Muhammed Zahid Sahin

Background: Psoriatic arthritis (PsA) is a chronic immune mediated inflammatory disease that may extend beyond the musculoskeletal and dermatological systems. Although cochlear and vestibular involvement has been reported in autoimmune rheumatic diseases, the frequency, pattern, and clinical correlates of audiovestibular dysfunction in PsA remain insufficiently characterized. Previous studies have generally focused on limited audiological or vestibular parameters. This study aimed to comprehensively evaluate cochlear and vestibular function in PsA patients using a multimodal audiovestibular test battery and to investigate the relationship between these findings and disease activity indices. Methods: A total of 35 PsA patients and 35 healthy controls underwent pure tone audiometry, word recognition score (WRS), speech reception threshold (SRT), tympanometry, acoustic reflexes, video head impulse test (vHIT), cervical vestibular evoked myogenic potentials (cVEMP), videonystagmography (VNG), and bithermal caloric testing. Disease activity in PsA patients was quantified using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Psoriasis Area and Severity Index (PASI), 28 - joint Disease Activity Score (DAS28), and Disease Activity Index for Psoriatic Arthritis (DAPSA28). Results: PsA patients had higher hearing thresholds ( p ≤ 0.001), lower WRS ( p ≤ 0.001), and higher (poorer) SRT values ( p = 0.011) than controls. cVEMP P1–N1 peak-to-peak amplitudes were lower bilaterally (right: p = 0.002; left: p = 0.034). P1 latencies and right N1 latency were shorter in the PsA group, whereas left N1 latency was retained as a descriptive variable because of its markedly skewed distribution. vHIT showed lower VOR gains in the right lateral, bilateral anterior, and right posterior canals; left lateral vHIT gain was retained descriptively because of marked skewness. Abnormal caloric unilateral weakness was present in 34.3% of PsA patients and in no controls ( p ≤ 0.001). DAS28 was negatively correlated with right lateral vHIT gain (Spearman’s ρ = −0.36, p = 0.027), and DAPSA28 was negatively correlated with the participant-level bilateral mean cVEMP P1–N1 amplitude (Spearman’s ρ = −0.42, p = 0.018). Disease duration was positively correlated with right and left caloric SPV responses (Spearman’s ρ = 0.41 and ρ = 0.47, respectively; both p ≤ 0.01). PASI was negatively correlated with caloric canal paresis (Spearman’s ρ = −0.41, p = 0.014). Conclusion: PsA was associated with subclinical auditory and vestibular abnormalities across complementary tests. Relationships with disease activity were exploratory and require confirmation in longitudinal studies.

Aim: Our aim in this study was to compare the reliability and clinical usefulness of answers generated by ChatGPT’s GPT-5.1 Instant and GPT-5.1 Thinking models for the most frequently searched patient questions on lateral epicondylitis.Materials and Methods: This study was designed as a pilot, descriptive, expert-evaluated large language model (LLM) output assessment study. Google Trends was queried for “tennis elbow” and “lateral epicondylitis”. The six highest-ranked questions were posed to GPT-5.1 Instant and GPT-5.1 Thinking. Three senior physiatrists independently rated every response using the seven-point Reliability and Usefulness Scales. Results: Both models produced reliable and moderately useful responses. Mean ± SD reliability scores were 5.11 ± 1.18 for GPT-5.1 Instant and 5.06 ± 1.21 for GPT-5.1 Thinking, while usefulness scores were 5.22 ± 1.22 and 5.50 ± 1.38, respectively. Differences were not statistically significant (reliability Z = -1.00, p = 0.317, r ≈ 0.41; usefulness Z = -1.60, p = 0.109, r ≈ 0.65), though GPT-5.1 Thinking trended higher in usefulness. Inter-rater agreement was excellent for all ratings (ICC = 0.94-0.98), indicating consistent scoring.Conclusion: GPT-5.1 Instant and GPT-5.1 Thinking both delivered reliable, moderately useful information on lateral epicondylitis, with GPT-5.1 Thinking showing a numerically higher usefulness score that did not reach statistical significance. These findings support ChatGPT’s potential as patient-education aid for musculoskeletal disorders while underscoring the need for expert oversight and further research across broader topics, languages, and chatbot platforms.

Objective: Plantar fasciitis is a common degenerative condition causing chronic heel pain and functional limitation. Corticosteroid injections are widely used but carry potential adverse effects, whereas ozone therapy has emerged as an alternative with anti-inflammatory and regenerative properties.The aim of this study is to compare the efficacy of ultrasound-guided corticosteroid and ozone injections on pain, function, and quality of life in chronic plantar fasciitis.Methods: This retrospective cohort study included 59 patients unresponsive to conservative treatment. Patients received either a single corticosteroid injection (Group S, n=30) or three weekly ozone injections (Group O, n=29). Outcomes were assessed using the Numerical Rating Scale (NRS), Foot Function Index (FFI), and Short Form-12 (SF-12) at baseline, 1 month, and 3 months. Treatment response was defined as ≥50% reduction in NRS.Results: Both groups showed significant improvement over time (p<0.001). Pain reduction was similar at 1 month. At 3 months, corticosteroids resulted in lower NRS scores (p=0.024) and higher responder rates (70.0% vs. 31.0%, p=0.003). Corticosteroids provided greater short-term functional improvement, whereas ozone showed superior FFI scores at 3 months (p<0.001). SF-12 physical scores improved similarly; mental scores favored corticosteroids (p=0.025). No serious adverse events occurred.Conclusions: Both injections effectively improve pain, function, and quality of life in plantar fasciitis. Corticosteroids provide superior pain relief, while ozone may offer better long-term functional improvement. Treatment selection should be individualized based on clinical priorities.

Objective: Knee osteoarthritis (KOA) is a major cause of pain and disability, particularly in the advanced stages, where treatment options are limited. Platelet-rich plasma (PRP) and ozone therapy have individually demonstrated beneficial effects. However, evidence regarding their combined use, especially in severe KOA, remains scarce. Therefore, with this study, we aimed to evaluate the efficacy of combined intra-articular PRP and ozone injections in patients with advanced knee osteoarthritis.Methods: This study included 61 patients with advanced KOA who were treated with three ultrasound-guided intraarticular injections of PRP, followed by ozone at two-week intervals. Pain and function were assessed using the Numerical Rating Scale (NRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline, 1month, and 3 months.Results: Significant improvements were observed in both pain and functional scores over time (P < 0.001). The mean NRS decreased from 7.70 ± 1.37 at baseline to 4.54 ± 1.15 at 1 month, increasing to 6.33 ± 1.29 at 3 months. WOMAC scores improved from 73.61 ± 12.64 to 54.44 ± 11.67 at 1 month but returned to near baseline (73.21 ± 12.33) at 3 months. At 1 month, 90.2% of patients achieved ≥30% pain reduction, decreasing to 9.8% at 3 months.Conclusion: Combined PRP and ozone therapy provides substantial short-term improvements in advanced KOA in terms of pain and function. Yet, these benefits decrease notably within 3 months. This treatment may be considered a short-term or adjunctive option rather than a durable, long-term solution.

Background/Objectives: Posterior knee pain is a common but often overlooked component of knee osteoarthritis (KOA), especially in advanced stages. Conventional nerve blocks targeting anterior innervation may provide insufficient relief. The IPACK block selectively targets posterior capsular innervation; however, evidence for its effectiveness in chronic KOA-related posterior pain remains limited. Methods: In this multicenter, prospective, single-arm, nonrandomized interventional study, patients aged 50–90 years with Kellgren–Lawrence grade III-IV KOA and predominant posterior knee pain unresponsive to conservative treatment received an ultrasound-guided IPACK block. Pain (NRS), function (WOMAC), and quality of life (SF-12) were assessed at baseline, 1 month, and 3 months. Results: Eighty-four patients (84 knees) were included. Mean NRS decreased from 7.8 ± 1.3 to 3.5 ± 1.5 at 1 month and 6.7 ± 1.3 at 3 months (p < 0.001). WOMAC improved from 71.5 ± 11.0 to 37.3 ± 10.4 and 60.2 ± 10.5 at 1 and 3 months, respectively (p < 0.001). SF-12 physical and mental scores also improved significantly (p < 0.001). Conclusions: Improvements in pain, physical function, and health-related quality-of-life measures were observed during the three-month period following the IPACK block. No serious procedure-related adverse events were recorded during the three-month follow-up period.

Background/Objectives: Although vitamin K has been implicated in osteoarthritis pathophysiology, the specific effects of vitamin K2 (menaquinone) on cartilage degeneration remain poorly characterized. This study aimed to investigate the effect of oral vitamin K2 supplementation in a monosodium iodoacetate-induced osteoarthritis model. Methods: Twenty-four male Sprague Dawley rats were included in the study and divided into 3 equal groups: sham group, control (osteoarthritis) group, and treatment group. Saline was applied to the right knee of the sham group, and MIA was applied intra-articularly to the right knee of the control and treatment groups to create an osteoarthritis model. Rats in the treatment group were given 8 micrograms (μg)/day of vitamin K2 orally in addition to the standard diet. After 28 days of follow-up, all rats were euthanized. The right knee articular cartilage was examined histologically with Hematoxylin–Eosin and Safranin O and immunohistochemically with type II collagen alpha 1 and Matrix Metalloproteinase-13. Results: Histological evaluation demonstrated significantly lower Mankin scores in the treatment group (4.25 ± 0.83) compared with the control group (11.10 ± 0.83). Immunohistochemical analysis showed more intense type II collagen staining and reduced matrix metalloproteinase-13 staining in the treatment group relative to the control group. Conclusions: Oral vitamin K2 administration was associated with reduced cartilage degeneration and improved matrix preservation at the 28-day endpoint in an induced MIA osteoarthritis rat model.

Recovery after acquired neurological injury is highly heterogeneous. Some patients improve rapidly with standard rehabilitation, whereas others recover slowly despite comparable lesion characteristics, comorbidity profiles, and therapy. The glymphatic system supports clearance of metabolic waste, neurotoxic proteins, excess interstitial fluid, and inflammatory mediators from the brain. This hypothesis proposes that a clinically meaningful subgroup of neurological rehabilitation patients has reduced glymphatic function, which contributes to slower functional gains through prolonged neuroinflammation, impaired proteostasis, edema persistence, sleep fragmentation, and reduced plasticity efficiency. Therefore, a glymphatic-optimized rehabilitation approach may improve recovery trajectories in individuals with low glymphatic reserve. As a result, impaired glymphatic function may represent an under-recognized biological determinant of rehabilitation responsiveness and prognosis.

Nanomaterials (NMs) are increasingly utilized in drug delivery, diagnostic imaging, and therapeutic applications. However, their widespread use raises concerns regarding potential neurotoxicity, particularly for metal and metal oxide nanoparticles. Accumulating evidence indicates that these nanoparticles induce neurotoxicity through interconnected mechanisms, including excessive reactive oxygen species generation, activation of neuroinflammatory pathways, mitochondrial dysfunction, and disruption of blood–brain barrier integrity. These molecular events collectively lead to synaptic impairment, neuronal apoptosis, and progressive cognitive and behavioral deficits, with toxicity severity influenced by dose, exposure duration, and age. Given that in vitro models often fail to capture complex systemic interactions such as nanoparticle biodistribution, blood–brain barrier dynamics, and neuroimmune responses, this review places particular emphasis on in vivo studies to provide a more physiologically relevant understanding of nanoparticle-induced neurotoxicity. Importantly, a growing body of in vivo evidence demonstrates that natural bioactive compounds can mitigate these effects by targeting key pathogenic pathways, including oxidative stress, inflammation, and mitochondrial dysfunction, while preserving neuronal integrity. These findings highlight the therapeutic potential of natural bioactives as protective agents against nanoparticle-induced neurotoxicity and as candidates for broader neuroprotective strategies. This review summarizes the mechanistic basis of metal and metal oxide nanoparticle neurotoxicity and critically evaluates the protective role of natural bioactive compounds, with a focus on evidence derived from animal models.