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Objectives: Obesity is a significant public health concern, as it is associated with the development of numerous chronic diseases. The prevalence of obesity and attendant diseases has been increasing over recent years. This study attempted to ascertain the frequency of chronic diseases in obese patients in Türkiye for the first time on this scale. Methods: A retrospective study was conducted, with patients admitted to the internal medicine outpatient clinics or obesity centers between December 2023 and December 2024 included in this study. Participants were recruited from seven regions, 20 provinces, and 28 centers, and the inclusion criteria were met by those aged 18 years and over with a body mass index (BMI) of 30 kg per square meter (kg/m2) or above. Their status, with respect to chronic diseases, and their anthropometric parameters were documented. Results: The total number of patients was 10,121, with a mean age of 45.2 ± 13.92. Of these, 7222 (71.35%) were female. The prevalence of type 2 diabetes mellitus (T2DM), hypertension (HT), dyslipidemia (DL), coronary artery disease (CAD), obstructive pulmonary disease (OPD), obstructive sleep apnea syndrome (OSAS), and fatty liver disease (FLD) was found to be 35.01%, 78.19%, 12.37%, 10.32%, 5.88%, and 75.12%, respectively. A subsequent analysis of the prevalence of these diseases by region revealed a statistically significant variation between regions (p < 0.001 for all regions). Conclusions: This study represents a substantial contribution to the existing body of knowledge in this field, particularly with regard to the identification of the current chronic disease rate of obese patients in Türkiye.

Thiamine plays a pivotal role in energy metabolism. The aim of the study was to determine serial whole blood TPP concentrations in critically ill patients receiving chronic diuretic treatment before ICU admission and to correlate TPP levels with clinically determined serum phosphorus concentrations. This observational study was performed in 15 medical ICUs. Serial whole blood TPP concentrations were measured by HPLC at baseline and at days 2, 5 and 10 after ICU admission. A total of 221 participants were included. Of these, 18% demonstrated low TPP concentrations upon admission to the ICU, while 26% of participants demonstrated low levels at some point during the 10-day study period. Hypophosphatemia was detected in 30% of participants at some point during the 10-day period of observation. TPP levels were significantly and positively correlated with serum phosphorus levels at each time point (P < 0.05 for all). Our results show that 18% of these critically ill patients exhibited low whole blood TPP concentrations on ICU admission and 26% had low levels during the initial 10 ICU days, respectively. The modest correlation between TPP and phosphorus concentrations suggests a possible association due to a refeeding effect in ICU patients requiring chronic diuretic therapy. •In adult critically ill patients receiving diuretics prior to ICU admission, we demonstrated low thiamine levels in 18% of 221 participants on ICU admission and in 26% during the initial 10 ICU days, respectively.•The correlation pattern between TPP and phosphorus levels suggests a possible association with refeeding in adult medical ICU patients requiring chronic diuretic therapy.

Pulmonary fibrosis is an important health problem; one of the drugs used in its treatment is pirfenidone (PFD). Fisetin (FST) is a flavonoid with antioxidative, anti-inflammatory, and antifibrotic effects. The aim of this study was to induce PF in rats with bleomycin (BLM) and to investigate the combined effect of PFD and FST in the treatment of fibrosis. In the study, 40 male Wistar rats were divided into five groups ( n  = 8). Sham group was administered saline on day 0 and BLM (5 mg/kg, i.t.) was administered to the other groups; BLM + PFD group: PFD (50 mg/kg) was administered every day between the first and 15th days; BLM + FST group: FST (25 mg/kg) was administered between the first and 15th days; BLM + PFD + FST group: PFD (50 mg/kg) and FST (25 mg/kg) were administered by gavage every day between the first and 15th days. At the end of the 15th day, BAL was performed under anaesthesia and lung tissues were removed. Histopathological, biochemical, and RT-PCR analyses were performed in the lung tissue. In our study, the concomitant use of FST and PFD caused downregulation of NF-κB p65, TGF-β1, and α-SMA expressions; downregulation of TIMP-1, MMP-2, and MMP-9 genes; downregulation of HYP, MPO, and MDA activity; decrease in the number of differential cells in BAL; and upregulation of GSH. This shows that FST and PFD have antifibrotic, antioxidative, and anti-inflammatory effects. Our results show that the combined use of PFD and FST in BLM-induced pulmonary fibrosis reduces extracellular matrix accumulation, downregulates the level of gelatinases and their inhibitors, and provides significant improvements in antioxidative defence parameters.

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) prevalence data in Türkiye is limited. We aimed to determine the nationwide prevalence of MASLD and advanced hepatic fibrosis risk in subjects with cardiometabolic risk factors (CMRF). Despite recent international consensus redefining fatty liver disease terminology, no nationwide MASLD study has been reported in Türkiye. Methods: This cross-sectional study included 14,371 adults with ≥1 CMRF from 44 centers across 31 cities. MASLD was diagnosed using liver ultrasonography plus cardiometabolic criteria. Advanced fibrosis risk was assessed by fibrosis-4 (FIB-4) score (≥1.3 for ≤65 years; ≥2.0 for >65 years). Logistic regression was used to identify independent predictors of high FIB-4. Results: A total of 61.4% of participants were women, the mean age was 51.3 ± 14.4 years, and the mean BMI was 31.4 ± 6.0 kg/m2. MASLD prevalence was 75.7% (n = 10,873), rising with the number of CMRFs (56.5% with one factor vs. 83.4% with all). The prevalence of high FIB-4 scores was 12.0% overall, being lower in MASLD patients than non-MASLD patients (11.2% vs. 14.4%, p < 0.001). FIB-4 scores decreased with increasing BMI (28.1% underweight vs. 8.7% class III obesity). Male sex, T2DM, and hypertension independently predicted high FIB-4 scores, while smoking, higher BMI, and MASLD were inversely associated. Conclusions: Three-quarters of Turkish adults with CMRF have MASLD. Standard FIB-4 thresholds may underestimate fibrosis risk in obese and smoking populations, underscoring the need for adjusted cut-offs or alternative tools. This study is the first to provide nationwide MASLD prevalence data in Türkiye.

PurposeThis study aimed to investigate the predictive value of circulating irisin levels in discriminating the presence and severity of obstructive sleep apnea (OSA) in obese individuals.MethodsThis study was conducted on obese volunteers with and without OSA. All volunteers underwent polysomnography. Blood samples were taken on the day of the test. In addition to routine biochemistry studies, irisin levels were determined by enzyme-linked immunosorbent measurement. ROC analysis was performed to determine the predictive value of irisin.ResultsOf 100 volunteers, 75 had OSA and 25 did not. Irisin levels were significantly lower in the group with OSA than in the non-OSA group. The lowest irisin levels were determined in the group with severe OSA. Irisin levels showed high sensitivity and specificity in distinguishing between OSA and non-OSA groups. It had high sensitivity and specificity in differentiating severe OSA from other groups in subgroups, while it had low sensitivity and specificity in differentiating patients with mild and moderate OSA. In logistic regression analysis, a low irisin level was determined to be a risk factor for OSA independent of BMI.ConclusionThis study indicated that irisin levels decrease in obese individuals with OSA, correlating with the severity of the condition. Additionally, irisin levels may act as an independent predictor for OSA. The predictive value of irisin in identifying severe OSA among obese patients suggests its potential as a promising biomarker.

PurposeObstructive sleep apnoea (OSA) involves recurrent obstructive apnoeas and hypopnoeas which cause cyclic hypoxia, reoxygenation and formation of reactive oxygen species (ROS). We aimed to investigate a member of the nicotinamide adenine dinucleotide phosphate oxidase (NOX) family of enzymes, specifically (NOX4), not previously studied in humans, as well as 8-OHdG/106dG, MDA and IMA, which are known to be associated with oxidative stress. We also evaluated these parameters in predicting the presence and severity of OSA.MethodsAll 120 subjects (90 with OSA, 30 healthy controls) underwent polysomnography and had blood serum samples taken at the same time of day. Subjects were grouped by presence and severity of OSA, and serum markers were compared among groups.ResultsAge and body mass index were not significantly different among groups. In the OSA group, the levels of NOX4, IMA, MDA and 8-OHdG/106dG were significantly higher than in the healthy control group. NOX4 and other parameters were positively correlated with the severity of OSA. For all parameters, the highest levels were detected in patients with severe OSA.ConclusionsThe repeated hypoxia of OSA is associated with increases in the serum levels of inflammatory mediators such as MDA, IMA and 8-OHdG/106dG and the ROS NOX4. In this study, NOX4 and other markers were associated with the presence and severity of OSA.

Neoadjuvant chemotherapy (NACT) is the standard treatment for locally advanced, high-risk breast cancer. Pathological complete response (pCR) improves survival. Peripheral blood-derived indices reflecting systemic inflammation and nutritional status have long been used as predictive and prognostic markers in solid malignancies. This retrospective study investigates whether eight commonly used indices in patients receiving NACT affect pCR and survival. This study includes 624 locally advanced breast cancer patients who received NACT. The biomarker indices were calculated from peripheral blood samples taken two weeks before starting chemotherapy. The indices’ optimal cut-off values were determined using ROC Curve analysis. During a median follow-up period of 42 months, recurrence was detected in 146 patients, and 75 patients died. pCR was observed in 166 patients (26.6%). In univariate analysis, NLR, PLR, SII, PNI, HALP, and HRR were statistically significantly associated ( p  = 0.00; p  = 0.03; p  = 0.03; p  = 0.02; p  = 0.00; p  = 0.02 respectively), but in multivariate analysis, only NLR was significantly predictive for pCR( p  = 0.04). In multivariate analysis, the HGB/RDW score significantly predicted DFS( p  = 0.04). The PNI score was identified as a marker predicting survival for both OS and PFS ( p  = 0.01, p  = 0.01, respectively). In conclusion, peripheral blood-derived indices have prognostic and predictive values on pCR and survival. However, further studies are needed to validate our findings.

Background Dehydration in children remains a common yet potentially life-threatening clinical challenge, particularly in primary care and emergency settings where rapid, objective, and non-invasive assessment tools are limited. Skin biomechanics may offer a new way of measuring hydration status. Objective To investigate the utility of a non-invasive skin biomechanical measurement device (MyotonPro ® ) in differentiating hydration status in children aged 6 months to 6 years. Methods In this prospective case–control study conducted at Gaziantep University Hospital, 64 children were evaluated using the MyotonPro ® device at three anatomical sites: 1.5 cm above the umbilicus, and 4 cm above the wrist on the posterior surfaces of both arms. Dehydration was defined by serum osmolality ≥ 290 mOsm/kg or urine specific gravity > 1.025. Oscillation frequency, dynamic stiffness, and elasticity were measured and compared between dehydrated ( n  = 32) and non-dehydrated ( n  = 32) participants. Laboratory results and World Health Organization clinical dehydration scale findings were analysed and compared with the device measurements. Results Children in the dehydration group exhibited significantly lower oscillation frequency (18.75 ± 2.63 Hz vs. 20.64 ± 4.16 Hz; p  = 0.034) and dynamic stiffness (430.06 ± 83.60 N/m vs. 499.78 ± 169.28 N/m; p  = 0.042) in the right arm. Although similar results were observed in the left arm, there was no statistically significant difference. Biochemical markers such as creatinine, sodium, plasma osmolality, and urine specific gravity were significantly elevated in the dehydration group. Correlations were observed between MyotonPro ® parameters and serum creatinine, BUN, and albumin levels. Conclusion MyotonPro ® demonstrated significant differences in selected parameters (right arm oscillation frequency and stiffness), suggesting potential sensitivity to hydration status. However, its overall discriminative ability was limited. Therefore, MyotonPro ® may serve as a supportive, but not standalone, tool in clinical decision-making for monitoring hydration levels, particularly in primary care and emergency settings.

Background The fact that medical students lie in this age (17–31 years) range and that they play a crucial role in delivering healthcare services makes their knowledge, attitudes and behaviors about blood donation (BD) important. Objectives The aim of this study was to examine the knowledge, attitude, and behavioral characteristics of medical students regarding BD. Materials and methods This study was carried out with a total of 396 students at Gaziantep University Faculty of Medicine from April 1st–15th, 2022 The sociodemographic characteristics of the students and their knowledge, attitudes, and behaviors about BD were interrogated. Results Among the 396 participants, 32.5% reported having previously donated blood, and 74.2% expressed a willingness to donate in the future. BD rates did not significantly vary by gender, religious beliefs, or year of education. However, students who had received training on BD were significantly more likely to have donated ( p  < 0.001). The mean knowledge score about BD was 16.37 ± 5.43 (out of 30), with no significant difference between males and females. Knowledge levels were notably higher among fifth-year students and those who had received prior training ( p  < 0.001). Despite a generally positive attitude toward BD, factors such as fear of contagion, lack of time, and misconceptions about donation during the COVID-19 pandemic negatively influenced participation. Conclusion It was determined that medical students exhibited a considerable lack of knowledge about BD. Training was shown to have a positive impact on their knowledge levels regarding BD. Furthermore, students expressed concerns and demonstrated insufficient understanding of the risk of COVID-19 transmission during BD. Providing up-to-date training on this topic is crucial to addressing these misconceptions and enhancing their knowledge.

PurposeThis study aimed to explore the association between anti-mullerian hormone (AMH) levels and obstructive sleep apnea (OSA) severity.MethodsA cross-sectional design was employed to evaluate AMH levels in 68 premenopausal women diagnosed with OSA at Van Yüzüncü Yıl University Faculty of Medicine. OSA severity was scored according to the 2018 AASM guidelines using a 16-channel Embla device. AMH levels were measured from blood samples using a commercially available kit.ResultsThe study found that AMH levels in OSA patients were significantly lower than those in the healthy control group. A statistically significant negative correlation between AMH and AHI levels was observed. When stratified by OSA severity, the lowest AMH levels were found in the severe OSA group.ConclusionOSA may have potential endocrine implications, especially concerning reproductive health. Decreased AMH levels in OSA patients could indicate future risks of infertility or early menopause.