Turkish Journal of Medical Sciences最新文献

Endocrine disruptors are chemical substances widely utilized across various industrial sectors. Due to their structural similarity to natural ligands, they bind to receptors and influence the endocrine system via agonist-antagonist mechanisms. Exposure occurs through the consumption of contaminated food and water, inhalation of polluted air and dust, and dermal contact. Owing to their dynamic remodeling capacity, bones represent potential targets for endocrine-disrupting chemicals. These chemicals can disrupt bone formation, skeletal development, hormonal regulation, and calcium metabolism. Sensitivity to endocrine-disrupting chemicals is greatest during the prenatal and early postnatal periods. This review summarizes the effects of endocrine-disrupting chemicals on bone tissue.

Background/aim: Rheumatoid arthritis (RA) is often accompanied by fatigue and sleep disturbances, which aggravate disease severity. Gender differences in these interrelationships remain insufficiently understood. This study aimed to examine whether fatigue mediates the association between sleep quality and disease severity in RA, and whether these pathways differ by gender.

Materials and methods: A single-center study was conducted with 68 RA patients (55.9% female). Disease severity was assessed using the Routine Assessment of Patient Index Data-3, fatigue using the Bristol Rheumatology Fatigue Multidimensional Questionnaire, and sleep quality using the Pittsburgh Sleep Quality Index (PSQI).

Results: Fatigue significantly mediated the relationship between poor sleep quality and disease severity (indirect effect β = 0.209, p = 0.003). While gender significantly predicted fatigue (β = 0.297, p = 0.005) and females reported higher fatigue and disease severity, gender did not significantly moderate the mediation pathway (PSQI × gender interaction β = 0.019, p = 0.856). The direct effect of sleep quality on disease severity was not significant (β = 0.047, p = 0.663), supporting a full mediation model. Menopausal status was not significantly related to symptom variation among women with RA.

Conclusion: Fatigue is a key mechanism connecting poor sleep to greater disease severity in RA. The female participants reported greater symptom burden, underscoring the importance of fatigue-focused, gender-sensitive management strategies.

Background/aim: Sensitivity to endocrine disruptors is higher in early life. Endocrine disruptor chemicals can be passed from pregnant women to their babies through the placenta or breast milk during lactation, leading to long-term and potentially permanent adverse effects.

Materials and methods: This review evaluates the effects of endocrine-disrupting chemicals (EDCs) on pregnancy by summarizing findings from experimental and observational studies. Exposure routes, reproductive outcomes, fetal development implications, and potential preventive strategies are analyzed.

Results: Exposure to EDCs during pregnancy has been linked to various complications, including infertility, implantation defects, premature birth, spontaneous abortions, gestational hypertension, and gestational diabetes. Intrauterine exposure to these chemicals may lead to metabolic disorders, congenital anomalies, low birth weight, and delayed physical and mental development in offspring depending on the level and timing of exposure.

Conclusion: Due to the significant impact of endocrine disruptors on maternal and fetal health, it is critical to implement protective measures to reduce exposure during pregnancy and lactation. Increased awareness and preventive strategies can help mitigate adverse effects.

Background/aim: Adolescent smoking remains common, highlighting the need to control tobacco use and identify influencing factors. This study aims to evaluate the outcomes of an adolescent-focused smoking cessation clinic and the factors influencing them.

Materials and methods: The study was conducted with 262 adolescents, who, along with their parents, had direct access to the clinic. Data were drawn from patient records containing structured registration and follow-up documentation. The study investigated the effects of baseline cigarette consumption, sociodemographic characteristics, and nicotine patch use on smoking cessation rates at three months, six months, and one year.

Results: The three-month, six-month, and one-year quit rates for adolescents were 18%, 14.3%, and 13.5%, respectively. The regression model revealed a positive association with three-month smoking cessation among those who had a cough (OR = 8.57; 95% CI: 1.83-40.11; p = 0.06) and those who used a nicotine patch (OR = 5.74; 95% CI: 2.06-15.94; p < 0.001). Additionally, individuals who used their pocket money to purchase cigarettes were more likely to quit smoking for three months (OR = 3.47; p = 0.038) and six months (OR = 9.26; p = 0.039). For every 10-cigarette increase in daily consumption, the likelihood of smoking cessation decreased at both 6 months (OR = 0.31; 95% CI: 1.28-8.33; p = 0.014) and one year (OR = 0.26; 95% CI: 1.39-10.42; p = 0.009).

Conclusion: Our findings suggest that not receiving extra pocket money and smoking fewer cigarettes at the time of admission are associated with higher quit rates. Even short-term use of nicotine patches and addressing symptoms such as coughing may support adolescents' intention to quit. Adolescent smoking cessation clinics provide a valuable opportunity to address these factors in collaboration with families.

Background/aim: To describe Graves' Disease (GD) associated with COVID-19 infection (COVID) or its vaccines (VAC) and to compare the clinical presentations, laboratory parameters, and short-term clinical course of the disease among different etiology groups (COVID, VAC, and GD control).

Materials and methods: Included in this multicenter matched case-control, retrospective cohort study were 239 patients with newly diagnosed (n = 196) or recurrent GD (n = 43) associated with COVID (n = 79) or VAC (n = 160). Each case was matched (1:1) with a control who had been diagnosed with GD prior to COVID.

Results: The median age of the entire group was 42 years (female:male = 137:102). Both the COVID (4.6-fold) and VAC (4.1-fold) groups demonstrated higher TSH receptor antibody (TRAb) titers (p < 0.001) compared with the control group (3.5-fold), as well as a higher proportion of recurrent cases. At baseline, the COVID group had higher free triiodothyronine (fT3) levels than the other groups. Graves orbitopathy (GO) was observed in 60 patients (12.6%), with a higher frequency in classical GD (18.4%). At baseline, the variables associated with thyrotoxicosis severity (defined as fT3 levels) were younger age, higher thyroid gland volume (TGV), and etiology, with the COVID and, to a lesser extent, VAC groups presenting with higher fT3 levels. The variables associated with GO were higher TGV, TRAb titers, and smoking, while no association with etiology was identified.

Conclusion: The clinical course was similar in all groups other than in some laboratory findings. Although the frequency of GO associated with COVID and VAC was lower, the proportion of cases with a Clinical Activity Score of ≥3 was higher compared to GD. This pattern suggests a potentially stronger immunologic trigger in these cases.

Background/aim: There is increasing interest in endocrine disrupting chemicals because of the potential effects on neurological health. These chemicals are widely found in various consumer products and industrial processes, and can lead to serious disorders of the endocrine system by disrupting hormone synthesis, expression, and function. The aim of this review was to examine epidemiological and experimental findings by investigating the link between exposure to endocrine disrupting chemicals and adverse neurological outcomes.

Materials and methods: In the preparation of this review, a PubMed literature search was conducted using the words "endocrine disruptors," "neuroendocrine effects," "neurobehavioral effects," and "neurodevelopmental effects" and articles containing relevant studies were examined.

Results: Recent studies have shown a strong correlation between exposure to endocrine disrupting chemicals and the development of neurodegenerative diseases such as Alzheimer's and Parkinson's disease, and neurodevelopmental diseases such as autism spectrum disorder and attention deficit hyperactivity disorder. The effects of common pollutants such as pesticides, bisphenol A, polychlorinated biphenyls, and heavy metals on the endocrine system have been especially emphasized.

Conclusion: In conclusion, understanding the role played by endocrine disrupting chemicals in the development of neurological diseases will be of critical importance in the development of new strategies to prevent these diseases.

Endocrine-disrupting chemicals (EDCs) are environmental contaminants that disrupt hormonal regulation by mimicking, inhibiting, or modifying endocrine signaling pathways. EDCs are commonly present in plastics, pesticides, industrial byproducts, and personal care products and pose substantial health risks, particularly to vulnerable groups such as infants and children. Early-life exposure is especially concerning due to the developing detoxification systems, the immaturity of the blood-brain barrier, and the ongoing organ differentiation, making these periods highly susceptible to EDCs' harmful effects. Moreover, exposure during critical developmental periods, such as sex differentiation and neurodevelopment, can lead to significant long-term developmental impairments that persist into later life. Perinatal and childhood exposure to EDCs has been linked to various adverse health outcomes, including neurodevelopmental delays, impairments in reproductive health, obesity, type 2 diabetes, thyroid dysfunction, and even a heightened risk of certain malignancies. These effects are mediated through various mechanisms, including direct modulation of hormone receptors, disruption of genetic regulation, and interference with endocrine feedback systems. Alterations in endocrine signaling, particularly disruptions in thyroid hormone homeostasis, may also indirectly impair cognitive development, increasing the risk of attention disorders and intellectual impairment. Although regulatory measures to reduce EDC exposure are crucial, current restrictions remain insufficient. Moreover, as new EDCs emerge, ongoing research is essential to understand their risks and develop effective strategies to minimize their potential harm. Protecting future generations requires a proactive approach that combines public health awareness, strong regulations, and ongoing scientific research. This review highlights the potential risks of EDCs exposure in children and highlights the significance of multidisciplinary research and policy efforts.

Background/aim: Menopause is associated with increased vascular risk. This study investigated the effects of 3 centrally acting muscle relaxants-tizanidine (TZ), thiocolchicoside (TCC), and cyclobenzaprine (CBZ)-on vascular reactivity in ovariectomized (OVX) rats as a model of menopause.

Materials and methods: Body weight, blood glucose, blood pressure, and heart rate were recorded, and the rats underwent oophorectomy surgery. Eight weeks after the operation, the rats were divided into 5 groups: sham operated rats, OVX rats, OVX rats treated with TZ (OVX + TZ), OVX rats treated with TCC (OVX + TCC), and OVX rats treated with CBZ (OVX + CBZ). All drug treatments were at a dosage of 2 mg/kg/day for 2 weeks. Isolated rat aortas were suspended in a tissue chamber. Vascular reactivity was assessed using increasing concentrations of phenylephrine, acetylcholine, and sodium nitroprusside, as well as potassium chloride at a concentration of 40 mM.

Results: Body weight, phenylephrine sensitivity, and potassium chloride responses significantly increased with OVX. TZ and CBZ decreased body weight gain and ameliorated receptor-dependent contractile sensitivity. TZ and CBZ had calcium antagonistic effects on vascular smooth muscle. TZ deteriorated endothelial function.

Conclusion: TZ cannot be considered a safe medication for patients with endothelial dysfunction. In high doses and for longer periods, TCC and CBZ might also have deleterious effects on vascular reactivity. These findings are noteworthy from the perspective of rational drug therapy.

Background/aim: Concerns about the use of topical corticosteroids (TCSs), commonly referred to as corticophobia, are widespread among dermatology patients and often lead to nonadherence to TCS treatment. This study aimed to evaluate the validity and reliability of the Turkish version of the topical corticosteroid phobia (TOPICOP) scale.

Materials and methods: The TOPICOP scale comprises 12 items grouped into 2 dimensions: beliefs (6 items) and worries (6 items). For cultural adaptation, the scale was forward and backward translated. The final Turkish version was administered to 123 patients with chronic dermatoses who rated their perceptions of TCSs using a 4-point Likert scale. Test-retest reliability was assessed in 30 patients over a 2-week interval. In the validity analysis of the scale, content, construct (exploratory factor analysis (EFA), confirmatory factor analysis (CFA)) and criterion validity were tested. Internal consistency (Cronbach's alpha coefficient) and test-retest analyses were performed in the reliability analysis.

Results: EFA yielded 2 subdomains explaining 67.61% of the total variance and factor loadings ranging between 0.81 and 0.42. In CFA, χ²/df, SRMR, RMSEA, CFI, and TLI were in the excellent/acceptable range. Internal consistency had Cronbach's alpha coefficients of 0.788 for the beliefs dimension, 0.815 for the worries dimension, and 0.861 for the total scale. A moderate-to-strong positive correlation was observed in test-retest reliability, with a correlation coefficient of 0.746 (p < 0.001). The mean (SD) global score of the Turkish TOPICOP scale was 50.74% (21.06%). Patients with higher educational levels had higher mean scores (p ≤ 0.05).

Conclusion: The Turkish version of the TOPICOP scale is a valid and reliable tool for assessing topical corticophobia among Turkish patients. Physicians should dedicate sufficient time to patient education to enhance TCS adherence.

Background/aim: Although low phosphorus (P) concentrations are a recognized feature of primary hyperparathyroidism (PHPT), they are not among the diagnostic or surgical criteria. The present study evaluates the association between serum phosphorus levels and clinical outcomes in PHPT patients.

Materials and methods: A search of the Turkish Ministry of Health's National Electronic Database was conducted using ICD-10 diagnostic codes and laboratory data to identify PHPT cases within the Turkish population from 2017 to 2022.

Results: The records of a total of 113,330 PHPT patients (77.5% female; mean age 58.9 ± 15.6 years) were analyzed, revealing a mean serum phosphorus level of 3.24 ± 0.79 mg/dL. Patients with nephrolithiasis, vitamin D <20 μg/L, and calcium ≥11.4 mg/dL had significantly lower phosphorus levels (p<0.0001). Hypophosphatemia (HypoP) (P < 2.5 mg/dL) was present in 14.3% of patients and was associated with higher parathyroid hormone, calcium, and alkaline phosphatase levels, and lower vitamin D levels (all p < 0.0001). HypoP independently increased the risk of kidney stone formation (OR = 1.53; 95% CI 1.46-1.61).

Conclusion: HypoPis associated with more severe biochemical abnormalities and a greater prevalence of nephrolithiasis in PHPT. In regions where vitamin D deficiency is common, low phosphorus levels may indicate more severe diseases, and so routine phosphorus monitoring should be considered as part of PHPT management.