Background/Objectives: In this study, a vision transformer (ViT) based ensemble architecture was developed for the classification of normal, benign, and malignant diseases from breast ultrasound images. The breast ultrasound images (BUSI) dataset was used for the implementation of the proposed method. This dataset includes 133 normal, 437 benign, and 210 malignant ultrasound images. Methods: ROI segmentation and image preprocessing were applied to the dataset to select only the tumor region and use it in the model. Thus, a better performance was achieved using only the lesion regions. Image augmentation was performed using the Albumentations library to increase the number of images. Feature extraction was performed on the obtained images using three ViT-based models (ViT-Base, DeiT, ViT-Small). The purpose of using three different models is to achieve high accuracy. The extracted features were classified using a multilayer perceptron (MLP). Training was performed using 10-fold stratified cross-validation. Results: The purpose of stratified cross-validation is to include a certain number of images from all three classes in each cross-validation proposed model provided 96.2% precision and 86.3% recall for the benign class and 92.9% recall and 76.4% precision for the malignant class. The normal class achieved 100% success. The area under the curve (AUC) values were 0.97, 0.96, and 1.00 for benign and malignant tumors, respectively, and 1.00 for normal tumors. Conclusions: The ROI-based ViT + MLP + Ensemble architecture provided higher accuracy and explainability compared to traditional convolutional neural network (CNN) based methods in medical image classification. It demonstrated a stable success, especially in minority classes, and presented a potential, reliable, and flexible solution in clinical decision support systems.

Hipernatremi, serum sodyum düzeyinin 145 mmol/L’nin üzerine çıkmasıyla karakterize, özellikle yaşlı ve yoğun bakım hastalarında sık görülen ve yüksek mortalite ile ilişkili bir elektrolit bozukluğudur. Genellikle serbest su kaybının sodyum kaybından fazla olması sonucu gelişir ve hipovolemi, övolemi veya hipervolemi ile ilişkili olabilir. Klinik bulgular çoğunlukla merkezi sinir sistemi etkilenmesine bağlı olup bilinç değişikliği, nöbet ve koma gibi belirtiler görülebilir. Tedavide altta yatan nedenin belirlenmesi, su açığının hesaplanması, uygun sıvı replasmanı ve sodyum düzeltme hızının dikkatli ayarlanması önemlidir. Sepsis ise enfeksiyona karşı düzensiz konak yanıtıyla ortaya çıkan ve hızlı tanı ile tedavi gerektiren yaşamı tehdit eden bir klinik tablodur. Yönetimde erken sıvı resüsitasyonu, kültürlerin alınması ve geniş spektrumlu antibiyotiklerin başlanması temel yaklaşımlardır. Sunduğumuz olguda, diyabet ve hipertansiyon öyküsü olan 73 yaşındaki erkek hasta; hipovolemik hipernatremi, sepsis ve dehidratasyona bağlı akut böbrek yetmezliği tanılarıyla yoğun bakımda izlenmiştir. Rehidrasyon, uygun sıvı tedavisi ve kültür sonucuna göre başlanan meropenem tedavisi ile hastanın sodyum düzeyi kontrollü şekilde düzeltilmiş, diürezi geri dönmüş ve nörolojik bulguları gerileyerek hasta iyileşmiştir. Sonuç olarak, hipernatreminin doğru hızda düzeltilmesi ve sepsisin erken tedavisi mortaliteyi azaltmada kritik öneme sahiptir. Hypernatremia is an electrolyte disorder characterized by a serum sodium level above 145 mmol/L, frequently observed especially in elderly patients and in intensive care settings, and associated with high mortality. It generally develops as a result of free water loss exceeding sodium loss and may be associated with hypovolemia, euvolemia, or hypervolemia. Clinical findings are mostly related to central nervous system involvement and may include altered consciousness, seizures, and coma. In treatment, identifying the underlying cause, calculating the water deficit, providing appropriate fluid replacement, and carefully adjusting the rate of sodium correction are essential. Sepsis, on the other hand, is a life-threatening clinical condition resulting from a dysregulated host response to infection and requires rapid diagnosis and treatment. Early fluid resuscitation, obtaining cultures, and initiation of broad-spectrum antibiotics are the main approaches in management. In the presented case, a 73-year-old male patient with a history of diabetes and hypertension was followed in the intensive care unit with diagnoses of hypovolemic hypernatremia, sepsis, and dehydration-related acute kidney injury. With rehydration, appropriate fluid therapy, and meropenem treatment initiated according to culture results, the patient’s sodium level was corrected in a controlled manner, diuresis returned, neurological findings regressed, and the patient recovered. In conclusion, correcting hypernatremia at an appropriate rate and early treatment of sepsis are critical in reducing mortality.

Objectives: Hospital-acquired anemia (HAA) is an important clinical problem that can adversely affect outcomes, particularly in critically ill patients. This study aimed to determine the incidence of hospital-acquired anemia in adult ICU patients and to evaluate its relation with diagnostic phlebotomy procedures and other etiologic factors. Methods: Data from 1170 adult ICU admissions between 1 January and 31 December 2024 were retrospectively reviewed and 321 patients were included in the analysis. The median age of the study cohort was 72 years (range: 18–102), with 45.2% females (n = 145) and 54.8% males (n = 176). The median ICU length of stay was 6 days (range: 3–29). Results: HAA developed in 35.8% of patients, while a decrease in hemoglobin levels was observed in 80.4%. Patients who developed HAA had significantly longer ICU stays and higher ferritin, CRP, and diagnostic phlebotomy (DP) volumes, while admission hemoglobin levels were lower compared with those without HAA (all p < 0.05). In multivariate analysis, a longer ICU stay, higher ferritin levels, lower admission hemoglobin levels and greater DP volumes were independently associated with the development of HAA. Conclusions: HAA was common in critically ill patients and was associated with several clinical and laboratory factors, including inflammatory burden, baseline hemoglobin level, ICU length of stay, and diagnostic phlebotomy volume. These findings suggest that HAA is a multifactorial process, with ICU length of stay, inflammatory status, baseline hemoglobin levels, and diagnostic phlebotomy volume all potentially contributing to its development.

Varis Dışı Akut Üst Gastrointestinal Sistem Kanamalarında Mortalite ve Morbiditeyi Etkileyen Faktörler Mustafa BAYDAR Bülent YILDIRIM Obezitede Farmakolojik Tedavi Nesibe AYDOĞDU C-Reaktif Protein/Albümin Oranının Fizyolojik ve Klinik Önemi Nurten SERİNGEÇ AKKEÇECİ Allerjik Bronkopulmoner Aspergillozis Özge GÖKTÜRK Kronik Eozinofilik Pnömoni Kerim GÖKTÜRK Yaşlanma Süreciyle Gastrointestinal Sistemde Gelişen Bazı Fonksiyonel Değişimlerin Mekanizması Meryem Dilek ACAR Proton Pompa İnhibitörü Kullanımında Fayda ve Risklerin Güncel Literatür Işığında Değerlendirilmesi Metin Deniz KARAKOÇ Kronik Ağrı ve Mindfulness Meditasyon Yasemin YILDIZ Anti-Tiroid İlaçlar Ne Kadar Güvenilir? Bünyamin AYDIN