INTRODUCTION: Artificial intelligence, particularly machine learning, has shown promise in medical applications. This study evaluates the diagnostic accuracy and generalizability of the large language model ChatGPT4.0 in predicting labor protraction.
METHODS: A prospective, single-center cohort study analyzed retrospective data from 100 term pregnancies at low risk for labor protraction. The sample size was calculated using G*Power for 95% statistical power (minimum 46 patients). ChatGPT4.0 was tested on identifying 14 cesarean cases due to labor protraction and predicting active labor durations. The process was repeated after one week to assess consistency. Statistical analyses included Kolmogorov-Smirnov, Mann-Whitney U, Fisher’s Exact, Friedman’s, and independent t-tests (p<0.05 significance).
RESULTS: ChatGPT4.0 achieved 80% overall diagnostic accuracy, with 28.57% sensitivity and 88.37% specificity at initial and follow-up predictions (p=0.105). However, predicted labor durations significantly differed from real-world data: initial (3.66±1.69 hours), follow-up (6.23±0.50 hours), and actual (5.17±2.80 hours) (p<0.001). The difference between initial and follow-up predictions was statistically insignificant (p=0.388).
DISCUSSION AND CONCLUSION: ChatGPT4.0 demonstrates high specificity in identifying labor protraction risks but shows inconsistencies in prediction accuracy, raising concerns about reliability and generalizability. Further research is needed to refine AI tools for clinical applications while ensuring ethical and safety standards. AI has potential in obstetric decision-making but requires rigorous evaluation before integration into practice. The significant limitation of ChatGPT is its restricted generalizability, largely due to the “black box” nature of the algorithm.

INTRODUCTION: The effect of changing the ovarian stimulation protocol on treatment outcomes after an unsuccessful IVF treatment is still a controversial issue. In this study, we investigated the effect of protocol changes in the second attempt on treatment outcomes in patients who failed in the first attempt.
METHODS: Our study included 60 patients who applied to Zeynep Kamil Training and Research Hospital due to infertility between 01.01.2013 and 01.01.2017, who had previously failed IVF treatment and were trying for the second time. The patients were divided into two groups: those with and without protocol changes in the second trial. The success of these two groups in pregnancy outcomes was compared. Of the 60 patients, 30 were selected from those who underwent protocol changes, while 30 were selected from those who did not undergo protocol changes.
RESULTS: A total of 60 patients between the ages of 22 and 41 were included in our study. Fifty of the 60 patients were primarily infertile, while 10 were secondarily infertile. There was no significant difference in β-hCG positivity in the first and second IVF attempts between the groups with and without protocol changes (p>0.05). There was no clinical pregnancy in either group in the first IVF attempt. In our study, no statistically significant difference was found in clinical pregnancy outcomes in the second attempt between the two groups (p>0.05).
DISCUSSION AND CONCLUSION: In couples whose first IVF attempt was unsuccessful, making a protocol change did not create a statistically significant difference in terms of β-hCG positivity and clinical pregnancy success in the second attempt compared to not making a protocol change.

INTRODUCTION: The aim of this study was to investigate the proportion of pregnant women whose diagnosis was confirmed with the first three measurements of the 100-g oral glucose tolerance test (OGTT) in the two-step approach used for diagnosing gestational diabetes mellitus (GDM).
METHODS: This descriptive study was conducted from May to June 2022 at Zeynep Kamil Women and Children Diseases Hospital. The results of pregnant women who underwent the 100-g OGTT between 2017 and 2021 were evaluated retrospectively. Blood glucose levels at fasting, 1-hour, 2-hour, and 3-hour intervals were assessed using the Carpenter and Coustan criteria. The frequencies of women for whom the first three values were adequate, those for whom the fourth value was required for GDM diagnosis, and those with single-value positivity were determined.
RESULTS: The test could not be completed in 91 (5.2%) pregnant women due to vomiting during the procedure. Gestational diabetes was diagnosed in 410 of the 1656 pregnant women (24.8%). While fasting, 1-hour, and 2-hour values were sufficient for diagnosis in 388 (94.6%) of the 410 women, 3-hour values were required in 22 (5.4%). A single value above the threshold was observed in 22.4% of pregnant women.
DISCUSSION AND CONCLUSION: The first three readings of the 100-g OGTT may be sufficient to diagnose GDM in the vast majority of cases. Reducing test duration can increase patient comfort and lead to savings in both time and resources. Analyzing test results and omitting subsequent steps when the diagnosis is already confirmed could be a viable approach.

INTRODUCTION: This study aimed to investigate the influence of single nucleotide polymorphisms of the macrophage expressor gene 1 on the chronicity of high-risk HPV.
METHODS: This prospective study involved patients with high-risk HPV infections who presented to the Selçuk University Faculty of Medicine, Gynecology and Obstetrics outpatient clinic and underwent a minimum of 2 years of follow-up. The study group comprised 55 cases with persistent high-risk HPV infection, while the control group included 55 cases that were HPV-negative. Via a questionnaire, data on sociodemographic history, sexual life history, obstetric history, and contraception methods were collected and recorded. The single nucleotide polymorphisms RS7944135, RS6462008, and RS171941 of the macrophage expressor gene 1 were analyzed and statistically compared between the groups.
RESULTS: No significant differences were observed between the two groups regarding sociodemographic, obstetric, and sexual life histories (p>0.05). Likewise, no significant differences were found between the two groups concerning the RS7944135, RS6462008, and RS171941 single nucleotide polymorphisms of the macrophage expressor gene 1 (p=0.975, p=0.656, and p=0.957, respectively). Additionally, the comparison between the most common wild type and other variants of these three single nucleotide polymorphisms showed no significant differences between the groups (p=0.500, p=0.299, and p=0.576, respectively).
DISCUSSION AND CONCLUSION: The single nucleotide polymorphisms of the macrophage expressor gene 1 showed no significant association with the chronicity of high-risk HPV. As further research emerges in this field, we anticipate more definitive insights elucidating the variations in clinical manifestations resulting from the chronicization or eradication of high-risk HPV among individuals.

INTRODUCTION: Pulmonary atresia with intact ventricular septum (PA/IVS) is a rare cyanotic congenital heart lesion that is managed with multiple interventions for palliation. This study aimed to evaluate the cases of neonatal PA/IVS followed in our clinic.
METHODS: This retrospective study was conducted at a pediatric cardiac center between January 2020 and December 2024. All patients with PA/IVS who were managed solely with catheterization-based interventions (valve perforation, pulmonary valvuloplasty, balloon atrial septostomy, or ductal stenting) as neonates were analyzed. Demographic, procedural, and clinical data were collected. The results were statistically evaluated.
RESULTS: During the study period, 22 neonates diagnosed with PA/IVS (n=11 male, median age 5 days [IQR 3–7 days], median weight 3.1 kg [2.9–3.3]) underwent heart catheterization. Four cases had tripartite, nine cases had bipartite, and nine cases had monopartite morphology. Three patients had coronary-dependent circulation, and nine cases had coronary artery fistula. Three patients underwent valve perforation and pulmonary balloon valvuloplasty; ten patients underwent valve perforation and pulmonary balloon valvuloplasty with a stent in the ductus arteriosus; four patients underwent ductus stenting + balloon atrial septostomy; and five patients underwent ductus arteriosus stent procedure. During the procedure, arrhythmia was observed in two cases; one case had pericardial tamponade and atrial fibrillation; one case had stent embolization; one case had mild pericardial effusion; and one case had temporary pulse loss. Three cases (13.6%) were lost within the first 30 days.
DISCUSSION AND CONCLUSION: The management of PA/IVS patients undergoing catheter-based neonatal interventions exhibits unique characteristics. Individualized management of these patients in the neonatal period may have a positive impact on outcomes.

INTRODUCTION: To evaluate the changes in central macular thickness (CMT) and macular ganglion cell complex (GCC) thickness measured by optical coherence tomography (OCT) before and after uncomplicated phacoemulsification cataract surgery.
METHODS: This retrospective study included 40 eyes from 33 patients who underwent uncomplicated phacoemulsification at Istanbul Education and Research Hospital Eye Clinic over a nine-month period. Eyes were further categorized based on cataract morphology. Best corrected visual acuity (BCVA), CMT, GCC thickness, and OCT image quality were recorded preoperatively and postoperatively at day 1, week 1, month 1, and month 3.
RESULTS: The mean age of the patients was 66.7±10.3 years. The mean preoperative CMT was 209.59±25.14 μm. Postoperative CMT values were 220.54±27.20 μm (day 1), 226.26±28.01 μm (week 1), 244.56±23.57 μm (month 1), and 240.29±21.78 μm (month 3). Preoperative mean GCC thickness was 89.78±5.42 μm, while postoperative values were 96.03±6.67 μm (day 1), 101.60±9.22 μm (month 1), and 102.83±8.22 μm (month 3). Statistically significant increases in CMT, GCC thickness, and OCT image quality were observed at all postoperative time points compared to preoperative measurements (p<0.001).
DISCUSSION AND CONCLUSION: OCT is a valuable tool for detecting and monitoring morphological changes and macular edema following cataract surgery. Postoperatively, improved OCT image quality enables more reliable measurements of CMT and GCC thickness.

INTRODUCTION: Neonatal sepsis is a life-threatening condition characterized by systemic infection during the first 28 days of life. Early and accurate diagnosis is critical to reducing morbidity and mortality. Irisin (IRI), a recently identified protein with anti-inflammatory and cytokine-like properties, has been suggested as a potential biomarker for various inflammatory conditions. However, its role in neonatal sepsis remains unexplored. This study aimed to evaluate the potential of irisin as a novel biomarker for the early diagnosis of neonatal sepsis in a prospective case-control design.
METHODS: This study included 58 neonates (30 with sepsis and 28 healthy controls) admitted to the neonatal intensive care unit. Neonates in the sepsis group were diagnosed based on clinical criteria, elevated sepsis scores, and laboratory markers, while controls were healthy neonates without infectious risks.
RESULTS: IRI levels were significantly lower in the sepsis group compared to the control group (p<0.01). A negative correlation was observed between IRI and CRP levels (r=-0.378, p<0.05), while no significant correlation was found between IRI and white blood cell count. ROC analysis revealed that irisin had an AUC of 0.843, with a sensitivity of 93% and specificity of 68% at a cutoff value of 10.48 ng/mL.
DISCUSSION AND CONCLUSION: This study demonstrates that irisin levels are reduced in neonatal sepsis and exhibit a significant inverse correlation with CRP. These findings suggest that irisin could serve as a promising biomarker for the early diagnosis of neonatal sepsis.

INTRODUCTION: Hereditary spherocytosis (HS) is a genetically heterogeneous hemolytic anemia characterized by mutations in erythrocyte membrane protein genes such as ANK1, SPTB, SPTA1, SLC4A1, and EPB42. While genotype–phenotype associations have been partially described, the clinical variability remains insufficiently understood, particularly in pediatric populations. This study aimed to investigate genotype–phenotype correlations in Turkish children with HS.
METHODS: This retrospective study included 13 pediatric patients diagnosed with HS between 2020 and 2024 at a single tertiary care center. Genetic testing was performed using targeted next-generation sequencing (NGS). Clinical data including hemoglobin levels, reticulocyte counts, bilirubin levels, transfusion requirements, and history of splenectomy were analyzed in relation to identified variants.
RESULTS: Ten of 13 patients (77%) had pathogenic or likely pathogenic variants. Mutations in ANK1 were the most common, followed by SPTB and SLC4A1. Two novel variants were identified: a nonsense mutation in SPTB (p.Gln1578*) and a start-loss mutation in ANK1 (p.Met1Ile). Although the p.Met1Ile protein change has been previously reported, the nucleotide substitution (c.3G>A) identified in our study was novel. Clinical severity varied, even among patients carrying the same mutation.
DISCUSSION AND CONCLUSION: This study reinforces established genotype–phenotype trends in HS and highlights the value of molecular diagnosis in clinical risk assessment and management. Despite observed associations, significant phenotypic variability underscores the necessity of integrating genetic testing with clinical evaluation to optimize patient care.

INTRODUCTION: Improper placement of an endotracheal tube can result in numerous severe complications. Several techniques have been suggested to determine the correct positioning of orotracheal intubation in neonates. Our objective was to evaluate measurements obtained at both the lip and gingival levels, with the aim of identifying an alternative approach for determining the optimal depth of the endotracheal tube.
METHODS: This prospective observational study was conducted between December 2022 and September 2023. The depth of the endotracheal tube was evaluated by a single investigator, and a chest X-ray (CXR) was performed afterwards. Immediately before the CXR, the investigator marked the tube both at the levels of the anterior superior gingival margin and the upper lip margin on the midline. The position of the endotracheal tube tip, as assessed in the CXR, was compared to measurements taken from the anterior superior gingival and upper lip margin levels. Since the main problem with most formulas for appropriate endotracheal tube positioning is faced when the babies are very small, we divided the group into very low birth weight infants and the others.
RESULTS: During the study period, 59 intubated patients had a scheduled CXR during working hours, resulting in a total of 94 measurements from 26 females (44%) and 33 males (56%). Endotracheal tube tip–lip, endotracheal tube tip–gingiva, and nasal tragus distances were classified according to whether the endotracheal tube was within the target range or positioned deep or high according to the CXR. It was determined that there was statistically high agreement among all measurements. Formulas were developed for the targeted lip and gum measurements for achieving the optimal endotracheal tube position, and the results were found to be statistically significant.
DISCUSSION AND CONCLUSION: The formulas established in this study provide a swift and precise method for determining the insertion depths of the endotracheal tube tip at the gingival level in neonates.

INTRODUCTION: This study aimed to evaluate postnatal outcomes in fetuses with isolated hydronephrosis diagnosed prenatally and to determine factors for progression and the need for surgical intervention based on the Urinary Tract Dilation (UTD) classification system.
METHODS: This retrospective study included fetuses with isolated hydronephrosis diagnosed in the second trimester. Fetal ultrasound data were classified using the UTD system in the second and third trimesters, as well as postnatally. Sonographic parameters (renal pelvis diameter, peripheral calyceal dilatation, parenchymal echogenicity, cortical cysts, and ureteral dilatation) were recorded. Postnatal outcomes, including surgical interventions, were assessed. Comparative analyses were performed between progressing and non-progressing cases, as well as surgical and non-surgical groups.
RESULTS: Of the 133 fetuses diagnosed with isolated prenatal hydronephrosis, 20.3% (n=27) showed progression, 8.3% (n=11) showed regression, and 71.4% (n=95) remained stable between the second and third trimesters. Postnatal surgery was required in 21.8% (n=29) of cases. Higher UTD grades in the second and third trimesters were significantly associated with both progression and the need for surgery (p<0.001). In the second trimester, peripheral calyceal dilatation (p<0.005), increased parenchymal echogenicity (p<0.05), and ureteral dilatation (p<0.01) were more common in the surgical group. In the third trimester and postnatally, renal pelvis diameter, decreased parenchymal thickness, and bilateral abnormalities were significantly higher in the surgery group (p<0.001).
DISCUSSION AND CONCLUSION: While most cases of prenatal hydronephrosis remain stable or regress, 1 in 5 may progress, especially those with higher UTD grades. The UTD classification provides superior prognostic information compared to renal pelvis diameter alone and is valuable in identifying patients at higher risk for postnatal surgery.