation (ROSC). Methods: This retrospective observational study included 322 patients who experienced cardiac arrest either upon arrival at the ED or during their ED follow-up. Demographic characteristics, complete blood count parameters, and blood gas measurements were recorded. Patients were categorized into ROSC-positive (n=294) and ROSC-negative (n=28) groups. Logistic regression and receiver operating characteristic (ROC) analyses were performed to assess the predictive value of eosinophil count and other parameters. Results: Patients who did not achieve ROSC had significantly higher eosinophil counts than those who survived (median: 0.025 vs. 0.01, p =0.045). Additionally, low bicarbonate, low pH, and high lactate levels were strongly associated with mortality ( p <0.001). ROC analysis showed that eosinophil count had moderate predictive value, while lactate and bicarbonate demonstrated better discrimination. Conclusion: Eosinophil count was significantly higher in non-survivors, suggesting a potential association with mortality in cardiac arrest patients. Given its rapid availability, eosinophil count may serve as an additional prognostic marker in the ED. However, further large-scale prospective studies are needed to validate its clinical utility.   How to cite this article: Turan ÖF, Gedikaslan Ş. The prognostic value of eosinophil count in emergency department cardiac arrest patients. J Med Dent Invest 2025;6:e250173. 

Aim: This study aimed to investigate the effects of ten sessions of Hyperbaric Oxygen Therapy (HBOT) on pain and quality of life in patients with bone marrow edema (BME) who had no specific etiological diagnosis and had previously tried immobilization and analgesic-anti-inflammatory drugs without success. Methods: This retrospective study involved patients aged 18-65 diagnosed with BME via MRI. Participants underwent ten HBOT sessions in a multi-place pressure chamber at 2.4 ATA for 120 minutes per session. Exclusion criteria included avascular necrosis, active malignancy, advanced osteoarthritis, inflammatory disease, claustrophobia, epilepsy, pregnancy, and lack of consent. The study utilized the SF-12 Quality of Life Scale and Visual Analog Scale (VAS) for pain to measure outcomes before and after HBOT, and data were analyzed using SPSS 25 with appropriate statistical tests. Results: The study included 64 patients (51.6% female, median age 44). HBOT significantly improved the overall quality of life (mean SF-12 score: before 4366 ± 2006, after 4889 ± 2053, p =0.034) and showed notable reductions in pain (mean VAS score: before 7,4 ± 1,2 after 3,8 ± 1,3, p <0.001). The male and overweight patients showed more significant benefits. Conclusion: HBOT is a promising treatment for BME-related pain and quality of life improvement, especially in cases unresponsive to standard therapies. Clinical improvement may begin after just ten sessions of HBOT. The findings suggest that male and overweight patients may benefit more from HBOT, highlighting the need for further research to explore the underlying mechanisms and optimize treatment protocols.   How to cite this article Demir L, Öztürk M, İlbasmış MS, Avcı M, Kahraman M, Yücel Uçarkuş T. The effect of hyperbaric oxygen therapy on pain and quality of life in bone marrow edema. J Med Dent Invest 2025;6:e250178.

Aim: This study investigated the role of systemic inflammatory markers in predicting mortality among intracerebral hemorrhage (ICH) patients. ICH is a severe stroke subtype with high mortality and disability rates. Methods: Researchers analyzed data from patients who underwent surgery, including decompressive craniectomy, between 2015 and 2023. The study examined demographic data, comorbidities, observation periods, mortality rates, hemogram, and biochemistry parameters. Patients were divided into survivor (n=1205) and non-survivor (n=440) groups. Results: Results showed non-survivors had lower hemoglobin levels and significantly higher C-reactive protein (CRP) levels compared to survivors. Inflammatory indices like the Systemic Immune-Inflammation Index (SII), Systemic Inflammation Response Index (SIRI), and Platelet-to-Lymphocyte Ratio (PLR) were also elevated in the non-survivor group. Cut-off values were determined for predicting outcomes. For example, the SII cut-off was 1793.62 (65,4% sensitivity, 58,9% specificity), and the SIRI cut-off was 4.81 (63,4% sensitivity, 58% specificity). Conclusion: The study concluded that elevated white blood cell counts, SIRI, SII, and CRP levels are associated with increased mortality risk in ICH patients.   How to cite this article Mutlucan UO, Zortuk Ö. Investigation of the predictive effect of hematologic indices in patients with intracerebral hemorrhage. J Med Dent Invest 2025;6:e250189.

Aim: Assisted reproductive techniques (ART) have made significant progress in infertility treatment and have found a wide range of applications with various methods, especially in vitro fertilization. Today, digital platforms such as YouTube have become an important resource for individuals seeking information about ART. However, uncertainties about the reliability and quality of this content pose a potential risk for viewers. This study aims to assess the quality and reliability of ART-related videos on YouTube. Methods: 76 videos were analyzed by applying elimination criteria from 350 videos uploaded between October 1, 2014, and October 1, 2024. These videos were obtained through the YouTube Data API v3 by searching seven different terms related to in vitro fertilization and infertility. In addition to descriptive statistics on video features, the Global Quality Scale (GQS), modified DISCERN, JAMA and UTvAC scales were used to evaluate the quality of the videos. Additionally, sentiment analysis was conducted based on the comments of the videos. Results: It was determined that the majority of the analyzed videos were at a medium quality level. While the JAMA scores indicate that most of the videos are of low quality, the GQS and modified DISCERN scores suggest that most videos fall within the medium-quality range. According to UTvAC, most videos are just below the high-quality limit. The majority of videos were uploaded by doctor-independent influencers (32.9%), non-governmental organizations (25.0%), and news/media (21.1%) channels. The positive comment percentage was found to be 28%, indicating that the videos were generally poorly appreciated by viewers. Conclusion:  This study revealed that the information quality and reliability of ART videos on YouTube are generally moderate. The findings of the study show that there is a significant need for improvements in digital health communication and educational content production.   How to cite this article Demirtaş S, Gördük MN. Analysis of YouTube videos on assisted reproductive techniques. J Med Dent Invest 2025;6:e250109. 

Aim: The risk of stroke increases in patients developing transient ischemic attack (TIA) in the short term, and early initiation of treatment significantly reduces this risk. Therefore, serum biomarkers that confirm or exclude TIA will be very valuable in clinical practice. This study aimed to investigate the relationship between the Allopregnanolone (AP) levels of TIA patients. Methods: We conducted a prospective observational study of consecutive emergency department patients with TIA (December 2018–October 2019) and age/sex-matched healthy controls. Serum allopregnanolone (AP) was measured by ELISA at presentation and compared between groups, and diagnostic performance was assessed using ROC analysis. Results: 40 patients (17 women 42.5%, 23 men 57.5%) who met the inclusion criteria, and 40 healthy volunteers were included in the study. AP levels were found to be significantly higher in both men and women according to their gender compared to the control group (P<0.001). AP levels were significantly higher in the patients compared to the control group (197.04±32.15 vs. 128.75±12.66, p<0.001). The optimum cut-off value of AP in detecting TIA was determined as AUC: 0.740 (0.630-0.850), sensitivity: 70%, and specificity: 72.5% at 134.5. Conclusion: Our study demonstrates that serum allopregnanolone levels are significantly elevated in patients diagnosed with transient ischemic attack. These results, obtained from a controlled cohort with rigorous exclusion criteria, provide a foundation for future studies investigating the diagnostic role of neurosteroids in cerebrovascular events.   How to cite this article:  Şimşek A, Beceren NG, Armağan HH, Hatip AY, Yalçın İG, Oğuzlar FÇ, Bedel C. The role of allopregnanolone level in the diagnosis of the disease in transient ischemic attack patients. J Med Dent Invest 2025;6:e250135. https://doi.org/10.5577/jomdi.e250135    

Aim: This study aimed to evaluate the efficacy and reliability of ChatGPT-4o and Gemini-2.5 Pro in providing patient education on lumbar disc herniation (LDH) by assessing their responses to frequently asked questions. Methodology: A list of 35 common patient questions about LDH and its treatment was compiled from neurosurgery and orthopedic websites. These questions were translated into Turkish and posed to both ChatGPT-4o and Gemini-2.5 Pro. Two independent neurosurgeons evaluated the responses using a 5-point scoring system (5 = accurate and understandable; 1 = incorrect/irrelevant). Discrepancies were resolved through joint review and consensus. Statistical analysis, including paired t-tests, was conducted using SPSS. Results: Both ChatGPT and Gemini showed similar overall performance with an average score of 4.74. While ChatGPT significantly outperformed Gemini in the "Exercise and Physical Activity" category (p=0.039), there were no significant differences in other categories, such as "Treatment," "Symptoms," "Surgical Treatment and Recommendations," or "Diagnosis". The findings suggest that large language models hold promise for patient information and guidance, but neither demonstrated a substantial overall superiority in educating patients about LDH. Conclusion: The findings suggest that large language models such as ChatGPT and Google Gemini show considerable promise for providing information and guidance to patients. While ChatGPT exhibited a significant advantage in the "Exercise and Physical Activity" category, overall, neither model demonstrated substantial superiority in educating patients about LDH. Further development is necessary to ensure accuracy and reliability for medical applications.

Aim: The objective of this study was to delineate the clinical and laboratory manifestations of antiepileptic drug toxicity in pediatric patients, to ascertain the characteristics of intoxication according to age group, and to appraise the management of these patients. Methods: This retrospective, cross-sectional, descriptive study included 39 pediatric patients aged 1 month to 18 years who presented with antiepileptic drug poisoning to a tertiary pediatric emergency department between January 1, 2014, and December 31, 2017. Demographic characteristics, clinical presentations, laboratory and electrocardiogram findings, antiepileptic drug types and levels, gastrointestinal decontamination practices, hospitalization units, length of stay, and outcomes were recorded. Patients were stratified by poisoning intent (accidental vs. intentional) and age group. Continuous variables were compared using the Mann–Whitney U test, while categorical variables were analyzed using the Pearson chi-square test, continuity correction chi-square test, or Fisher's exact test, as appropriate. A two-sided p-value of ≤0.05 was considered statistically significant. Results: Twenty-two (56.4%) of the cases were accidental, while 17 (43.6%) were intentional and aimed at self-harm. Twenty-five (64.1%) of the patients had no underlying disease; however, seven (17.9%) had epilepsy, three (7.8%) had epilepsy and intellectual disability, two (5.1%) had bipolar disorder, one (2.6%) had substance addiction, and one (2.6%) had syncope. Among the patients, 18 (46.2%) were poisoned with carbamazepine, 13 (33.3%) with sodium valproate, two (5.1%) with phenobarbital, two (5.1%) with diazepam, one (2.6%) with clonazepam, one (2.6%) with levetiracetam, one (2.6%) with oxcarbazepine, and one (2.6%) with lacosamide. All self-harm cases (n = 17) involved individuals aged ≥ 12 years, and a positive correlation was observed between age and self-harm cases, particularly at age 12 and above (p = 0.001). Girls were more likely to engage in self-harm, whereas boys were more likely to be accidentally poisoned (p = 0.011). Additionally, a significant relationship was observed between self-harm cases and multiple drug ingestion (p = 0.022). Conclusion: The present study observed a higher frequency of poisoning cases involving carbamazepine and sodium valproate, which are frequently used for epilepsy and non-epileptic indications, compared to other antiepileptic drugs. It is imperative for clinicians to exercise caution and refrain from prescribing these medications in excessive quantities or at elevated doses. It is also noteworthy that symptoms of poisoning may emerge even in cases where the antiepileptic dose is non-toxic or the drug level is low.

Aim: The aim of this study is to determine the reliability of ChatGPT-4 Pro and Gemini 2.5 Pro chatbots through a systematic evaluation of the responses provided by neurosurgical specialists to patients' inquiries regarding brain tumors. Methods: The present study was conducted using artificial intelligence programs, and there is no relationship between the authors and the AI companies and sites associated with the study. The final tally revealed that a total of 56 frequently asked questions were identified. The present study will examine the ChatGPT-4 Pro and Gemini 2.5 Pro. The responses furnished by both artificial intelligence models were produced in Turkish and subsequently assessed by two independent neurosurgeons. The evaluation of the responses was conducted by two independent evaluators, who assigned scores without the knowledge of each other's evaluations. In the event that two neurosurgeons assigned the same score to a given response, it was accepted as final. In instances of discordance, a collaborative discussion was initiated, culminating in the determination and documentation of a consensus score. Results: The distribution of these questions is illustrated in Table 2. The mean GPT score for anatomy questions was 4.25 ± 0.88, while the mean GEMINI score was 4.50 ± 0.53 (p = 0.282). For inquiries pertaining to general questions, the mean GPT score was 4.43 ± 0.81, while the mean GEMINI score was 4.38 ± 0.81 (p = 0.500). Inquiries pertaining to prognostication and daily living activities revealed a mean GPT score of 5.00 ± 0.00, accompanied by a mean GEMINI score of 4.57 ± 0.78 (p = 0.100). In the treatment questions, the mean GPT score was 4.63 ± 0.67, while the mean GEMINI score was 4.36 ± 0.67 (p = 0.138). Figure 1 presents a comparative analysis categorized by inquiry group. A comparison of the mean scores revealed that GPT and GEMINI exhibited similar performance, with mean scores of 4.54 and 4.44, respectively. Conclusion: The present study demonstrates that large language model (LLM) technologies, including ChatGPT-4 Pro and Gemini 2.5 Pro, exhibit considerable promise in the provision of information and guidance to patients. Furthermore, the investigation revealed that artificial intelligence models do not demonstrate a substantial degree of superiority in the education of patients regarding brain tumors.

Aim: This study aimed to compare treatment outcomes (mortality and relapse) between two pediatric acute lymphoblastic leukemia (ALL) protocols (TR-ALL BFM 2000 vs ALL-IC-BFM 2009) and to describe the demographic, clinical, and laboratory characteristics of patients treated at a single center (2010–2015). Methods: We retrospectively reviewed the medical records of 121 children (<18 years) diagnosed with ALL and treated with either TR-ALL BFM 2000 or ALL-IC-BFM 2009. Baseline characteristics, risk group, immunophenotype, protocol, relapse status, and survival status were recorded. Categorical variables were compared using the chi-square test or Fisher’s exact test, as appropriate (p < 0.05). Results: The cohort was 53.7% male, with a mean age at diagnosis of 7.55 ± 3.89 years. B-cell ALL accounted for 78.5% and T-cell ALL for 21.5%. The overall mortality rate was 11.6% (14/121), and relapse occurred in 5.8% (7/121) of patients. Mortality differed by risk group (SRG 6.5%, IRG 7.3%, HRG 23.5%; p = 0.036). Relapse was higher in T-cell ALL than in B-cell ALL (23.1% vs 1.1%; p = 0.001). Compared with ALL-IC-BFM 2009, TR-ALL BFM 2000 was associated with higher mortality (19.2% vs 5.8%; p = 0.022) and relapse (11.5% vs 1.4%; p = 0.019). Conclusion: In this single-center retrospective cohort study, the high-risk group was associated with higher mortality, and the T-cell immunophenotype was associated with higher relapse. Patients treated with ALL-IC-BFM 2009 had lower crude mortality and relapse rates than those treated with TR-ALL BFM 2000; however, these protocol comparisons should be interpreted cautiously, given potential confounding and limited event numbers.

Aim: The aim of this study was to evaluate and compare the accuracy and completeness of responses to open-ended questions related to chronic cracked and fractured teeth given by four recently introduced large language models (LLMs): ChatGPT-5, Grok 4, Gemini 2.5 Flash, and DeepSeek-R1-0528. Methods: A total of 25 open-ended questions related to cracked and fractured teeth were prepared. The responses to these questions given by the LLMs were evaluated in terms of accuracy and completeness by restorative and endodontic specialists with 15 years of experience. Accuracy was evaluated using a 5-point Likert scale, and completeness was evaluated using a 3-point Likert scale. The Intraclass Correlation Coefficient (ICC), Shapiro-Wilk test, Kruskal-Wallis test, Dunn-Bonferroni test, and Spearman correlation analysis were used in the statistical analyses of the study.  Results: The responses given to the questions about the diagnosis, causes, and treatment of cracked and fractured teeth showed significant differences among the four artificial intelligence (AI) models (p=0.015). In the subgroup analysis, the mean points of ChatGPT-5 (5±0) were significantly higher than those of DeepSeek-R1-0528 (4.48±0.77) (p=0.013). No significant difference was observed in the other paired comparisons (p>0.05). The completeness points also showed a difference between the models (p=0.028). The mean points of ChatGPT-5 (3±0) were significantly higher than those of DeepSeek-R1-0528 (2.76±0.44) (p=0.046), and no significant difference was observed in the other paired comparisons (p>0.05). Conclusion: Differences in terms of accuracy and completeness were observed between the LLMs in the responses given to open-ended questions about cracked and fractured teeth. The lowest mean points were obtained by DeepSeek-R1-0528, followed by Grok 4 and Gemini 2.5 Flash, with the highest points obtained by ChatGPT-5. It must not be forgotten that the results obtained can show variability according to the subject, the form of the question, and the content. Therefore, further studies encompassing both similar and different subjects are needed. It must also not be ignored that misinformation in healthcare services can lead to serious consequences.

Aim: Cardiopulmonary bypass (CPB) surgery causes changes in biomarkers associated with inflammatory responses and cardiac stress. Maresin-1 is a novel lipid mediator involved in inflammation resolution, and its role in cardiac function and its prognostic value postoperatively have not yet been sufficiently investigated. The aim of this study is to investigate the effect of CPB on Maresin-1 levels and to comparatively evaluate the prognostic value of Maresin-1 in the pathophysiology of coronary artery disease. Methods: Eighty patients were included in this study. Maresin-1 levels were investigated in 40 patients before surgery (group 1) and after surgery (group 2). The other 40 individuals included in the study formed the healthy control group. Maresin-1 and NT-proBNP levels were measured in the preoperative and postoperative periods. The data were evaluated comparatively using the Wilcoxon test and ROC analysis. Results: Preoperative Maresin-1 levels were significantly higher than those in the control group (p < 0.001). Postoperative Maresin-1 levels decreased markedly (p < 0.001); however, no significant difference was detected between postoperative Maresin-1 levels in the control group (p = 0.942). ROC analysis demonstrated that Maresin-1 and NT-proBNP possess high discriminatory power in distinguishing patients with coronary artery disease from healthy controls (AUC: 0.918 and 0.923) Conclusion: Maresin-1 levels significantly increase before CPB and decrease significantly in the early post-CPB period, reflecting pathophysiological changes in cardiac function. Maresin-1 can be considered a complementary biomarker with prognostic potential in patients undergoing CPB, compared with NT-proBNP.

This case report presents the diagnostic challenges and successful management of chronic lead toxicity in a 31-year-old female with persistent nonspecific symptoms, including fatigue, cognitive dysfunction, and constitutional complaints. Despite comprehensive prior evaluations showing only mildly elevated inflammatory markers, a definitive diagnosis was achieved through DMSA-provoked urinary lead testing, revealing an approximately 80-fold increase from baseline (1.1 to 85.3 μg/g creatinine). The patient underwent a 3-month DMSA chelation regimen (30 mg/kg/day in 5-day cycles with 9-day intervals), resulting in a significant reduction of provoked lead levels to 11.3 μg/g creatinine and resolution of clinical symptoms. The case highlights three critical aspects of heavy metal toxicity: (1) the limitations of conventional testing in chronic low-level exposure, (2) the diagnostic utility of provoked urinary metal analysis, and (3) the therapeutic efficacy of oral DMSA chelation. This report emphasizes the importance of considering heavy metal toxicity in refractory cases of multisystem complaints and demonstrates the value of protocol-based diagnostic provocation testing in occult exposure scenarios. The favorable outcomes support DMSA as both a diagnostic and therapeutic agent for lead toxicity, suggesting that there should be standardized guidelines for interpreting provoked testing. How to cite this article Baydar İ. Unveiling chronic lead toxicity: A case study on diagnosis, treatment, and recovery. J Med Dent Invest 2025;6:e250090. https://doi.org/10.5577/jomdi.e250090