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This study examines the prognostic significance of tumor necrosis and dirty necrosis in gastric cancer. Tumor necrosis, often linked to rapid tumor growth and insufficient vascularization, is a known poor prognostic indicator in several cancer types. Dirty necrosis, a special form seen with neutrophils and necrotic debris, has prognostic value in cancers like colorectal carcinoma and renal cell carcinoma. The presence of tumor-associated neutrophils (TANs) and NETosis, a process where neutrophils release extracellular traps, also plays a role in tumor progression and prognosis. This study included 187 gastric cancer patients who underwent surgery at Eskisehir Osmangazi University. Dirty necrosis was present in 39.6% of cases, with significant associations found between dirty necrosis and tumor type, grade, lymph node stage, and TIL presence. The study demonstrated that dirty necrosis correlated with longer recurrence-free survival and overall survival. Additionally, patients with dirty necrosis and prominent TILs exhibited improved survival outcomes. The findings suggest that dirty necrosis, particularly when associated with TIL, may indicate a better prognosis in gastric cancer. This study highlights the importance of re-evaluating necrosis types in gastric cancer prognosis and treatment strategies.

Background Streptococcus pneumoniae infections continue to pose significant health risks, particularly in adults with underlying conditions. This study assesses both demographic and clinical profiles of adult patients with invasive and non-invasive pneumococcal diseases, focusing on their vaccination status and outcomes. Methods We retrospectively analyzed clinical data from 217 adults diagnosed with pneumococcal infections at Eskişehir Osmangazi University Faculty of Medicine, a tertiary-care university hospital in Eskişehir, Türkiye, from January 2016 to November 2023. Cases meeting specific clinical and microbiological criteria were included. Logistic regression was utilized to identify key predictors of mortality. Results Of the 217 patients initially screened, 155 were included in the final analysis, comprising 75 cases of invasive and 80 cases of non-invasive disease. Notably, among those recommended for pneumococcal vaccination, only 20.6% were vaccinated, and strikingly, only 9% were vaccinated before infection. Significant correlations were observed between mortality and various factors, including age, comorbidities, bacteremia, invasive disease, and intensive care unit admissions. Mortality occurred in 39 (25.2%) of the patients, with notably higher risks among those with comorbidities and requiring intensive care. Conclusion Pneumococcal infections continue to impose a significant health burden, particularly among older adults and those with pre-existing conditions. Our findings highlight the critical role of comorbidities and intensive care unit admissions in affecting patient outcomes, stressing the importance of timely interventions and enhanced health strategies to improve vaccination rates and overall outcomes in high-risk populations.

Objectives: Age-related macular degeneration (AMD) is the most common cause of central vision loss in individuals aged 65 years and older in developed countries. Earlier imaging systems did not enable visualization of the peripheral retina in diseases affecting the macula. With the introduction of new-generation devices, the peripheral retina is easily visualized. In our study, we aimed to evaluate the incidence of peripheral retinal changes in the color and autofluorescence fundus images of patients with AMD. Materials and Methods: In the study group, 550 eyes of 277 patients who were diagnosed with AMD and 90 eyes of 45 healthy patients in the control group were evaluated. An ultra-wide-angle imaging device was used to record standard 200° color and autofluorescence fovea-centered fundus images followed by superior and inferior fundus images obtained using the device’s fixation light. The fundus images were examined in 3 sections: zone 1, zone 2, and zone 3. Results: Evaluation of color fundus images revealed peripheral retinal changes in 67.8% of the 550 AMD eyes and 47.8% of the healthy eyes. Drusen was the most common peripheral retinal change. Evaluation of autofluorescence images revealed peripheral autofluorescence changes in 39.6% of the AMD eyes and 28.9% of the healthy eyes. Hypoautofluorescence was the most common autofluorescence change. Conclusion: Peripheral retinal changes were more common in AMD patients than the control group, indicating that AMD is not only a macular disease, but can affect the entire retina. Future prospective studies will elucidate the relationship between these peripheral retinal changes and patients’ genetic features and their importance in prognosis, diagnosis, and treatment.

Background Although more than a year past since COVID-19 was defined, there is no specific treatment yet. Since COVID-19 management differs over time, it is hard to determine which therapy is more efficacious. In this study, we aimed to evaluate the efficacy of the regimen with Favipiravir (FPV) and determine if the timing of FPV addition offers any improvement. Methods A retrospective observational case-controlled cohort study was performed between March and September 2020, including adults with COVID-19 in a single-center in Turkey. We categorized patients into age-sex matched three groups, group 1 (n = 48) and group 2 (n = 48) included patients treated with the combination of FPV plus Hydroxychloroquine (HQ) early and late, respectively. Group 3 (n = 48) consisted of patients on HQ monotherapy. In Group 2, if the respiratory or clinic condition had not improved sufficiently, FPV was added on or after day 3. Results We found that starting FPV early had an impact on PCR negativity and the progression of the disease. 'No progression' was defined as the absence of a new finding in the control radiological examination and the absence of accompanying clinical deterioration. Also, the decrease in C-reactive protein (CRP) was greater in Group 1 than Group 3 ( p  < 0.001). However, we found that early initiation of FPV treatment did not have a positive effect on the estimated survival time. Conclusions According to this retrospective study results, we believe that for better clinical outcomes, FPV treatment should be started promptly to enhance antiviral effects and improve clinical outcomes.

Psoriasis and seborrheic dermatitis are both chronic erythemato-squamous dermatoses that can involve the scalp. It may be difficult to differentiate these two diseases when there is isolated scalp involvement. Recently, trichoscopy is commonly used to differentiate noncicatricial alopecias including psoriasis and seborrheic dermatitis that can lead to telogen effluvium (TE). The objective of this study is to evaluate the trichoscopic figures that may help to differentiate scalp psoriasis and seborrheic dermatitis. Thirty one with scalp psoriasis and 112 patients with seborrheic dermatitis were enrolled. Trichoscopic examinations were performed using a videodermatoscope (MoleMax 3(®)). Trichoscopic findings of scalp psoriasis and seborrheic dermatitis were compared with each other, with 100 healthy individuals and with other noncicatricial alopecias including female androgenetic alopecia (FAGA) (n: 138), male androgenetic alopecia (n: 63), FAGA of male pattern (FAGA.M) (n: 5), alopecia areata (39), TE (n: 22) and trichotillomania (n: 4). Atypical red vessels, red dots and globules (RDG), signet ring vessels (SRV), structureless red areas and hidden hairs (HH) were statistically more common in psoriasis while twisted red loops and comma vessels (CV) in seborrheic dermatitis. RDG were considered as the characteristic videodermatoscopic figure for psoriasis and arborizing red lines and CV for seborrheic dermatitis. In comparison with previous reports, our study yielded two new trichoscopic structures supporting the diagnosis of psoriasis; HH and SRV. Besides, according to our study, CV were described for the first time in seborrheic dermatitis and considered to be specific for seborrheic dermatitis. This study confirmed that trichoscopy might be useful in differentiating scalp psoriasis and seborrheic dermatitis from each other and from other noncicatricial alopecia with three trichoscopic structures as HH, SRV and CV.

Bloodstream infections (BSIs) in non-intensive care unit (ICU) wards are common yet less well characterized than ICU BSIs. Differences in monitoring intensity, diagnostic timelines, empirical therapy, and local resistance may shape outcomes, but pathogen-specific data in non-ICU settings remain limited. To address this gap, we provide regional data from Türkiye. We conducted a retrospective cohort study at a tertiary-care center in Türkiye, including 537 adult non-ICU inpatients with first monomicrobial BSI episodes between January 2020 and November 2023. Pathogens were grouped as Gram-negative, Gram-positive, or fungal. Demographic, clinical, microbiological, and outcome data were analyzed. Independent predictors of mortality were evaluated using multivariable logistic regression. Among 537 patients (mean age 66.4 ± 16.4 years), Gram-negative pathogens predominated (65.0%), followed by Gram-positive (25.0%) and fungal pathogens (10.1%). The most frequent microorganisms were (27.7%), spp. (20.7%; including clinically significant resistance), and (16.9%). Overall, 12.5% required ICU transfer, and in-hospital mortality was 23.3%, higher in fungal infections (46.3%) than bacterial infections (p<0.001). Fungal BSIs were associated with delayed initiation of appropriate therapy. In adjusted analyses, higher Charlson Comorbidity Index (OR 1.20; p<0.001), fungal pathogens (OR 2.41; p=0.026), ICU transfer (OR 24.66; p<0.001), and longer time from admission to infection onset (OR 1.03; p=0.003) were independently associated with mortality. In non-ICU settings, early recognition, rapid organism identification, and tailored antimicrobial/antifungal stewardship are essential-particularly given local resistance pressures (eg, carbapenem-resistant ) and the elevated risk with candidemia. Implementing pathways that expedite diagnosis and timely appropriate therapy may improve patient outcomes.

Background: Studies have reported the presence of sleep disorders in approximately 50-70% of diabetic patients, and these may contribute to poor glycemic control, diabetic neuropathy, and overnight hypoglycemia. The aim of this study was to determine the frequency of sleep disorders in diabetic patients, and to investigate possible relationships between scores of these sleep disorders and obstructive sleep apnea syndrome (OSAS) and diabetic parameters (fasting blood glucose, glycated hemoglobin A1c [HbA1c], and lipid levels). Methods: We used the Berlin questionnaire (BQ) for OSAS, the Epworth Sleepiness Scale (ESS), and the Pittsburgh Sleep Quality Index (PSQI) to determine the frequency of sleep disorders and their possible relationships with fasting blood glucose, HbA1c, and lipid levels. Results: The study included 585 type 2 diabetic patients admitted to family medicine clinics between October and December 2014. Sleep, sleep quality, and sleep scores were used as the dependent variables in the analysis. The ESS scores showed that 54.40% of patients experienced excessive daytime sleepiness, and according to the PSQI, 64.30% experienced poor-quality sleep. The BQ results indicated that 50.20% of patients were at high-risk of OSAS. HbA1c levels correlated significantly with the ESS and PSQI results (r = 0.23, P < 0.001 and r = 0.14, P = 0.001, respectively), and were significantly higher in those with high-risk of OSAS as defined by the BQ (P < 0.001). These results showed that HbA1c levels were related to sleep disorders. Conclusions: Sleep disorders are common in diabetic patients and negatively affect the control of diabetes. Conversely, poor diabetes control is an important factor disturbing sleep quality. Addressing sleep disturbances in patients who have difficulty controlling their blood glucose has dual benefits: Preventing diabetic complications caused by sleep disturbance and improving diabetes control.

[LANGUAGE=”English”]Background and Design: Alopecia areata (AA) is a common, chronic, autoimmune disease that causes psychological effects on patients. Distress and psychological factors play roles in the onset and flares of the disease. We aimed to evaluate the relationship between neurotrophins (NT) and psychological distress in AA patients.Materials and Methods: The study included 50 AA patients and 50 healthy volunteers as a control group. The Distress Tolerance Scale (DTS) and the Depression Anxiety Stress Scale-21 (DASS-21) were used in the evaluation of psychological distress. Serum levels of NTs [brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), neurotrophin-3 (NT-3), and neurotrophin-4 (NT-4)] were measured.Results: Scores of DASS-21 were found to be higher, and scores of DTS were found to be lower in AA patients. Serum BDNF and NT-3 levels did not differ significantly between groups. While the serum NGF level was significantly higher, the NT-4 level was significantly lower in the AA group than in the control group. In the AA group, a similar significant relationship was found between BDNF and stress subscale scores; in the control group, no significant correlation was found between serum NT levels and DASS-21 and DTS scores.Conclusion: Our study supports the relationship between AA, psychological factors, and NTs. More studies are needed to investigate the relationship between AA and stress neuroimmunology to understand better the common pathophysiology of AA, stress, and various psychiatric diseases.[LANGUAGE=”Turkish”]Amaç: Alopesi areata (AA), hastalar üzerinde psikolojik etkileri olan, sık görülen, kronik, otoimmün bir hastalıktır. Hastalığın ortaya çıkmasında ve alevlenmesinde sıkıntı ve psikolojik faktörler rol oynamaktadır. Çalışmamızda AA hastalarında nörotrofinler (NT) ile psikolojik distres arasındaki ilişkiyi değerlendirmeyi amaçladık.Gereç ve Yöntem: Çalışmaya 50 AA hastası ve kontrol grubu olarak 50 sağlıklı gönüllü dahil edildi. Psikolojik distresin değerlendirilmesinde Sıkıntıya Dayanma Ölçeği (SDÖ) ve Depresyon Anksiyete Stres Ölçeği-21 (DASS-21) kullanıldı. Serum NT düzeyleri [beyin kaynaklı nörotrofik faktör (BDNF), sinir büyüme faktörü (NGF), nörotrofin-3 (NT-3) ve nörotrofin-4 (NT-4)] ölçüldü.Bulgular: AA hastalarında DASS-21 puanları daha yüksek, DTS puanları ise daha düşük bulundu. Serum BDNF ve NT-3 düzeyleri gruplar arasında anlamlı farklılık göstermedi. AA grubunda kontrol grubuna göre, serum NGF düzeyi anlamlı olarak yüksek bulunurken, NT-4 düzeyi anlamlı olarak düşük bulundu. AA grubunda BDNF ile stres alt ölçeği puanları arasında da aynı yönde anlamlı ilişki bulundu; kontrol grubunda ise serum NT düzeyleri ile DASS-21 ve SDÖ skorları arasında anlamlı bir korelasyon saptanmadı.Sonuç: Çalışmamız AA ile psikolojik faktörler ve NT’ler arasındaki ilişkiyi desteklemektedir. AA, stres ve çeşitli psikiyatrik hastalıkların ortak patofizyolojisini daha iyi anlamak için AA ile stres nöroimmünolojisi arasındaki ilişkiyi araştıran daha fazla çalışmaya ihtiyaç vardır.

PurposeTo identify the effect of corneal geometrical and biomechanical parameters on the intraocular pressure (IOP) measurements obtained by Goldmann Applanation Tonometer (GAT), non-contact tonometer, iCare Pro Rebound Tonometer (IRT), Tonopen and Ocular Response Analyzer (ORA, Goldmann-correlated IOP: IOPg, corneal compensated IOP: IOPcc).MethodsWe prospectively recruited patients with a tomographically confirmed diagnosis of keratoconus. IOP measurements were performed in the following order: non-contact tonometry, ORA, IRT, GAT and Tonopen. The means of the three IOP measurements were used for the analysis. Correlation analyses were performed to assess the association between tonometer readings and the corneal geometrical and biomechanical parameters including ORA waveform parameters. Tonometer variability was assessed using a stepwise linear regression analysis.ResultsFifty-one patients with keratoconus (27 females, mean age 30.8 ± 8.7 years) were evaluated. The highest mean IOP was measured by IOPcc (14.6 ± 2.3 mmHg) followed by IRT IOP (13.0 ± 3.2 mmHg), Tonopen IOP 12.0 ± 2.6 mmHg), GAT IOP (11.7 ± 3.1 mmHg), NCT IOP (10.2 ± 3.2 mmHg) and IOPg (10.2 ± 3.6 mmHg). NCT and IOPg were affected from all corneal parameters including thickness, curvature and biomechanical parameters. While GAT and IRT had significant correlations with corneal resistance factor (CRF) and corneal hysteresis, IOPcc only had a significant correlation with CRF. None of the corneal factors had any statistically significant correlation with Tonopen. CRF predicted tonometer measurement variability in 7 of the 15 inter-device variability assessments.ConclusionTonopen was the least affected from the corneal parameters followed by IOPcc and GAT. CRF was a strong determinant of tonometer variability.

Objective: Computerized tomography remains the gold standard imaging in renal colic patients. In this study, we develop a scoring system to select patients in emergency department for unnecessary computerized tomography imaging in order to decrease radiation exposure. Methods: Computerized tomography imaging of patients with renal colic in emergency department were retrospectively reviewed. Symptoms, laboratory results were recorded. Significant parameters were determined by univariate and multivariate analysis. Coefficients were found to obtain score points and receiver operating curve was used to find a cut-off value. Results: A total of 123 patients with a mean age of 42 years (18-75 years) were enrolled in the study. About, 20.3% of patients were stone-free in computerized tomography. Mean stone size was 6.1 +- 1.89 mm. According to analysis, four parameters were significant; nausea, stone history, creatinine, and hematuria with a total score 9 called as Osmangazi University STONE score. Cut-off value was found as > 3, which computerized tomography imaging is recommended. Conclusion: Osmangazi University STONE score is useful and simple tool in emergency department to reduce unnecessary computerized tomography imaging in renal colic patients and also lowers cost and ionizing radiation exposure.