Anti-tumor necrosis factor agents are widely used in treating ankylosing spondylitis, but they increase the risk of infection by suppressing the immune response. Therefore, physicians should be careful about recurrent infections in patients under anti-tumor necrosis factor agents.

Background/Objectives: Multimodal large language models are emerging tools for medical image interpretation, but their performance on isolated diffusion-weighted imaging (DWI) for acute ischemic stroke remains largely unexplored. We evaluated GPT-5 for stroke detection and vascular territory classification on preselected representative DWI images using a structured two-step prompting protocol. Methods: This single-center, retrospective, balanced case–control study included 220 cases (110 stroke patients and 110 stroke-negative controls). Four representative axial DWI slices per case were provided without apparent diffusion coefficient maps. Step 1 queried stroke presence and vascular territory; Step 2 queried the middle cerebral artery (MCA) segment-associated territory (M1–M4) following an MCA response. The reference standard was radiologist–neurologist consensus based on full multimodal magnetic resonance imaging, blinded to GPT-5 outputs. Diagnostic performance metrics and Cohen’s kappa (κ) were calculated. Results: Stroke detection showed a sensitivity of 100% (95% confidence interval [CI], 96.6–100%), specificity of 83.6% (95% CI, 75.6–89.4%), accuracy of 91.8%, and κ = 0.836. Accuracy was 93.6% for anterior/posterior circulation (κ = 0.838) and 90.9% for vascular territory (κ = 0.799). Conditional MCA segment-associated territory accuracy was 71.6% (53/74; κ = 0.602); end-to-end accuracy was 66.3% (53/80). Exploratory analysis of the 18 false-positive cases identified four overlapping error categories: artifactual and physiologic signal misinterpretation (72.2%), chronic lesion misclassification (27.8%), terminological inconsistency or unsupported report statements (77.8%), and etiological scenarios or unhedged definitive diagnoses (38.9%). Conclusions: GPT-5 achieved high sensitivity and a specificity of 83.6% for stroke classification on preselected representative DWI images using a vascular territory-based diagnostic framework. However, the 16.4% false-positive rate indicates that positive findings require radiologist confirmation. These findings support further evaluation of GPT-5 as a potential clinician-assisted image-interpretation tool but do not establish a clinical decision-support role.

Kounis syndrome is defined as a coronary artery distortion due to hypersensitivity to various reasons such as drugs, environmental exposure, nutrients, coronary stents, etc. Diffuse alveolar hemorrhage is a life-threatening condition that clinically presents with hypoxemic respiratory distress, low hematocrit level, hemoptysis, and extensive pulmonary infiltration. Drugs involving pinaverium bromide as an active ingredient is frequently used for relieving gastrointestinal complaints. In this report, we present a case of a young female patient with Kounis syndrome accompanying diffuse alveolar hemorrhage admitted to our emergency department due to allergic reaction following Pinaverium Bromide intake.

Objective: This study aimed to evaluate the diagnostic performance of point-of-care ultrasound (POCUS) for detecting and grading hydronephrosis in patients presenting to the emergency department (ED) with suspected renal colic, using non-contrast computed tomography (CT) as the reference standard. Material and Methods: This prospective observational diagnostic accuracy study included 106 adult patients who underwent both renal POCUS and non-contrast CT during the same ED visit. Hydronephrosis was classified as none, mild, moderate, or severe. The diagnostic performance of POCUS was assessed for detecting any hydronephrosis (grade ≥2) and moderate-to-severe hydronephrosis (grade ≥3). Agreement between POCUS and CT grading was evaluated using kappa coefficients.Results: CT demonstrated hydronephrosis in 58 patients (54.7%). For any hydronephrosis, POCUS showed a sensitivity of 86.2%, specificity of 83.3%, and overall accuracy of 84.9% (κ=0.695; p<0.001). Exact agreement across the four grades was 62.3%, while within-one-grade agreement was 98.1%. Linear-weighted and quadratic-weighted κ values were 0.626 and 0.777, respectively. POCUS assigned a higher grade than CT in 30 cases and a lower grade in 10 cases (p=0.001). For moderate-to-severe hydronephrosis, sensitivity was 88.9%, specificity was 82.3%, and negative predictive value was 95.6%.Conclusion: POCUS provides good diagnostic performance for the rapid, radiation-free assessment of hydronephrosis in renal colic. However, because it tends to overestimate hydronephrosis severity compared with CT, high-grade POCUS findings should not be considered directly equivalent to the corresponding CT grade.

Background: Vascular inflammation and vasculotoxic heavy metals have each been linked to acute coronary syndrome (ACS) but have rarely been studied together. This study compared serum pentraxin-3 (PTX-3), a proposed marker of local vascular inflammation, and whole-blood lead (Pb), arsenic (As), and nickel (Ni) between ACS patients and controls. Methods: In this single-center, cross-sectional case–control study, 50 patients with angiographically confirmed ACS were compared with 50 age- and sex-comparable emergency department controls with minor non-cardiac complaints. Results: PTX-3, Pb, As, and Ni were higher in ACS patients (all false discovery rate-adjusted q < 0.001). Between-group discrimination was highest for Pb (area under the curve [AUC] 0.962) and PTX-3 (AUC 0.951). PTX-3 and Pb remained independently associated with ACS after adjustment for hypertension, hyperlipidemia, and smoking and, separately, for age, diabetes, and renal function. Within the ACS group, PTX-3 was not significantly correlated with the Gensini score (ρ = 0.12, p = 0.41). Conclusions: PTX-3 and whole-blood Pb, As, and Ni were markedly elevated in ACS, with PTX-3 and Pb showing the strongest and most robust associations. Prospective multicenter studies in patients with suspected ACS are needed to confirm these findings and establish whether these biomarkers add value beyond established clinical assessment.

ÖzetAmaç: Bu çalışmanın amacı, akut miyokard enfarktüslü hastaların diurnal varyasyon gösterip göstermediğini ve etkilenen koroner arter ile bu diurnal varyasyon arasındaki ilişkiyi araştırmaktır.Material ve Metodlar: Ocak-Aralık 2017 tarihleri arasında akut koroner sendrom semptomları ile Yozgat Bozok Üniversitesi Acil Servisine başvuran hastalar retrospektif olarak incelendi. 24 saatlik zaman dilimi içinde diurnal değişimler 6 grupta (00:01-04:00, 04:01-08:00, 08:01-12:00, 12:01-16:00, 16:01-20:00, 20:01-00:00), mevsimsel değişimler 4 grupta (İlkbahar, Yaz, Sonbahar, Kış), haftalık değişimler ise 2 grupta (Hafta içi, Hafta sonu) analiz edilmiştir.Bulgular: Koroner arterlerin gün içindeki diurnal etkilenimleri incelendiğinde istatistiksel olarak anlamlı bir sonuç bulunamadı. Diurnal etkilenimin hafta içi ile hafta sonu değişimleri incelendiğinde ise hafta içi olgularında her üç koroner arter lezyonlarının hafta sonu görülen lezyonlara oranla istatistiksel olarak artmış olduğu saptandı (p<0,05). Sonuç: Çalışmamızın sonucu olarak günlük değişkenlik tespit edilmediyse de, koroner arter hastalığının artmasının, hafta içi günlerde stres ve yoğun iş temposu gibi sosyal nedenlerden etkilendiği açıkça belirlenmiştir.