Objectives: Environmental smoke exposure is a poorly understood issue and might be a potential source of long-term respiratory exposure to toxic pollutants. Both secondhand and thirdhand smoke (THS) exposure are important matters of public health. We aimed to document the knowledge about smoke exposure of vulnerable groups with respiratory diseases.
Methods: A total of 911 currently smoking patients admitted to the outpatient clinics between October 2023 - October 2024 enrolled in our study. Following a medical examination and pulmonary function assessment, individuals were asked to complete the BATHS questionnaire on thirdhand smoking exposure.
Results: Of the 911smoker participants who comprised our sample, 322 (35.3%) had COPD, 227 (24.9%) had asthma and 570 (62.5%) experienced moderate to severe secondhand exposure. Patients with COPD had the lowest BATHS total and persistence scores (3.61±0.58 and 3.77±0.69, respectively), while asthmatics had the lowest BATHS health scores (3.41±0.46) (p<0.05). Total and subdimension scores were significantly higher among individuals aged 18-30, university graduates, employed in the workforce, and earning exceeds minimum wage (p <0.05). No gender difference was noted (p>0.05). BATHS total scores had significant negative correlation with secondhand smoke exposure and disease duration (p<0.05) whereas positively correlated with better pulmonary function values, attending a smoking cessation clinic, and living at home with children under sixteen (p<0.05).
Conclusion: This study identifies the knowledge gap about the detrimental effects of smoke exposure in patients with respiratory diseases. It underscores the importance of focusing initiatives to reduce both active and passive smoking through educational programs targeting active smokers at risk of lung illnesses.
Objectives: Alopecia areata (AA) is a common, chronic autoimmune disease that causes non-cicatricial hair loss. Its relapsing and remitting nature leads to the search for new, effective treatment options. The study aimed to evaluate the therapeutic efficacy of intralesional platelet-rich plasma (PRP) and intralesional steroid (ILS) injections in patients with AA.
Methods: A retrospective chart review was carried out from 2020-2021. A total of 75 patients with AA were included in the study. Thirty-six patients were treated with intralesional PRP, and 39 patients were treated with ILS injections for three sessions. The patients were evaluated with a hair pull test and SALT scores at months 0, 3, and 6.
Results: Of 75 patients, the mean age of the PRP group was 34.33±10.61, and the mean age of the ILS group was 33.82±13.31 years. After three PRP or ILS therapy sessions, at 3. and 6. months, SALT 3 and SALT 6 scores were statistically significantly lower in the PRP group than in the ILS group (p=0.038, p<0.001, respectively). When the treatment response was evaluated at the end of the 6th month in the PRP group, there was no response in 2 (5.5%) patients, partial response in 1 (2.7%) patient, good response in 3 (8.4%) patients, and very good response in 30 (83.4%) patients. Only 2 (5.9%) patients had a clinical relapse in a 6-month period. Side effects were seen in 16 (44.4%) patients in the PRP group and 8 (20.5%) patients in the ILS group, and the frequency of side effects in the PRP group was statistically significantly higher than in the ILS group (p=0.026). However, the side effects of both groups were minor, such as itching, pain, burning, ecchymosis, and folliculitis.
Conclusion: PRP seems to be an effective and safe treatment option for limited patchy alopecia areata, but its superiority over ILS has not been fully demonstrated, making ILS still the first-line treatment.
American Thyroid Association (ATA) guidelines for the management of thyroid nodules and differentiated thyroid cancer (DTC) were first published in 1996 and subsequently updated in 2006, 2009, and 2015. In 2025, the ATA released a revised version focusing exclusively on DTC and excluding thyroid nodules from its scope. In our previous review, we summarized the updates regarding preoperative evaluation, diagnosis, and surgical management of DTC. In this second part of the series, we aimed to compare the 2015 and 2025 ATA guidelines in terms of initial postoperative management. The main changes are evaluated at the level of recommendations, with a particular emphasis on recurrence risk stratification, postoperative risk-adapted surveillance, adjuvant radioactive iodine (RAI) use, postoperative imaging, and radiation safety. This review provides a comprehensive comparison of the 2015 and 2025 ATA guidelines, outlining the key changes in early postoperative management of DTC and highlighting their potential impact on individualized patient care.
Objectives: Despite the prevalence of saphenous vein graft (SVG) failure following coronary artery bypass graft (CABG) surgery, SVGs continue to be widely used. This study aimed to investigate the value of the CHA2DS2-VASc score, originally developed for predicting thromboembolic events in atrial fibrillation, in predicting SVG failure post-CABG.
Methods: This retrospective study analyzed data from 526 patients with a history of CABG who presented with non-ST-elevation myocardial infarction between January 2017 and April 2024. SVG failure was defined as exhibiting stenosis of 70% or greater, or complete occlusion. Preoperative CHA2DS2-VASc scores were calculated for each patient. Multivariable analysis was conducted to identify independent predictors of SVG failure.
Results: Among the 526 patients, 242 (46%) experienced SVG failure. Patients with SVG failure exhibited higher CHA2DS2-VASc scores. Multivariable analysis identified the CHA2DS2-VASc score (OR: 2.203, 95% CI: 1.672-2.902, p<0.001), time interval after CABG (OR: 1.167, 95% CI: 1.081-1.259, p<0.001), and number of SVGs (OR: 2.378, 95% CI: 1.745-3.241, p<0.001) as independent predictors of SVG failure. Of those parameters, the CHA2DS2-VASc score demonstrated a higher AUC value (AUC=0.796, AUC=0.724, AUC=0.641, respectively).
Conclusion: Pre-operative CHA2DS2-VASc score may be predictive of late SVG failure after CABG.
With the increasing use of electronic toys, the number of cases involving battery ingestion has risen significantly in recent years. This case report presents a child who attended the emergency department with sudden chest pain and crying episodes. The electrocardiogram (ECG) revealed signs of myocardial ischemia in inferior leads, despite completely normal cardiac function. A chest X-ray detected a button battery lodged in the esophagus. A 4-year-old boy presented to the emergency department with sudden, intense chest pain and crying while playing with his toys. An electrocardiogram showed prolonged corrected QT interval (cQT 0.56), marked ST depression, and negative T waves in leads DII, DIII and aVF. Echocardiography (ECHO) revealed normal cardiac function. Cardiac enzyme and biochemical tests returned normal results (troponin-I ≤ 3.2 ng/L, CK-MB 29.8 U/L). A disc-shaped battery was detected on chest radiography, and electrocardiographic findings completely normalized after the battery was removed endoscopically. In the literature, rare adult cases of multiple cylindrical battery ingestion have been reported with ECG findings that mimic myocardial ischemia or infarction. Our case is notable as it presents a single disc battery lodged in the esophagus of a pediatric patient that mimicked an inferior myocardial infarction.
Objectives: Gastrointestinal Kaposi sarcoma (GI-KS) is a rare vascular neoplasm associated with human herpesvirus 8 (HHV 8), most often emerging in immunosuppressed individuals. Its endoscopic appearance-ranging from nodular and polypoid lesions to ulcerations-can be subtle. In addition, histopathological features of KS may mimic benign inflammatory conditions or other mesenchymal tumors, delaying accurate diagnosis. This study aimed to evaluate the histopathological features of GI-KS and to clarify the neoplastic and non-neoplastic diagnostic challenges in a single-center cohort.
Methods: We retrospectively reviewed 13 GI-KS cases diagnosed between 2005 and 2025. Clinical data and endoscopic findings were retrieved from the hospital's electronic medical records. Hematoxylin and eosin-stained sections, along with HHV-8 immunohistochemistry (IHC) slides, were retrospectively evaluated.
Results: Thirteen patients (11 male; mean age 47±18 years) were identified, of whom 84.6% were immunosuppressed (eight HIV-positive, two renal transplant recipients, and one receiving corticosteroids). Cutaneous or extraintestinal KS lesions were present in 11 cases. Endoscopic evaluation revealed nodular lesions (30.8%), polypoid lesions (23.1%), snake-skin-like hemorrhagic areas (7.7%), infiltrative lesions (7.7%), erythematous elevated lesions (7.7%), or nonspecific erythematous changes (7.7%). Suspicion of KS was documented in only three endoscopy reports. Lesions were most commonly located in the stomach (76.9%), followed by the rectum (15.4%) and colon (7.7%). Histologically, slit-like vascular channels and erythrocyte extravasation were observed in 84.6% of cases, hemosiderin deposits in 53.8%, chronic inflammatory infiltrates including plasma cells in 76.9%, and foveolar epithelial hyperplasia in 70% of gastric cases. The histologic spectrum included diagnostic pitfalls such as chronic gastritis-like features in three cases, reactive gastropathy-like changes in one case, granulation tissue-like appearance in one case, and GIST/leiomyoma-like spindle cell morphology in one case.
Conclusion: The histologic features of GI-KS can mimic both neoplastic and inflammatory conditions. Therefore, histopathological evaluation should be conducted alongside clinical information, as GI-KS may present with subtle or nonspecific findings. Given the potential for life-threatening complications such as obstruction, bleeding, or perforation, accurate diagnosis and timely treatment are critically important. Routine application of HHV-8 IHC -even in cases with minimal suspicion- is essential for ensuring diagnostic accuracy, guiding appropriate management, and preventing serious outcomes.
Objectives: The aim of this retrospective study was to evaluate and compare cervical ultrasound findings, fine needle aspiration biopsy (FNAB) results and excisional biopsy results in the diagnosis of patients presenting with cervical lymphadenopathy and to reveal the most common causes.
Methods: A total of 137 patients who underwent cervical ultrasonography and FNAB before excision were included in the study. Demographic data, cervical ultrasonographic findings, FNAB pathology results and final pathology results after excisional biopsy were analysed.
Results: The pathological results indicated that reactive follicular hyperplasia was diagnosed in 33.6% (n=46) of the patients. A diagnosis of non-Hodgkin lymphoma (NHL) was made in 27.7% (n=38) of cases, while 13.1% (n=18) were diagnosed with Hodgkin lymphoma. Malignant pathology was diagnosed in 66 patients. In the FNAB results of patients diagnosed as malignant, 57 were interpreted as non-diagnostic and suspicious, while 9 were interpreted as benign. Of these, 8 had a pathological examination of lymph node excision that revealed non-Hodgkin lymphoma (NHL), and in one patient with a benign FNAB result, the result of lymph node excision was reported as malignant.
Conclusion: Especially in cervical lymphadenopathies in patients over 40 years of age, the possibility of malignancy increases significantly. In lymphoproliferative diseases and in cases accompanied by clinical suspicion, it would be rational to use the direct excisional biopsy option. Although prior fine needle aspiration biopsy may provide significant guidance in metastatic diseases, it should be kept in mind that false negative rates may increase in the diagnosis and staging of lymphoma.
Objectives: This study aimed to identify the clinical factors independently associated with depressive symptoms in patients with multiple sclerosis (MS) and to evaluate the impact of depression on health-related quality of life (QoL).
Methods: In this prospective observational study, 90 patients with MS were evaluated. Age, sex, disease duration, MS subtype, and Expanded Disability Status Scale (EDSS) scores were recorded. The Fatigue Severity Scale (FSS), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) scale, and the EuroQol 5-Dimension 3-Level (EQ-5D-3L) questionnaire were administered. The presence of restless legs syndrome (RLS) was also recorded. Depression severity was measured using the Patient Health Questionnaire-9 (PHQ-9). First, univariable associations were examined, and relevant variables were subsequently entered into a multivariable linear regression model using backward elimination.
Results: Higher FSS, ISI, and EDSS scores were independently associated with higher PHQ-9 scores. FSS and ISI scores showed the strongest correlations with depression (ρ=+0.52 and +0.57; p<0.001). EDSS showed a modest association (ρ=+0.23, p=0.031). Age, sex, and disease duration were not significant predictors. S-LANSS scores, MS subtype, and RLS were significant in univariate analysis but excluded from the final model. Depression scores were significantly associated with higher EQ-5D-3L scores, indicating poorer QoL (p<0.001).
Conclusion: Fatigue and insomnia were the strongest independent predictors of depression in MS, surpassing traditional clinical indicators. Routine screening for these symptoms may facilitate earlier detection and treatment of depression and improve QoL in clinical practice.
American Thyroid Association (ATA) guidelines for the management of thyroid nodules and differentiated thyroid cancer (DTC) were first published in 1996 and updated in 2006, 2009, and 2015. In 2025, the ATA released a revised version that, for the first time, focuses exclusively on DTC. In our previous reviews, we summarized the updates on preoperative, diagnostic, surgical, and early postoperative management of DTC. In this third and final part, we compare the 2015 and 2025 ATA guidelines with respect to long-term follow-up, TSH suppression strategies, thyroglobulin monitoring, follow-up of low-risk patients. Diagnostic radioiodine whole-body scanning, FDG-PET/CT, dynamic risk stratification, and the management of recurrent or metastatic disease, including local therapies, radioiodine preparation and dosing, and systemic treatments were also highlighted in this part. Particular emphasis is placed on the expanded recommendations for kinase inhibitor therapy, sequencing of systemic agents, targeted therapies (NTRK, RET, ALK, BRAF), redifferentiation approaches, immunotherapy, and supportive care strategies addressing bone and brain metastases, financial toxicity and psychosocial needs. This review provides a comprehensive synthesis of these updates and discusses their implications for individualized long-term management of DTC.
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