Aims: To date, no studies have examined the relationship between the hemoglobin-albumin-lymphocyte-platelet (HALP) score and the systemic inflammatory response index (SIRI) in pregnancy. The aim of this study was to compare HALP, SIRI, and other systemic inflammatory indices, including the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and aggregate index of systemic inflammation (AISI), between pregnant women with intrahepatic cholestasis of pregnancy (ICP) and healthy pregnant controls. Methods: This retrospective cross-sectional study included pregnant women diagnosed with ICP and healthy controls matched for age and pregnancy. Participants were screened using complete blood count data collected at diagnosis. The primary endpoint was a comparison of systemic inflammatory markers, including NLR, MLR, PLR, SII, SIRI, AISI, and HALP score. Results: A total of 143 pregnant women with a mean age of 29.3 years were included. Of these, 73 were in the ICP group and 70 were in the control group. PLR, SII, and HALP scores were significantly higher in the ICP group than in the control group (p=0.026, p=0.019, and p=0.016, respectively), while NLR, MLR, SIRI, and AISI showed no significant differences between the groups. Weak positive correlations were found between the presence of ICP and each of PLR (r=0.187, p=0.025), SII (r=0.197, p=0.019), and HALP (r=0.201, p=0.016). Receiver operating characteristic analysis showed that HALP [area under the curve (AUC)=0.616, sensitivity 97%, p=0.016], SII (AUC=0.614, specificity 94%, p=0.019), and PLR (AUC=0.608, specificity 89%, p=0.026) had significant predictive value. Conclusions: HALP and selected systemic inflammatory indices can serve as helpful biomarkers for the diagnosis of ICP.
Aims: Familial Mediterranean fever (FMF) is a common autoinflammatory disease in Türkiye and worldwide. Diagnosis may be delayed because it can present with diverse clinical phenotypes. This study aims to determine the initial symptoms of patients with FMF, the time from symptom onset to diagnosis, and factors associated with delayed diagnosis. Methods: This cross-sectional study included patients with FMF who were under follow-up, receiving treatment, and who volunteered to participate. A face-to-face data collection form, including questions about the first symptoms of FMF, age at onset, and age at diagnosis, was administered to the patients. Results: Of the 169 patients, 58% (n=98) were female, and the mean age was 34.31±10.96 years. The mean age at onset of symptoms was 17.26±11.43 years, and the mean age at diagnosis was 24.67±12.62 years. The diagnostic delay was 7.41±8.57 years. The most common initial symptom of FMF was abdominal pain (72.8%, n=123). Diagnostic delay was significantly longer in patients with joint pain than in patients without joint pain [6.00 (0-39) years vs. 3.00 (0-35) years; p=0.007]. Similarly, the diagnostic delay was significantly shorter in patients who had undergone surgery compared with those without a history of surgery [3.00 (0-39) years vs. 8.00 (0-37) years; p=0.002]. Conclusions: This study demonstrated that diagnostic delay remains a significant issue among patients with FMF, particularly those presenting with joint pain.
Aims: Helicobacter pylori (H. pylori) infection is a frequent chronic condition in childhood, and determining whether it provokes a systemic inflammatory imprint is clinically relevant. This study aimed to evaluate whether pediatric H. pylori infection was associated with alterations in complete blood count (CBC)-derived inflammatory indices, particularly the platelet-to-lymphocyte ratio (PLR) and the mean platelet volume-to-lymphocyte ratio (MPVLR). Methods: This retrospective cross-sectional study included children aged 6-18 years who underwent upper gastrointestinal endoscopy for dyspeptic symptoms and had histopathological confirmation of H. pylori infection. Pre-procedural CBC and serum albumin levels were recorded, and CBC-derived inflammatory indices (such as the PLR and the MPVLR) were calculated. The primary endpoint was the association between H. pylori positivity and these inflammatory indices. Results: A total of 453 children were included, of whom 171 were H. pylori positive and 282 were H. pylori negative [median age 13.4 years (interquartile range 10.8-15.7); predominantly female (65.6%)]. Children with H. pylori infection had significantly higher PLR (127.45 vs. 113.50; p<0.001) and MPVLR (4.45 vs. 4.02; p<0.001) values compared with controls. Neutrophil, lymphocyte, and monocyte counts were lower in the positive group (p<0.01 for all), while no meaningful differences were observed in other composite indices. Conclusions: Pediatric H. pylori infection is associated with a measurable, low-grade systemic inflammatory response, as reflected by elevated PLR and MPVLR values.
Alström syndrome (AS) is a rare autosomal recessive ciliopathy caused by pathogenic variants in the ALMS1 gene on chromosome 2p13, with multisystem involvement including the retina, cochlea, heart, liver, and kidneys. It is characterized by progressive cone-rod dystrophy, sensorineural hearing loss, truncal obesity, insulin resistance, type 2 diabetes mellitus and cardiomyopathy. Although hepatic involvement is frequent, advanced complications such as portal hypertension and variceal bleeding are extremely rare in childhood. We report the case of a 16-year-old girl with AS who presented with hematemesis and altered mental status. Laboratory evaluation revealed chronic liver disease and diabetic ketoacidosis. Upper gastrointestinal endoscopy demonstrated grade 2-3 esophageal varices that were treated with band ligation. Genetic testing identified a homozygous pathogenic frameshift mutation (NM_001378454.1:c.10218del, p.Ser3407Valfs*12) in exon 15 of the ALMS1 gene. This patient is the youngest reported pediatric AS case in Türkiye presenting with life-threatening variceal hemorrhage secondary to portal hypertension. The case underscores the importance of early genetic confirmation and proactive hepatic monitoring in pediatric patients with AS.
Aims: This study aimed to compare imaging-based evaluation of retroperitoneal nodal status with pathologic findings, and to identify the advantages and disadvantages of laparoscopy. Methods: This retrospective study included patients with invasive cervical cancer who underwent laparotomy or extraperitoneal laparoscopy for evaluation of para-aortic nodal status between 2002 and 2006 at two tertiary care hospitals. The primary objectives were to compare the imaging modalities with pathological findings and laparoscopy with laparotomy. Results: Forty-one women (mean age: 51±10 years) having invasive cervical cancer were included in the study. Laparoscopic extraperitoneal lymphadenectomy was performed in 26 patients [International Federation of Gynecology and Obstetrics (FIGO) stage IIB-IIIB], and laparotomic hysterectomy and para-aortic lymphadenectomy were performed in 15 patients (FIGO stage IB-IIB). Operation times (115.1 minutes vs. 182.0 minutes, p<0.001), the average length of hospital stay (6.1 days vs. 12.6 days, p<0.001), and the need for narcotic analgesics in the postoperative period (34.6% vs. 80.0%, p<0.005) were better in laparoscopy group. Lymphadenectomy times were similar (56.6 minutes vs. 52.2 minutes, p=0.07). Sensitivities of computed tomography, magnetic resonance imaging, and positron emission tomography (PET) for the para-aortic lymphatic region were 20%, 25%, and 33.3%, respectively; specificities were 92.3%, 96.2%, and 100%, respectively. PET was found to have 100% positive predictive value for both pelvic and para-aortic lymphatic evaluations. Extraperitoneal laparoscopic lymphadenectomy was found to have lower morbidity as a minimally invasive procedure for locally advanced cervical cancer. Conclusions: Surgical staging is the gold standard for the retroperitoneal evaluation in cervical cancer. Laparoscopy appears to be a favorable option for surgical staging due to lower morbidity and faster recovery while maintaining comparable oncologic adequacy. PET was the most specific imaging modality.
Aims: Long-term stress is a contributing factor to the development of major depressive disorder. Persistent stress can lead to sleep disturbances, which in turn, sustain sympathetic nervous system activation and elevate cortisol levels. Stress, poor sleep quality, and depression adversely affect mental and physical health, leading to increased morbidity and mortality. This study aims to assess stress levels, sleep quality, and heart rate variability (HRV) among individuals with depressive symptoms. Methods: This cross-sectional study enrolled 80 participants (mean age of 23.4±5.57 years) comprising 40 individiuals diagnosed with the symptoms of depression by a psychiatrist and 40 healthy controls. Stress levels, sleep quality, depression levels, and cardiac autonomic function were measured using the Perceived Stress Scale (PSS), the Pittsburgh Quality of Sleep Index (PSQI), the Patient Health Questionnaire-9 (PHQ-9) and the Hamilton Depression Rating Scale (HAM-D) for depression, and HRV analysis for cardiac autonomic function. Results: Participants with depressive symptoms demonstrated significantly poorer HRV parameters compared to healthy controls (p<0.05), as indicated by lower root mean square of successive differences (31.74±18.74 vs. 44.57±23.79), higher low frequency (LF) power in normalized units (LF nu: 70.57±12.45 vs. 42.69±11.96), and lower high frequency (HF) power in normalized units (HF nu: 29.48±11.57 vs. 55.39±11.45). Depression severity was significantly higher in patients with depression compared to healthy participants including PHQ-9 scores (9.90±3.84 vs. 1.98±1.33) and HAM-D scores (12.05±2.83 vs. 4.10±1.68) (p<0.001). Additionally, patients with depression exhibited significantly elevated PSS scores (27.42±3.21 vs. 13.35±2.68) and PSQI scores (8.62±2.12 vs. 3.67±1.67), indicating higher stress levels and poorer sleep quality (p<0.001). Conclusions: Individuals with depressive symptoms exhibited significantly lower HRV parameters, higher perceived stress levels, and poorer sleep quality compared to healthy controls. The findings suggest that depression is associated with altered autonomic function and increased stress perception. These results highlight the importance of monitoring HRV, stress, and sleep quality as potential biomarkers for depression severity and treatment response.
Aims: The use of handheld devices has increased rapidly over the past decade. Smartphones and tablets are commonly used for reading and work-related tasks. This study aims to compare the effects of smartphone and tablet screen sizes on the ocular surface of adolescents and young adults. Methods: This was a prospective observational study involving 90 healthy volunteers divided into three age-based groups: adolescents (n=30, 10-18 years), young adults (n=30, 18-24 years), and adults (n=30, 24-40 years, control). Participants read for 30 minutes using a smartphone, a tablet, and a printed book. The Ocular Surface Disease Index©, the ocular discomfort questionnaire, fluorescein break-up time (FBUT), corneal fluorescein staining, the Schirmer test, and the blink rate were assessed before and after each reading session. Results: Ninety participants (mean age for adolescents: 13.33±1.33 years; young adults: 20.77±2.32 years; adults: 33.47±5.38 years; sex distribution: 56%, 56%, 53% female, respectively) were included. FBUT values decreased significantly after reading in all groups (p<0.01). In adolescents, corneal fluorescein staining significantly increased after smartphone reading, from 0 to 0.30±0.46 (p=0.001). Schirmer test values did not change significantly (p>0.05) among all groups. Blink rate decreased from 18.2±2.7 to 9.8±1.8 blinks/min and incomplete blinking increased from 1.8±0.9 to 4.9±1.6 blinks/min during smartphone reading (p<0.001). Discomfort scores were highest after smartphone use (34.8±13.8) compared with tablet (24.8±10.1) and print reading (21.0±12.4) (p<0.001). Conclusions: Reading from smartphones and tablets causes measurable alterations in ocular surface integrity, tear film stability, and blinking patterns. Ocular discomfort scores were highest after smartphone use, particularly in adolescents and young adults.These findings highlight the ocular strain associated with handheld devices and the need for preventive strategies, especially for younger populations with extended screen exposure.
Aims: Hydrocephalus in children can be treated using various surgical techniques, each associated with distinct risks of infection and revision. This study aimed to evaluate and compare these risks associated with different surgical approaches in pediatric patients. Methods: This retrospective study included pediatric patients aged 0-60 months who underwent surgical treatment of hydrocephalus between January 2010 and October 2020 at a tertiary neurosurgical centre. Demographic, clinical, and laboratory data were analysed, including cerebrospinal fluid (CSF) protein levels and microbiological culture results. The primary endpoint was the occurrence of postoperative infection, which was compared across surgical techniques and age groups. Results: Eighty-seven children (mean age 11±3 months; 56.3% male) were included. Five surgical techniques were performed: ventriculoperitoneal shunting (VPS), external ventricular drainage, Ommaya reservoir insertion, endoscopic third ventriculostomy (ETV), and combined ETV+VPS. Infection occurred in 12 patients (13.8%), with significantly higher rates in neonates than in older children (25.9% vs. 8.3%, p=0.042). Among procedures, infections were more frequent in patients who underwent Ommaya reservoir implantation than in patients treated with other methods (28% vs. 8%, p=0.034). CSF protein levels showed no significant correlation with age or sex. Conclusions: Neonatal age and Ommaya reservoir use were associated with an increased risk of infection in pediatric hydrocephalus. Careful patient selection and early conversion to definitive shunt procedures may help reduce infection-related complications.
Aims: Data on permanent pacemaker implantation (PPI) after the Ozaki procedure are limited. This study evaluates the incidence of PPI and compares echocardiographic and clinical outcomes between patients with PPI and without PPI. Methods: We conducted a retrospective study to evaluate patients who underwent the Ozaki procedure between January 1, 2019, and September 1, 2022. Patients were divided into PPI and non-PPI groups after the procedure. Preoperative and postoperative echocardiographic parameters, surgical details, and clinical outcomes were compared. Results: The study included 89 patients: two patients in the PPI group, aged 69 and 71 years, and 87 patients in the non-PPI group, with a mean age of 62.3±13.6 years. PPI was required in 2.2% of patients. While the numbers of men and women in the pacemaker group were equal, the number of men in the non-pacemaker group was higher (male/female: 49/38). The PPI group had cardiopulmonary bypass times of 135 and 100 minutes, respectively, compared with 100±30 minutes in the non-PPI group, and aortic cross-clamp times of 75 and 88 minutes, respectively, compared with 70±20 minutes in the non-PPI group. At discharge, peak gradients decreased from 78 and 74 mmHg to 22 and 29 mmHg in the PPI patients (non-PPI: 78±30 to 25±12 mmHg), and mean gradients decreased from 44 and 45 mmHg to 10 and 14 mmHg (non-PPI: 45±15 to 12±6 mmHg). No in-hospital mortality or paravalvular leak was observed. Conclusions: In our experience, PPI after the Ozaki procedure was uncommon, while early echocardiographic and clinical outcomes remained favorable. Our findings are consistent with the available literature and highlight the need for vigilant postoperative conduction monitoring, especially in patients with baseline conduction disease or prolonged operative times.
Aims: Military jet pilots are mandated to undergo human centrifuge training (HCT) to experience the adverse effects of +Gz acceleration during flight. The present study aimed to analyze short-term respiratory changes following +Gz exposure via pulmonary function testing (PFT) among jet pilots. Methods: This single-center, cross-sectional study was conducted among healthy military jet pilots. Participants were classified as smokers or non-smokers. Each participant underwent PFTs immediately before and after the HCT. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC, maximal voluntary ventilation (MVV), peak expiratory flow rate (PEFR), and forced expiratory flow at 25-75% (FEF25-75%) have been measured. The participants’ PFT parameters were evaluated to assess potential +Gz-related alterations. Results: The study included 21 male pilots with a mean age of 27.95±3.60 years. Ten (47.6%) pilots were active smokers. After HCT, significant improvements were observed in the mean values of FEV1 (4.45±0.55 vs. 4.55±0.57, p=0.001), FEV1/FVC (80.0±0.6 vs. 83.0±0.7, p=0.002), FEF25-75% (4.72±1.43 vs. 4.96±1.52, p=0.007), and MVV (169.3±28.6 vs. 181.5±32.4, p=0.002); however, no significant changes were observed in FVC or PEFR (p>0.05). Among smokers, significant post-training improvements were observed in FEV1, the FEV1/FVC ratio, and PEFR (p<0.05), whereas no significant changes were detected in FVC, FEF25-75%, or MVV (p>0.05). In non-smokers, significant increases were observed in FEV1, FEV1/FVC, and MVV (p<0.05), while the remaining parameters showed no significant changes. Conclusions: This study revealed that +Gz exposure was associated with short-term improvements in expiratory flow parameters and effort-dependent ventilatory performance in jet pilots. Additionally, subgroup analysis demonstrated that smokers predominantly exhibited significant increases in flow-dependent parameters.
Aims: Shift-working healthcare professionals (SWHPs) are prone to gastrointestinal symptoms (GSs) due to irregular work schedules, unhealthy eating behavior, and psychological stress. This study examined the interrelationships among GSs, consumption of ultra-processed foods (UPF), acute stress, and reward-related eating (RRE) behavior in SWHPs. Methods: This cross-sectional study included SWHPs. Socio-demographic data, body mass index (BMI), and eating habits were recorded. The Gastrointestinal Symptom Rating Scale (GSRS), Screening Questionnaire of Highly Processed Food Consumption (sQ-HPF), Self-applied Acute Stress Scale for Healthcare Providers (EASE), and RRE Scale were used to assess relationships among the variables. Results: A total of 301 participants (mean age =32.9±8.1 years; 55.1% female) were included in the study. The mean BMI was 24.1±3.3 kg/m². GSRS total scores correlated positively with sQ-HPF (ρ=0.208, p<0.001), EASE (ρ=0.353, p<0.001), and RRE (ρ=0.313, p<0.001). The EASE score was also positively correlated with all GSRS subdimensions (ρ=0.202-0.370, all p<0.001). In multivariable regression analyses, sQ-HPF scores were predicted by age (β=-0.145, p=0.011) and EASE (β=0.136, p=0.017) (R²=0.202). RRE scores were predicted by EASE (β=0.340, p<0.001) and BMI (β=0.227, p<0.001) (R²=0.408). GSRS total score was predicted by gender (β=-0.210, p<0.001), sQ-HPF (β=0.137, p=0.008), RRE (β=0.233, p<0.001), and EASE (β=0.201, p<0.001) (R²=0.485). Conclusions: The findings indicate that GSs are significantly associated with UPF consumption, acute stress, and RRE among SWHPs. These results emphasize the importance of acute stress management in reducing unhealthy eating behaviors and related GSs in this population.
Aims: We aimed to investigate whether the Assessment of SpondyloArthritis International Society Health Index (ASAS HI) correlates with scales assessing overall health status, disease activity, spinal mobility, quality of life, and functional capacity in individuals with ankylosing spondylitis (AS). Methods: This cross-sectional study included patients with AS diagnosed according to the 2010 ASAS classification criteria. ASAS HI, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score-C-Reactive Protein (ASDAS-CRP), Bath Ankylosing Spondylitis Functional Index (BASFI), Dougados Functional Index (DFI), Bath Ankylosing Spondylitis Metrology Index, Bath Ankylosing Spondylitis Patient Global Score (BAS-G), Visual Analog Scale (VAS) for pain and morning stiffness scores, Ankylosing Spondylitis Quality of Life (ASQoL), EuroQol-5D (EQ-5D), and EQ VAS were measured. Statistical analyses were conducted to examine correlations between the ASAS HI and other measurement instruments. Results: A cohort of 141 patients (84 males and 57 females) with a mean age of 39.02±12.16 years was included in the study. ASAS HI was positively correlated with BASDAI, ASDAS-CRP, and ASDAS-ESR (p<0.001, r=0.63, r=0.61, r=0.64). ASAS HI demonstrated strong positive correlations with BASFI and DFI (p<0.001, r=0.71, r=0.72), and a significant negative correlation with EQ-5D (p<0.001, r=-0.67). Additionally, notable positive associations were observed with ASQoL (p<0.001, r=0.79) and BAS-G (p<0.001, r=0.63). Conclusions: The ASAS HI may serve as a measure of overall health in patients with AS, provide additional insights alongside assessments of disease severity, functional ability, and well-being, and facilitate longitudinal monitoring of treatment outcomes.
Aims: This study aimed to evaluate the impact of antenatal education on childbirth-related anxiety, mode of delivery, and the risk of postpartum depression (PPD). A secondary aim was to assess the relationship between antenatal education, obstetric outcomes, social support, and demographic characteristics. Methods: This retrospective observational study included postpartum women who received antenatal care and delivered at the same tertiary center. Participants were categorized according to whether they attended an antenatal education program. Demographic characteristics, obstetric outcomes, and Edinburgh Postnatal Depression Scale (EPDS) scores were obtained from routine postpartum assessments. The primary endpoint was the effect of antenatal education on PPD risk (EPDS ≥13). Secondary endpoints included mode of delivery, social support, and factors associated with EPDS scores. Results: The study included 265 women (mean age: 28.72±5.42 years). The rate of spontaneous vaginal delivery was higher among women who attended antenatal education (54.13%; p=0.021), while cesarean section was more common among those who did not attend (60.26%; p=0.021). Attendees had higher educational levels and more frequent support with infant care (p<0.05). The mean EPDS score was 6.22±5.04, and there was no significant difference in EPDS scores between attendees and non-attendees (6.83 and 5.81; p=0.095). Higher gravida, parity, and number of living children were associated with lower EPDS scores (p<0.001). The proportion of women classified as high risk for PPD (EPDS ≥13) was similar between the two groups (12.15% and 9.62%; p=0.513). Conclusions: Antenatal education was associated with higher rates of vaginal delivery and increased social support, but it did not significantly reduce PPD risk. Increasing gravida, parity, and number of living children were associated with lower EPDS scores. While antenatal education contributed positively to obstetric outcomes, it may be insufficient alone to reduce the likelihood of PPD.
Aims: To examine (1) the etiological patterns of low vision across pediatric, working-age, and geriatric populations; (2) the severity distribution of visual impairment; and (3) the prescription trends of low-vision devices (LVDs) at a single tertiary eye care centre in western India. Methods: This single-center retrospective study reviewed the records of 1,039 patients who visited a low-vision clinic between January 2019 and April 2024. Demographic details, ocular diagnoses, visual acuity [classified per International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10)], and LVD prescriptions were analysed. Results: The cohort consisted predominantly of male patients (70.0%), with the following age distribution: working-age adults (45.0%; mean age 38.9±16.1 years), children (40.2%; mean age 10.2±3.3 years), and geriatric patients (14.7%; mean age 76.0±6.6 years). Retinal disorders (57.8%) were the leading cause of low vision, with age-specific variations: nystagmus (17.9%) and congenital cataracts (20.3%) in children; retinitis pigmentosa (25.0%) and diabetic retinopathy (25.6%) in working-age adults; and age-related macular degeneration (37.9%) and cataracts (55.6%) in the geriatric population. Moderate visual impairment was most common (48.8%), followed by blindness (25.9%). Telescopes were the most frequently prescribed LVDs (72.9%), and spectacle magnifiers were the most common near-vision aid (83.4%). Conclusions: The findings highlight distinct age-related patterns in the etiology of low vision and assistive device needs within this patient population. Although limited by its single-centre scope, this study offers valuable baseline data to guide age-specific rehabilitation strategies.
Aims: Calcaneal spurs and plantar fasciitis cause intractable plantar pain amenable to radiation therapy (RT). However, because of individual variations in neural capillaries within the spurs, reirradiation may be needed to relieve recurrent pain from irradiated heel spurs and thereby achieve a better quality of life. The aim of this study is to document the benefit of reirradiation for recurrent heel spur pain. Methods: This single-center retrospective study included patients who underwent reirradiation between November 2016 and December 2024 for recurrent calcaneal spur pain after the first radiotherapy course. Patient inclusion criteria included a previous history of irradiation with recurrent pain; patients younger than 35 years or weighing more than 120 kg were excluded. A total RT dose of 8 Gy was delivered over 2 consecutive days. Treatment response was assessed at the eighth week after completion of reirradiation. The primary endpoint was pain relief for recurrent calcaneal spur, assessed using the Numeric Rating Scale pain intensity score at 6 months post-irradiation. Results: A total of 103 patients with calcaneal spur who were irradiated for recurrent pain were included in the study. The ages of the study group ranged from 36 to 77 years with a median age of 52 years (range 36-77, interquartile range: 14) and male to female ratio was 1:4. Most patients with a spur size of 6 mm or greater required reirradiation for recurrent pain. Reirradiation resulted in a complete response in 58 patients (56%), a partial response in 31 patients (30%), and no response in 14 patients (14%); no radiation-related adverse effects were observed. Conclusions: Reirradiation for recurrent calcaneal spur pain is an effective treatment option to relieve pain in selected patients where other treatment options do not work.
Carbon monoxide (CO) poisoning can cause delayed neurological sequelae (DNS), a condition with no effective treatment. We report a 66-year-old male patient who recovered from acute CO poisoning but developed DNS and delirium one week later. He showed akinetic mutism, parkinsonism, rigidity, and cognitive impairment. Non-pharmacological approaches and donepezil were tried, but due to side effects, memantine (20 mg/day) was started. Over the course of one year, the patient showed significant improvement in neurological and functional status, with improvements in cognitive function (Mini-Mental State Examination: 26) and brain magnetic resonance imaging findings. This case suggests memantine may contribute to DNS recovery.
Aims: Duodenogastric reflux (DGR) and Helicobacter pylori (H. pylori) infection are two common etiologies implicated in gastric mucosal injury during childhood. However, their interplay remains poorly understood. This study aimed to investigate the relationship between DGR and H.pylori colonization through comprehensive endoscopic and histopathological evaluation in a pediatric cohort. Methods: In this retrospective study, the medical records of 698 children who underwent esophagogastroduodenoscopy between January 2024 and March 2025 were reviewed. Patients were classified into DGR and non-DGR groups, based on the presence or absence of bile residues in the stomach during endoscopy. Histopathological assessments were conducted using the modified Sydney classification to evaluate H.pylori presence and density. Demographic, endoscopic, and histological parameters were compared across groups. Results: DGR was identified in 21.6% of patients and was significantly associated with older age and female sex (p<0.001 and p=0.017, respectively). However, no significant differences were observed between the DGR and non-DGR groups regarding the frequency or density of H.pylori colonization (p=0.647 and p=0.731). Both DGR and H.pylori positivity were independently associated with increased endoscopic abnormalities (p<0.001 for both) and gastric mucosal inflammation (p=0.047, and p<0.001 respectively). Conclusions: DGR and H.pylori infection independently contribute to gastric mucosal pathology in children. However, DGR does not appear to influence H.pylori colonization significantly. These findings underscore the need for further prospective and molecular studies to elucidate the mechanistic interactions between bile reflux and H.pylori in pediatric populations.
Aims: Breast cancer (BC) remains a major global health challenge, characterized by molecular heterogeneity and a complex interplay of risk factors. Epidermal growth factor receptors (EGFRs) role in BC underscores the importance of targeted therapies and the need for personalized treatment approaches. This study aimed to examine EGFR expression in tumor samples from BC patients and assess its relationship with molecular subtypes and receptor status. Methods: This cross-sectional study involved female BC patients with confirmed diagnoses. Core-cut biopsy specimens were formalin-fixed, paraffin-embedded, and assessed for EGFR expression using immunohistochemistry (IHC). A chi-square test was performed to assess its association. The patients’ records were reviewed for demographic data, and receptor status was determined using IHC as part of routine clinical evaluation. Results: A total of 62 BC patients were included in the study, with ages ranging from 25 to 70 years (mean ± standard deviation: 49.9±10.8 years). EGFR expression showed predominantly weak staining intensity (61.3%), followed by moderate staining (17.7%), no staining (17.7%), and strong staining (3.3%). Regarding receptor status, weak EGFR expression was prevalent in estrogen receptor (ER)-positive (57.9%) and progesterone receptor (PR)-negative (65.8%) patients, whereas strong EGFR expression was observed in the ER-negative, PR-negative, and human epidermal growth factor receptor 2 (HER2)/neu-negative subgroups (2 cases each). Assessment by molecular subtype showed a prevalence of weak and moderate EGFR staining in the Luminal B subtype, whereas strong EGFR expression was observed only in triple-negative BC patients (2 cases, 100%). However, there was no statistically significant association between EGFR expression and molecular subtypes or hormone receptor status. Conclusions: EGFR expression was more common in aggressive subtypes, such as HER2-positive and Luminal B, highlighting its potential role in tumor progression. However, the lack of a significant association suggests that the relevance may be subtype-specific.
Skin picking disorder (SPD) is a chronic psychiatric condition characterized by recurrent self-excoriation behaviors that often lead to marked psychosocial and functional impairment. Although the disorder is relatively prevalent and substantially disabling, therapeutic options for persistent and treatment-resistant cases remain scarce. The present case report discusses a 54-year-old woman with a three-decade history of SPD and coexisting depressive disorder who exhibited significant clinical improvement following combined treatment with sertraline and aripiprazole. This case underscores the potential clinical value of integrating selective serotonin reuptake inhibitors with atypical antipsychotics in addressing refractory forms of SPD.
