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This study aimed to determine the relationship between nutritional status and systemic inflammation using four validated nutrition indices-Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score, Prognostic Nutritional Index (PNI), Controlling Nutritional Status (CONUT) score, and Nutritional Risk Index (NRI)-and three immune-inflammation biomarkers-Systemic Immune-Inflammation Index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR)-in healthy adults with varying body mass index (BMI) levels. This retrospective study included 290 clinically healthy adults aged 18-60 years, categorized by BMI. Individuals with chronic diseases, medication use, or morbid obesity (BMI ≥ 40 kg/m ) were excluded. Nutrition scores (HALP, PNI, NRI, CONUT) and systemic immune-inflammation indices (SII, NLR, PLR) were calculated from laboratory data. For the comparisons of SII, PLR, NLR, PNI, HALP, NRI, and CONUT values between groups, age was adjusted for, and an ANCOVA test was performed. Among the systemic immune-inflammation indices, SII and NLR were significantly higher in both the overweight and obesity groups. The CONUT score, a negative indicator of nutritional status, demonstrated positive correlations with SII, NLR, and PLR in the overweight group, and with PLR in the obesity group. Although PNI showed significant inverse correlations with SII, PLR, and NLR in both groups, the mean PNI values remained above 50, indicating overall normal nutritional status in the study population. HALP was inversely correlated with SII, PLR, and NLR in both groups. The HALP score appears to be the most reliable marker, as it reflects the inverse relationship between nutritional status and systemic immune-inflammation indices.

Real-world studies showed varying levels of effectiveness of CoronaVac vaccine against COVID-19 disease. This study aimed to assess the association between the vaccination with CoronaVac and the COVID-19 infections among the health care workers in a university hospital and to determine the vaccine effectiveness against COVID-19 in a period when alpha variant was dominant. This retrospective cohort study was conducted in a university hospital in Istanbul, Turkey employs 4067 health care workers. The follow-up period was defined as starting 14 days after receiving the second dose for fully vaccinated group. Health care workers were censored when have a positive PCR test result or at the end of the study. Unvaccinated health care workers were censored if they receive any COVID-19 vaccine doses. The incidence rate ratio and Cox regression were used to estimate the unadjusted and adjusted effectiveness of the vaccine. Findings: Seventy-one percent of the health care workers were fully vaccinated whereas 29% percent did not receive any doses. The incidence rate of SARS-CoV-2 infection was 133.7 vs 70.7 per 100.000 person-days in the unvaccinated and fully vaccinated groups, respectively. The unadjusted effectiveness against COVID-19 infection was 47% (95% CI 31–59%) whereas adjusted effectiveness was 39% (95% CI 20–64%). Interpretation: This real life study conducted in health care workers demonstrated that the effectiveness of two doses of the CoronaVac vaccine (39%) was lower than that determined in clinical trials. Due to reduce in protection over time or against variants, booster doses may be needed.

Healthcare workers (HCWs) were among the first groups to be vaccinated in Turkey. The data to be obtained by the vaccination of HCWs would guide wide spread vaccination programs. The study included 330 HCWs working at Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty Hospital and vaccinated with inactive CoronaVac (Sinovac Life Sciences, China) SARS-CoV-2 vaccine in two doses (28 days apart). Anti-Spike /RBD IgG levels were measured 14 days after the first dose and 28 days after the second dose. Chemiluminescent microparticle immunoassay (CMIA) (ARCHITECT IgG II Quant test, Abbott, USA), which is 100% compatible with plaque reduction neutralization test (PRNT), was used. Of the participants, 211 (63.9%) were female, 119 (36.1%) were male, and mean age was 39.6 ± 7.7 years. In those without prior COVID-19 history; (n = 255) antibody positivity was detected as 48.2% (95% CI: 42.1–54.3) 14 days after the first dose of vaccine, and 99.2% (95% CI: 98.1–100) at day 28 after the second dose. Antibody titers were significantly lower in patients with hypertension (p = 0.011). In those with prior history of COVID-19 (n = 75); both the antibody positivity rates after the first vaccine (48.2% vs 100%, p = 0.000) and the anti-spike/RBD antibody levels after the second vaccine (with a ≥ 1050 AU/mL titer equivalent to PRNT 1/80 dilution) was significant than infection-naive group (25.9% vs. 54.7%, p = 0.000). Antibody positivity after two doses of vaccination for all study group was 99.4% (95% CI: 98.6–100). Two doses CoronaVac produce effective humoral immunity in HCWs. Antibody response is significantly higher in those with prior history of COVID-19 than infection-naive group. Given no significant benefit of the second dose, a single shot of vaccination may be sufficient for those with prior history of COVID-19. Monitoring humoral and cellular immune responses, considering new variants, is required to validate this approach.

Background Internet addiction; excessive and uncontrolled use of the internet is a global problem that affects different segments of the population at different levels. There are many measurement tools in the literature that assess individuals’ internet addiction. The aim of this study was to analyze the agreement and compare the characteristics and results of the two most commonly used scales developed by Young and Chen to measure internet addiction. Methods This cross-sectional study was conducted between March 2023 and June 2023 among 5th- and 6th-year medical school students. The questionnaire consisted of a section that included questions about the sociodemographic and life characteristics of the students and the Young Internet Addiction Test (IAT) and the Chen Internet Addiction Scale (CIAS-R). Results The prevalence of Internet addiction in 244 medical students was 15% according to the Young IAT with 50 as the cutoff, 56% according to the Young IAT with 30 as the cutoff and 11% according to the CIAS-R. There was moderate agreement (kappa coefficient: 0.50) between the CIAS-R and Young IAT (50); there was slight agreement (kappa coefficient: 0.17) between the CIAS-R and Young IAT (30). In addition, there was no significant difference between the Young IAT (50) and CIAS-R results. There was a significant, strong correlation ( r  = 0.81) between the Young IAT (50) and the CIAS-R. Although there was moderate agreement between the Young IAT (50) and CIAS, the agreement between the Young IAT (30) and CIAS-R was poor. Conclusions This study showed that the Young IAT and CIAS-R, which are most commonly used for determining internet addiction, did not function in as high agreement as expected. We think that the selection of the population to be applied in new scale development studies will contribute to the importance of selecting people with clinical diagnoses and generalizable to the society.

Heat waves are extreme weather and climate events that threaten public health by increasing morbidity and mortality. To reduce the health effects of heat waves, it is necessary to increase the knowledge level of the public, conduct awareness and protection activities and monitor these activity outcomes. The present study aimed to develop and validate a Turkish language scale of heat wave knowledge, awareness, practice and behavior for Turkish nationality. After item generation and creating dimensions, content validity analysis was performed. To evaluate the validity and reliability of the knowledge construct, the difficulty index, discriminant index and Kuder Richardson 20 (KR20) were used. The validity and reliability of the awareness, practice and behavior constructs were evaluated with exploratory and confirmatory factor analyses, and Cronbach’s alpha was used. The 15 items had a good difficulty, discrimination index and KR20 in the knowledge construct. The 14 items were yielded in EFA; 13 items were retained in CFA, and Cronbach’s alpha values of 0.878, 0.768, 0.855, and 0.858 were obtained for total items, practice, awareness and behavior, respectively. Eventually, a Turkish language scale was developed that is reliable and valid for assessing heat wave knowledge, awareness, practice and behavior.

Immune related adverse events (irAEs) occur due to the inflammatory side effects of immune check point inhibitors (ICIs) and irAEs have been associated with improved efficacy in advanced non-small lung cancer (NSCLC) patients. Corticosteroids can reduce the efficacy of ICIs due to their immunosuppressive effects. In this study, we aimed to show the effects of the development of irAEs and the use of ≥ 10 mg prednisone and equivalent steroids on treatment response. We analyzed the outcomes of patients with NSCLC treated with ICIs as monotherapy or ICIs in combination with chemotherapy (ChT) at a single academic center based on the presence of irAEs and the use of corticosteroids . A landmark analysis was performed due to the time-dependent nature of irAEs. 90 patients were included in the study. irAEs were seen in a total of 45 (50%) patients. In the landmark analysis, the median overall survival (OS) was 52.1 months in those who developed irAEs and 14.4 months in those who did not (HR 2.71, 95% CI (1.55–4.73), p  < 0.001), and the median progression-free survival (PFS) was also higher in the patients with irAEs (25.9 vs. 8.4 months, HR 2.54, 95% CI (1.52–4.25), p  < 0.001). The objective response rate (ORR) was significantly higher in patients experiencing irAEs than without irAEs: 60% versus 33.3%, respectively ( p  = 0.011). The number of patients using steroids was 22 (24%), while 68 patients (76%) were not using steroids. There was no significant difference in mOS: 26.5 versus 28.7 months (HR 1.14, 95% CI (0.63–2.08), p  = 0.652) and mPFS: 16.9 versus 13.5 months (HR 0.99, 95% CI (0.57–1.74), p  = 0.997) between patients who used steroids and those who did not. ICIs efficacy is higher in patients who developed irAEs. In our analyses, the grade of irAEs or the number of irAEs occurring in the individual had no effect on mOS and mPFS. In our patient group, steroid use was mostly related with irAEs, and we did not detect any negative effects of corticosteroid use on PFS and OS.

Heat waves are one of the most common direct impacts of anthropogenic climate change and excess mortality their most apparent impact. While Turkey has experienced an increase in heat wave episodes between 1971 and 2016, no epidemiological studies have examined their potential impacts on public health so far. In this study excess mortality in Istanbul attributable to extreme heat wave episodes between 2013 and 2017 is presented. Total excess deaths were calculated using mortality rates across different categories, including age, sex, and cause of death. The analysis shows that three extreme heat waves in the summer months of 2015, 2016, and 2017, which covered 14 days in total, significantly increased the mortality rate and caused 419 excess deaths in 23 days of exposure. As climate simulations show that Turkey is one of the most vulnerable countries in the Europe region to the increased intensity of heat waves until the end of the 21st century, further studies about increased mortality and morbidity risks due to heat waves in Istanbul and other cities, as well as intervention studies, are necessary.

Background Fever of unknown origin (FUO) remains a significant diagnostic challenge. Changes in patient populations and diagnostic technologies may shift the spectrum of underlying etiologies. This study aimed to examine recent FUO cases at a single tertiary center to identify changes in etiology compared with previous reports and between the pre- and post-COVID-19 pandemic periods, assess the diagnostic value of laboratory and imaging findings, and examine FUO characteristics in underrepresented subpopulations, including people living with HIV (human immunodefficiency virus), those on immunosuppressive therapy, and individuals with recurrent fever, with the goal of informing a center-specific diagnostic approach. Methods A retrospective analysis was performed on 100 patients hospitalized with FUO between 2017 and 2024, classified according to Durack and Street’s criteria. Subgroups included classical ( n  = 85), HIV-associated ( n  = 13), neutropenic ( n  = 1), and nosocomial FUO ( n  = 1). Clinical, laboratory, imaging, and biopsy findings were reviewed, and subgroup-specific analyses were conducted. Results Among 100 FUO patients (mean age 45.1 years; 52 males), recurrent fever was observed in 14 patients within the classical FUO group. The median fever duration at admission was 6 weeks. The average time to diagnosis was 14 days, and the mean hospital stay was 21 days. Final diagnoses were: collagen vascular diseases (CVD, 39%), infections (19%), malignancies (17%), miscellaneous (12%), and undiagnosed (13%). Vasculitis predominated among CVDs (25.6%), extrapulmonary tuberculosis (TB) among infections (36.8%), lymphomas among malignancies (52.9%) and, subacute thyroiditis among “miscellaneous” category (25%). In subgroup analysis, people living with HIV had no CVD, while no infections were found in recurrent fever cases. Among people living with HIV, infections (46%) and malignancies (38%) were most common. Immunosuppressed patients had diverse etiologies, including drug-induced pneumonitis and disease flares. CRP ≥140 mg/L, low hemoglobin, and anti-HIV positivity were independent predictors of malignancy; ferritin ≥875 µg/L was significantly associated ( p  = 0.01). PET-CT (Positron Emission Tomography – Computed Tomography) had the highest diagnostic yield, especially in infections and malignancies ( p  = 0.004). Microbiological studies were diagnostic in > 50% of infectious cases; autoantibodies aided diagnosis in ~50% of CVDs. During follow-up, 11 patients died, including 7 from the malignancy group. Conclusion Our findings indicate a shift toward non-infectious inflammatory causes of FUO, with CVD surpassing infections. PET-CT and targeted biopsies are valuable diagnostic tools, particularly in suspected malignancies or infections. Subgroup-specific approaches are essential, especially in people living with HIV and immunosuppressed patients. Despite advances, a proportion of FUO cases remain undiagnosed, underscoring the need for stepwise, individualized diagnostic strategies. Clinical trial number Not applicable.

Background: Air pollution is one of the major environmental risk factors for health. Children are vulnerable to the negative health consequences of air pollution. We aimed to determine the effect of PM10 levels on postneonatal mortality in Istanbul, the most populous city in Türkiye. Methods: In this cross-sectional study, the relationship between PM10 levels and postneonatal deaths occurring in Istanbul, Türkiye in 2015-2019 was examined. PM10 levels for Istanbul were calculated by taking the average of daily PM10 measurements between 01.01.2015 and 31.12.2019, made available from Istanbul Air Quality Monitoring Stations. Data were analyzed using Microsoft Office Excel 2016 and AIRQ+ 2.2.3 software. Results: If the PM10 value in Istanbul province had been reduced to 20 μg/m3, the limit value recommended by the WHO; in 2019; 36(19-61) postneonatal infant deaths could have been prevented; 7.73% (3.98-12.95) of postneonatal infant deaths were attributed to PM10. During this period, the PM10 value in Istanbul was above the limit value recommended by WHO, the European Union and Turkish legislation. Conclusion: Infant mortality due to air pollution is an important public health problem.