Turkish Journal of Medical Sciences最新文献

Background/aim: Acute appendicitis (AA) is a frequent indication for emergency surgery in children; accurate diagnosis is essential to prevent complications. We examined whether serum Galectin-3 is associated with pediatric AA and quantified its diagnostic performance relative to routine inflammatory markers.

Materials and methods: This prospective, single-center study was conducted in a tertiary emergency department between July 1, 2023, and January 31, 2024. Children younger than 18 years with pathologically confirmed AA were enrolled as cases; age-compatible healthy volunteers served as controls. Venous blood was obtained at presentation before any therapeutic intervention. Galectin-3 concentrations were quantified using a commercial enzyme-linked immunosorbent assay. The primary endpoint was the ability of Galectin-3 to discriminate AA from controls. Receiver operating characteristic analysis was performed to assess discrimination, yielding area under the curve estimates with 95% confidence intervals (CIs); sensitivity and specificity were quantified at prespecified thresholds.

Results: Seventy-four children were analyzed (AA group n = 47; control group n = 27). Compared with controls, the AA group had higher Galectin-3, leukocyte and neutrophil counts, C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lower lymphocyte counts and platelet-to-neutrophil ratio (PNR) (all p < 0.05). Galectin-3 yielded an area under the curve (AUC) value of 0.680 (95% CI, 0.55-0.81). At a threshold of >130.71 pg/mL, sensitivity was 91.49% and specificity was 33.33%; at >115.71 pg/mL, sensitivity was 100.00% with the same specificity; at >254.90 pg/mL, specificity was 92.30% with sensitivity 29.79%.

Conclusion: Serum Galectin-3 is elevated in pediatric AA and affords moderate discrimination. Owing to limited specificity at pragmatic cut-offs, Galectin-3 alone is insufficient as a standalone test; however, it may serve as a rule-out adjunct within multimodal pathways. External validation in larger, multicenter cohorts is warranted.

Background/aim: Accurate postoperative refraction assessment is essential for optimal visual rehabilitation after cataract surgery. Although handheld autorefractometers (HH-ARMs) are widely used in pediatric and uncooperative patients, their reliability in adults after cataract surgery remains uncertain. This study compared refractive outcomes obtained with a HH-ARM (Mediworks V100; Mediworks, Guangzhou, China) and a TB-ARM (Canon RK-F2; Canon Inc., Tokyo, Japan) to evaluate the clinical applicability of HH-ARM in this population.

Materials and methods: This prospective study included 150 eyes of 150 patients (aged 55-85 years) who underwent uncomplicated phacoemulsification with intraocular lens (IOL) implantation. At 1 month postoperatively, spherical value (SV), cylindrical value (CV), cylindrical axis (CVA), and spherical equivalent (SE) were measured under cycloplegia with both devices. Agreement between devices was evaluated using nonparametric tests and Bland-Altman analysis.

Results: SV and CV differed significantly between devices (p = 0.04 and p < 0.001, respectively), while no significant differences were observed in CVA (p = 0.44) or SE (p = 0.09). Bland-Altman analysis confirmed close agreement for SE (mean difference -0.08 D; 95% limits of agreement [LoA] -1.57 D to 1.42 D). Regression analysis indicated that SE values were statistically interchangeable, whereas SV and CV were not.

Conclusion: HH-ARM demonstrated clinically acceptable agreement with TB-ARM for SE values, making SE the most reliable parameter for postoperative refraction in adults. These findings underscore the clinical relevance of HH-ARM as a practical alternative for patients with limited mobility and represent a novel contribution by validating its use in a population where evidence has been scarce. Further studies comparing HH-ARM with subjective refraction and across diverse surgical contexts are warranted.

Background/aim: Malnutrition and muscle wasting are common in terminal cancer patients and adversely affect prognosis. Bedside muscle ultrasonography (US) has emerged as a practical tool to assess nutritional status and monitor therapy. This study evaluated the relationship between achieving individualized nutritional targets and changes in muscle indices measured by US in terminal cancer patients receiving palliative care.

Materials and methods: Subcutaneous fat tissue thickness (SFTT), muscle thickness (MT), and cross-sectional area (CSA) of the rectus femoris (RF) and biceps brachii (BB) muscles were assessed by US over 10 days and normalized to height squared (m²). A total of 95 patients with complete retrospective data were included; 74.7% achieved their caloric targets, while 25.3% did not.

Results: Patients who failed to meet caloric goals exhibited significantly greater reductions across all muscle parameters. Among those who achieved caloric targets, protein intake ≥1.5 g/kg/day was associated with reduced muscle loss compared to lower intake. The RF muscle was particularly sensitive to nutritional status, exhibiting more pronounced changes in response to both caloric and protein adequacy. No significant differences were observed between feeding routes, although patients receiving parenteral nutrition tended to exhibit greater decline. Correlation analyses demonstrated a significant negative association between time to achieve caloric targets and muscle preservation, underscoring the importance of early intervention. Linear regression further identified delayed caloric achievement as an independent predictor of accelerated muscle loss.

Conclusion: Achieving caloric and high-protein targets is critical for preserving muscle mass in terminal cancer patients. US, particularly of the RF muscle, provides a reliable, noninvasive, and practical tool for monitoring the effects of nutritional interventions in this vulnerable population.

Background/aim: Epstein-Barr virus-positive (EBV+) diffuse large B-cell lymphoma, not otherwise specified (DLBCL-NOS), is a rare and aggressive subtype of B-cell lymphoma, recognized as a distinct entity in the revised fourth edition of the 2016 World Health Organization (WHO) classification. This retrospective study aims to evaluate the prevalence, clinical and histopathological characteristics, and survival outcomes of patients diagnosed with EBV+ DLBCL-NOS.

Materials and methods: This retrospective study included 92 newly diagnosed DLBCL patients treated at two centers between 2016 and 2024. EBV status was determined by in situ hybridization for EBER, with positivity defined as ≥ 50% nuclear staining in tumor cells.

Results: Among 92 patients, 81 (88.1%) were EBV-negative and 11 (11.9%) were EBV-positive. The median age was 63 years. EBV-positive patients had significantly more advanced-stage disease (100% versus 71.6%, p = 0.049), higher rates of splenic involvement (72.7% versus 38.3%, p = 0.048), elevated LDH levels (median: 773 U/L versus 326 U/L, p = 0.043), and a higher proportion with high-risk IPI scores (IPI ≥ 4: 63.6% versus 27.2%, p = 0.032). No significant differences were observed in age, sex, bulky disease, extranodal involvement, or molecular subtype. Median PFS was 12 months in the EBV-positive group, whereas it was not reached in the EBV-negative group (p = 0.005). EBV positivity was identified as an independent risk factor for inferior PFS (HR: 6.256, 95% CI: 2.398-16.324, p < 0.001), but not for overall survival (OS). Patients with ECOG performance status ≥ 2 and bone marrow involvement also had significantly worse PFS and OS.

Conclusion: EBV+ DLBCL is characterized by distinct clinical features, including advanced-stage disease and poorer PFS. Variability in reported prevalence highlights the need for standardized diagnostic criteria. Further research is essential to develop tailored therapeutic strategies and improve outcomes for this rare lymphoma subtype.

Leukemia is a malignant disorder that affects the bone marrow and blood. It is frequently diagnosed in adults, with a higher incidence in males than females. Globally, it ranks as the 15th most widespread cancer and is the 11th leading cause of cancer-related fatalities. The intensity and severity of treatment have increased, leading to a rise in relapse rates, toxicity, and adverse health effects. Therefore, there is a critical need for new treatments. The antileukemic properties of natural compounds have been extensively studied. Aquatic organisms are a rich source of potential medicinal compounds. Anticancer peptides offer an ideal treatment approach due to their anticancer effects and reduced toxicity to normal cells. This review provides a comprehensive analysis of the diverse mechanisms through which marine-derived peptides exert their physiological effects, including modulation of cell viability, induction of apoptosis, cell cycle arrest, antimitotic and antimetastatic activities, immunostimulation, mitochondrial dysfunction, and oxidative stress. Additionally, these peptides target alterations in lipid composition and microtubule dynamics within cancer cell membranes. Notably, their efficacy has been proven in multidrug-resistant (MDR) leukemic cell lines, with evidence of synergistic effects when combined with conventional antileukemic therapies. Collectively, these findings support the potential of marine peptides as promising candidates for the development of novel antileukemic agents.

[This corrects the article on p. 696 in vol. 55, PMID: 40686699.].

[This corrects the article on p. 1789 in vol. 49, PMID: 31655538.].

Background/aim: This study aimed to evaluate the metabolic profile of adults with Down syndrome (DS) using novel anthropometric and metabolic indices, while also highlighting the limitations of traditional obesity assessment methods compared with the non-DS population.

Materials and methods: This cross-sectional study included 22 adults with DS and 28 age- and sex-matched non-DS controls. Anthropometric measurements, including BMI, waist circumference (WC), and hip circumference (HC), were recorded alongside novel indices such as waist-to-height ratio (WHtR), body adiposity index (BAI), A body shape index (ABSI), and visceral adiposity index (VAI). Metabolic parameters (fasting plasma glucose, HbA1c, lipid profiles, HOMA-IR) and CBC-derived inflammation indices (NLR, PLR, MHR, NHR, LHR, PHR, SII, AISI, SIRI) were evaluated.

Results: Despite comparable BMI, individuals with DS exhibited significantly higher WHtR and BAI values (p < 0.001), suggesting greater central adiposity. Interestingly, the prevalence of metabolic syndrome was lower in the DS group (9.1%), and diastolic blood pressure was significantly lower as well. WHtR and BAI demonstrated stronger associations with metabolic markers than BMI. Among inflammatory indices, PLR was uniquely elevated in individuals with DS (p = 0.038), while VAI showed strong correlations with both.

Conclusion: Adults with DS display distinct cardiometabolic profiles that are poorly captured by traditional indices. Novel markers such as WHtR, BAI, and VAI offer enhanced insight into metabolic risk, whereas PLR emerges as a potential inflammatory biomarker. These findings underscore the need for population- and sex-specific criteria in evaluating metabolic health in DS. Tailored diagnostic models may improve risk stratification and clinical outcomes for this vulnerable group.

Background/aim: Shoulder pain is common and often evaluated with physical examination tests, yet their diagnostic accuracy remains controversial. The aim of this cross-sectional study was to determine the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) rates of clinical test results in patients with shoulder pain, based on ultrasonography (US) and magnetic resonance imaging (MRI) findings as reference diagnostic methods.

Materials and methods: The study included 78 patients who had complaints of shoulder pain. All patients underwent physical examinations and specific clinical tests (such as Neer and Jobe tests) to reveal shoulder pathologies, and US and MRI evaluations were performed.

Results: The sensitivity of clinical examination tests for subacromial impingement syndrome, biceps tendinitis and rupture, and infraspinatus tendinitis was higher than US. The specificity of tests for biceps rupture, rotator cuff rupture, infraspinatus and subscapularis tendinitis was higher compared with US. Subacromial impingement tests also showed higher sensitivity compared to MRI. The specificity of tests for acromioclavicular arthritis, biceps rupture, rotator cuff rupture, infraspinatus tendinitis was higher than MRI. Comparison of diagnostic performance with US was significant for subacromial impingement syndrome, acromioclavicular arthritis, biceps tendinitis and rupture, rotator cuff rupture and subscapularis tendinitis (p values; 0.003, 0.003, 0.000, 0.026, 0.000, 0.000, respectively). In contrast, comparison with MRI was significant only for subacromial impingement syndrome (p = 0.026).

Conclusion: Clinical tests have an important place in practice when examining shoulder lesions with their high specificity and sensitivity. Although US reveals many shoulder lesions that cannot be detected by clinical tests or support our examination, MRI maintains its importance in shoulder imaging.

Background/aim: The purpose of this study is to investigate how anxiety levels are affected by preoperative holding area waiting times and how these fears affect pain following surgery. Patients waiting for surgery frequently suffer from preoperative anxiety, which can have an impact on how well they manage their postoperative pain.

Materials and methods: Forty-eight individuals with lumbar disc herniation scheduled for surgery participated in the study. Patients' anxiety and pain levels were measured both during and after the preoperative holding area waiting period using the Amsterdam Preoperative Anxiety and Information Scale (APAIS), State-Trait Anxiety Inventory (STAI), and Visual Analog Scale (VAS). Additional information was also documented, including waiting times and tramadol usage.

Results: The APAIS (postwait) score and preoperative holding area waiting time had a significant correlation (r = 0.669, p < 0.001). Initially, a positive correlation was found between waiting time and postoperative VAS scores (r = 0.309, p = 0.033), as well as between the tramadol dosage used for postoperative pain management and the STAI-S (postwait) and STAI-T scores (STAI-S (postwait): r = 0.286, p = 0.046; STAI-T: r = 0.306, p = 0.035). However, after applying the Bonferroni correction for multiple comparisons, these associations no longer remained statistically significant.

Conclusion: Patients' anxiety levels rise with longer preoperative holding area waiting times, and this has an impact on their postoperative discomfort. Increased preoperative anxiety is associated with greater postoperative analgesic requirements, whereas reducing preoperative anxiety may enhance patient satisfaction and surgical outcomes. Postoperative pain and recovery may be enhanced by cutting down on waiting periods, educating patients about the surgical procedure, and putting anxiety management strategies into practice.