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Objectives: This study aimed to develop and validate a sensitive and reliable liquid chromatography–tandem mass spectrometry (LC-MS/MS) method for the quantification of flualprazolam and isotonitazene in serum samples to address critical gaps in forensic and clinical toxicology. Materials and Methods: A single-center validation study was conducted using serum samples spiked with analyte standards. Analytical parameters, including linearity, precision, recovery, the limit of detection (LOD), and the limit of quantification (LOQ), were evaluated in accordance with international guidelines. The LC-MS/MS method employed a Shimadzu Triple Quadrupole™ MS 8045 system with solid-phase extraction (SPE) for sample preparation. Results: The method exhibited high linearity for flualprazolam (r2 = 0.997) and isotonitazene (r2 = 0.999) over a concentration range of 1–100 ng/mL. The LODs were determined as 0.608 ng/mL and 0.192 ng/mL, and the LOQs were 1.842 ng/mL and 0.584 ng/mL for flualprazolam and isotonitazene, respectively. Recovery tests yielded results within the acceptable range of 70–120%. Flualprazolam demonstrated recovery rates of 98.0% and 97.0% at theoretical concentrations of 10 ng/mL and 50 ng/mL, respectively. In contrast, the isotonitazene recovery rates were slightly lower, measuring 75.5% at 10 ng/mL and 71.9% at 50 ng/mL, suggesting minor matrix effects that could influence its quantification. Precision analysis, including both repeatability and reproducibility, highlighted the reliability of the method. The %RSD values for flualprazolam were consistently below 7.07%, with mean concentrations closely aligning with theoretical values across fortification levels. For isotonitazene, the %RSD values remained below 6.24%, although recoveries at higher concentrations indicated potential challenges in matrix interaction. Conclusions: This validated LC-MS/MS method offers high sensitivity, precision, and recovery for detecting flualprazolam and isotonitazene in serum, filling a critical need in toxicological investigations. Further validation in other biological matrices is recommended to broaden its applicability.

Objectives: This study aimed to evaluate the efficacy and reliability of LC-MS/MS and biochip-based screening in detecting narcotics from blood and urine samples. Materials and Methods: In this single-center study, a total of 250 subjects provided urine and/or blood samples: 234 provided urine and blood samples, and 16 provided only blood samples. Biochip-based narcotics screening was performed on 234 urine and 16 blood samples, and all samples were analyzed using tandem liquid chromatography-mass spectrometry (LC-MS/MS). Results: The two most prevalent narcotics were methamphetamine and amphetamine, with both biochip-based array and LC-MS/MS. Cohen’s kappa correlation indicated a substantial agreement between LC-MS/MS and biochip-based screening for both methamphetamine (κ = 0.661, p <0.001) and amphetamine (κ = 0.663, p < 0.001). LC-MS/MS demonstrated near-perfect agreement between urine and blood samples for both methamphetamine (κ = 0.855, p <0.001) and amphetamine (κ = 0.881, p < 0.001). Conclusions: Biochip-based arrays are a valid method offering a faster, less material-intensive alternative to LC-MS/MS for substance detection in forensic examination.

The relationship between patients and physicians has maintained its importance throughout human history because of special features of the medical profession. This relationship engendered true loyalty of patients to their physicians as well as serious legal conflicts. Medical malpractice has gained importance among physicians and ignited discussion because of new articles added to the Turkish Penal Code in 2005. In a very short time, the penalties mandated had a chilling, negative effect on doctors, resulting in loss of affection for the profession, hesitation to intervene, and burnout syndrome. Cardiologists work in an environment where the line between life and death is very thin. The aim of the present study was to raise awareness and avoid possible grievances by informing them of their responsibilities under the law.

Aim: This study aimed to analyze the judicial reports prepared in emergency services and to emphasize the importance of forensic medicine education for the physicians working at these services and the reflection of the situation to the judicial authorities. Materials and Methods: Reports prepared by Forensic Medicine Department of Gaziantep University Medical Faculty were accepted as the gold standard and the judicial reports of the same patients prepared in emergency services were compared retrospectively. Results: Most reports were found to be prepared as temporary reports. The concepts of general condition, consciousness, life-threatening clinical status and simple medical interventions were frequently mentioned, while other concepts were not mentioned. The success rate of identifying cases with and without life-threatening clinical status in emergency services was 83.49% and 85.52%, respectively. The success rate of identifying cases that could and could not be treated with simple medical intervention was 84.20% and 58.62%, respectively. Conclusion: It has been determined that the problems in both mentioning basic concepts and accurate report writing cannot be solved in the judicial reports organized in emergency departments. In order to protect themselves, physicians have a tendency to report the consequences more severe than they actually are. However, it should be kept in mind that this tendency may not protect the physician, but also may cause additional legal problems.

Syrian people are the largest refugee population globally and are mainly hosted by the Turkish government. Due to the conflict-driven displacement and their insecure immigration status, many have limited access to basic human needs and develop further mental health issues due to forced displacement. The study aims to identify reasons for forensic evaluation in specific age groups and gender among Syrian refugees. For this descriptive study, the demographic and case information of 781 Syrian refugees, consisting of 74.6 % males and 25.4 % females who are referred to the Forensic Medicine Clinics due to five main reasons: psychoactive drug testing, age estimation, DNA analysis, injury assessment, and forensic-psychiatric evaluation were included. The patient information is collected from the patient files. The nominal data were categorized by gender and under 4 different age groups: pediatric (age 0–14), adolescent (age 15–24), young adult (age 25–34), and adult (age 35 and older). Drug tests were the most prevalent reason in males older than 14 years old (79.7 %), and age estimation, due to early marriages for the female refugees (53.3 %). DNA testing was the primary reason for female adults. The majority of the refugees’ injuries were untreatable with simple medical treatment (SMT) (89.2 % males, 58.8 % females). Pediatric injury assessments demonstrated head injuries (33.3 %), not treatable with SMT (100 %), and 33.3 % of those cases were life-threatening. Identifying vulnerable individuals among the Syrian refugee population based on demographics, gender, and age will further promote more effective approaches to improve the interventions. •There are gender-based differences in the reason for referrals of Syrian refugees.•The major reason for the referral of male refugees is psychoactive drug tests.•53.3 % of female refugees underwent age estimation due to early marriage suspicion.•Adult female refugees are mainly referred to examine family bonds via DNA tests.

Background Age ≥ 65 years is regarded as a relative contraindication for bariatric surgery. Advanced age is also a recognised risk factor for adverse outcomes with Coronavirus Disease-2019 (COVID-19) which continues to wreak havoc on global populations. This study aimed to assess the safety of bariatric surgery (BS) in this particular age group during the COVID-19 pandemic in comparison with the younger cohort. Methods We conducted a prospective international study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into two groups — patients ≥ 65-years-old (Group I) and patients < 65-years-old (Group II). The two groups were compared for 30-day morbidity and mortality. Results There were 149 patients in Group 1 and 6923 patients in Group II. The mean age, preoperative weight, and BMI were 67.6 ± 2.5 years, 119.5 ± 24.5 kg, and 43 ± 7 in Group I and 39.8 ± 11.3 years, 117.7±20.4 kg, and 43.7 ± 7 in Group II, respectively. Approximately, 95% of patients in Group 1 had at least one co-morbidity compared to 68% of patients in Group 2 ( p = < 0.001). The 30-day morbidity was significantly higher in Group I (11.4%) compared to Group II (6.6%) ( p = 0.022). However, the 30-day mortality and COVID-19 infection rates were not significantly different between the two groups. Conclusions Bariatric surgery during the COVID-19 pandemic is associated with a higher complication rate in those ≥ 65 years of age compared to those < 65 years old. However, the mortality and postoperative COVID-19 infection rates are not significantly different between the two groups. Graphical abstract

Purpose Acromegaly is a chronic endocrine disorder characterized by prolonged exposure to excess growth hormone (GH) and insulin-like growth factor-1 (IGF-1), leading to systemic connective tissue remodeling. Although corneal and choroidal structural changes have been extensively reported, scleral alterations remain poorly understood. This prospective case–control study aimed to quantitatively assess anterior scleral thickness (ST) across multiple meridians in patients with acromegaly compared with healthy controls using anterior segment optical coherence tomography (AS-OCT). Methods Fifty-five eyes were examined 22 from patients with confirmed acromegaly and 33 from age- and sex-matched healthy controls. Baseline ocular characteristics, including axial length (optical biometry) and refractive status (manifest refraction; spherical equivalent = sphere + ½ cylinder), were recorded for all participants.Scleral thickness was measured at eight meridians (inferior, superior, temporal, nasal, inferotemporal, inferonasal, superotemporal, superonasal) using standardized AS-OCT imaging. Between-group differences were analyzed using the Mann–Whitney U test, and effect sizes were expressed as Cohen’s d . Results Across all meridians, acromegaly patients demonstrated significantly thicker sclera compared with controls: inferior (673.2 ± 51.6 μm vs. 636.9 ± 33.1 μm, p  = 0.024, d  = 0.87), superior (650.7 ± 31.3 μm vs. 613.0 ± 31.3 μm, p  = 5.6 × 10⁻⁵, d  = 1.20), temporal (674.2 ± 35.8 μm vs. 620.6 ± 42.4 μm, p  = 5.0 × 10⁻⁶, d  = 1.34), and nasal (694.1 ± 53.5 μm vs. 637.2 ± 59.5 μm, p  = 0.0016, d  = 0.99). Oblique meridians showed parallel trends. Axial length was higher in the acromegaly group, while spherical equivalent did not differ significantly between groups. Conclusions Anterior sclera is significantly thickened in acromegaly, consistent with GH/IGF-1–driven extracellular matrix expansion. These findings extend the ocular phenotype of acromegaly beyond corneal and choroidal changes, highlighting the need to consider scleral biomechanics in ocular and systemic disease evaluation.

Objectives Malassezia species are common, clinically relevant, and lipid‐dependent yeasts of humans. They are also the leading causes of the dandruff problem of humans, and the azoles are used primarily in their topical and systemic treatment. Resistance to azoles is an emerging problem among Malassezia sp., which indicates the need of new drug assessments that will be effective against dandruff and limit the use of azoles and other agents in treatment. Among them, the efficacy of various combinations of piroctone olamine and climbazole against Malassezia sp. is highly important. Here, we assessed the efficacies of various piroctone olamine and climbazole formulations against Malassezia sp. in comparison with ketoconazole. Methods A total of nine formulations were included in the study, where each formulation was prepared from different concentrations of piroctone olamine and climbazole and both. All formulations contained the same ingredients as water, surfactants, hair conditioning agents, and preservatives. Malassezia furfur CBS1878, Malassezia globosa CBS7874, and Malassezia sympodialis CBS9570 were tested for antifungal susceptibility of each formulation by agar diffusion method. Sizes of the inhibition zones were compared with standard medical shampoo containing 2% ketoconazole, and the data were analyzed by Dunnett's multiple‐comparison test. Results For all Malassezia sp. strains, climbazole 0.5% and piroctone olamine/climbazole (0.1%/0.1% and 0.1%/0.5%) combinations were found to have the same effect as the medical shampoo containing 2% ketoconazole. Piroctone olamine/climbazole 1.0%/0.1% formulation showed the same efficacy as 2% ketoconazole on M. furfur and M. sympodialis, while 0.1%/0.5% formulation to only M. furfur. For M. globosa, none of the formulations tested were as effective as ketoconazole. Conclusion The species distribution of Malassezia sp. varies depending on the anatomical location on the host. According to the results of this study, climbazole and piroctone olamine combinations seem to be promising options against the dandruff problem with their high antifungal/anti dandruff efficacy.

Incidence of cancer is increasing in the developing countries such as Turkey. Screenings are important part of preventive medicine practices which can reduce deaths due to cancer. Our aim was to identify patient’s awareness and knowledge level of cancers and screenings and to create a road map of what we need to do to increase screening rates. This study was a descriptive type, and the research population was the patients between the age of 30 and 75, who went to 18 different Family Health Centres in different places in Turkey for any reason in July–September 2016. The survey was completed by face-to-face interview and consisted of 20 questions about the socio-demographic attributes, level of cancer and cancer screenings knowledge, causes of screening, and reasons for not doing. Screening rates was self-reported by patients. A total of 643 patients, 394 women (61.3%) and 249 men (38.7%), participated in the study. The average age was 45.67 ± 11.49. The most well-known cancer type was breast cancer (79%). Having no screening was high in general population (64.7%). Having a screening was statistically significantly higher in women, over 50 year olds group, divorced/widower group, housewives, primary school graduates, the group who have green-card (having very low or no income) as social security, and in the group who have a history of family member with cancer. 55.8% of patients received the information about screenings from healthcare professionals. The reasons for not having a screening were “not seeing themselves as under risk” (27.4%), not having knowledge (22.8%), and fear of the results (15%). First of all, the importance of cancer screening as an important part of the preventive health services should be understood by family doctors through in-service training. Then family doctors would share the information and experience, clear the lack of knowledge of them and by doing this rates of screening would increase.

Suicide is a major cause of morbidity and mortality in adolescents and is increasingly recognized among younger children. Pediatric emergency departments (EDs) are critical points for the identification and management of suicide attempts. This study aimed to evaluate the demographic and clinical characteristics, methods, and temporal trends of suicide attempts among children and adolescents presenting to pediatric EDs in Türkiye. We conducted a retrospective, multicenter study across 29 pediatric EDs from July 1, 2017, to June 30, 2022. Patients aged 8–18 years with a confirmed suicide attempt were included. Data collected included demographics, methods, psychiatric history, prior attempts, medications used in self-poisoning, psychiatric consultations, and outcomes. Statistical analyses included chi-square and Mann–Whitney U tests. During the study period, 6004 suicide attempt presentations were identified among 9,736,825 ED visits (0.5/1000). The median age was 15 years (IQR: 14–16), with 78.8% female (female-to-male ratio 3.7:1). Most patients (92.9%) were aged 13–18 years. Self-poisoning was the predominant method (95.4%), commonly involving NSAIDs, paracetamol, SSRIs, and atypical antipsychotics; 23.5% ingested their own medications, 76.2% of which were psychotropics. A known psychiatric disorder was present in 36.4%, and 16.4% had a prior suicide attempt. Psychiatric consultation was obtained in 73% of cases. Hospitalization occurred in 89.8%, with 15.5% requiring intensive care. Eleven deaths were recorded. Suicide attempts among children and adolescents are a significant and ongoing public health problem in Türkiye, with self-poisoning as the dominant method. The findings underscore the need for targeted prevention strategies, safe medication storage, and strengthened psychiatric services in pediatric EDs to improve outcomes for this high-risk population.