Eurasian Journal of Medicine最新文献

Impulsivity and compulsivity are complex constructs that underpin a wide range of psychiatric disorders. While traditionally viewed as opposing dimensions, emerging evidence suggests they exist on an overlapping spectrum, influencing diagnosis and treatment. Impulsivity is characterized by poorly planned, premature responses aimed at achieving gratification, while compulsivity involves repetitive behaviors driven by anxiety relief. Both constructs share common neurobiological substrates, such as impaired response inhibition and urgency, but differ in their executive dysfunction patterns. Psychiatric disorders traditionally associated with impulsivity (e.g., attention-deficit hyperactivity disorder, bipolar disorder) and those aligned with compulsivity (e.g., obsessive-compulsive disorder, anorexia nervosa) often exhibit overlapping symptoms. Additionally, the same disorder may present varying levels of impulsivity and compulsivity across individuals and time points. The impulsivity-compulsivity spectrum offers a dimensional framework for understanding psychiatric disorders, emphasizing the need for individualized clinical approaches. This review aims to highlight the shared and distinct features, as well as the neurobiological pathways, associated with this spectrum, while underscoring the need for future research to refine dimensional models that enhance diagnostic accuracy and guide personalized interventions.

Background: In this study, the aim was to assess the association between procalcitonin levels and culture positivity in patients with acute renal failure (ARF) admitted to the intensive care unit due to Type 1 and Type 2 respiratory failure. Methods: About 128 patients with ARF were restrospectively included between January 2022 and December 2023. Based on admission culture results, patients were grouped as infection-positive (n=40) or infection negative (n=88). Laboratory parameters, particularly procalcitonin levels, were compared. Results: Platelet levels were significantly higher in patients with positive culture results (P=.03), while procalcitonin levels did not differ between groups (P=.33). Escherichia coli was the most frequently isolated microorganism (25%), with the urinary tract being the most common site of growth. In culture- positive patients, procalcitonin levels exhibited a stronger negative correlation with glomerular filtration rate (GFR) (R=-0.355, P= .02) and a positive correlation with creatinine (R=0.385, P= .01), highlighting the impact of renal function. Additionally, procalcitonin levels were positively correlated with C-reactive protein (CRP) (R=0.586, P < .001) and negatively correlated with serum sodium (R=-0.39, P=.01) in patients with culture growth. As a secondary observation, platelet levels were elevated in patients with positive cultures. Conclusion: Although procalcitonin is a recognized marker for infection and sepsis, its diagnostic reliability appears limited in critically ill patients with ARF due to its association with renal dysfunction. Additionally, defining infection based solely on culture positivity has inherent limitations, and further research including comprehensive clinical and laboratory parameters is warranted.

Background: Skin-related health problems constitute a considerable portion of the reasons for consulting a family physician. Therefore, family physicians play a key role as gatekeepers in evaluating the signs and symptoms of various skin diseases, triaging the patients, and deciding upon the necessity for referral. The aim was to investigate the most common dermatological diseases encountered by family physicians in the outpatient clinics and determine the diagnostic and remedial approach of family physicians to these skin diseases in Türkiye. Methods: An online questionnaire composed of 48 questions related to the demographic and educational information of the participants, the most frequently seen dermatoses in outpatient settings, and the management skills of the participants for various skin disorders, was created using Google Forms. Via instant messaging and e-mail, the survey was distributed among practitioner family physicians, family physician residents, and family medicine specialists who were actively employed in different healthcare facilities in Türkiye. The snowball sampling method was used to convey the survey. Results: The present questionnaire-based study was conducted between October 2024 and January 2025. A total number of 176 participants who were actively working in different healthcare facilities in Türkiye were included in the study. The median number of patients examined in a month was 1025 (range: 90-4000). The most commonly encountered cutaneous diseases were fungal infections of the hair, nail, skin, and mucous membranes (91.5%) followed by scabies (80.1%), acne vulgaris (72.2%), and herpes simplex infection (65.9%). Herpes simplex infections, fungal infections of the skin, hair, nails, mucosa, and scabies were the 3 leading skin diseases at which family physicians felt competent while administering treatment. Conclusion: The results of the current study point out that since family physicians deal with a relatively high rate of skin disorders in their daily practice, it is quite essential to reinforce their diagnostic and therapeutic proficiencies through intensified dermatology courses and rotations.

Background: This study aimed to evaluate cardiac involvement during active inflammation in 2 pathophysi- ologically different diseases, rheumatoid arthritis (RA) and ankylosing spondylitis (AS), and the change in cardiac involvement with suppression of inflammation after effective treatment. Methods: The study involved 30 newly diagnosed, active RA and 31 active AS patients in need of biologi- cal treatment. The patients were evaluated by the same cardiologist using pulse wave Doppler and tissue Doppler echocardiography at the beginning of the study and after 3 months of treatment. Myocardial per- formance index (MPI) was obtained by dividing the sum of isovolumetric relaxation time and isovolumetric contraction time, calculated from the recorded Doppler tracing, by ejection time (ET) from the same tracing was calculated separately for both ventricles. Results: It was found that diastolic dysfunction was present at the time of diagnosis and did not improve after treatment, despite regression in inflammatory values and joint findings. In the pre-treatment period, MPI was found to be higher than the normal value range in both groups. The MPI was 0.5 ± 0.07 for RA patients and 0.51 ± 0.1 for AS patients. No significant difference was found between the 2 groups before treatment (P=.697). In the post-treatment evaluation, no significant difference was found in RA and AS patients compared to pretreatment. Conclusion: Inflammation-induced cardiac involvement may develop in both RA and AS patients, despite their different pathophysiologic pathways. Longer follow-up periods are necessary for the improvement of inflammation-induced diastolic dysfunction and MPI values compared to joint findings used in activation parameters.

Background: Prostate cancer is the most common malignancy in men, and androgen deprivation therapy (ADT) serves as the primary approach for managing advanced cases. Certain research has suggested the impact of androgens on the physiological homeostasis of the optic nerve. Our aim was to investigate the impact of surgical ADT on peripapillary retinal nerve fiber layer (RNFL) thickness in patients with advanced prostate cancer. Methods: The study comprised 30 patients who had undergone bilateral orchiectomy for advanced prostate cancer, with a total of 60 eyes included in the analysis. Each participant received a standard ophthalmological examination. Peripapillary RNFL thickness measurements were performed preoperatively and 12 months postoperatively using optical coherence tomography. Results: The mean age of the patients was 73.77 ± 8.8 years. At the 12th month following surgery, we observed that the mean average thickness of the right and left RNFL, as well as the thickness of the left nasal, left inferior, and right and left temporal quadrants, was significantly thinner compared to presurgical values (P< .05). However, when comparing pre- and postsurgical measurements, the RNFL thickness in the right and left superior quadrants, as well as the right nasal and right inferior quadrants, showed no statistically significant difference. Conclusion: In this study, a significant difference was observed between the preoperative and 12-months postoperative peripapillary RNFL thickness values in patients who underwent surgical ADT for advanced prostate cancer. Additional research using larger sample sizes is required to clinically examine the impact of ADT on optic nerve homeostasis.

The Decipher genomic classifier (GC) is a 22-gene expression test that refines risk stratification and informs treatment decisions in localized prostate cancer. Traditional clinicopathologic factors, including prostate-specific antigen levels and kinetics, Gleason score, histologic variants, and tumor stage, do not fully capture disease heterogeneity, leading to potential overtreatment or undertreatment. The Decipher GC has demonstrated clinical utility across risk groups, helping to distinguish candidates for active surveillance in low-risk prostate cancer, refine the need for androgen deprivation therapy in intermediate-risk disease, and guide treatment intensification in high-risk patients. In the post-radical prostatectomy setting, the GC aids in determining the need for early salvage radiation therapy and hormonal therapy. While retrospective studies support its prognostic value, limitations include heterogeneity in study designs and the lack of established predictive utility for treatment response. Ongoing prospective trials, such as NRG GU-009 and NRG GU-010, aim to validate further the Decipher GC's role in clinical decision-making and treatment personalization.

Background: Magnusiomyces capitatus (M. capitatus) and Magnusiomyces clavatus (M. clavatus) are rare cause of fungemia leading to high mortality rates, particularly in neutropenic patients with hematological malignancies. This research set out to explore the clinical characteristics of patients with hematological malignancies with M. capitatus and M. clavatus fungemia. Methods: Eight patients from whom Magnusiomyces spp. were isolated, from among patients hospitalized at the Atatürk University Hospital between October 2017 and November 2022, were enrolled in this retrospective observational study. The 8 patients' medical data were subjected to analysis. Results: Magnusiomyces capitatus emerged as the pathogen in 5 cases and M. clavatus in 3. The patients' median age was 35.5 years. The most common underlying hematological malignancy was acute leukemia. Neutrophil values of 500 cells/mm3 were detected in all patients during Magnusiomyces spp. isolation, with severe neutropenia at less than 100 cells/mm3 in 5. The mean duration of neutropenia prior to Magnusiomyces spp. isolation was 29 days. Breakthrough fungemia developed in 7 patients using echinocandins, fluconazole, and posaconazole. Liposomal amphotericin B and voriconazole were used for initial treatment. The general mortality rate was 37%. All isolates were resistant to echinocandins. Voriconazole possessed the lowest minimum inhibitory concentration value against all isolates. The survival rate was higher among young patients. Mortality was higher among patients followed up in the intensive care unit. Conclusion: Life-threatening Magnusiomyces spp. can spread among patients with long-term neutropenia under treatment for hematological malignancies. Awareness and prompt initiation of treatment can reduce the risk of mortality in invasive infections caused by Magnusiomyces spp.

Background: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are among the problems affecting public health worldwide. In this study, we aimed to retrospectively examine the results of patients whose hepatitis B (hepatitis B surface antigen (HBsAg), anti-HBs (Hepatitis B surface antibody) and hepatitis C serology were analyzed by family physicians in the provincial center of Erzurum and to investigate the change in seroprevalence by gender, age groups, and years. Methods: The serology results of individuals whose HBV and anti-HCV serology were analyzed by family physicians in Erzurum between 2015-2023 were evaluated retrospectively. Hepatitis B virus and anti-HCV analyses of the patients were performed in the Public Health Microbiology Laboratory using the chemilu minescence enzyme immunoassay method in accordance with the study procedure of the producing company. These records of the patients were obtained from the laboratory automation system with permission obtained from the Health Directorate. Results: Our study's population consisted of 150 862 people. The study determined that HBsAg, anti-HBs, and anti-HCV seropositivity rates were 1.7%, 58.0%, and 0.02%, respectively. The difference between HBsAg and anti-HBs seropositivity results was statistically significant between individuals born before 1998 and those born after 1998. Conclusion: In our study, it is significant that the HBsAg positivity rate tends to decrease, and anti-HBs sero- positivity has been observed at higher rates in recent years. The rate of anti-HCV seropositivity was found to be lower compared to other studies conducted in our region.

Background: Although extensive research highlights the detrimental effect of cribriform pattern 4 (CP4) on survival in non-high-risk prostate cancer (PC), its prognostic significance in high-risk PC is not well understood. Methods: The individual patient data from the The Cancer Genome Atlas (TCGA) database following radical prostatectomy was retrospectively examined. A predefined statistical analysis was conducted to evaluate the potential association between CP4 and progression-free survival (PFS). Results: Of the 135 patients examined, CP4 was present in 66 (48.9%). Median follow-up was 45.93 months (interquartile range: 22.87, 80.10). Cribriform pattern 4 was associated with a significantly reduced PFS (subdistribution hazard ratio, 1.99; 95% CI, 1.01-3.92; P=.045) following adjustment for covariates. Conclusions: The presence of CP4 in high-risk Gleason 8-10 PC portends worse PFS. Further studies are warranted to fully understand its implications in risk stratification and post-operative management of PC.

Objective: Diabetic retinopathy (DR), considered one of the most common microvascular complications associated with diabetes mellitus (DM), involves both neuronal and vascular dysfunctions in the retina. Neuronal damage and vision loss occur progressively in patients with DR. A number of genetic targets have been identified for DR and gene-related treatments as well as early diagnostic techniques have been developed. Despite some medical advances, DR remains a devastating complication of diabetes. This study aimed to identify new gene targets that can be used for the prognosis and treatment of DR.. Materials and Methods: Eight candidate genes were analyzed using Synergy Brands Green (SYBR-green)- based real-time polymerase chain reaction in peripheral blood mononuclear cells (PBMCs) from 45 individuals: DR patients (n=15), DM patients without DR (n=15), and healthy controls (n=15). STRING v11 was used for protein-protein interaction analysis. Gene expression differences were evaluated using ANOVA, with significance set at P < .05. Results: HIF1A and VEGFA were significantly upregulated in both DR and DM groups compared to controls (HIF1A: fold change 5.28; VEGFA: fold change 5.20 for DR group). SERPING1 was specifically upregulated in DR patients (fold change 3.42). CX3CR1 and BDNF were downregulated in both DR and DM groups (CX3CR1: fold change 8.32; BDNF: fold change 3.21), while IGFBP3 was significantly downregulated only in DR patients (fold change 6.5). STRING analysis revealed strong interactions between SERPING1 and complement pathway components, while IGFBP3 was linked to insulin-like growth factor signaling. Conclusion: In light of these findings, we observed that SERPING1 and IGFBP3 genes might be proposed as targets for early diagnosis and treatment for DR.