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Abstract Aim The aim of the present study was to examine the relationship between anemia and basic and instrumental activities of daily living in older female patients. Methods 540 older female outpatients were included in this cross-sectional study. Anemia was defined as a hemoglobin below 12 g/dL. Patients’ demographic characteristics, comorbidities, Geriatric Depression Scale, Mini Nutritional Assessment, and Mini-Mental State Examination (MMSE) were also recorded. Handgrip strength (HGS) was measured with a hand dynamometer to detect dynapenia. Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL) questionnaires were used to evaluate functional capacity. Results The mean age of the participants was 77.42 ± 7.42 years. The prevalence of patients with anemia was 35%. A significant difference was observed between anemic and non-anemic groups in terms of age, presence of diabetes mellitus (DM), hypertension, coronary artery disease (CAD), chronic kidney disease (CKD), malnutrition, dynapenia, and MMSE, BADL and IADL scores (p

BackgroundAlthough vaccination is one of the most effective means of controlling the spread of COVID-19, public concerns and indecision about vaccination still continue. Because pregnant and breastfeeding individuals are at high risk for severe outcomes in case of infections, determining their level of hesitation and attitude toward COVID-19 vaccines will guide the management of the disease. This study aimed to determine pregnant and breastfeeding women’s levels of hesitation and attitude toward COVID-19 vaccines as well as their related factors.MethodsThe sample of this descriptive research consisted of 103 pregnant or breastfeeding individuals who were seen at the obstetrics and gynecology outpatients clinic of a state hospital in Istanbul, Turkey. The data were collected using a ‘demographic data form’, the ‘Vaccine Hesitancy Scale in Pandemic’, and the ‘Attitudes toward COVID-19 Vaccine Scale’. The research data were analyzed with appropriate statistical methods.ResultsThe mean age of the participants was 29.71 ± 4.75, 51% were pregnant, and 74.8% had received the COVID-19 vaccine. The mean score of the ‘Vaccination Hesitancy Scale in Pandemic’ was 30.83 ± 6.91, and the mean score for the ‘Attitude Scale toward the COVID-19 Vaccine’ was 25.50 ± 5.20. A significant difference was found between the total score of the ‘Vaccine Hesitation Scale in the Pandemic’ and the mean score of the ‘Lack of Confidence’ sub-dimension between the ‘working status’ and the ‘influenza vaccination’ status. In terms of the mean score of the ‘Risk’ sub-dimension, a significant difference was found between the ‘period of vaccination’ (p

Ovarian cancer (OC) ranks as the eighth most prevalent malignancy among women globally. The short non-coding RNA molecules, microRNAs (miRNAs) target multiple mRNAs and regulate the gene expression. Here in this study, we aimed to validate miR-3135b and miR-1273g-3p as novel biomarkers for prognostic and diagnostic factor OC. After RNA isolation, we analyzed the miR-3135b and miR-1273g-3p expression in peripheral blood samples derived from 150 OC patients. Subsequently, we compared their expression levels with 100 healthy controls. The differences of miR-3135b and miR-1273g-3p expression were detected using the Quantitative Real Time-PCR (qRT-PCR) technique following miRNA-specific cDNA synthesis pursing miRNA separation. The miR-3135b and miR-1273g-3p were higher in OC patients who tested positive for BRCA1/2 compared to BRCA-negative patients, and healthy cases. The level of miR-3135b demonstrated a roughly 4.82-fold increase in OC patients in comparison to the healthy cases, while miR-1273g-3p expression exhibited a roughly 6.77-fold increase. The receiver operating characteristic (ROC) analysis has demonstrated the potential of miR-3135b and miR-1273g-3p as markers for distinguishing between OC patients and healthy controls. The higher expressions of miR-3135b and miR-1273g-3p could be associated with OC development. Moreover, miR-3135b may have a diagnostic potential and miR-1273g-3p may have both diagnostic and prognostic potential in OC cell differentiation. The string analysis has revealed an association between miR-1273g-3p and the MDM2 gene, suggesting a potential link to tumor formation through the proteasomal degradation of the TP53 tumor suppressor gene. Additionally, the analysis indicates an association of miR-1273g-3p with CHEK1, a gene involved in checkpoint-mediated cell cycle arrest. String analysis also indicates that miR-3135b is associated with the MAPK1 gene, causing activation of the oncogenesis cascade. In conclusion, miR-1273g-3p, and miR-3135b exhibit significant potential as diagnostic markers. However, further research is needed to comprehensively investigate these miRNAs diagnostic and predictive characteristics in a larger cohort.

Abstract The ten countries with the highest population during the pandemic were analyzed for clustering based on the quantitative numbers of COVID-19 and policy plans. The Fuzzy K-Means (FKM) and K-prototype algorithms were used for clustering, and various performance indices such as Partition Coefficient (PC), Partition Entropy (PE), Xie-Beni (XB), and Silhouette Fuzzy (SIL.F) were used for evaluating the clusters. The analysis included variables such as confirmed cases, tests, vaccines, school and workplace closures, event cancellations, gathering restrictions, transport closures, stay-at-home restrictions, international movement restrictions, testing policies, facial coverings, and vaccination policy statuses. PC, PE, XB, and SIL.F indices were used to analyze the performance indices of the clusters. The Elbow method was used to analyze the performance evaluations for the K-prototype. The K-prototype algorithm's performance evaluations were analyzed using the Elbow method, and the optimum number of clusters for both methods was found to be two. The first cluster included Brazil, Mexico, Nigeria, Bangladesh, US, Indonesia, Russia, and Pakistan, while the second cluster comprised India and China. The analysis also examined the relationship between population and confirmed tests and vaccines, and standardization was made for the country with the largest population for significant correlations. The results showed that the FKM method was superior to the K-prototype method in terms of clustering. In conclusion, it is crucial to accurately evaluate COVID-19 data for countries and develop appropriate policies. The clustering analysis using the FKM and K-prototype algorithms provides valuable insights into identifying groups of countries with similar COVID-19 data and policy plans.

AimClinical and epidemiological studies suggest links between dementias and Type 2 diabetes (T2DM). The underlying mechanisms of diabetes-related cognitive impairment are largely unknown. This study aims to investigate the role of BDNF in cognitive impairment in prediabetes and T2DM.MethodsThe study included 68 patients with prediabetes (preDM), 96 patients with T2DM, and 65 healthy controls. The cognitive function of the patients was evaluated with the Montreal Cognitive Assessment (MoCA) test and serum BDNF levels were measured by Elisa. The MoCA scores and BDNF levels were compared between diabetes groups after adjusting for age, gender, and education using ANCOVA. The role of BDNF in the diabetes-related cognitive impairment was investigated through mediation analysis.ResultsPatients with T2DM had significantly lower cognitive performance, particularly in memory. Diabetes was found to be a predictor of both cognitive impairment and BDNF levels. A significant increase in serum BDNF levels was observed in patients with T2DM. However, the mediator role of BDNF in the pathology of cognitive impairment in diabetes was not determined.ConclusionCognitive impairment is prevalent in patients with T2DM and should be included in routine screening for complications. The results of the mediation analysis suggest that although BDNF is a biomarker affected by T2DM and cognition, it does not play a mediator role between cognitive impairment and diabetes.

IntroductionCoronavirus Disease 2019 (COVID-19) disease first appeared in Wuhan, China in December 2019. Subsequently, the pandemic spread rapidly throughout the entire world. The number of people who died from COVID-19 is rising daily due to the growing number cases. This retrospective study aims to classify patients with hepatosteatosis (HS) who had COVID-19, depending on additional disease characteristics and to compare survival times and death rates.Material and methodsThe study included 433 individuals with COVID-19 and HS at Amasya University Sabuncuoglu Serefeddin Education and Research Hospital. Additional disease characteristics of patients with HS were analyzed using latent class analysis (LCA) and the patients were divided into two groups.ResultsThe study results indicate that the survival time of the first group, which was formed as a result of the LCA, was significantly lower than that of the second group (p = 0.038). The rate of diabetes, coronary artery disease, chronic rhythm disorder, chronic obstructive pulmonary disease (COPD) and chronic kidney disease was significantly higher in group 1 than in group 2 (respectively p < 0.001; p < 0.001; p < 0.001; p < 0.001; p = 0.015).DiscussionIn patients with HS, the presence of diabetes, coronary artery disease, chronic rhythm problem, COPD, and chronic renal disorders contributes to an increase in death rates due to COVID-19.

Background: Evaluating the quality of life patients with subacromial impingement syndrome is important for further treatments Aim: The aim of the study was to evaluate simultaneously the quality of life with subacromial impingement syndrome using different parameters in a single model. Material and Methods: Ninety patients diagnosed subacromial impingement syndrome were included in the study. Mental component score and physical component score were measured using SF-36 in the assesment of the quality of life and different scores were evaluated. The indirect and direct effects of these tests on the quality of life were examined in a single model using the structural equation modelling. Results: The most total effect on physical component score was Shoulder Disability Questionnaire and the Quick Disabilities of the Arm, Shoulder and Hand Score, Visual Analog Score had the least total effect on physical component score. Considering the results of mental component score, the total most effect was VAS had the the minimum total effect. Conclusion: The quality of life of the patients with subacromial impingement syndrom give more detailed informations when analysing the scores dependently. Evaluating the quality of life of subacromial impingement syndrome, using different measures of patients dependently will provide a more detailed research opportunity. If the patient quality of life evaluation is done in detail, it will facilitate the selection of appropriate treatment.

The aim of this study was to investigate associations between serum magnesium levels with insomnia and excessive daytime sleepiness (EDS) in older adults. A total of 938 older outpatients were included in the study. Hypomagnesemia was defined as serum magnesium concentration below p < 0.05). Hemoglobin and HDL cholesterol were lower, whereas HbA1c, triglyceride, and number of drugs used were higher in the hypomagnesemia group compared to the normomagnesia group (p < 0.05). In both univariate analysis and multivariate analysis adjusted for gender, age and all confounders, there were significant associations between hypomagnesemia and EDS [odds ratio (OR):1.7; 95% confidence interval (CI): 1.6–2.6, and OR: 1.9; 95%CI: 1.2–3.3, respectively (p < 0.05)]. There was no significant relationship between hypomagnesemia and insomnia (p > 0.05). The present study identified an association between hypomagnesemia and EDS in older adults. Therefore, it may be prudent to consider hypomagnesemia when evaluating older adults with EDS and vice versa.

Abstract Cognitive impairment is frequently seen in patients with type 2 diabetes (T2DM), ranging from mild impairment to dementia. However, our knowledge of the specific profiles and risk factors for these different levels of impairment is limited. In this study involving 152 patients with T2DM, cognitive function was assessed using the Montreal Cognitive Assessment test. The Fuzzy C-means clustering algorithm was utilized to group individuals with similar cognitive characteristics. The study evaluated how well clinical parameters could classify characteristics of clusters using the Classification and Regression Trees algorithm. ROC analysis was then used to assess the classification success. Three distinct cognitive clusters were identified. Cluster 1 had the poorest cognitive performance and was characterized by more women, lower education levels, and lower levels of iron, hemoglobin, and creatine. Cluster 3, the amnestic cluster, was distinguished by low TSH levels. The decision tree model highlighted several parameters, including education level, hemoglobin, duration of diabetes mellitus (DM), iron, TSH, gender, family history of diabetes, and microalbumin/creatinine ratio, as significantly affecting the distinction of cognitive clusters. Diabetes-associated cognitive impairment stems from multifaceted pathophysiological mechanisms influenced by complex risk factors, resulting in diverse types of cognitive deficits.

The aim of this study was to assess the effect of continued smoking before and during pregnancy on mid-trimester fetal head development. A total of 250 pregnant women enrolled in the study. All participants were confirmed to be smokers or non-smokers by verifying breath carbon monoxide readings. Biparietal diameter (BPD), head circumference (HC), lateral ventricle (LV), and cisterna magna (CM) were evaluated by ultrasound between 20–22 weeks of pregnancy. Gender and gestational age-adjusted BPD z- scores were not statistically different between smokers and non-smokers (−0.75 ± 1.6 vs −0.51 ± 1, p = .3). HC measurements and z- scores were significantly lower in the smoking group than in the non-smoking groups (183.38 ± 14.56 vs. 189.28 ± 12.53, p = .003, 0.18 ± 1.39 multiple of median (MoM) vs. 0.56 ± 0.92, respectively, p = .023). At linear regression analysis, maternal smoking was the only independent factor associated with fetal HC z score (p = .041). In conclusion, continued smoking during pregnancy reduces fetal HC and has no effect on BPD, LV, or CM measurements at mid-gestation.IMPACT STATEMENT What is already known on this subject? Smoking during pregnancy is one of the most common environmental factors affecting fetal and neonatal growth and well-being. Despite the well-known effects of smoking on somatic growth, current studies have shown that it selectively affects some parts of the fetal brain, even in appropriately growing fetuses. What do the results of this study add? Continued smoking during pregnancy reduces fetal HC and has no effect on BPD, LV or CM measurements at mid-gestation. Since smoking is well known for its early and late childhood behavioral and neurological consequences, smaller mid-trimester fetal HC measurements should bring maternal smoking to mind as one of the potentially reversible causes. What are the implications of these findings for clinical practice and/or further research? The harmful effects of smoking start before the third trimester and antenatal counseling should be started early in the gestation. Every effort should be made to quit smoking before or early in pregnancy.

IntroductionConcerning contemporary in-vitro fertilisation (IVF) practice, the use of frozen embryo transfer (FET) cycles has become more common than fresh transfers. Natural cycle (NC), programmed artificial cycle and mild stimulation cycle are primary endometrium preparation cycles. Monitoring serum progesterone levels in FET cycles are in the scope of current research focus. Low progesterone levels on the day of embryo transfer is presumed to negatively affect pregnancy outcomes, while progesterone supplementation may improve pregnancy rates. The purpose of our trial is to evaluate whether initiating subcutaneous (SC) progesterone supplementation on the day of embryo transfer when serum progesterone levels are below 10 ng/mL in tNC-FET will result in pregnancy rates comparable to those of patients with sufficient serum progesterone.MethodsRetrospective single centre study was conducted between August 2022 and April 2023 with 181 tNC-FETs. Patients were separated into groups according to serum progesterone concentrations (≥10 ng/mL and

Introduction:Advanced age is an independent risk factor for increased mortality in coronavirus disease-2019 (COVID-19). However, the best method for estimating mortality in elderly patients with COVID-19 is still under debate. We performed this study to assess the shock index (SI) and the modified shock index (MSI) for the abovementioned problem.Methods:A retrospective study was conducted including elderly cases (≥65 years) confirmed with COVID-19 who admitted to a tertiary university hospital between March-December 2020. The SI and MSI at the time of the emergency department visits were used to evaluate the intensive care unit admission, ventilator support, septic shock, and 30-day mortality in all patients. The receiver operating characteristic and area under the curve (AUC) were used to measure the overall ability of SI and MSI to predict clinical outcomes.Results:We recruited 334 consecutive COVID-19 patients with a mean age of 75.2±7.3 and an almost equal gender distribution [170 males (50.9%)]. In deceased and surviving patients, the SI was 0.66±0.16 and 0.6±0.1 (p=0.014), while the MSI was 0.95±0.22 and 1.09±0.34 (p=0.003), respectively. In predicting mortality, the AUC of the SI and MSI were 0.590 [95% confidence interval (CI): 0.535 to 0.643] and 0.608 (95% CI: 0.553 to 0.660), respectively.Conclusion:Increased SIs and MSIs are associated with 30-day mortality. SI and MSI can benefit the triage of elderly patients hospitalized for COVID-19. However, it was found that there is no single cut-off value of SI or MSI with optimum accuracy for predicting COVID-19-related clinical outcomes.

OBJECTIVE:The aim of this study is to investigate the prognostic factors of lung cancer by evaluating the most appropriate survival model with a selection criteria. MATERIAL AND METHODS:In the study, the data of 185 patients diagnosed with lung cancer from the Medical Oncology Outpatient Clinic of Mustafa Kemal University Faculty of Medicine were retrospectively obtained from the patient files. The frailty models with different distributions were used for evaluating the heterogeneity between patients. Model selections were made according to AIC and BIC criteria. RESULTS:The median survival time of patients with lung cancer in the study was 11 months (95% confidence interval 9.57-12.42). The best frailty models’ frailty distribution was lognormal and the basic hazard function distribution was loglogistic. The best model results showed that, the effect of the albumin variable on the risk of death of lung cancer patients was statistically significant (p = 0.018). CONCLUSIONS:Generally, environmental and genetic factors that affect the survival time of lung cancer patients can not be evaluated.Thus, the term of the frailty resulting from the heterogeneity of factors when assessing individuals influencing survival of patients with lung cancer should be taken into account.

Amaç: Çeşitli hastalıkların yaşam kalitesi üzerindeki etkilerini değerlendirmek için çok sayıda yaşamkalitesi ölçeği kullanılmaktadır. Bunlar arasında en yaygın kullanılan ölçek, SF‐36 yaşam kalitesiölçeğidir. Bununla birlikte, son yıllarda bu ölçeğin çeşitli versiyonları ve daha kısa formlarıgeliştirilmiştir. Daha kısa sürede uygulanabilen, daha kolay yorumlanabilen, güvenilir ve geçerli sonuçlarveren yaşam kalitesi ölçekleri daha fazla tercih edilmektedir. Bu çalışmanın amacı, Osteoartrit (OA) veRomatoid Artrit (RA) 'da yaşam kalitesini daha iyi ve kısa sürede ölçen ölçekleri belirlemektir.Materyal ve Metot: Ölçeklerin iç tutarlılığı için Cronbach alfa katsayısı, madde‐toplam puan ilişkilerive SF‐12, SF‐8 ve SF‐6D ölçek puanları ile SF‐36 ölçek puanları arasındaki uyum sınıf içi korelasyonkatsayısı ve ölçeklerin toplam puanları arasındaki ilişkilerin değerlendirilmesinde Spearman Rankkorelasyon analizi kullanıldı. SF ölçeklerinin kriter geçerliliğini incelemek için WHOQOLBref veQuickDASH ölçekleri kullanıldı.Bulgular: Her iki hastalık grubunda da ölçeklerin iç tutarlılığının oldukça iyi düzeyde bulundu. OAhastalarında, SF‐6D ölçeğinin Fiziksel Fonksiyon, Vücut Ağrısı ve Canlılık alt boyutlarına ait uyumu enyüksek bulundu. Buna karşın SF‐12 ölçeğinin Fiziksel Rol, Duygusal Rol ve Genel Sağlık algısı altboyutlarının uyumunun daha yüksek olduğu belirlendi. RA hastalarında SF‐6D ölçeğinin Canlılık veVücut Ağrısı alt boyutlarının uyumu, SF‐12 ölçeğinin ise Fiziksel Fonksiyon, Fiziksel Rol, Genel SağlıkAlgısı ve Duygusal Rol uyumu daha yüksek bulundu. Ayrıca her iki hastalık grubunda ve birçok altboyutta SF‐12 ve SF‐6D ölçeklerinin geçerliliği birbirine benzer ve SF‐8 ölçeğine göre daha iyi bulundu.Sonuç: Elde edilen bulgular doğrultusunda, RA ve OA hastalarında yaşam kalitesini değerlendirmek içinSF‐12 veya SF‐6D ölçeklerinden etkin bir şekilde yararlanılabileceği görüldü.

ABSTRACT Introduction: Durasphere® EXP (DEXP) is a compound of biocompatible and non--biodegradable particles of zirconium oxide covered with pyrolytic carbon. The aim of this study is to evaluate the durability of off-label use of DEXP in the treatment of primary vesicoureteral reflux in children. Materials and Methods: Patients who underwent subureteric injection of DEXP for the correction of primary VUR were retrospectively reviewed. Patients aged >18 years as well as those who had grade-I or -V VUR, anatomic abnormalities (duplicated system, hutch diverticulum), neurogenic bladder or treatment refractory voiding dysfunction were excluded. Radiologic success was defined as the resolution of VUR at the 3rd month control. Success was radiographically evaluated at the end of the first year. Results: Thirty-eight patients (9 boys, 29 girls; mean age, 6.3±2.7 years) formed the study cohort. Forty-six renal units received DEXP (grade II: 22; grade III: 18; grade IV: 6). Mean volume per ureteric orifice to obtain the mound was 0.70±0.16mL. First con- trol VCUG was done after 3 months in all patients. After the first VCUG, 6 patients had VUR recurrence. Short-term radiologic success of DEXP was 84.2%. Rate of radiologic success at the end of the first year was 69.4% (25/32). Lower age (p:0.006) and lower amount of injected material (p:0.05) were associated with higher success rates at the end of 1 year. Conclusion: This is the first study to assess the outcomes of DEXP for treatment of primary VUR in children. After 1 year of follow-up, DEXP had a 69.4% success rate.