Purpose: Metastatic hormone-sensitive prostate cancer requires accessible biomarkers for better prognostication. This study investigated the prognostic value of the alkaline phosphatase-to-albumin ratio (APAR) in metastatic hormone-sensitive prostate cancer survival risk stratification. Methods: We retrospectively analyzed 128 metastatic hormone-sensitive prostate cancer patients treated at a single institution between January 2015 and January 2025. A cut-off of 2.92 for the alkaline phosphatase-to-albumin ratio was determined via receiver operating characteristic analysis. Overall survival was assessed using Kaplan-Meier methods and multivariable Cox regression adjusting for standard prognostic factors, including tumor volume and Gleason score. Results: Patients with an alkaline phosphatase-to-albumin ratio of 2.92 or higher had significantly shorter overall survival compared to those with a ratio lower than 2.92 (log-rank p<0.001). In multivariable analysis, an alkaline phosphatase-to-albumin ratio of 2.92 or higher remained an independent predictor of poor overall survival (Hazard Ratio 3.26, 95% Confidence Interval 1.76-5.97; p<0.001), alongside Eastern Cooperative Oncology Group performance status (ECOG PS). Conclusion: The alkaline phosphatase-to-albumin ratio is an inexpensive, accessible marker that independently predicts survival in metastatic hormone-sensitive prostate cancer. APAR should be interpreted as a supportive, complementary marker alongside established clinical parameters such as ECOG PS, Gleason grade, and metastatic burden rather than as a standalone determinant. It holds promise for early risk stratification, though prospective validation is warranted
Purpose: Systemic amyloidosis encompasses a spectrum of protein misfolding disorders that result in amyloid deposition and organ dysfunction. Amyloid A (AA) amyloidosis, typically secondary to chronic inflammatory diseases, remains an important cause of renal morbidity. Therefore, the aim of this study was to evaluate factors associated with renal replacement therapy and mortality in patients with systemic amyloidosis. Materials and Methods: This retrospective single-center cohort study included 79 patients with biopsy-proven systemic amyloidosis diagnosed between 2010 and 2016. Demographic, clinical, and laboratory data were analyzed to identify factors associated with renal replacement therapy (RRT) and overall survival. Amyloid subtypes were determined by histopathology and immunohistochemistry. Results: Of the 79 patients, 62 (78.5%) had AA amyloidosis and 17 (21.5%) other types. The mean age was 55.8 +/- 15.8 years, and 53.2% were female. The median observation duration was 36 months. The kidneys were the most frequently involved organ (75.6%), and nephrotic syndrome was present in 50%. RRT was required in 33.8%, and overall mortality was 43%. Patients with AA amyloidosis were younger (p=0.047) and had higher creatinine and inflammatory markers (p<0.05). In multivariate Cox analysis, baseline serum creatinine (HR=1.20, 95% CI1.11-1.30, p<0.001) and proteinuria (HR=1.10, 95% CI1.01-1.20, p=0.031) were independently associated with RRT requirement. Older age was independently associated with mortality, with a 5% increase in risk per year of age (HR=1.05, 95% CI 1.01-1.09, p=0.006). Conclusion: In this cohort of systemic amyloidosis, where AA amyloidosis predominated, renal involvement was frequent and emerged as a major determinant of clinical outcomes. Baseline renal function and proteinuria are key associated factors of progression to RRT, while age remains the main determinant of overall survival.
Purpose: Bladder ischemia-reperfusion (I/R) injury leads to tissue damage through oxidative stress, inflammation, and cellular dysfunction. Cardamom (Elettaria cardamomum) has shown protective effects on various tissues thanks to its antioxidant and anti-inflammatory properties. However, its effects on bladder I/R injury have not been adequately investigated. The aim of this study was to evaluate the biochemical and histopathological protective effects of cardamom extract on bladder I/R injury. Materials and Methods: Wistar albino rats were allocated into three groups: I/R, sham and cardamom treatment group. The I/R group underwent 30 minutes of ischemia followed by 30 minutes of reperfusion. The cardamom group received 50 mg/kg of cardamom extract via gavage 24 hours before the I/R process. Bladder tissues were collected for biochemical analysis of oxidative stress markers (MDA, SOD, CAT) and histopathological examination. Results: In the cardamom treatment group, MDA levels were significantly lower, and SOD and CAT enzyme activities were significantly higher compared to the I/R group (p < 0.05). Histopathological analysis showed prominent inflammation, edema, and disruption of epithelial integrity in the I/R group, while the cardamom group exhibited notably reduced tissue damage and better-preserved epithelial integrity. Conclusion: Cardamom extract exhibited a protective role in bladder I/R injury by alleviating oxidative stress and inhibiting inflammatory responses. Further clinical studies are needed to better understand the bladder-protective effects of cardamom.
Purpose: This study aimed to investigate the effects of exercise on circulating microRNA expression and clinical outcomes in patients with rheumatoid arthritis. Materials and Methods: This prospective non-randomized interventional study included 30 RA patients (18-60 years) and 30 age-and sex-matched healthy controls. The RA group completed an 8-week supervised exercise program consisting of stretching, strengthening, and walking exercises. Pain , disease activity, functional status, and health-related quality of life were evaluated before and after the intervention. Circulating levels of miRNA-145, miRNA-146a, miRNA-155, and miRNA-16 were measured using real-time PCR. Results: After the exercise program, significant improvements were observed in pain, functional status, disease activity, and health-related quality of life (p<0.05). Circulating miRNA analysis showed a trend toward reduced expression after exercise. miRNA-145 demonstrated the largest change between pre-and post-exercise measurements, but this difference did not remain statistically significant after Bonferroni correction. No significant changes were observed for miRNA-146a, miRNA-155, or miRNA-16. No correlations were found between clinical improvements and miRNA expression changes Conclusion: Exercise was associated with improvements in clinical outcomes in RA patients, while molecular changes in circulating miRNAs were modest and exploratory.
Purpose: Quality management systems in healthcare services are developing within a multi-layered structure through general management standards, sector-specific adaptations, and accreditation frameworks. This study examines ISO 9001, ISO 15224, ISO 7101, the European Foundation for Quality Management Excellence Model, and healthcare-specific accreditation systems (such as standards developed by he Joint Commission International and the T & uuml;rkiye Health Care Quality and Accreditation Institute in terms of scope, conceptual orientation, clinical risk management, performance measurement, and external evaluation mechanisms. Material and Methods: The research used the qualitative document analysis method. Relevant standard texts and official documents were evaluated through thematic content analysis. Results: The results show that ISO 9001 provides a process architecture for quality management independent of the sector; ISO 7101 is a quality management system for healthcare organizations; ISO 15224 integrates clinical risk management into the core of the system; and accreditation systems in healthcare contain more detailed and operational clinical requirements. The EFQM model, on the other hand, offers a governance framework that provides a perspective on organizational maturity and sustainable performance rather than being a compliance-based certification standard. Conclusion: The study demonstrates that these systems are complementary, not contradictory, and that they create a layered quality architecture in healthcare organizations.
Purpose: This study aimed to assess baseline hematological profiles and systemic inflammatory status of elite (EWL) and sub-elite (S-EWL) female weightlifters in relation to performance. Material and Methods: Twenty-seven female athletes (Age: 18.48 +/- 1.72 years) were categorized as EWL (n = 14) or S-EWL (n = 13). Age, height, body weight, BMI, training experience, and maximal snatch (MSn), clean & jerk (MC&J), and total lift (MTotal) performances were recorded. Performance values were adjusted for body weight using allometric scaling (ASn, AC&J, ATotal). Basal hematological parameters and systemic inflammatory markers were analyzed. Between-group comparisons were performed using Mann-Whitney U test, and correlations were assessed with Spearman's coefficient. Results: No significant differences were found in demographics or training experience (p > 0.05). EWL showed significantly MSn (p = 0.011), MC&J (p = 0.004), and MTotal (p = 0.005) performances. Allometrically scaled relative strength was superior in EWL for AC&J and ATotal (p < 0.05). Hematological and inflammatory parameters were largely similar, although MONO% was higher in EWL (p = 0.046). In EWL, NEU% and NLR positively correlated with ASn performance (r = 0.631 and r = 0.565; p < 0.05); no significant correlations were observed in S-EWL. Conclusion: Elite female weightlifters exhibited superior absolute and allometrically scaled performance compared to sub-elites. Hematological and inflammatory markers were similar between groups, except for MONO%, which was elevated in elite athletes, potentially reflecting adaptive immune responses. These findings underscore the importance of individualized training and recovery strategies and regular blood monitoring to optimize performance and prevent overtraining.
Purpose: To assess the level of awareness and knowledge regarding the link between periodontal disease (PD) and systemic diseases and to identify factors associated with awareness among adult patients in Turkey. Materials and Methods: This cross-sectional study was conducted with 273 adult patients. Data were collected using a validated, self-administered questionnaire that included sections on demographics, oral hygiene practices, medical history, knowledge of PD symptoms and its specific associations with systemic diseases. Multivariable binary logistic regression analysis was performed to identify independent predictors of awareness. Results: While 57.1% of participants self-reported knowing PD symptoms, objective assessment revealed that knowledge was largely superficial: only 24.2% possessed adequate knowledge, and only 8.8% could identify all six symptoms. Awareness of the links between PD and systemic conditions was low: 27.5% for heart disease, 16.5% for diabetes, 11.0% for rheumatoid arthritis, and 6.6% for Alzheimer's disease. Conclusion: A significant gap exists in patient knowledge regarding the association between periodontal and systemic health among patients attending a university dental clinic in Turkey. Knowledge of periodontal symptoms is often inadequate, particularly among males, individuals with lower education, and those with limited prior dental contact.
Purpose: Diabetic cardiomyopathy (DCM) is a distinct cardiac disorder that develops independently of other risk factors such as hypertension and coronary artery disease. Adiponectin activates various intracellular signaling cascades. Akt, a critical serine/threonine kinase in cardiomyocytes, regulates cell survival, growth and metabolism. The role of Adiponectin in regulating Akt in Diabetic cardiomyopahty remains unclear. This study aimed to investigate how Adiponectin regulates Akt expression under varying glucose conditions mimicking hypoglycemic and hyperglycemic conditions in HL-1 cell line. Material and Methods: Total RNA was isolated from HL-1 cells and Akt expression was analyzed by RT-PCR using specific forward and reverse primers. Statistical analysis was performed using two-way ANOVA followed by Tukey's multiple comparison test. Results: Adiponectin showed differential effects on Akt expression depending on glucose concentration, as well as dose and time dependent conditions in HL-1 cells. Conclusion: Adiponectin stimulation significantly regulated Akt expression under hypoglycemic, basal, and hyperglycemic conditions. These findings suggest that Adiponectin regulates the insulin signaling pathway and may influence cardiac energy metabolism by shifting substrate utilization toward fatty acids. Therefore, Adiponectin may represent a potential therapeutic target in Diabetic cardiomyopathy and contribute novel insights to the literature.
Purpose: Trimethylamine N-oxide (TMAO), a gut-microbiota-derived metabolite, is associated with cardiometabolic diseases, and therapeutic strategies targeting TMAO reduction are gaining interest for disease management. This study aimed to compare serum TMAO levels in patients with alcohol use disorder (AUD) and smokers versus healthy controls, and to assess changes following medically supervised alcohol detoxification. Material and Methods: Demographic data, biochemical parameters, and serum TMAO levels were analyzed. These parameters were quantified in healthy controls and patients with AUD and smokers before and after alcohol detoxification. Results: The study included thirty-four healthy controls (six females and 28 males) and thirty-three patients (five females and 28 males) with AUD and smokers. At baseline, patients demonstrated significantly lower TMAO levels but higher levels of ferritin, CRP, AST, ALT, GGT, and MCV compared to healthy controls. Following detoxification, patients exhibited a further decrease in TMAO levels (p=0.024), alongside significant improvements in hepatic enzymes (AST and GGT) and ferritin levels (p<0.001). Conclusion: These findings provide novel evidence that AUD combined with smoking is associated with markedly reduced TMAO levels, and that detoxification treatment leads to a further decline. This suppression likely reflects underlying gut dysbiosis, impaired hepatic function, and malnutrition, and persists even after detoxification.
Purpose: The prognostic value of systemic inflammatory markers in ovarian cancer is contradictory. This study aimed to compare the performance of monocyte-lymphocyte ratio (MLR) in predicting advanced stage disease and peritoneal metastasis with neutrophil-lymphocyte (NLR) and platelet-lymphocyte ratio (PLR) in treatment-naive serous ovarian cancer. Material and Methods: NLR, PLR, and MLR were calculated from preoperative blood samples of 63 treatment-naive ovarian cancer patients (58 serous, 92.1%) who underwent primary debulking surgery. FIGO 2021 staging criteria were used. Mann-Whitney U and Kruskal-Wallis tests (with Bonferroni correction) were used for intergroup comparisons; multivariate logistic regression analysis was applied to determine independent predictors. The discriminative performance of MLR was evaluated using ROC analysis. Results: 92.1% of the cohort had serous histology, and 61.9% had advanced-stage disease (FIGO stages III-IV). In multivariate analysis (adjusted for age and menopause), only MLR was found to be independently associated with advanced-stage disease (p=0.021). NLR and PLR showed no significance. MLR was also associated with peritoneal metastasis (p=0.017) and intestinal infiltration (p=0.019). In ROC analysis, the optimal cut-off value was determined as 0.30 (sensitivity 48.7%, specificity 91.7%). Conclusion: In treatment-naive serous ovarian cancer, MLR demonstrated superior performance compared to NLR and PLR in predicting advanced disease and peritoneal metastasis (adjusted OR: 4.25; AUC: 0.706). This finding supports the clinical significance of the monocyte-macrophage axis in serous ovarian cancer with predominantly transcoelomic spread.
Purpose: Female androgenetic alopecia (FAGA) and telogen effluvium (TE) are two of the most common causes of hair loss in women. Due to the considerable overlap in their clinical features, accurate differentiation is essential for appropriate treatment planning. Material and Methods: This cross-sectional study included 110 female patients clinically diagnosed with FAGA or TE at the Department of Dermatology, Dokuz Eylul University. Trichoscopic images of the frontal and occipital scalp regions were obtained at 40 & times; magnification. The presence of predefined trichoscopic features was assessed by two blinded dermatologists. Results: Trichoscopic findings associated with FAGA included hair diameter diversity (p<0.001), short vellus hairs (p<0.001), increased single-hair follicular units (p<0.001), yellow dots (p<0.001), white dots (p=0.006), and the honeycomb pigmentation pattern (p<0.001). In contrast, perifollicular scaling (p=0.030) and simple red loops (p=0.008) were associated with TE. A comparative analysis of the frontal and occipital scalp regions revealed more pronounced thinning, a higher ratio of vellus hairs, and greater follicular miniaturization in FAGA patients (all p<0.05). Conclusion: This study highlights the utility of trichoscopy as a practical tool in the differential diagnosis of FAGA and TE.
Purpose: Catheter-related bloodstream infections (CRBSIs) remain a significant cause of morbidity and mortality in intensive care units (ICUs). Chlorhexidine gluconate (CHG)-impregnated dressings may reduce catheter colonization and infection. This prospective single-center observational study evaluated the effectiveness and safety of a 2% CHG-containing hydrogel pad dressing in preventing local infection and CRBSI in critically ill adults. Material and Methods: Between June and December 2025, adult ICU patients who underwent jugular or subclavian central venous catheter insertion and received a 2% CHG hydrogel pad dressing were included. Patients were followed daily for seven days and assessed for dermatitis, local infection, and CRBSI. Results: A total of 122 patients (mean age 68.4 +/- 16 years; 52.5% male) were included. Only one patient (0.8%) developed a local infection; no CRBSI was observed. The catheter-related infection incidence density was 1.34/1000 catheter-days (95% CI: 0.03-7.48). No dermatitis or allergic reactions occurred. Dressing detachment was noted in 4.1% of cases. Conclusion: The 2% CHG hydrogel pad dressing was associated with low infection rates. Controlled comparative studies are warranted.
Purpose: The relationship between urban green space and well-being in certain age groups such as the older adults is an important interdisciplinary topic. This qualitative content analysis aimed to investigate the views of the older adults regarding the components of urban green space related to the well-being. Materials and Methods: This qualitative content analysis study was conducted from March to June 2022 with participation of 18 older adults who used the urban green space of Kermanshah, Iran. Data were collected using semi-structured interviews and analyzed based on the Graneheim and Lundman method. Results: In this study, 18 older people (9 women and 9 men) participated with a mean age of 67.78 +/- 3.69 years. Three categories and seven subcategories emerged from the content analysis of the interviews. The category of physical components consisted of four subcategories including access to facilities, safety, comfort, and legibility. The category of social components had a sub-category titled vitality. The category of psychological components also had two subcategories: sense of place and sense of security. Conclusion: Physical, social and psychological aspects of the urban green space were related to the wellbeing of the older adults. Paying attention to these components can improve well-being of the older adults.
Purpose: This retrospective study aimed to evaluate clinical and radiographic changes in the interproximal area between single-unit implant-supported restorations and adjacent natural teeth, and to assess their relationship with periodontal and peri-implant tissue health. Materials and Methods: A total of 22 single-unit implants placed in 18 patients (mean age 52.38 +/- 8.78 years) were followed for a mean period of 18.5 +/- 3.2 months (range: 3-24 months). During recall appointments, periodontal and peri-implant clinical parameters, radiographic findings, adjacent tooth vitality, opposing dentition status, and patient-reported food impaction were comprehensively recorded. Results: Interproximal contact loss (ICL) was detected in 68.2% of restorations, with mesial (36.4%) and distal (40.9%) contact loss observed. Additionally, contact loss affected both surfaces in 9.1% of cases. Among the 15 ICL implants, 9 (60.0%) were associated with patient-reported food impaction. ICL prevalence was notably higher in females (86.7%) compared to males (28.6%). Peri-implant mucositis was diagnosed in 53.3% of implants exhibiting contact loss, whereas no peri-implantitis was detected. Conclusion: ICL between implant-supported restorations and adjacent natural teeth is a frequent finding often associated with food impaction and peri-implant mucosal inflammation. Therefore, regular clinical and radiographic evaluation of interproximal contacts is essential for maintaining peri-implant tissue health and ensuring long-term restorative success.
Introduction: This study aimed to evaluate the diagnostic yield and surgical morbidity of isolated axillary surgery in non-breast pathologies, specifically comparing the safety profiles of excisional biopsy and axillary dissection.Methods: A retrospective review was conducted on patients who underwent isolated axillary surgery at a secondary-level center between 2018 and 2024. Data on demographics, surgical parameters, and pathology were analyzed. Comparative statistical analyses were performed using Fisher's exact and Mann-Whitney U tests.Results: A total of 42 patients were included (mean age: 58.1±14.4 years). Excisional biopsy was the most common procedure (71.4%), followed by axillary dissection (23.8%). Patients with malignancy were significantly older than those with benign pathologies (65.3 vs. 54.9 years; p=0.026). While the overall morbidity was 16.7%, a significant disparity was observed based on the surgical approach: morbidity was 70% in the axillary dissection group compared to 0% in the excisional biopsy group (p
The family is the first and most enduring environment in which individuals develop health-related behaviors, values, and ways of coping, shaping health trajectories throughout the life course. Moving beyond its conventional sociological framing, the family is now increasingly recognized within health sciences as a clinically meaningful and evidence-based context that influences health promotion, disease prevention, adherence to treatment, and long-term disease management. Accumulating epidemiological evidence demonstrates that many major modifiable risk factors for non-communicable diseases, including cardiovascular and metabolic disorders, are closely linked to family norms, patterns of communication, and the intergenerational transmission of behaviors. As a result, family-centered approaches have become increasingly important in preventive medicine, chronic disease care, and health systems research, particularly in situations where interventions focused solely on the individual are insufficient. At the same time, advances in digital health technologies such as artificial intelligence–supported decision tools, remote monitoring devices, and mobile health applications have expanded the reach and effectiveness of family-based models. By enabling integrated data collection, personalized risk assessment, and shared behavior change strategies, these innovations position the family as an active partner within modern healthcare systems, supporting improved clinical outcomes, stronger health literacy, and more efficient use of healthcare resources.
Purpose: Low levels of vitamin D (25-[OH]D) represent a common health problem, recently linked to chronic conditions such as metabolic syndrome (MetS), cardiovascular diseases, and type 2 diabetes mellitus. This study aimed to investigate the relationship between vitamin D levels, insulin resistance (IR), and MetS. Material and Methods: This retrospective study included 52 MetS patients diagnosed per the National Cholesterol Education Program Adult Treatment Panel III criteria and 74 age-and sex-matched healthy controls. IR was defined using a HOMA-IR threshold of >= 2.5. Participants were divided into four groups: group 1 (MetS IR+, n=31), group 2 (MetS IR-, n=21), group 3 (healthy IR+, n=22), and group 4 (healthy IR-, n=52). Results: Mean 25-(OH)D levels were significantly lower in MetS patients (17.3 +/- 9.1 ng/mL) compared to controls (25.5 +/- 11.9 ng/mL, P<0.0001). Among the groups, 25-(OH)D levels differed significantly (16.9 +/- 9.4, 18.6 +/- 8.5, 25.8 +/- 15.2, and 25.3 +/- 9.3 ng/mL; P=0.001). Logistic regression analysis identified 25-(OH)D as an independent predictor of MetS IR+ (P=0.004). Conclusion: Vitamin D deficiency appears to play a role in the pathogenesis of MetS and IR. Furthermore, it may serve as a predictor of insulin resistance in MetS patients.
Purpose: Anophthalmia is a rare congenital ocular malformation defined by the complete absence of the eyeball. It may occur as an isolated finding or systemic and syndromic abnormalities. This study aimed to evaluate the clinical and systemic features of patients with anophthalmia in a tertiary care center. Materials and Methods: A retrospective review was performed on patients diagnosed with unilateral or bilateral anophthalmia at the Ophthalmology Department of Dokuz Eylul University Hospital between January 2005 and July 2025. Demographic data, ocular findings, and systemic evaluations were analyzed. Results: Fifteen patients were included, with a mean age of 1.84 +/- 2.94 years. Unilateral anophthalmia was found in nine patients and bilateral in six. Systemic anomalies were present in 11 patients (73.3%). Four patients (26.6%) had syndromic diagnoses, including CHARGE, Goldenhar, and Fryns syndromes. The most common non-syndromic anomalies were congenital heart defects and craniofacial malformations. A history of consanguinity was observed in six patients (40%). Conclusion: The high frequency of systemic and syndromic associations, particularly in bilateral cases, emphasizes the importance of a multidisciplinary approach. Early neuroimaging, systemic screening, and genetic counseling are essential for optimal diagnosis and management.
Purpose: Moyamoya disease is a rare cerebrovascular disorder characterized by progressive stenosis of the terminal segments of the internal carotid arteries and the development of collateral vessels with a characteristic "puff of smoke" appearance. Case Report: In this case report, a 36-year-old female patient with a known diagnosis of Moyamoya disease underwent on-pump coronary artery bypass grafting (CABG) for significant stenosis in the LAD and CX arteries. Special attention was paid to intraoperative cerebral protection strategies, including maintenance of pulsatile flow, higher hematocrit levels, adequate mean arterial pressure, and avoidance of deep hypothermia. No neuromonitoring modalities were used, as they were not routinely available in our institution. No instances of vasculitis were detected in the LIMA and saphenous vein grafts. The postoperative course was uneventful. Conclusion: This case demonstrates the safe application of surgical revascularization in patients with coexisting Moyamoya disease and coronary artery disease.
Purpose: This study aimed to evaluate the prevalence of frailty and identify predisposing factors among older adults with coronary artery disease (CAD). Methods: This descriptive cross-sectional study was conducted with 107 patients aged >= 65 years, who were assessed using an introductory information questionnaire and the Edmonton Frail Scale (EFS). Data were analyzed using descriptive statistics, independent t-tests, one-way ANOVA with Bonferroni post-hoc tests, and multiple linear regression analyses. Results: The prevalence of frailty (mild, moderately, and severely) was 44.0%, and "apparently vulnerable" frailty was 15,9%. Participants aged >= 75 years had higher mean EFS scores compared to those aged 65-74 years (beta=0.677, p<0.001). Participants using >5 medications had higher EFS scores compared to those using <= 3 medications (beta=0.566, p=0.009). Female participants exhibited higher frailty scores compared to males (beta=-0.590, p=0.003). Conclusion: The overall frailty prevalence was 44.0% (mild, moderate, severe) among older adults with CAD. Age, polypharmacy, and female gender were independently associated with frailty. These findings highlight the importance of routine frailty assessment in older adults with CAD to ensure holistic care planning and targeted interventions.
