Bulimia nervosa (BN) is an eating disorder characterized by recurrent binge eating and compensatory behaviors. Diagnostic crossover to anorexia Hervosa (AN) often occurs in chronic cases. We report a 29-year-old male with a ten-year BN history who presented with mild dyspepsia and a single episode of black-colored vomiting. Physical examination was unremarkable. However, laboratory tests revealed hypokalemia and renal dysfunction. Imaging demonstrated a 1-cm gastric perforation that required emergency surgery. Psychiatric evaluation confirmed AN-binge-eating/purging type (AN-b/p). Following surgery, combined therapy with fluoxetine and topiramate achieved clinical stabilization, promoted weight gain, and eliminated purging behaviors. This case underscores that gastric perforation, although rare, is a potentially life-threatening complication of AN-b/p. In eating disorders, altered pain perception may blunt symptom awareness, enabling serious complications to progress silently. Multidisciplinary collaboration is essential for effective treatment and recovery
Aim: Delirium is a frequent acute neuropsychiatric condition in intensive care units and is associated with increased morbidity and mortality. However, prognostic factors among cardiac patients with delirium in the coronary intensive care unit (CICU) remain insufficiently defined. This study aimed to evaluate clinical characteristics and mortality-associated factors in delirious CICU patients. Materials and Methods: In this single-center retrospective cohort study, 62 patients diagnosed with delirium during CICU hospitalization at Tekirda & gbreve; Nam & imath;k Kemal University Hospital between January and December 2024 were analyzed. Demographic, clinical, laboratory, and treatment-related variables, as well as in-hospital and 6-month mortality outcomes, were evaluated. Results: The mean age was 76.6 +/- 10.5 years, and 58.1% were female. Prolonged mechanical ventilation (p=0.012), respiratory tract infection (p=0.038), and central venous catheter use (p=0.036) were significantly associated with adverse in-hospital outcomes. Elevated blood urea nitrogen (BUN) (p=0.034), creatinine (p=0.007), lactate (p=0.012), decreased pH (p=0.026), and prolonged CICU stay (p=0.001) were significantly associated with in-hospital mortality. Six-month mortality was significantly associated with depression history (p=0.002), nursing home residence (p=0.002), morphine use (p=0.002), central venous catheterization (p=0.011), heart failure (p=0.003), elevated BUN (p=0.003), creatinine (p=0.007), lactate (p=0.012), and mechanical ventilation duration (p=0.049). Conclusion: Among delirious CICU patients, mortality is closely associated with organ dysfunction markers, infection burden, invasive interventions, and psychosocial vulnerability. Delirium appears to reflect systemic clinical instability, underscoring the importance of comprehensive risk assessment and multidisciplinary management.
Aim: This study aimed to investigate how a child’s quality of life influences the connection between a mother’s and child’s levels of illness anxiety. Materials and Methods: Online data was collected from 302 mother-child pairs with children aged 10-15. The scale for the Assessment of Illness Behavior was applied to assess the mothers’ level of illness anxiety. The Pediatric Quality of Life Inventory was applied to assess children’s quality of life, and the Childhood Illness Attitude scale was applied to assess children’s level of illness anxiety. To determine participant eligibility based on study criteria, mothers completed a sociodemographic questionnaire. The study employed Process Macro to analyze the mediating effect. Results: The analysis revealed a significant association between maternal and child illness anxiety, with the child’s quality of life serving as a partially significant mediating factor in this relationship. Conclusion: Considering the study findings, it can be stated that the child’s quality of life is an important determinant in the relationship between maternal and child illness anxiety. Therefore, the results highlight the importance for professionals working on the treatment of illness anxiety in children to also focus on the quality-of-life variable during intervention.
Aim: This study presents the first clinical data from T & uuml;rkiye on the use of transcranial magnetic stimulation (TMS) in treating psychiatric disorders among children and adolescents. This study aimed to evaluate clinical outcomes and the safety of TMS in treatment-resistant child and adolescent psychiatric cases etrospectively. Materials and Methods: Medical records of 23 patients who received TMS between April 2015 and October 2024 at the Department of Child and Adolescent Psychiatry, Pamukkale University Faculty of Medicine, were reviewed. Demographic and clinical variables-including age, sex, diagnosis, comorbidities, medication use applied MS potocal and Clinical Globalimpression Scurity & Ge Stand Improvement (Col- scores were analyzed. Results: The mean age was 15.65 plus/minus 1.64 years, and 69.6% were male. The most frequent diagnoses were obsessive-compulsive disorder [(OCD); 39.1%] and depressive disorder (30.4%). Diagnosis-specific protocols targeted distinct brain regions and frequencies. Among patients with available CGI-1 data (n = 18) , marked improvement was observed in 38.9% of cases, mild improvement in 38.9%, and no significant change in 22.2%. Among patients with depression, 60% showed marked improvement, compared with 25% of those with OCD. Mild, transient side effects (headache, visual dimming) occurred in 13% of patients. Conclusion: TMS appears to be a safe and well-tolerated adjunctive treatment option and was associated with clinical improvement in a proportion of children of children and adolescents with partially or fully treatment-resistant psychiatric disorders. These findings represent the first national data on pediatric TMS use in T & uuml;rkiye and underscore the need for larger, prospective, and controlled studies to confirm its efficacy and optimize treatment protocols.
Aim: Kidney biopsy is the gold standard for the diagnosis of parenchymal diseases of the kidney. The most common complication after kidney parenchymal biopsy is bleeding. The aim of this study was to investigate patient-related factors that increase the risk of bleeding complications after percutaneous native renal parenchymal biopsy. Materials and Methods: A total of 132 patients who underwent percutaneous native kidney parenchymal biopsy were included in the study. Demographic data, comorbidities, indications for kidney biopsy, anticoagulant and/or antiaggregant drug use, blood pressure, hemoglobin (HGB), platelet, international normalised ratio (INR), glomerular filtration rate (GFR), urea, creatinine values recorded in patient files before biopsy, development of bleeding complications after biopsy, need for intervention for bleeding, need for transfusion and length of hospital stay due to bleeding were retrospectively analysed. Results: Bleeding complications occurred in 17 patients (12.9%) after biopsy. Of the 17 patients with bleeding, 5 (3.8%) were major bleedings. No patient required embolisation or surgical intervention. A statistically significant correlation was observed between pre-procedural antiaggregant and/or anticoagulant drug use, HGB levels, INR and development of bleeding complications. In the group without bleeding complications, mean pre-procedure HGB; 11.5 +/- 2.45 gdL /and INR; 1.05 +/- 0.1, while in the bleeding group, HGB; 10 +/- 1.99 mg/dL and INR: 1.12 +/- 0.12 ( p = 0.013 p = 0.009 respectively). A history of anticoagulant and/or antiaggregant use was 29.4% in the patients with bleeding and 10.4% in the group without bleeding (p = 0.045) Conclusion: Our study draws attention to the necessity of determining new safe limits especially in terms of haemogram, INR levels, anticoagulant and/or antiaggregant drug use parameters, defining the high-risk patient group and taking appropriate precautions before biopsy in order to perform percutaneous native renal parenchymal biopsy with a lower bleeding risk.
Aim: The aim of this study was to identify the occupational risks, working conditions, health problems, and protective practices related to worker health among auto paint workers. Materials and Methods: This research was designed as a qualitative study using a phenomenological approach. A total of 13 auto paint workers participated in the study. Data were collected through face-to-face, semi-structured, and in-depth interviews. Results: Participants primarily reported exposure to chemical hazards as their main occupational risk. In addition, long working hours and working in cold environments, particularly during the winter months, were identified as additional occupational risks. The most commonly reported health problems were respiratory diseases and dermatological conditions. The findings also revealed that occupational training activities and protective practices were inadequate. Furthermore, participants expressed concerns about the lack of new apprentices in industrial areas, emphasizing the potential shortage of skilled auto paint workers in the future. Conclusion: The respiratory and dermatological health problems observed among auto paint workers were largely associated with chemical exposure and insufficient protective measures. These findings indicate a clear need for systematic interventions aimed at increasing risk awareness and ensuring the effective and consistent use of personal protective equipment.
Aim: Pulmonary embolism (PE) and pulmonary artery sarcoma (PAS) present with similar clinical symptoms but differ significantly in pathology and treatment. Accurate differentiation is critical yet challenging in clinical practice. This study aimed to evaluate the diagnostic efficacy of large language models (LLMs) in distinguishing PE from PAS, and to explore their potential as clinical decision support tools. Materials and Methods: Eighteen cases with confirmed diagnoses of PE or PAS were assessed using three LLMs: DeepSeek V3, Gemini Flash 2.5, and ChatGPT-4o. Models were provided with basic clinical data, followed by advanced imaging and treatment information. The Role-Goal-Context framework was applied to standardize the input prompts. Results: DeepSeek V3 achieved the highest accuracy in detecting PE during the preliminary diagnostic phase (88.9 %), while Gemini Flash 2.5 performed best in identifying PAS in the conclusive phase (22.2 %). ChatGPT-4o yielded more stable results under conditions of limited data availability. Conclusion: LLMs show promise as supportive tools in differentiating PE from PAS when guided by structured prompts and expert oversight. Their utility is limited in rare or data-deficient scenarios. A hybrid model involving human expertise and LLM integration appears most effective in enhancing diagnostic precision and clinical decision-making.
Aim: The aim of this study was to investigate the effects of botulinum toxin injection on upper extremity muscle thickness and motor recovery in stroke patients. Materials and Methods: The study was conducted retrospectively. Twenty stroke patients (11 males, 9 females) who received botulinum toxin injections into the forearm muscles of the upper extremity were included in the study. Muscle thickness measurements, brunnstrom motor recovery stages, and modified Ashworth scale scores were assessed before and one month after botulinum toxin injection. Results: There were no significant change in the brunnstrom upper extremity and hand stages before or after botulinum toxin application (p>0.05). No significant change in forearm muscle thickness was observed in measurements taken from the proximal third of the volar surface of the forearm before or after the injections (p>0.05). A significant decrease in spasticity levels was observed in wrist flexor group and finger flexor group muscles after botulinum toxin application (p=0.001). Conclusion: The study shows that botulinum toxin reduces spasticity but has no effect on brunnstrom motor recovery and muscle thickness.
Aim: Coronary artery disease (CAD) remains a major global health burden, and currently available blood biomarkers lack sensitivity for early detection. This study aimed to identify and validate circulating mRNA and long non-coding RNA (lncRNA) biomarkers of CAD and to develop a predictive transcriptomic model. Materials and Methods: We analyzed plasma RNA-seq data from stable CAD patients and healthy controls (GSE208194) and validated findings in an independent peripheral blood microarray cohort (GSE113079). Differential expression was assessed using a threshold of |log2 fold-change| >= 1 and false-discovery rate <0.05. Enrichment analysis of gene ontology and Kyoto Encyclopedia of Genes and Genomes pathways was performed. A predictive model was constructed using logistic regression model-penalized logistic regression, with hyperparameters tuned within a nested cross-validation framework, and evaluated in the independent validation cohort. Results: A total of 182 transcripts (177 mRNAs, 5 lncRNAs) were differentially expressed, with 91% down-regulated in CAD. Enrichment analysis revealed coordinated dysregulation of ribosomal biogenesis, cytoplasmic translation, mitochondrial oxidative phosphorylation, and p53/NF-kappa B inflammatory pathways. Cross-platform validation confirmed 85 transcripts, indicating a robust expression signature. The predictive model selected two genes, NEUROD2 and RPS27, achieving an external area under the curve of 0.820 in the validation cohort. Conclusion: Blood transcriptomic profiling identifies a reproducible CAD-associated expression signature and supports a concise two-gene classifier reflecting inflammatory and metabolic stress-related pathways. These findings provide a framework for the further development of blood-based transcriptomic assays and warrant validation in larger, diverse populations to define clinical utility in cardiovascular risk assessment.
Aim: Pathological cardiac hypertrophy precedes heart failure and alters myocardial structure, function, and molecular signaling. miRNAs, particularly miR-214, regulate key remodeling and hypertrophic pathways. Although polydatin has reported cardioprotective effects, whether these involve miRNA-mediated mechanisms is unclear. This study investigates the potential role of the miR-214/Forkhead box O3 (FOXO3)/nuclear factor of activated T-cells (NFAT) axis in mediating polydatin’s effects. Materials and Methods: Male Wistar rats were divided into three groups: Control, isoproterenol (ISO), 5 mg/kg/day, s.c.), and ISO + polydatin (100 mg/kg/day, oral). Following four-weeks treatment, cardiac hypertrophy was assessed by measuring heart weight, heart weight/body weight ratio, and heart weight/tibia length ratio. For molecular analyses, the expression levels of miR-1, miR-214, and miR-133b, as well as the mRNA levels of FOXO3, NFAT, atrial natriuretic peptide (ANP), and brain natriuretic peptide (BNP), were measured by real-time polymerase chain reaction. Results: Morphological parameters were significantly increased in the ISO group compared with controls (p<0.001) and were markedly suppressed by polydatin (p<0.05). Among the miRNAs, only miR-214 was significantly upregulated by ISO (p=0.006), and this effect was attenuated by polydatin (p=0.030). ISO downregulated FOXO3 (p=0.027) and upregulated NFAT (p<0.001), effects that were reversed by polydatin. Expression of fetal gene markers ANP (p=0.029) and BNP (p=0.002) was markedly elevated in the ISO group, but these increases were abolished with polydatin treatment (p>0.05 vs. control). Conclusion: Polydatin demonstrates cardioprotective effects against ISO-induced pathological cardiac hypertrophy. These effects involve not only morphological improvements but also molecular regulation via the miR-214/FOXO3/NFAT axis and suppression of the fetal gene program. These findings suggest that polydatin may have potential as a pharmacological agent for preventing pathological cardiac remodeling.
Aim: The fundamental objective of endovascular aortic repair (EVAR) is the effective exclusion and subsequent shrinkage of the aneurysm sac. Nevertheless, a clinical challenge persists in a subset of patients who exhibit progressive sac enlargement despite the total absence of detectable endoleaks, a phenomenon known as endotension or type V endoleak. This study investigates the morphological, biomechanical, and systemic determinants of persistent sac expansion following EVAR.Materials and Methods: A longitudinal analysis was performed on 41 consecutive patients with a minimum 18-month follow-up. We evaluated anatomical metrics via thin-slice computed tomography angiography, biochemical markers including high-sensitivity C-reactive protein (hs-CRP), and systemic comorbidities. Multivariable logistic regression was employed to identify independent predictors of adverse sac dynamics.Results: Sac expansion (>= 5 mm) was observed in 14.6% of the cohort during the follow-up period. Multivariable analysis demonstrated that a preoperative sac diameter exceeding 60 mm [odds ratio (OR): 3.24] and an increased mural thrombus burden (OR: 2.86) were the strongest independent biomechanical predictors of persistent enlargement. Patients with adverse sac behavior frequently exhibited elevated hs-CRP levels and a higher prevalence of systemic conditions such as obesity, chronic obstructive pulmonary disease, and hypothyroidismConclusion: Post-EVAR sac expansion is a multifactorial systemic phenotype influenced by landing zone quality, mural thrombus biomechanics, and host inflammatory status. These findings suggest that in endotension cases, the transmission of pulsatile energy through the mural thrombus may maintain sac pressurization even without a visible flow channel. Recognizing persistent expansion as a distinct phenotype necessitates a shift in post-EVAR surveillance from a binary endoleak-focused approach toward a more comprehensive assessment of longitudinal sac dynamics and biomechanical risk factors
Aim: This study aims to evaluate the clinical outcomes of our case series involving finger extension restoration using the flexor carpi radialis (FCR) tendon in patients with radial nerve palsy. Materials and Methods: We retrospectively evaluated patients who underwent tendon transfers using FCR for radial nerve palsy between January 2016 and December 2021. Nineteen patients (15 males, 4 females) were included. Data on the side of injury, gender, age, etiology, history of nerve repair, and time of admission were recorded. Functional outcomes were assessed by comparing preoperative and postoperative Quick-DASH and Bincaz scores. Results: Postoperative Quick-DASH scores showed statistically significant improvement (p<0.001). The mean functional loss score decreased from 31.82 +/- 14.82 preoperatively to 16.03 +/- 7.97 postoperatively. Analysis of Bincaz scores using the Wilcoxon signed-rank test also demonstrated significant functional recovery (p<0.001). Conclusion: Tendon transfers remain a reliable strategy for restoring motor function when radial nerve repair is not feasible. While various techniques exist, each presents distinct advantages and disadvantages. Surgeons should adopt a case-specific approach tailored to the patient's occupational and functional requirements.
Aim: Approximately 10% of the population experiences a seizure at some point in their lives. However, the prevalence of epilepsy in the general population is around 3%. It is important to predict which individuals presenting with a first-time seizure are at high risk of recurrence and who should be started on antiepileptic medication. Materials and Methods: This study included 140 patients over the age of 18 who presented to the emergency department or Neurology outpatient clinic for the first time with a complaint of fainting, starting from January 2022. Demographic characteristics, neurological examination findings, electroencephalography (EEG), and brain magnetic resonance imaging (MRI) data were obtained from the hospital information system. Patients were contacted via their registered phone numbers to inquire about seizure recurrence after the first episode, and outpatient follow-up records were reviewed to identify those diagnosed with epilepsy. Results: A total of 140 patients were included in the study. The mean age of the patients was 56.17 +/- 19.45 years, and 74 (52.9%) were female. Twenty-three patients (16.4%) were newly diagnosed with epilepsy. A statistically significant relationship was found between medication use and loss of consciousness with seizure recurrence [(p=0.006), (p=0.022)]. No statistically significant difference was found between seizure recurrence and gender, history of febrile convulsions, family history of epilepsy, history of head trauma, brain MRI findings, or EEG results (p>0.05). Conclusion: Considering the challenges of a long-term treatment process, the decision to initiate antiepileptic drugs is important for clinicians. Knowing the rate of epilepsy development after a first seizure and which patient groups are at risk of recurrence can assist clinicians in making this difficult decision.
Aim: Tibial shaft fractures constitute approximately 2% of all fractures. Intramedullary nails are considered the gold standard in their treatment due to less soft tissue damage and biomechanical superiority. The learning curve is an expression of how quickly and efficiently a person learns a skill or process in a certain period. Our aim in this study is to analyze the suprapatellar nailing learning curve, using operative time and total fluoroscopy time as outcome measures. Materials and Methods: Between January 2021 and December 2021, patients aged 18-65 with fresh tibial shaft fractures, no open fractures, who underwent surgery with a senior physician and had complete records, were included in the study. Forty-seven patients met the inclusion criteria. Demographic data of the patients, fracture types, side, surgical duration and total fluoroscopy dose were examined. Results: Surgeon-1 operated on 23 patients (48.9%) and surgeon-2 on 24 patients (51.1%). The study included 34 males (72.3%) and 13 females (27.7%), with a mean age of 36.11 +/- 12.92 years (range: 19-64). Mean operative time was 64.89 +/- 10.41 minutes (range: 48-90), and the number of fluoroscopy shots averaged 54.09 +/- 13.46 (range: 30-78). No significant differences were observed regarding gender, age, side, or operative time (p>0.05). Over time, both surgeons showed a significant decrease in operative duration, with surgeon-1 reducing time by 1.557 minutes per case [beta (ss)=-1.557; p=0.001] and surgeon-2 by 0.847 minutes (ss=-0.847; p=0.001). No significant learning curve was found for fluoroscopy usage (p>0.05). Conclusion: Our study showed that the suprapatellar intramedullary nailing technique resulted in a significant reduction in operative time and a significant regression curve.
Composite lymphoma refers to the simultaneous presence of two or more morphologically and immunophenotypically distinct lymphomas within the same tissue or organ. While cases of composite lymphoma consisting of classical Hodgkin lymphoma (cHL) and B-cell lymphoma have been reported, the combination of splenic marginal zone B-cell lymphoma (SMZL) and cHL is extremely rare. In this report, we present a case initially treated with insufficient response for SMZL, later experiencing recurrence, followed by a diagnosis of cHL. Additionally, thyroid tissue from the same patient revealed the presence of thyroid papillary and medullary cancers with a poor prognosis. This report presents a case of composite lymphoma involving four different primary malignancies occurring simultaneously.
Aim: This study aimed to explore the prevalence of depressive symptoms among nurses working in intensive care units (ICUs) and to analyze how these symptoms relate to both individual (e.g., age) and occupational (e.g., stress level, job satisfaction) variables. Furthermore, it sought to assess the functional consequences of depression using the final item of the Patient Health Questionnaire-9 (PHQ-9) scale. Materials and Methods: A descriptive cross-sectional design was employed among ICU nurses from a tertiary-level hospital. Data were gathered through a structured questionnaire incorporating the PHQ-9, a job satisfaction measure, and a perceived stress scale. Statistical analyses included descriptive evaluations, correlation tests, and chi-square analyses, with effect sizes computed via Cramer’s V where appropriate. Results: More than half of the nurses (55.4%) demonstrated moderate-to-severe depressive symptoms. Depression scores showed significant associations with age (r=-0.210, p=0.016), perceived stress (p<0.001, Cramer’s V =0.344), and job satisfaction (p<0.001, Cramer’s V =0.297). According to the PHQ-9 item assessing functional impairment, 36.2% of participants indicated that depressive symptoms had a moderate-to-severe impact on their daily and professional functioning (p<0.001, Cramer’s V =0.484). Conclusion: Depression appears to be highly prevalent among ICU nurses and is influenced by both personal and workplace factors. The strong link between depressive symptoms and functional impairment highlights the importance of comprehensive mental health evaluations in nursing populations. Early recognition of vulnerable individuals, along with institutional programs addressing stress management and job satisfaction, may enhance nurses’ psychological well-being and improve the overall quality of critical care delivery.
Aim: The aim of this study was to evaluate clinical, pathological, and inflammatory markers that can predict pathological complete response (pCR) after neoadjuvant chemotherapy (NACT) in patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2 (HER2) HER2- breast cancer.Materials and Methods: A retrospective analysis was conducted on 109 patients aged 18-80 years with HR+/HER2- breast cancer who underwent NACT at University of Health Sciences T & uuml;rkiye, Bal & imath;kesir Atat & uuml;rk City Hospital between January 1, 2020, and May 1, 2025. All patients received standard anthracycline-taxane-based chemotherapy. Pre-treatment blood tests were used to calculate the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII). pCR was defined as the absence of residual invasive tumor in the breast and axillary lymph nodes. Factors affecting pCR were evaluated using logistic regression analysis.Results: pCR was achieved in 21.1% of patients. Most of the pCR group was under 50 years of age and had the luminal B subtype. ROC analysis showed that NLR, PLR, and SII were not significant predictors of pCR (p>0.05). In univariate analysis, luminal B subtype, low estrogen receptor (ER) levels, high Ki-67, and high tumor grade were significantly associated with pCR. In multivariate analysis, only low ER levels and high Ki-67 remained independent predictors.Conclusion: Inflammatory markers are insufficient to predict pCR in HR+/HER2- breast cancer. Low ER levels and high Ki-67 are associated with a better response to NACT. The findings highlight the importance of biomarkers in personalizing treatment response
Aim: This study aimed to evaluate the effect of obesity on the symptom profile and radiological disease burden in patients with chronic rhinosinusitis (CRS). Materials and Methods: A total of 123 patients with ERS were retrospectively analyzed. The patients heights, weights, 22-item Sinonasal Outcome test (SNOT-22) scores, and Lund-Mackay scores were recorded. Patients were grouped into obese (>= 30 kg/m & sup2;) and normal (<30 kg/m & sup2;) based on their body mass index (BMI) values. Symptom profiles and radiological disease burden were assessed using SNOT-22 and Lund-Mackay scoring, respectively BMI was correlated with each SNOT-22 question and with the total SNO1-22 score using Spearman's rank correlation, while the Lund-Mackay score was analyzed using Pearson correlation. Results: Increase in BMI was positively correlated (p<0.05) with certain SNOT-22 items, these associations were more pronounced in women with nasal congestion and sleep-related symptoms and in Inen with postrasal drip. However, no significant differences were found in total SNOT-22 and Lind Mackay stores between the ottese and ionial groups, Conclusion: Obesity may be associated with specific symptom patterns, although it does not significantly increase the total symptom burden. The fact that obesity is associated with obstructive symptoms in women and secretory symptoms in men underscores the need for personalized treatment approaches in this patient group. Large-scale studies are needed to more clearly demonstrate the effect of obesity on CRS symptoms, phenotypes, and radiological findings.
