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Determination of serum perfluorooctanoic acid and perfluorooctanesulfonic acid levels with different stages of chronic kidney disease
(Wolters Kluwer Medknow Publications, 2021) Erdal, Hüseyin; Sungur, Sana; Köroğlu, Muaz; Turgut, Faruk
The aim of this study is to investigate the perfluorooctanoic acid (PFOA) and perfluorooctanesulfonic acid (PFOS) levels in patients with different stages of chronic kidney disease (CKD). Sixty-one CKD stage 1-4 patients who applied to the nephrology outpatient clinic were recruited. A control group consisting of 26 age- and sex-matched healthy controls were also included in the study. Concentrations of PFOA and PFOS were determined by comparing their peak areas with their standard curves. All samples were analyzed three times. The average values of blank samples were subtracted from the detected PFOA and PFOS values. PFOA and PFOS levels were significantly higher in CKD group than the controls (11.4 ± 7.47, 0.45 ± 0.55; 0.13 ± 0. 17, 0.19 ± 0.4 ng/mL, respectively) (P = 0.001). Hemoglobin, serum albumin, and estimated glomerular filtration rate (eGFR) levels were significantly lower and potassium and uric acid levels were higher in the CKD group than the controls. PFOA and PFOS levels were significantly higher in all stages of CKD patients than healthy controls. However, there was no correlation between eGFR, and PFOS and PFOA. We have demonstrated significantly increased PFOA and PFOS concentrations in different stages of CKD patients. We could not find an association between eGFR, age, and serum PFOS and PFOA concentrations.
Alteration in choroidal microvasculature determined by optical coherence tomography angiography in patients with acromegaly
(Elsevier B.V., 2021) Selvinaz, Erol R.; Tiryaki, Semra; Çil Şen, Esra; Yener, Öztürk F.; Masum, Canat M.; Yıldız, Duygu; Batman, Adnan; Güven, Dilek; Altuntaş, Yüksel; Süren, Elçin; Kazım, Erol M.
We aimed to investigate the retinal layers and macular capillary structure using optical coherence tomography angiography (OCTA) with acromegaly patients and determine the relationship between OCTA parameters and disease duration, Growth hormone (GH) and Insuline growth factor (IGF - 1) levels. Patients and Method: Twenty-two patients with acromegaly who were followed up in the endocrinology outpatient clinic of Sisli Hamidiye Etfal Health Training and Research Hospital, were recruited into the study. Healthy control group was consisted of 22 age and gender matched subjects. Complete opthalmological examination including best visual acuity (BCVA), axial lenght, intraocular pressure (IOP) measurement, anterior segment and fundus examination, central corneal thickness with pachymetry and OCTA measurement were performed in the patients and healthy control group. Foveal avascular zone (FAZ), foveal vascular density (FVD), parafoveal vascular density (PFVD), choroidal flow (CF), foveal thickness (FT) and choroidal thickness (CT) were compared beetwen groups. Correlation between disease duration, GH and IGF-1 levels and OCTA parameters were evaluated. Results: There was no statistically significant difference between the groups in terms of BCVA, axial length, IOP, FT, FAZ, FD and PFVD. Choroidal thickness and CF was significantly high in the patients group compared to healthy controls (respectively, p = 0.003, p = 0.022). The mean follow-up period in patients with acromegaly was 90±50.2 months. There was a significant correlation between GH and subfoveal choroidal thickness in the patient group (p < 0.001, r = 0.52), a significant correlation was determined between disease duration and corneal thickness (p = 0.01, r = 0.41). In addition, an inverse correlation was detected between the IGF-1 level and the FAZ domain (p = 0.022, r= -0.34). Conclusion: In patients with acromegaly, choroidal vasculature seems to be more affected than the retinal vasculature.
Familial mediterranean fever: assessment of clinical manifestations, pregnancy, genetic mutational analyses, and disease severity in a national cohort
(Springer, 2020) Bodur, Hatice; Yurdakul, Fatma Gül; Çay, Hasan Fatih; Uçar, Ülkü; Keskin, Yaşar; Sargın, Betül; Gürer, Gülcan; Kaplan, Hüseyin
The aims of this study were to investigate the main clinical and laboratory features, including pregnancy and genetic analysis, of Turkish Familial Mediterranean Fever (FMF) patients and to analyze the relationships between genotypic features, age of disease onset, clinical findings, and disease severity. A study was planned within a national network of 22 different centers. Demographics, clinical and laboratory findings, attack characteristics, drugs, pregnancy and birth history, disease severity, and gene mutation analyses were evaluated. Disease severity, assessed using a scoring system developed by Pras et al., was evaluated in relation to gene mutations and age of disease onset. A total of 979 patients (643 females and 336 males; mean age: 35.92 ± 11.97 years) with FMF were included in the study. Of a total of 585 pregnancies, 7% of them resulted in preterm birth and 18.1% resulted in abortions. During pregnancy, there was no FMF attack in 61.4% of patients. Of the MEditerranean FeVer (MEFV) mutations, 150 (24.3%) cases were homozygous, 292 (47.3%) cases were heterozygous, and 175 (28.4%) were compound heterozygous. Patients with homozygous gene mutations had more severe disease activity, earlier age of disease onset, higher rates of joint and skin involvement, sacroiliitis, and amyloidosis. Patients with compound heterozygous genotype displayed severe disease activity in close resemblance to patients with homozygous mutation. In addition, patients with compound heterozygous mutations had higher rates of protracted febrile myalgia and elevated fibrinogen levels. In 63.9% of compound heterozygous patients, age of onset was < 20 years, with greater disease severity, and high rates of attack frequency and colchicine resistance. Our results suggest that indicators for disease severity include early onset of disease and homozygous gene mutations. Furthermore, patients with compound heterozygous mutations displayed significant presentations of severe disease activity.
Assessment of the compatibility of the real-world nonvalvular atrial fibrillation patients in Turkey with the study population of Phase 3 novel oral anticoagulant trials: an auxiliary study of NOAC-TR
(Wolters Kluwer Medknow Publications, 2020) Emren, Sadık; Zoghi, Mehdi; Karagöz, Uğur; İnci, Sinan; Açıksarı, Gönül; Bekar, Lütfü; Emren, Zeynep; Ergene, Oktay
Introduction: Although the indication of novel oral anticoagulant (NOAC) treatment in atrial fibrillation (AF) is comparatively similar, Phase 3 NOAC trials have variable inclusion criteria that differentiate each other and also from the real-world population. Aim: We aim to investigate the similarity between real-world nonvalvular AF patients and the population of Phase 3 NOAC trials in terms of eligibility. Methods: A total of 2802 patients using rivaroxaban, dabigatran, and apixaban were retrospectively evaluated. All the patients met the exclusion criteria of NOAC Phase 3 trials. These patient population were compared with the population of Phase 3 rivaroxaban (ROCKET-AF), dabigatran (RELY), apixaban (ARISTOTLE), and edoxaban (ENGAGE) trials in terms of inclusion criteria. Furthermore, the patients were stratified on the basis of CHA 2 -DS 2 -VASCc is enaogh score. Results: The proportion of population who met the eligible criteria for ARISTOTLE trial (91%) was different from that of RELY (78%), ROCKET-AF (50%), and ENGAGE (61%) trials (P < 0,001). For the population at intermediate risk (CHA 2 DS 2 -VASc score ≥1), the proportion which met the inclusion criteria for RE-LY trial (99%) was different from that of ARISTOTLE (91.2%), ROCKET-AF (50%), and ENGAGE trials (61%) (P < 0.001). For the population at high risk (CHA 2 DS 2 -VASc score ≥2), the proportion which met the inclusion criteria was as follows: 94% for ARISTOTLE, 83% for RELY, 65% for ENGAGE, and 53% for ROCKET-AF trials (P < 0.001). In this population, 38% of patients using rivaroxaban, 46% of patients using dabigatran, and 12% patients of using apixaban did not meet the inclusion criteria for the ROCKET-AF, RE-LY, and ARISTOTLE trials, respectively. Conclusion: Eligibility of the real-world population for NOAC trials is variable. A considerable number of real-world patients using NOAC do not meet the inclusion criteria of the corresponding drug.
Update on the effect of age on acute pancreatitis morbidity: a retrospective, single-center study
(Termedia Publishing House Ltd., 2018) Kara, Banu; Ölmez, Şehmus; Yalçın, Mehmet Suat; Taş, Adnan; Öztürk, Nevin A.; Sarıtaş, Bünyamin
Acute pancreatitis (AP) is one of the urgent diseases of gastroenterology. Due to the growth of the elderly population, the frequency of the disease in the elderly population is also increasing. Aim: To evaluate the contributing factors of mortality in geriatric patients (age ≥ 65 years) and non-geriatric (age < 65 years) patients. Material and methods: We retrospectively analyzed data of consecutive patients with AP, in the Adana Numune Education and Research Hospital between March 2013 and September 2015. Results: Of the 602 patients studied, 405 were female and 197 were male and their mean age was 55.2 ±19.5 years. The most common etiological factors were biliary stone, hyperlipidemia and alcohol, respectively. Two hundred and four patients were in the geriatric group and 394 patients were in the non-geriatric group. 84.4% of patients had mild AP, and 15.6% of patients had moderate to severe AP according to the revised Atlanta classification. 91.7% of non-geriatric patients had mild AP while 70.7% of geriatric patients had mild AP (p < 0.001). 29.4% of geriatric patients had moderate-to-severe AP while 8.4% of non-geriatric patients had moderate-severe AP. Duration of hospital stay was 6.2 ±3 days and 5.3 ±2.3 days in geriatric and non-geriatric groups respectively (p < 0.001). Mortality was higher in the geriatric group than the non-geriatric group (9.6% vs. 0.5%, respectively) (p < 0.001). Conclusions: Acute pancreatitis in the geriatric population shows a more severe course than the non-geriatric population. Geriatric patients have longer duration of hospital stay and higher mortality than non-geriatric patients.
AI-Assisted knowledge assessment: comparison of ChatGPT and Gemini on undescended testicle in children
(Aksaray Üniversitesi, 2025) Özdemir Kaçer, Emine; Tuşat, Mustafa; Kılıçaslan, Murat; Memiş, Sebahattin
This study aimed to evaluate the accuracy and completeness of ChatGPT-4 and Google Gemini in answering questions about undescended testis, as these AI tools can sometimes provide seemingly accurate but incorrect information, raising caution in medical applications. Methods: Researchers created 20 identical questions independently and submitted them to both ChatGPT-4 and Google Gemini.A pediatrician and a pediatric surgeon evaluated the responses for accuracy, using the Johnson et al. scale (accuracy rated from 1 to 6 and completeness from 1 to 3).Responses that lacked content received a score of 0. Statistical analyses were performed using R Software (version 4.3.1) to assess differences in accuracy and consistency between the tools. Results: Both chatbots answered all questions, with ChatGPT achieving a median accuracy score of 5.5 and a mean score of 5.35, while Google Gemini had a median score of 6 and a mean of 5.5. Completeness was similar, with ChatGPT scoring a median of 3 and Google Gemini showing comparable performance. Conclusion: ChatGPT and Google Gemini showed comparable accuracy and completeness; however, inconsistencies between accuracy and completeness suggest these AI tools require refinement.Regular updates are essential to improve the reliability of AI-generated medical information on UDT and ensure up-to-date, accurate responses.
New frontiers in radiologic interpretation: evaluating the effectiveness of large language models in pneumothorax diagnosis
(PLOS One, 2025) Bulut, Bensu; Akkan Öz, Medine; Genç, Murat; Gür, Ayşenur; Yortanlı, Mehmet; Yortanlı, Betül Çiğdem; Sarıyıldız, Oğuz; Yazıcı, Ramiz; Mutlu, Hüseyin; Kotanoğlu, Mustafa Sırrı; Çınar, Eray; Uykan, Zekeriya
Background: This study evaluates the diagnostic performance of three multimodal large language models (LLMs)-ChatGPT-4o, Gemini 2.0, and Claude 3.5-in identifying pneumothorax from chest radiographs. Methods: In this retrospective analysis, 172 pneumothorax cases (148 patients aged >12 years, 24 patients aged ≤12 years) with both chest radiographs and confirmatory thoracic CT were included from a tertiary emergency department. Patients were categorized by age and pneumothorax size (small/large). Each radiograph was presented to all three LLMs accompanied by basic symptoms (dyspnea or chest pain), with each model analyzing each image three times. Diagnostic accuracy was evaluated using overall accuracy (all three responses correct), strict accuracy (≥2 responses correct), and ideal accuracy (≥1 response correct), alongside response consistency assessment using Fleiss' Kappa. Results: In patients older than 12 years, ChatGPT-4o demonstrated the highest overall accuracy (69.6%), followed by Claude 3.5 (64.9%) and Gemini 2.0 (57.4%). Performance was significantly poorer in pediatric patients across all models (20.8%, 12.5%, and 20.8%, respectively). For large pneumothorax in adults, ChatGPT-4o showed significantly higher accuracy compared to small pneumothorax (81.6% vs. 42.2%; p < 0.001). Regarding consistency, Gemini 2.0 demonstrated excellent reliability for large pneumothorax (Kappa = 1.00), while Claude 3.5 showed moderate consistency across both pneumothorax sizes. Conclusion: This study, the first to evaluate these three current multimodal LLMs in pneumothorax identification across different age groups, demonstrates promising results for potential clinical applications, particularly for adult patients with large pneumothorax. However, performance limitations in pediatric cases and with small pneumothoraces highlight the need for further validation before clinical implementation.
Eosinophilic infiltration in gallbladder pathologies: A clinical dilemma
(2025) Martlı, Hüseyin F.; Aydın, Arzu H.; Şahingöz, Eda; Er, Sadettin; Akgül, Özgür; Turhan, Nesrin; Tez, Mesut
Objectives: To determine the clinicopathological features and prevalence of Eosinophilic cholecystitis (EC) with a single-center experience. Eosinophilic cholecystitis is an exceedingly uncommon pathologic issue caused by examining cholecystectomy specimens. Methods: A retrospective analysis was performed on 8,342 cholecystectomy specimens. Of these, 33 pathology results confirmed EC and were re-examined by pathologists. This study obtained demographic data, medical histories, comorbidities, clinical laboratory results, radiological findings, and pathological information from an electronic record system. Results: The average age of the patients was 47 years, with a range of 24 to 82 years. Acute cholecystitis was reported in 5 (15.6%), chronic cholecystitis in 25 (75.8%), and cholelithiasis in 3 (9.1%) gallbladder specimens. Five of the 33 patients had liver hydatid cysts. There was no statistically significant difference in parameters such as blood eosinophil count, eosinophil ratio, eosinophil count in the gallbladder wall, and gallbladder wall thickness between patients with and without liver hydatid cysts who had eosinophilic cholecystitis. Conclusion: Eosinophilic infiltration is a component of inflammatory processes, including acute and chronic inflammation. Importantly, hydatid cysts can be observed in the liver, which relates to EC. In our study, no distinct clinical, laboratory, or radiological findings of EC were identified, and the diagnosis of EC was made pathologically.
Successful implantation of a dual-chamber permanent pacemaker in a patient with persistent left superior vena cava and absence of right superior vena cava: tips and tricks
(Czech Society of Cardiology, 2025) Demir, Vahid; Yıldırım, Oğuz; Keskin, Pınar; Gül, Murat; Aktaş, Halil; İnci, Sinan
An absent right superior vena cava associated with persistent left superior vena cava (PLSVC) is a rare and generally asymptomatic congenital malformation. It is usually discovered incidentally during pacemaker (PM) implantation. In this report, we describe our experience with implanting a dual-chamber pacemaker in a patient with such complex anatomy and the clinical value of peripheral phlebography for clearly describing venous anatomy in the surgical room. In particular, we highlight the methods used to ensure correct lead positioning.
Evaluation of acute scrotal pathologies in pediatric emergency settings: a retrospective analysis of etiologies, clinical presentations, and management timelines
(Springer, 2025) Özdemir Kaçer, Emine; Tuşat, Mustafa
Acute scrotal pathologies are characterized by sudden onset of pain, swelling, and redness in the scrotum. This condition is commonly observed in male patients presenting to emergency departments. Prompt diagnosis and treatment are crucial for effective management of this condition. The objective of this study is to evaluate the etiology, clinical presentation, sociodemographic characteristics, and timelines for presentation, diagnosis, and treatment in boys diagnosed with acute scrotum.Study designThis retrospective study reviewed the files of male patients under the age of 18 who were admitted to our pediatric emergency department between July 2019 and July 2024 with a diagnosis of acute scrotum. The data collected encompassed a wide range of information, including sociodemographic characteristics, the etiology of acute scrotum, the presenting complaints, the physical examination findings, the time interval from the onset of symptoms to presentation, imaging studies, and surgical consultations.ResultsA total of 151 cases were identified, with ages ranging from 0 to 17 years. The etiologies included epididymitis (n = 43), torsion of the appendix of the testis (n = 33), testicular torsion (n = 28), scrotal cellulitis (n = 23), incarcerated/strangulated inguinal hernia (n = 15), trauma (n = 8), and Henoch-Sch & ouml;nlein purpura (n = 1). The most prevalent presenting complaints were swelling (n = 39, 30.7%) and pain (n = 36, 28.3%). While the time to presentation and imaging were similar across cases, surgical consultation was significantly faster for patients with testicular torsion.ConclusionIn pediatric emergency settings, acute scrotum necessitates meticulous evaluation. Early diagnosis and timely intervention are imperative to avert complications, including testicular loss, and to ensure the patient's well-being.
Urinary total superoxide dismutase activity is low in rheumatoid patients, and its low levels are associated with higher DAS28 scores
(Elsevier, 2025) Kor, Mehmet; Yalçın, Merve; Okyar, Göktuğ; Kor, Tahire Betül; Doğan, İsmail; Atalar, Ebru; Konak, Hatice Ecem; Dağlı, Pınar Akyüz; Tam, Dudu Çelik; Işık, Sema; Polat, Bünyamin; Neşelioğlu, Salim; Erel, Özçal; Erten, Şükran
Rheumatoid factor and anti-citrullinated peptide antibodies are generally used to diagnose rheumatoid arthritis (RA). However, these antibodies are negative in 15-20 % of RA cases. This study aimed to investigate new biomarkers that can be used in diagnosing RA and evaluating disease activity. Methods: This study included 99 RA patients and 94 healthy volunteers. Modified Disease Activity Score28 (DAS28) erythrocyte sedimentation rate (ESR) was used for disease activity score. Thiol/disulfide molecules were measured using an automatic spectrophotometric method, and ischemia-modified albumin was measured using an albumin-cobalt binding test. A spectrophotometer calculated urinary and serum total superoxide dismutase (SOD) activities at 420 nm wavelength. Results: In the RA group, serum IMA level was higher (unstandardized beta [B]: 5.552, Odds Ratio [OR]: 250.1, CI 95 %: 1.29-48219.1, p: .040), and urinary total SOD activities were significantly lower (B: 2.640 OR: .071, CI 95 %: .027-.192, p < 0.0001) than in the control group. A cut-off value of 5.06 for urinary total SOD was found to have a sensitivity of 97.9 % and a specificity of 97 % in distinguishing RA patients from healthy controls (AUC [95 %Cl] = .986 [.967-1.000], p < 0.001). Urinary total SOD activity was significantly lower in the RA subgroup with high disease activity compared to the groups with moderate disease activity (B: .954, OR: 2.596, CI 95 %: 1.104-6.103, p: .029) and low disease activity (B: 1.251, OR: 3.494, CI 95 %: 1.143-10.678, p: .028). Conclusion: This study showed that urinary total SOD activity has high sensitivity and specificity in distinguishing RA patients from healthy controls and that RA patients with higher DAS28 ESR activity scores have lower urinary total SOD activity.
A comparative analysis of the performance of large language models in the basic life support exam: comprehensive evaluation of ChatGPT-4o, Gemini 2.0, Claude 3.5, and DeepSeek R1
(Bayrakol Medical Publisher, 2025) Bulut, Bensu; Öz, Medine Akkan; Genç, Murat; Gür, Ayşenur; Yortanlı, Mehmet; Yortanlı, Betül Çiğdem; Yazıcı, Ramiz; Mutlu, Hüseyin; Kotanoğlu, Mustafa Sırrı; Çınar, Eray
Considering the growing role artificial intelligence technologies play in medical education, this study aims to provide a comparative evaluation of the performances of large language models ChatGPT-4o, Gemini 2.0, Claude 3.5 , DeepSeek R1 in the Basic Life Support (BLS) Exam. Materials , Methods: In this observational study, we presented four large language models with 25 multiple-choice questions based on the American Heart Association (AHA) guidelines. Questions were divided into two categories as knowledge-based (n = 14, 56%) and case-based (n = 11, 44%). Response consistency was ensured by presenting each question on three separate days to all models. Models' accuracy rates were assessed using overall accuracy, strict accuracy, and ideal accuracy criteria. Results: In the overall accuracy assessment, ChatGPT-4o and DeepSeek R1 models showed 100% success, and Gemini 2.0 and Claude 3.5 models achieved 96% success rate. All models performed perfectly on the case-based questions. On the knowledge-based questions, ChatGPT-4o and DeepSeek R1 scored full points, while Gemini 2.0 and Claude 3.5 achieved 90.9% success. Statistical analysis showed no significant difference between results (p = 0.368). Discussion: Large language models show high accuracy rates in BLS training. These technologies can be used in supportive roles in medical education, but human supervision is critical in clinical decision-making.
Evaluation of the systemic immune-inflammation index in relation to histological stages of celiac disease
(BMC, 2025) Kıvrakoğlu, Fatih; Ergin, Mustafa
Celiac disease (CD) is an immune-mediated enteropathy characterized by histopathological changes, such as villous atrophy and chronic inflammation, often assessed using the Marsh classification. The systemic immune-inflammation index (SII), a novel inflammatory biomarker, has been increasingly investigated in chronic inflammatory diseases, including CD.ObjectiveThis study aims to evaluate the relationship between SII and histopathological progression in CD, as classified by the Marsh scores, and to assess other hematological and inflammatory parameters.MethodsA retrospective analysis was conducted on 115 biopsy-confirmed CD patients from 2 hospitals between February 2022 and November 2023. Demographic, clinical, and laboratory data were analyzed, and SII values were calculated. Statistical comparisons were performed across Marsh stages.ResultsSII levels did not significantly differ among Marsh groups (p = 0.408). However, the Marsh Grade 3a group exhibited higher median SII values compared to others. Hemoglobin (Hb) levels showed significant differences across Marsh stages (p = 0.012), with a notable decrease in Marsh Grade 3c. Other parameters, such as ESR and CRP, showed no significant variation across groups.ConclusionWhile SII shows potential as an inflammatory marker, its limited association with histological stages suggests a need for larger, prospective studies to validate its utility in clinical practice.
Comparison of patient adherence and treatment response in patients with chronic viral hepatitis: results of a 48-week observational study
(Galenos Publishing House, 2025) Yıldırım, Seval Sönmez; Kürklü Bozkır, Filiz; Köksal, İftihar
Viral hepatitis is one of the significant health problems in the world. The main purpose of treatment is virological eradication. There are many factors that determine treatment response. The most important factor that can be affected is treatment adherence. In our study, we aimed to compare compliance with treatment response, which is one of the factors that can be affected in chronic viral hepatitis patients. We highlight that this element should be considered in treatment failures, especially in chronic diseases that require long-term treatment. Materials and Methods: Chronic hepatitis patients over 18 years of age and under 65 years of age, who were neither co-infected with Human immunodeficiency virusnor pregnant, were prospectively analyzed after receiving ethics committee approval. Treatment adherence was defined as taking the prescribed medication in the required number of doses and for the required duration. Drug count and questionnaires were used in the compliance assessment. Patients' compliance and patients' 12, 24, 36, and 48th-week virological responses were compared. Results: Seventy-six patients were included in the study. Sixty point five percent of patients had chronic hepatitis B, and 39.5% had chronic hepatitis C. According to the drug count data, it was determined that 83.9% of the patients did not take their treatment during at least one visit. At the end of the treatment (48th-week follow-up), 89.4% of all chronic hepatitis patients were compliant and 92.6% of the compliant patients responded to the treatment. Five out of eight non-compliant patients, accounting for 62.5%, were able to respond to the treatment. Response rates of compliant and non-compliant patients to treatment were found to be statistically significant. Conclusion: Non-adherence to treatment in chronic viral hepatitis is infrequent. Given the increased risk of virological failure in poorly adherent patients, clinicians should keep in mind adherence issues in every patient treated for viral hepatitis.
Prediction of treatment efficacy in psoriasis vulgaris using dermoscopic and capillaroscopic findings: a prospective cohort study
(Springer, 2025) Reşat Akkuş, Muhammet; Özyurt, Kemal; Atasoy, Mustafa; Ertas, Ragıp; Kulu, Huzeyfe; Özata, Sinem Sogancıoğlu; Demirbaş, Abdullah; Faruk Elmas, Ömer; Diremsizoğlu, Esin
Psoriasis is a chronic inflammatory skin disorder affecting millions worldwide. Dermoscopy and proximal nailfold capillaroscopy have emerged as valuable tools for understanding the pathophysiology and treatment response of psoriasis lesions.ObjectivesThis study aimed to contribute to the limited literature on using dermoscopic findings to detect treatment effectiveness in patients with psoriasis vulgaris.MethodsThis prospective, single-blinded, observational cohort study included 101 patients aged 18-71 years diagnosed with psoriasis vulgaris who initiated or altered systemic treatment. Monthly dermoscopic and capillaroscopic evaluations were performed alongside assessments of Psoriasis Area Severity Index (PASI), Body Surface Area (BSA), and Dermatology Life Quality Index (DLQI) scores.ResultsA significant relationship was found between first-month dermoscopic findings and third-month severity scores (PASI, BSA, DLQI). Patients with positive treatment responses exhibited changes from baseline regular capillary dilations to hemorrhagic spots or the absence of vascular findings during the first month. The correlations between dermoscopic changes and severity scores evolved over time, becoming stronger in the second and third months. Nailfold capillaroscopy findings at the third month of treatment showed significant differences from baseline.ConclusionsDermoscopy is a fast, practical, and inexpensive tool for early prediction of treatment effectiveness in psoriasis vulgaris. The disappearance of regular capillary dilations or their change to hemorrhagic spots suggests treatment efficacy, while their persistence indicates poor treatment response. Early detection of treatment effectiveness using dermoscopic findings can facilitate timely adjustments, improving patient outcomes and reducing unnecessary treatment exposure.
Brucellosis case presenting with bicytopenia due to hemophagocytic syndrome
(Bayrakol Medical Publisher, 2025) Kürklü Bozkır, Filiz; Yıldırım, Seval Sönmez; Çiftçiler, Rafiye
Hemophagocytic syndrome is a rare syndrome of excessive inflammation and tissue destruction due to abnormal immune activation and inflammation. Brucellosis is one of the rare causes of hemophagocytosis. Several reports revealed the relationship between hemophagocytosis and brucellosis. In this case, a case of brucellosis presenting with bicytopenia due to hemophagocytic syndrome is presented by blood and bone marrow culture analyses. The Rose Bengal test, Coombs' test and the standard tube agglutination test were performed and were negative. Brucella melitensis was isolated in the blood and bone marrow cultures on the seventh day of incubation. After the diagnosis was confirmed by bone marrow biopsy and blood culture analyses, antibiotic treatment (oral doxycycline 200 mg/day and rifampicin 600 mg/day for 6 weeks) was immediately initiated. Bone marrow aspiration biopsy has shown platelets, neutrophils, and lymphocytes phagocytosed by macrophages. Peripheral blood counts of the patient returned to normal levels after 2 weeks of antibiotic treatment of brucellosis. Antibiotic treatment was stopped after 6 weeks of therapy once patient's complaints have resolved.
Evaluation of chatgpts performance in Türkiye's first emergency medicine sub-specialization exam
(Galenos Publishing House, 2025) Mutlu, Hüseyin; Kokulu, Kamil; Sert, Ekrem Taha; Topuz, Muhammed Ali
This study aims to evaluate ChatGPT's performance in T & uuml;rkiye's Emergency Medicine Sub-Specialization Exam by assessing its success in answering both standalone and scenario-based questions through repeated testing. Materials and Methods: This study utilized 60 multiple-choice questions from the Emergency Medicine Sub-Specialization Exam, comprising 30 standalone questions (50%) and 30 scenario-based questions (50%). Each question was presented to ChatGPT five times on different days, with all tests being conducted by researchers using the same computer. The latest version of ChatGPT, based on the GPT-4 architecture and extensively trained on medical texts and journals as of October 2023, was employed to ensure the highest available level of medical knowledge. Results: ChatGPT achieved an overall accuracy rate of 85%, correctly answering 255 out of 300 questions across five trials. The accuracy rates for the five trials were 85% (51/60), 86.7% (52/60), 86.7% (52/60), 85% (51/60), and 81.7% (49/60), respectively, with no statistically significant difference between trials (p=0.94). ChatGPT demonstrated significantly higher accuracy in standalone questions compared to scenario-based questions [91.3% (137/150) vs. 78.7% (118/150), p=0.002]. Notably, ChatGPT exhibited consistent accuracy in interpreting visual data and correctly answering the two radiology-related questions across all five trials. Conclusion: ChatGPT demonstrated high performance and consistency in T & uuml;rkiye's first Emergency Medicine Sub-Specialization Exam, particularly excelling in standalone questions and radiological image interpretation. While the system is generally promising, its lower performance on scenario-based questions highlights the need for further development of clinical reasoning skills. These findings suggest potential applications of artificial intelligence systems in medical education and assessment, while emphasizing the necessity for improvements in clinical decision-making abilities.
Does Zn-Mediated regulation of the Kynurenine Pathway provide the link between periodontal disease and diabetes
(Springer, 2025) Afşar, Ebru; Doğan, Kadirhan; Arslan, Erdem; Eranil, Işıl; Oral, Neşe; Kuzzu, Kadir Bahadır; Ceylan, Tayfun; Öz, Mehmet
It has long been known that there is a relationship between periodontal diseases and diabetes. The present study aimed to assess the effect of pancreatic zinc (Zn) levels on Kynurenin pathways (KP) and glucose homeostasis and the impact of Thymoquinone (TQ) in the periodontal disease animal model. Ten microliters of Porphyromonas gingivalis-lipopolysaccharide (P. gingivalis-Lps) (1 mg/ml) was injected at 48-h intervals into the palatal gingiva of rats, and TQ was given by oral gavage (10 mg/kg per day) for 2 weeks. Glucose homeostasis was assessed using the Homeostatic Model Assessment (HOMA-IR), and β-cell function (HOMA-β Levels). Kynurenine (KYN), Tryptophan (TRP), kynurenic acid (KYNA), quinolinic acid (QA), KYN 3-monooxygenase (KMO), kynureninase, interferon-γ (IFN-γ), insulin, ZIP10, and caspase-3 levels measured by the enzyme-linked immunosorbent assay (ELISA). Zinc levels in the pancreas tissue and plasma samples were measured using a colorimetric method. Morphological changes in the pancreas were identified by hematoxylin and eosin staining, and X-ray radiography determined bone resorption in the maxillary bone. In the LPS group, pancreas ZIP10 and Zn levels increased, the KP pathway was altered to favor KYNA, and impaired glucose homeostasis was observed. TQ administration decreased pancreatic Zn levels, changed KP to favor QA, and improved morphological changes in the pancreas. During the progression of periodontal diseases, KP may be altered by Zn levels through ZIP10 in the pancreas, thereby impairing pancreatic function. Regulation of Zn levels may be key to shared pathways between periodontal diseases and diabetes.
Assessment of p-wave dispersion and atrial electromechanical delay in patients with non-obstructive coronary artery myocardial infarction
(Springer International Publishing, 2025) Keleşoğlu, Şaban; Yılmaz, Yücel; Elçik, Deniz; İnci, Sinan; Gül, Murat; Kalay, Nihat
We investigated p-wave dispersion (Pd) and atrial electromechanical delay (EMD) in patients diagnosed with non-obstructive coronary artery disease and myocardial infarction (MINOCA). Background: The clinical importance and recognition of MINOCA are increasing. However, there is a gap in knowledge regarding the risk of atrial fibrillation in patients with MINOCA. Methods: Forty-three patients with MINOCA (average age 48.69 ± 5.83 years) and thirty-four patients with non-obstructed coronary artery disease (INOCA) (average age 49.82 ± 10.22 years) were enrolled in the study. Echocardiographic studies were conducted in the MINOCA and INOCA groups in the left lateral decubitus position using a medical ultrasound device. Atrial electromechanical coupling (PA) and intra-atrial and interatrial EMD were measured using tissue Doppler echocardiography. Pd was measured using 12-lead electrocardiography. Results: Clinical and demographic characteristics were similar between groups. The maximum P-wave (Pmax) time and Pd values of patients diagnosed with MINOCA were significantly longer than those of patients diagnosed with INOCA (Pmax times: 109.72 ± 7.09 ms and 95.17 ± 7.50 ms, respectively, p < 0.01; Pd: 47.30 ± 8.99 ms and 34.14 ± 11.31 ms, respectively, p < 0.01). Tissue Doppler Imaging (TDI) revealed significantly longer atrial EMD parameters (PA lateral and PA septum) in patients diagnosed with MINOCA than in those diagnosed with INOCA (69.60 ± 8.79 ms and 57.08 ± 11.54 ms, respectively, p < 0.01; 54.83 ± 6.45 ms and 45.35 ± 8.50 ms, respectively, p < 0.01). Conclusion: This study showed that the duration of atrial EMD and Pd was prolonged in patients with MINOCA, suggesting a potential susceptibility to atrial conduction abnormalities.
PET-CT indications and contributions to diagnosis in the rheumatology clinic: a retrospective analysis
(Springer Science and Business Media Deutschland GmbH, 2025) Kahraman Denizhan, Tuğba; Kaplan, Hüseyin; Kızıltepe, Melih; Kökoğlu, Emel Oğuz; Cengiz, Celil Barlas; Abdulrezzak, Ümmühan; Şenel, Abdurrahman Soner
Positron emission tomography-computed tomography (PET-CT) is a valuable imaging modality in both oncology and autoimmune or inflammatory diseases. This study evaluates the indications for PET-CT in rheumatology patients, compares PET-CT findings with other imaging modalities, and assesses its contribution to definitive diagnosis. Methods: Between January 2022 and December 2023, 63 patients (38 women, 25 men) who underwent PET-CT at Erciyes University Rheumatology Clinic were retrospectively analyzed. Clinical, laboratory, and imaging findings—including prior CT, magnetic resonance imaging (MRI), and angiographic evaluations—were reviewed. PET-CT findings were classified based on metabolic uptake patterns indicating malignancy, vasculitis, inflammatory involvement, lymphadenopathy, and IgG4-related diseases. PET-CT results were statistically compared with final diagnoses. Results: The most common indications for PET-CT were suspected vasculitis (42.9%), fever/inflammation of unknown origin (30.2%), and suspected malignancy (27.0%). PET-CT detected inflammation in 65.1% of cases, lymphadenopathy in 52.4%, nodules in 41.3%, malignancy in 31.7%, and vasculitis in 20.6%. Vasculitis findings were significantly higher in patients with pre-existing rheumatic disease (p = 0.012), while malignancy-related findings were more frequent in those without (p = 0.025). Anti-SSA and anti-Scl70 positivity were significantly associated with malignancy (p = 0.003 and p = 0.030, respectively). PET-CT effectively detected malignancy (p < 0.001) but showed limited diagnostic accuracy for vasculitis (47.6%). Conclusion: PET-CT complements conventional imaging in evaluating vasculitis, inflammation, and malignancy in rheumatic diseases. However, it is insufficient for diagnosing vasculitis alone, necessitating a comprehensive clinical and laboratory approach. While PET-CT is highly effective in malignancy detection, autoantibody presence should be carefully considered in suspected cases.

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