INTRODUCTION: Generalised anxiety disorder (GAD) is primarily characterized by persistent anxiety and worry, factors which are potentially associated with alterations in P-wave parameters. This study aimed to investigate P-wave dispersion in patients with GAD to determine if these atrial electrophysiological changes are present in this population.
METHODS: P-wave dispersion, along with Pmax and Pmin values, was assessed via electrocardiography (ECG) in twenty patients with GAD and twenty age- and sex-matched healthy controls.
RESULTS: Statistical analysis revealed that Pmax and Pmin values were significantly elevated in patients with GAD compared to healthy controls. Notably, the primary outcome measure—mean P-wave dispersion—was significantly higher in the patient cohort (50.74 ± 6.10 ms) than in the control group (35.32 ± 3.79).
DISCUSSION AND CONCLUSION: In conclusion, patients with GAD exhibited significantly higher Pmax, Pmin, and P-wave dispersion values compared to healthy controls. These findings suggest that individuals with GAD may warrant closer clinical monitoring of their atrial electrophysiology.

INTRODUCTION: Degenerative lumbar spine surgery is increasingly common, but osteoporosis and the need for long-segment fixation negatively impact implant stability. In our study, we investigated the effect of osteoporosis presence and instrumentation level on implant loosening in geriatric patients using preoperative DEXA.
METHODS: 148 geriatric patients who underwent spinal instrumentation surgery due to degenerative lumbar pathology and had preoperative DEXA measurements were retrospectively examined. Based on DEXA results, they were divided into two groups: osteoporosis and non-osteoporosis (osteopenia + normal). Instrumentation level was classified as ≤2 levels (short) and >2 levels (long). Implant loosening was defined as radiolucent line, screw displacement, or implant fracture. Data were analyzed using SPSS 25.0.
RESULTS: The median age of the 148 patients was 71. 88 patients were in the osteoporosis group and 60 in the non-osteoporosis group. Implant loosening was detected in 14 patients (9.5%). The loosening rate was 12.5% in the osteoporosis group and 5% in the non-osteoporosis group (p=0.02). The loosening rate was significantly higher in patients who underwent long-segment instrumentation (p=0.01). In logistic regression analysis, osteoporosis (OR=2.6; p=0.02), >2 level instrumentation (OR=2.3; p=0.04), and a combination of these two (OR=4.8; p=0.01) were identified as independent risk factors. Revision surgery was performed in 11 of the 14 patients (78.6%) who developed loosening.
DISCUSSION AND CONCLUSION: Implant loosening in geriatric patients is most frequently seen in the presence of osteoporosis and in cases where long-segment instrumentation is performed. The combination of osteoporosis and multi-level fixation significantly increases the risk of loosening and the need for revision.

INTRODUCTION: Malva moschata L. has long been used in traditional medicine for its calming and sedative properties, indicating potential antidepressant activity. This study evaluated the antidepressant-like effects of its ethanol extract in female Swiss albino mice through behavioral and biochemical assessments.
METHODS: A total of sixty mice (weighing between 25–30 g) were randomly allocated into six experimental groups, each consisting of ten animals. The extract was given by oral gavage at concentrations of 125, 250, and 500 mg/kg daily over a four-week period, whereas fluoxetine (10 mg/kg, p.o.) was used as the reference antidepressant. To evaluate depression- and anxiety-related behaviors, animals were subjected to a series of behavioral paradigms, including the Rotarod, Forced Swim Test (FST), Elevated Plus Maze (EPM), and Tail Suspension Test (TST). After the behavioral procedures, blood samples were obtained for the assessment of IL-10, IL-17, Total Antioxidant Status (TAS), and Total Oxidant Status (TOS).
RESULTS: The findings demonstrate that administration of the 500 mg/kg dose significantly attenuated depressive-like behaviors, exhibiting an efficacy comparable to that of fluoxetine. Biochemical analyses revealed a dose and time dependent response, with TAS levels elevated and TOS and IL-17 levels reduced, particularly in the 250 and 500 mg/kg groups after four weeks.
DISCUSSION AND CONCLUSION: These findings demonstrate that Malva moschata exerts antidepressant-like effects in mice, potentially mediated through modulation of oxidative stress and inflammatory pathways. Further studies are warranted to clarify its mechanisms and therapeutic potential in mood disorders.

INTRODUCTION: To assess changes in tear film parameters and meibomian gland (MG) morphology after upper eyelid blepharoplasty.
METHODS: This prospective observational study included 58 eyes from 29 patients who underwent upper eyelid blepharoplasty. Noninvasive tear break-up time (NITBUT) and MG morphology were evaluated for all patients. Patients were assessed before surgery and three months postoperatively.
RESULTS: The mean percentage of MG dropout showed a significant increase in the postoperative period (p < 0.001). Morphological assessment revealed a significant increase in MG shortening scores at postoperative month three (p = 0.014), whereas distortion scores, dropout scores, and total meiboscore did not differ significantly between the preoperative and postoperative evaluations. No statistically significant differences were observed in the first NITBUT or average NITBUT values at three months after surgery compared with preoperative measurements.
DISCUSSION AND CONCLUSION: Upper eyelid blepharoplasty may lead to mild and localized alterations in MG morphology, particularly characterized by gland shortening and a modest increase in gland dropout area. However, tear film stability, as assessed by non-invasive methods, remains largely unaffected within the three-month postoperative period. Upper eyelid blepharoplasty is generally safe in terms of MG integrity and tear film dynamics, although longer-term studies are needed to clarify the persistence of these changes.

INTRODUCTION: Interstitial lung disease (ILD) is one of the most clinically significant extra-articular manifestations of rheumatoid arthritis (RA), yet the contribution of micronutrient imbalances—particularly magnesium deficiency—to pulmonary involvement remains largely unexplored. This study aimed to characterize serum magnesium levels in patients with RA and to investigate their potential relationship with ILD.
METHODS: In this cross-sectional analysis, 425 patients with RA were assessed for clinical features, comorbidities, disease activity, and bone health. Serum magnesium levels were classified as normal or reduced using a 2.0 mg/dL threshold, and ILD was determined by high-resolution computed tomography. Multiple logistic regression evaluated whether magnesium deficiency independently predicted ILD.
RESULTS: Although hypomagnesemia clustered with diabetes and poorer bone health, it was not an independent predictor of ILD after adjustment for demographic factors, metabolic comorbidities, and treatments (OR = 1.15; p = 0.736). Increasing age (OR = 1.10; p < 0.001) and male sex (OR = 6.6; p < 0.001) remained strong independent predictors of ILD. Biologic therapy was independently associated with ILD (OR = 9.97; p < 0.001). Age and disease duration were the main determinants of impaired bone status, with older age (OR = 1.04 per year; p < 0.001) and longer disease duration (OR = 1.03 per year; p = 0.008) independently predicting poorer bone health.
DISCUSSION AND CONCLUSION: Serum magnesium levels were not independently associated with ILD risk in RA. Although hypomagnesemia correlated with metabolic and skeletal comorbidities, it lost significance in multivariable analyses. Pulmonary and bone outcomes were mainly driven by demographic factors and cumulative disease burden.

INTRODUCTION: Aim is to investigate changes in intracranial pressure (ICP) during the weaning process by comparing continuous positive airway pressure (CPAP) and T-piece spontaneous breathing trials using serial optic nerve sheath diameter (ONSD) measurements by ultrasonography.
METHODS: This prospective, single center study included 40 mechanically ventilated adult intensive care patients undergoing weaning. Patients were allocated to either a CPAP group (n=20) or a T-piece group (n=20). ONSD, mean arterial pressure, and rapid shallow breathing index were (RSBI) measured at predefined stages during weaning and one hour after extubation. Changes in repeated measurements and correlations between sequential measurement differences and time intervals were analyzed.
RESULTS: ONSD values increased progressively during the weaning process in both groups, with a more pronounced increase observed during T-piece trials. ONSD decreased after extubation, particularly in the CPAP group. Within-group changes in ONSD were statistically significant (p<0.001). No significant differences were observed between groups regarding weaning success or RSBI changes. A significant positive correlation was identified between the change in ONSD and the duration between measurements in the T-piece group after extubation (r=0.453, p=0.045). No significant differences in ONSD were found between patients with successful and unsuccessful weaning.
DISCUSSION AND CONCLUSION: T-piece spontaneous breathing trials are associated with greater increases in ONSD, suggesting higher ICP during the weaning process. Serial ONSD measurement may be a useful non-invasive tool for monitoring ICP, particularly in patients at risk of intracranial hypertension during weaning.

INTRODUCTION: In vitro studies indicate that UV radiation causes photoaging in the skin through oxidative stress, collagen destruction, DNA damage, and chronic inflammation. These models play a critical role in the development of anti-aging therapies. The study aimed to investigate the anti-photoaging effects of the combination therapy of vanillin and colostrum-derived exosomes on UVB-irradiated human dermal fibroblast cells.
METHODS: UVB-exposed HDF-1 cells were treated with vanillin (30 µM) and colostrum exosomes (0.1 mg/mL) to assess cell viability and total antioxidant capacity. MMP-1 and procollagen type-1 levels were measured by ELISA, and cell nucleus morphology was examined by DAPI staining.

RESULTS: Cell viability increased in UVB-irradiated HDF-1 cells in the vanillin and vanillin+exosomes groups (p<0.05). Following UVB exposure, a decrease in procollagen type 1 and antioxidant levels and increased MMP-1 levels were observed in HDF-1 cells (p<0.05). Vanillin+exosome treatment was associated with decreased MMP-1 expression in HDF-1 cells and increased collagen production (p<0.05). Increased antioxidant activity, which UVB suppressed, was observed in the vanillin+exosome group (p<0.05). Furthermore, irregular nuclear shapes (signs of apoptosis) were observed in UVB-damaged cells, while near-normal nuclear morphology and a decrease in nuclear fragmentation were observed after vanillin+exosome treatment.
DISCUSSION AND CONCLUSION: The combination of vanillin and colostrum-derived exosomes showed synergistic effects on skin damage and anti‑photoaging by triggering antioxidant activity and increasing collagen synthesis.

INTRODUCTION: Poisoning cases constitute approximately 0.7-5% of emergency department visits in Türkiye. This study aimed to investigate the demographic, etiological, and clinical characteristics of poisoning cases presenting to the XXXXX over 8 year period.
METHODS: This retrospective study was conducted in the adult and pediatric emergency departments. Records of all patient admissions between 2010 and 2018 were reviewed to identify cases diagnosed with intoxication. Data were obtained from the hospital's electronic database using the ICD-10 (International Classification of Diseases) coding system. The patients' demographic characteristics, intoxication agents, modes of exposure, treatment processes, need for ICU admission, and in hospital mortality rate were analyzed in the study.
RESULTS: It was found that 0,63% (n=2,090) of total admissions were intoxication cases. While poisoning cases were most concentrated in the 19–30 age group (25.1%, n=525), the overall age range ranged from 3 months to 85 years. Of the cases, 62.3% (n=1,303) were accidental, while 37.7% (n=787) were due to suicide attempts. Etiologically, the most common agents were drugs and biological substances, accounting for 54.6% (n=1,142) of the cases. The overall in-hospital mortality rate was low at 0.14% (n=3).
DISCUSSION AND CONCLUSION: This study identifies a female predominance (57.7%) and a decreasing incidence trend over eight years, aligning with global patterns. While childhood cases are primarily accidental, suicidal intent (p=0.021) and medical agent ingestion (p<0.001) emerge as critical 'red flags' significantly associated with severe clinical presentations requiring inpatient care. These findings emphasize the need for gender-specific psychosocial support and community education to reduce the persistent burden on emergency departments.

INTRODUCTION: To investigate the relationship between visually assessed myocardial late gadolinium enhancement (LGE), native T1/T2 mapping abnormalities, and left ventricular ejection fraction (LVEF) in a real-world adult cardiovascular magnetic resonance (CMR) cohort.
METHODS: This retrospective study included consecutive adults referred for clinical CMR with evaluable LGE. LGE presence (yes/no) was used as the comparative reference. Mapping abnormality was defined as elevated native T1 and/or T2 values using protocol-specific institutional reference limits derived from healthy controls (non-parametric upper reference limit; 95th percentile). Associations between LGE, mapping findings, and LVEF were assessed using univariable and multivariable logistic regression adjusted for age and LVEF.
RESULTS: A total of 1074 consecutive adult patients undergoing clinical CMR were screened. After predefined exclusions, 1005 patients in whom both late gadolinium enhancement and myocardial T1/T2 mapping were evaluable constituted the final analysis set. Myocardial LGE was present in 54.5%. Mapping abnormalities were strongly associated with LGE positivity (OR 8.61; 95% CI 6.05–12.26; p<0.001) and remained independently associated after multivariable adjustment for age and LVEF (adjusted OR 7.73; 95% CI 5.38–11.10; p<0.001). LGE-positive patients had lower LVEF than LGE-negative patients, and mapping abnormalities were also associated with lower LVEF. The mapping–LGE association persisted in both preserved and reduced LVEF strata.
DISCUSSION AND CONCLUSION: In a large heterogeneous adult CMR population, T1/T2 mapping abnormalities show a strong and independent association with visually assessed LGE and ventricular function, supporting mapping as a complementary component of integrated myocardial tissue characterization.

INTRODUCTION: Intussusception is one of the most common causes of acute abdominal pain in childhood, and early diagnosis with appropriate treatment can reduce the need for surgery. This study aimed to evaluate the clinical, laboratory, radiological, and treatment characteristics of pediatric intussusception cases followed at a single center and to identify factors associated with surgical intervention.
METHODS: This retrospective study included 385 pediatric patients diagnosed with intussusception at “XXX University” between January 1, 2015, and December 30, 2024. Demographic data, presenting symptoms, laboratory findings, radiological diagnostic methods, treatment approaches, and clinical outcomes were obtained from medical records. Statistical analyses were performed using non-parametric tests, and p<0.05 was considered statistically significant.
RESULTS: The median age was 26 months, and 60% of the patients were male; 83% were under five years of age. The most common symptoms were abdominal pain (100%), vomiting (86.2%), and bloody stools (28.8%). Diagnosis was established by ultrasonography in 97.4% of cases. Hydrostatic reduction was performed in 79% of patients, enema in 4.9%, and surgery in 15.4%. Patients undergoing surgery had lower age and body weight, lower hemoglobin levels, and higher leukocyte and platelet counts (p<0.05). The median intussusception length was significantly greater in the surgical group (10 cm; p<0.001). Multivariate logistic regression analysis identified intussusception length as the only variable significantly associated with surgical intervention.
DISCUSSION AND CONCLUSION: Ultrasonographically measured intussusception length is a strong and independent predictor of surgical intervention. Early diagnosis and appropriate non-operative management are crucial for reducing surgical need.

INTRODUCTION: This study aimed to investigate serum levels of proline, prolidase, proline dehydrogenase (PRODH), and reactive oxygen species (ROS) in patients with schizophrenia and healthy controls, to evaluate potential differences between groups and to examine the interrelationships among these biomarkers that may be associated with the pathophysiology of schizophrenia.
METHODS: A total of individuals aged 18–65 years were enrolled and divided into two groups. The patient group consisted of 85 individuals diagnosed with schizophrenia according to the DSM-5 criteria, while the control group included 74 healthy volunteers with no history of psychiatric disorders. Clinical assessments, including the Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression Scale (CGI), Sheehan Disability Scale, Calgary Depression Scale for Schizophrenia, and Hamilton Anxiety Rating Scale, were administered exclusively to the patient group. Serum levels of proline, prolidase, PRODH, and ROS were measured, and statistical analyses were performed using SPSS version 24.0.
RESULTS: Patients with schizophrenia showed significantly lower serum proline, prolidase activity, PRODH, and ROS levels compared with healthy controls (all p ≤ 0.005). Biochemical parameters were strongly intercorrelated within both groups, but none were associated with clinical symptom severity or functional outcomes.
DISCUSSION AND CONCLUSION: The significantly reduced serum prolidase levels observed in patients with schizophrenia, together with the strong positive correlations between prolidase and proline, PRODH, and ROS, suggest a dysregulation of prolidase activity in schizophrenia. This dysregulation may exert downstream effects on proline metabolism and oxidative stress pathways, thereby contributing to the underlying pathophysiological mechanisms of the disorder.

INTRODUCTION: The objective of this study is to evaluate the clinical parameters that affect mortality in patients diagnosed with COVD-19. We examined the following variables: Reverse transcription polymerase chain reaction (RT-PCR) test positivity, vaccination status, chest CT images and degree of lung involvement, hospitalization status, and chronic disease parameters.
METHODS: In this retrospective observational study, a total of 2,325 patients diagnosed with COVID-19 between January 2020 and December 2021 were examined. The vaccination status, RT-PCR test results, and comorbidity of the patients were documented. The impact of these parameters on mortality was subsequently analyzed.
RESULTS: A total of 2,325 patients were included in the study, 50.4% male and 49.6% female. The mean patient age was 48.8 ± 17.4 years. The RT-PCR test yielded 38% positive and 55% negative results. Among those diagnosed with COVID-19, 763 were fully vaccinated, while 1,256 were unvaccinated. Of the 1,598 patients who underwent chest CT, 791 had normal findings and 807 showed lung involvement. The most common comorbidities were hypertension (HT), chronic obstructive pulmonary disease (COPD), and diabetes mellitus (DM). A total of 272 patients were hospitalized, and 59 patients died.
DISCUSSION AND CONCLUSION: Lower rates of RT-PCR positivity and pulmonary involvement have been observed in vaccinated patients. It is noteworthy that the majority of patients presenting with severe chest CT findings were unvaccinated, and higher mortality rates were also observed in the unvaccinated group. These findings suggest that vaccination may provide a significant protective effect in reducing the severity of pulmonary involvement and mortality.

Introduction: Online Gambling Disorder is an increasingly prevalent behavioral addiction frequently accompanied by depressive symptoms and significant functional impairments. Despite growing clinical recognition, pharmacological treatment options remain limited, and empirical evidence regarding combination therapy strategies is scarce.
Case Presentation: We report three male patients diagnosed with online gambling disorder and comorbid major depressive disorder according to DSM-5-TR criteria who demonstrated early clinical improvement following combined sertraline (50 mg/day) and naltrexone (titrated up to 100 mg/day) therapy integrated with structured motivational interviewing sessions provided through the Green Crescent Counseling Center (YEDAM), a community-based addiction support service in Turkey. From the second week of treatment, all patients reported a marked reduction in gambling urges and guilt distress, as reflected in both weekly clinical scale assessments and clinical interview findings. Clinical severity and symptom changes were assessed using the Online Gambling Addiction Scale (OGAS), Beck Depression Inventory (BDI), and Clinical Global Impression Scale (CGI-S) at baseline and weekly throughout the four-week period. By week four, consistent improvements were observed across all clinical measures. No clinically significant adverse effects were observed.
Conclusions: This three-case clinical report suggests that combined sertraline and naltrexone therapy may represent a potentially useful and well-tolerated pharmacotherapeutic approach for managing online gambling disorder with comorbid depression. When integrated with community-based motivational interventions, this dual-pathway strategy may contribute to early clinical responses and treatment engagement. These findings should be interpreted as hypothesis-generating and warrant further investigation in controlled clinical trials.

Breast cancer is the most common type of cancer among women. Advances in medical technology have made early diagnosis possible. However, as with many other diseases, the diagnosis of breast cancer may be delayed due to hospital-related phobia. This case report presents the clinical course of a patient with a longstanding breast mass who avoided medical consultation due to hospital phobia, ultimately requiring hospital admission due to the development of profound anemia and dyspnea. The subsequent diagnostic and therapeutic process is also discussed. The tumor identified in this patient likely exhibited indolent biological behavior and did not metastasize despite being present for over a decade. However, chronic blood loss from the ulcerated tumor surface, consistent with iron deficiency anemia, gradually led to a decline in hemoglobin levels, and the slowly developing anemia was initially well tolerated by the patient. Eventually, the patient presented to the emergency department with dyspnea as a result of profound anemia. Following clinical evaluation, a malignant breast mass was detected, and treatment was initiated. The patient underwent neoadjuvant chemotherapy followed by surgical resection. This case underscores several important considerations: treatment response in breast cancer is primarily determined by tumor biology, including molecular subtype and proliferation index; patients may tolerate gradually developing anemia for extended periods; non-healing wounds should raise suspicion for malignancy; all breast masses should be considered malignant until proven otherwise; and while dyspnea is often associated with metastatic breast cancer in the literature, it may also be a presenting symptom in non-metastatic cases.