Eurasian Journal of Medicine最新文献

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.

Objective: Sarcopenia, the gradual decline in skeletal muscle mass (SMM), strength, and functionality, has negative health consequences such as premature death and disability. It is prevalent in chronic lung disease (CLD). Timely recognition of sarcopenia is required for focused therapy. This study sought to analyze the rate of sarcopenia in patients with CLD and to assess the diagnostic accuracy of the sarcopenia screening tests: the SARC-F, SARC-CalF, and Ishii tests. Materials and Methods: This study comprised individuals diagnosed with CLD and referred for pulmonary rehabilitation. Sarcopenia was evaluated based on the European Working Group on Sarcopenia in Older People criteria (EWGSOP and EWGSOP2), utilizing handgrip strength, SMM index, and gait speed. The diagnostic accuracy of screening tests (SARC-F, SARC-CalF, and Ishii) was assessed by sensitivity, specificity, and the area under the curve (AUC) in the Receiver Ooperating Ccharacteristics. Results: A total of 227 patients, with a mean age of 59.00 ± 13.98 years, of whom 50.7% had chronic obstructive pulmonary disease (COPD), were included. The rate of probable sarcopenia was 41.2%, confirmed sarcopenia 2.5%, and severe sarcopenia 0.5%. The Ishii test exhibited the highest sensitivity (71.59%) and specificity (90.48%) for probable sarcopenia (AUC: 0.810); it also showed 100% sensitivity and substantial specificity (78.57%, AUC: 0.893) for confirmed sarcopenia. Conclusion: Sarcopenia is highly prevalent in CLD patients, underscoring the need for routine screening. Among the screening tools, the Ishii test exhibited the highest diagnostic accuracy, making it a valuable tool for early detection. Routine assessment and targeted interventions for sarcopenia could improve functional outcomes in CLD patients.

Background: Major bleeding is a common and severe complication associated with vitamin K antagonist use. Rapid reversal of anticoagulation is crucial in cases of acute bleeding. Prothrombin complex concentrates (PCC) have emerged as an effective option. This study examines the efficacy of 4-factor PCC (4F-PCC) alone and in combination with vitamin K for International Normalized Ratio (INR) control in patients with life-threatening bleeding due to warfarin. Methods: This retrospective cross-sectional study included 50 patients who presented with bleeding and coagulopathy to the Ondokuz Mayıs University Health Practice and Research Center Adult Emergency Department between January 1, 2022, and January 1, 2023. Patients were divided into 2 groups based on vitamin K administration within 24 hours: group 1 received only 4F-PCC, while group 2 received both 4F-PCC and vitamin K. Results: The median age of patients was 72 years, 56% were male. The most common indication for warfarin use was heart valve disease (54%). Gastrointestinal hemorrhage was the leading cause of bleeding (44%). Mortality was 26%, with all deaths occurring within 72 hours of admission. Group 2 had significantly lower INR levels at 24th-hour than group 1 (P=.048). No significant differences were found in INR levels between the 1st and 24th hours within either group (P > .05). Conclusion: The study demonstrates that the combination of 4F-PCC and vitamin K is more effective in controlling INR than 4F-PCC alone, though it does not significantly impact rebound INR increases. Further prospective, multicenter studies are needed to confirm these findings and explore long-term outcomes.

Background: Tea ranks among the most popular beverages globally. In this study, we assessed the short-term changes in ocular biometric and specular microscopic parameters in healthy subjects following the consumption of different types of tea. Methods: A total of 144 subjects were randomly assigned to 3 groups (black, green, and white tea groups) in this study. Ocular parameters, including axial length (AL), aqueous depth (AD), lens thickness (LT), and central corneal thickness (CCT), were measured using optic biometry. Endothelial cell density (ECD), coefficient of variation (CV), number of hexagonal cells (A6A), and average cell area (AVG) were evaluated using non-contact specular microscopy before, as well as 1 hour and 4 hours after, consuming a cup of tea (containing 60 mg of caffeine per 100 mL). Results: The average age of the subjects was 32.9 ± 5.9 years. A significant increase in AD values was observed specifically at the 1st hour following the consumption of black, green, or white tea in healthy subjects. Additionally, black and white tea significantly reduced LT in the 1st hour of the study. The differences in AL and CCT values, as well as in specular microscopy parameters, were not significant among all participants after consuming different types of tea. Conclusion: Black, green, and white tea induce a significant increase in AD, particularly observed 1 hour after oral intake. Furthermore, a reduction in LT parameters was observed in the black and white tea groups, respectively.

Alzheimer's disease (AD) remains a formidable challenge, impacting individuals, families, caregivers, and soci- ety. Despite being identified over a century ago, effective drug treatments for AD remain elusive, with numerous clinical trials failing to produce meaningful results. The pathological hallmarks of AD, including the accumulation of beta-amyloid plaques and tau protein tangles, are well-established contributors to cogni- tive decline. However, recent research has raised questions about the efficacy of therapies targeting these abnormalities. Emerging evidence suggests that AD should not be viewed purely as a brain-centered disease but as a systemic condition involving complex interactions between the brain and peripheral organs. While the mechanisms linking peripheral processes and AD pathology remain unclear, studies indicate that these systems may contribute to or be affected by the disease. Recognizing AD as a heterogeneous disorder with systemic implications opens new opportunities for therapeutic innovation. Multimodal therapies targeting both central and peripheral aspects of AD pathology-such as amyloid-beta deposition, neuroinflammation, and systemic dysfunction-hold promise for slowing disease progression. This review aims to critically assess the current understanding of AD pathology, with a particular focus on the peripheral system's involvement and its interplay with the brain. Additionally, it will explore novel therapeutic strategies and emphasize the importance of interdisciplinary collaboration to advance our knowledge and develop effective treatments.

Background: To reveal whether the quality perceptions service expectations of patients and their relatives who come to health institutions for examination and treatment differ according to their demographic structures. Methods: The data collection tool used was the Patient Satisfaction Survey. The sample of the study consisted of 428 patients aged 21 and over 21 years who applied to Atatürk University Faculty of Dentistry for dental examinations between April 1, 2022 and July 31, 2022. The descriptive scanning method, one of the quantitative research methods, was used in the study. Survey analyzes were evaluated using scientific statistical analysis techniques described in the literature, and IBM Statistical Package for the Social Sciences (IBM SPSS Corp.; Armonk, NY, USA) Statistics 20 software was used. Results: Since the normal distribution condition was not met in normality tests, nonparametric tests were performed. Nonparametric tests revealed that patients' perceptions of quality and expectations did not differ according to gender, education, or marital status. On the other hand, patients' perceptions of quality and expectations differed according to age, profession, and monthly income. Conclusion: As a result of the statistical evaluation of the survey results, it was revealed that the quality perception and patient expectations in health institutions and organizations vary according to the demographic structures of the patients such as gender, age, education level, and monthly income.