Dahili Tıp Bilimleri Bölümü Koleksiyonu

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https://hdl.handle.net/20.500.13055/58

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Child and adolescent psychiatry consultations during the COVID-19 pandemic
(Springer Nature Link, 2025) Vatansever Pınar, Zeynep; Çimen, İrem Damla; Küçük, Elif; Köle, Mehmet Tolga; Kandemir, İbrahim
This study aimed to identify the biopsychosocial stressors influencing child and adolescent mental health during periods when facetoface education was suspended and to evaluate the psychological sequelae of school closures and related restrictions. We conducted a retrospective observational study at Kartal Dr. Lütfi Kırdar City Hospital, a tertiary care center in İstanbul, reviewing all patients referred to the child and adolescent consultation-liaison psychiatry (CLP) unit between March 2020 and March 2022. We assessed associations between psychiatric diagnoses and health-related stressors, school closure status, age, and sex using both frequentist and Bayesian methods. During the study period, 264,013 pediatric admissions were recorded, of whom 270 (0.10%) required psychiatric consultation. The proportions of suicide attempts and anxiety diagnoses did not differ between periods of open and closed schools (BF10 = 0.21 and 0.138, respectively; moderate evidence for the null). Multivariate analysis showed that the odds of suicide attempts were higher in patients exposed to family or schoolrelated stressors (OR = 6.63, 95% CI 2.72–16.19), in females (OR = 8.10, 95% CI 4.16–15.77), and with increasing age (OR = 1.32 per year, 95% CI 1.16–1.50). Female sex (OR = 4.17, 95% CI 2.03–8.55) and older age (OR = 1.30 per year, 95% CI 1.12–1.50) were also associated with depression. Anxiety was more likely in those facing isolation or healthrelated stressors (OR = 3.91, 95% CI 1.66–9.22). These findings highlight the differential impact of stressor type on internalizing symptoms and may inform resource allocation and crisisresponse planning in child mental health services.
Impact of obesity on metabolic control in type 2 diabetes: Five-year trends of Turkish nationwide survEy of glycemic and other Metabolic parameters of patients with Diabetes (TEMD Obesity Study, 2017-2022)
(S. Karger AG, 2025) Kıyıcı, Sinem; Demirci, İbrahim; Sönmez, Alper; Haymana, Cem; Mert, Meral; Nuhoğlu, İrfan; Taşçı, İlker; Salman, Serpil; Satman, İlhan; Bayram, Fahri
Background: Türkiye has the highest obesity prevalence in Europe. Obesity not only causes type 2 diabetes mellitus (T2DM) but also impairs glycemic control in patients with T2DM. There is insufficient information about the demographic and clinical differences between individuals with T2DM who are living with or without obesity. Objectives: The second TEMD survey across Türkiye investigated the latest overweight and obesity prevalence in patients with T2DM. The present study evaluated the five-year changes in the prevalence, factors associated with an obesity diagnosis and the association between obesity and metabolic control. Methods: Patients under follow-up in tertiary units specialized for diabetes care were consecutively enrolled. The sociodemographic, anthropometric, and clinical variables were recorded. Metabolic targets were defined as HbA1c <7%, home arterial blood pressure (ABP)<135/85 mmHg, or LDL-C<100 mg/dL or <70 mg/dL or <55 mg/dL according to the risk factors or complications of patients. Metabolic target attainment rates were investigated across normal-weight, overweight and obesity body mass index (BMI) classes. Results: The TEMD Obesity Study enrolled 4935 patients with T2DM (age 58.9±10.1 years; women 59.8%). The prevalence of overweight and obesity was 33.4% and 55.1%, respectively. Obesity was more frequent in women with T2DM than men (66.2% vs. 38.1%; p=<0.001). From 2017 to 2022, the obesity rate decreased from 59.0% to 55.1%, while the overweight rate increased from 31.0% to 33.4%. As BMI class increased, the achievement of three metabolic targets decreased while the incidence of microvascular complications rose. Significant associations were found between obesity and sociodemographic characteristics (age, sex, education level) and lifestyle measures (diet, exercise, smoking) in multivariable logistic regression analysis. Conclusion: The TEMD Obesity study showed a decrease in obesity rates among patients with T2DM between 2017 and 2022. Also, the findings suggest that obesity poses an important barrier to the achievement of metabolic goals.
Çocuk Hastalıklarında Beslenme
(Orient Yayınları, 2025) Haspolat, Yusuf Kenan; Akçay, Teoman; Peltek Kendirci, Havva Nur
Fruktoz: Dost mu düşman mı?
(Orient Yayınları, 2025) Akçay, Teoman
Fruktozun Kimyası ve Kaynakları. Fruktoz, basit bir şeker (monosakkarit) olup, doğada meyvelerde, balda ve bazı sebzelerde bulunur. Glukozdan yaklaşık 1,7 kat daha tatlıdır, bu nedenle gıda endüstrisinde yaygın olarak kullanılır. Ancak, fruktozun metabolizması glukozdan oldukça farklıdır ve bu farklılık, sağlık üzerinde hem olumlu hem de olumsuz etkilere yol açabilir (Tappy & Lê, 2010).
Akdeniz diyeti: Sağlıklı yaşamın sırrı
(Orient Yayınları, 2025) Akçay, Teoman; Akyıldız, Dilek; Haspolat, Yusuf Kenan; Kavak, Vatan
Akdeniz diyeti, Akdeniz bölgesinde yaşayan insanların geleneksel beslenme alışkanlıklarını temsil eder. Bu diyet, özellikle 1950’lerde İtalya, Yunanis tan ve İspanya gibi ülkelerde yaygın olarak uygulanmıştır. Tarihsel olarak, Akdeniz’e kıyısı olan 22 ülkenin çoğunda, ancak hepsinde değil, nişasta içermeyen sebzelerin, asgari düzeyde işlenmiş tam tahıllı tahılların, baklagillerin, kuruyemişlerin ve tohumların bolluğu ve çeşitliliği hem erkekler hem de kadınlar için temel gıdalardı (Şekil 1). Kuzey Amerika ve Avrupa’nın aksine et, balık, süt, peynir ve yumurta lüks gıdalardı. Örneğin, 1950’lerde Güney İtalya’da çok az et yenirdi, genellikle haftada bir veya iki kez yenirdi ve süt, kahve (caffé macchiato) veya bebekler dışında asla kullanılmazdı. Şeker ve beyaz patates çok az miktarda tüketilirdi ve tereyağı veya krema asla kullanılmazdı. Soğuk sıkım sızma zeytinyağı başlıca yağ kaynağıydı. Meyveler ve çok az miktarda yerel peynir, yemeklerde orta düzeyde kırmızı şarap alımıyla birlikte oldukça düzenli olarak tüketilirdi ( Keys A. 1983, Keys A, 1954).
Oyun bağımlılığı ve hipertansiyon: Güncel bir inceleme
(Orient Yayınları, 2025) Akçay, Teoman
Oyun bağımlılığı, dijital oyunların aşırı ve kontrolsüz bir şekilde oynan ması sonucu ortaya çıkan bir davranışsal bağımlılık türüdür (Grüsser et al., 2007). Dünya Sağlık Örgütü (WHO), 2018 yılında “oyun oynama bozukluğu”nu (gaming disorder) Uluslararası Hastalık Sınıflandırması (ICD-11) kapsamına alarak, bu durumun ciddiyetini resmen tanımıştır (WHO, 2018). Gü nümüzde özellikle çocuk ve adolesanlar arasında yaygınlaşan bu durum, bireylerin fiziksel, psikolojik ve sosyal sağlığını olumsuz yönde etkilemektedir (Kuss & Grif fiths, 2012). Yapılan çalışmalar, çocuk ve ergenlerde oyun bağımlılığı prevalansının %5-10 arasında değiştiğini ve bu oranın pandemi döneminde daha da arttığını göstermektedir (King et al., 2020; Paulus et al., 2018). Bu yaş grubunda oyun bağımlılığı, sadece psikolojik sorunlara değil, aynı zamanda fizyolojik sağlık prob lemlerine de yol açabilmektedir
Predicting risk of lymph node metastasis in papillary thyroid cancer using miRNAs and clinicopathological features
(Springer Nature Link, 2025) Ergün, Penbe Gül; Aydoğan, Çağatay; Ceviz, Ayşe Begüm; Candan, Gonca; Batur, Şebnem; Yılmaz Aydoğan, Hülya; Öztürk, Oğuz; Öztürk, Tülin
This study investigates potential prognostic values in models created with clinico pathological features and expression profles of miRNAs known for their critical roles in papillary thyroid carcinoma (PTC) for lymph node metastasis (LNM) in PTC cases. Forty-seven lymph node-metastatic PTC patients and 46 non-metastatic patients were included. Using RT-PCR, miR-21, miR-146b, miR-221, and miR-222 expression was analyzed in carcinoma tissues and metastatic lymph nodes of the same PTC patients and carcinoma tissues of non-metastatic PTC patients. MiR 146b (p<0.001) and miR-221 (p=0.009) were overexpressed in metastatic PTCs compared to non-metastatic PTCs. The miRNA expression profles were similar in the lymph nodes and primary cancer of metastatic PTCs. In the presence of larger tumors (>1 cm) in metastatic PTCs, miR-146b and miR221 were overexpressed in the tumor tissue (p=0.036), while miR-222 was overexpressed in metastatic lymph nodes (p=0.035). miR-146b was also upregulated in lack of peritumoral lympho cyte infltration (p=0.006). In conclusion, our fndings suggest that the overexpres sion of miR-146b and miR-221 in PTC tissues may be associated with lymph node metastasis and a poorer prognosis. Furthermore, the presence of larger tumors and increased levels of intratumoral fbrosis in non-metastatic PTC patients could indi cate a poor prognosis.
Antihypertensive treatment of a patient with normal blood pressure: Case report and call for paying attention
(Wolters Kluwer, 2025) Atmaca, Hasan; Erol, Mustafa Kemal; Yetkin, Ertan
The current 2024 European Society of Cardiology (ESC) guideline for the management of elevated blood pressure and hypertension defines blood pressure less than 115/65 mmHg by ambulatory blood pressure monitoring (ABPM) as nonelevated, blood pressures in-between 115–129 and 65–79 mmHg as elevated blood pressure, and hypertension as ≥130/80 mmHg. There, might be patients seeking medical attention for the symptoms, apparently nonspecific but suggestive of hypertension with optimal, or not elevated, or elevated blood pressure values. A female patient with complaints of headache and dizziness lasting for 2 months has been evaluated in cardiology outpatient clinic and assessed by ABPM. It has been told that she had previously blood pressure of 90–100/50–60 mmHg and was suffering from headache when systolic blood pressure exceeds 110 mmHg. Her 24-h ABPM revealed systolic and diastolic blood pressure as 106/63 mmHg showing nighttime decrease compared with daytime pressures (98/59 mmHg and 108/68 mmHg, respectively). Thereafter, she was instructed to keep continuing the life-style modification and given to beta-blocker (bisoprolol 5 mg) as an antihypertensive treatment. At the end of the 2 weeks of follow-up period, she was headache-free and was feeling comfortable and well with a mean home blood pressure of 98/56 mmHg. We have presented prosperous antihypertensive treatment of a female patient suffering from headache and dizziness with a numerically normal or nonelevated blood pressure. In the presence of symptoms and having not elevated or elevated blood pressure levels, patients’ history on previous measure of blood pressure might facilitate our decision-making process.
Suicide risk in psychiatric patients: An analysis of demographic and psychosocial factors
(SOCIAL SCIENCES STUDIES JOURNAL, 2025) Er, Filiz; Duyan, Veli; Özkan, Cengiz; Taymur, İbrahim
The aim of this study is to assess the likelihood of suicide in patients diagnosed with psychiatric disorders and currently receiving treatment, and to examine the relationship between this likelihood and demographic data, as well as psychosocial factors. Using a descriptive and cross sectional model, the data from 165 participants were collected and evaluated through a personal information form and the Suicide Probability Scale (SPS). The study revealed significant relationships between suicide risk and variables such as age, education level, marital status, place of residence, and types of social support. It was also highlighted that the participants generally had a negative perception of their psychological health, and individuals lacking emotional social support showed higher levels of hopelessness and negative self-concept. Furthermore, individuals receiving low social support were found to have a higher suicide risk. The findings indicate that social work professionals can play a significant role in identifying individuals at risk for suicide and developing preventive measures. These results point to the necessity of strengthening social support systems and improving psychological health services.
GWAS analysis of sudden cardiac death cases in a Turkish population
(İstanbul University Press, 2025) Özel Cavlak, Gülay; Cavlak, Mehmet; Kınoğlu, Kubilay; Ceviz, Ayşe Begüm; Eronat, Allison Pınar; Kobak, Işıl; Şam, Bülent; Yıldız, Mustafa; Bayraktar, Bülent; Yılmaz Aydoğan, Hülya; Öztürk, Oğuz
Objective: Sudden death is defined as death occurring within one hour of the onset of symptoms, with cardiovascular diseases being one of the leading causes. The most common genetic factors leading to sudden cardiac death are hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomy6 opathy. In some cases, autopsies may reveal no evidence of long QT syndrome, short QT syndrome, catecholaminergic polymorphic ventricular tachycardia, or Brugada Syndrome. Materials and Methods: We collected samples from sudden cardiac death cases aged 5–40 years (arrhythmia as Group 1, hypertrophy as Group 2, and ischemic heart disease as Group 3), as well as from healthy athletes (control group as Group 4), and analyzed them using genome6wide association study (GWAS) with a DNA microchip containing 196,725 single nucleotide polymorphism (SNP) markers thought to be associated with sudden cardiac death or other cardiovascular diseases. Results: We detected any possible genetic variations or patterns that could elucidate the mechanisms underlying sudden cardiac death in a Turkish population. In our study group, two polymorphisms; rs2971851 and rs9609516, stood out as prominent variants compared with healthy elite athletes. Conclusion: We aimed to identify potential genetic variations or patterns that could shed light on the mechanisms underlying sudden cardiac death in the Turkish population. In our study group, two poly6 morphisms, rs2971851 and rs9609516, emerged as prominent variants when compared to healthy athletes.
Dual etiology vs. MetALD: how MAFLD and MASLD address liver diseases coexistence
(OAE Publishing, 2025) Zerehpooshnesfchi, Shadi; Lonardo, Amedeo; Fan, Jian-Gao; Elwakil, Reda; Tanwandee, Tawesak; Altarrah, Munira; Örmeci, Necati; Eslam, Mohammed
Fatty liver disease associated with metabolic dysfunction has emerged as a significant global health challenge. This condition often coexists with other liver diseases, such as alcohol-related liver disease and viral hepatitis, complicating both diagnosis and management. To address the limitations of the non-alcoholic fatty liver disease (NAFLD) classification, two alternative frameworks have been proposed: metabolic dysfunction-associated fatty liver disease (MAFLD) in 2020 and metabolic dysfunction-associated steatotic liver disease (MASLD) in 2023. A key difference between these definitions is how they consider fatty liver disease in relation to the coexistence of other liver conditions. MAFLD adopts a dual etiology concept, creating a unified classification system that aligns with contemporary clinical and epidemiological needs. In contrast, MASLD introduces a new term, MetALD (metabolic and alcohol-related/associated liver disease), to describe patients who have both metabolic dysfunction and excessive alcohol intake. This review critically examines the clinical, research, and epidemiological implications of the differing approaches of MAFLD and MASLD, offering insights into their potential to enhance the understanding and management of multi-etiology liver diseases.
Early stage effectiveness of the automated insulin delivery system—is artificial intelligence really effective?
(AVES, 2025) Çetin, Ferhat; Göncüoğlu, Enver Şükrü; Abalı, Saygın; Arslanoğlu, İlknur; Deyneli, Oğuzhan; Telci Çaklılı, Özge; Yalın Turna, Hülya; Şahiner, Elif; Güzel, Dila; Yılmaz, Mehmet Temel
Objective: This study aimed to evaluate the effectiveness of the self-learning capabilities of artificial intelligence (AI) algorithms. The hypothesis was that if the success of closed-loop insulin delivery is mainly attributed to AI algorithms, then the improvement in glycemic control would be more signifi cant just after the “learning” phase. Methods: The Medtrum A8 TouchCare® Nano system was used on 15 patients with type 1 diabetes. Daily continuous glucose monitoring (CGM) data pre-automated insulin delivery (AID) was statisti cally compared with the post-AID period. Results: Patients (median age 32 (6-54) years, 40% female) had a median HbA1c of 8.4% (5.3-10.7) before initiation of AID and a median GMI of 6.6% (5.8-8.3) after 2 weeks. The shifts in glycemia and glycemic variability between the 5-day period pre-AID vs. the first day and the 3 5-day periods post-AID were significant (pre-AID vs. 1-5-10-15 days; time in range (TIR, %): 55.9 vs. 76.6-81.7-83.8- 81.5 (P=.001); Q1 (mg/dL): 123 vs. 112-108-106-110 (P=.009); Q3 (mg/dL): 204 vs. 176-173-168-169 (P=.004); inter-quarter range (IQR, mg/dL): 78 vs. 57.2-56.6-53-55 (P=.002)). The biggest shift in TIR was achieved in the first day (10.1%). Comparative analysis of the 5-day intervals post-AID was insig nificant by means of the improvement in glycemia (P > .05). No significant change in glycemic param eters between 15, 30, and 90 days were noted (P > .05). Conclusion: Artificial intelligence-augmented AID becomes effective at the very early stages of initia tion. There is a need for further research into glycemic changes in the early days of AID initiation to better define the principles of initiating AID systems.
Cytotoxic and anti-migratory effects of polyphenolic compounds on breast cancer cells by altering Jam-A, LFA-1, and VLA-4 gene expression
(Taylor & Francis, 2025) Özkara, Gülçin; Ceviz, Ayşe Begüm; Eronat, Allison Pinar; Pehlevan Karabıyık, Funda; Candan, Gonca; Özturk, Oğuz; Yılmaz Aydoğan, Hülya
This study represents the initial research of the effects of a com bination of the largest number (13) of different polyphenic sub stances (PFK5120), formulated based on the propolis content on cell viability, migration and expression of lymphocyte function-associated antigen-1 (LFA-1), very late antigen-4 (VLA-4) and junction adhesion molecule A (Jam-A) in breast cancer (BC) cells. PFK5120 negatively affected cell viability at a 5% concentra tion as compared with unexposed ones (p<0.001). Treatment with 20% PFK5120 for 48h down-regulated Jam-A in MCF-7 and MCF-10A, up-regulated LFA-1 in MCF-10A and MDA-MB-231, and down-regulated VLA-4 in MCF-10A and MDA-MB-231 (p<0.001). Furthermore, migration was found to be inhibited by PFK5120 at varying doses and times. Migration was completely inhibited by 35% PFK5120 treatment in MDA-MB-231, while even lower concen trations (10%) were effective in MCF-7. Current findings indicate that PFK5120 represents a valuable natural component of BC ther apy through its cytotoxic and anti-migratory effects.
Evaluation of demographic, clinical, laboratory findings and treatments of our cases with febrile convulsions: A descriptive research
(Turkiye Klinikleri Yayınevi, 2025) Özdil Yılmaz, İlkiz Özge; Karal, Yasemin
Objective: In this study, we aimed to determine the sociodemographic, clinical and laboratory characteristics, responses to treatment options, and risk factors for the development of epilepsy in cases who presented to our clinic with febrile convulsions (FC) and were diagnosed with FC. Material and Methods: 200 patients who applied to Trakya University Faculty of Medicine, Department of Pediatrics Outpatient Clinic and Child Neurology Polyclinic between January 2014-December 2018 and were diagnosed with febrile convulsion were evaluated retrospectively. In recurrent simple febrile convulsions and in all complicated febrile convulsions, electroencephalography (EEG) was performed. In case of abnormal EEG findings, appropriate treatment was started. Results: The male/female ratio was 1.22/1, 78% were term births. The average age at diagnosis was 21.82±12.69 months. 52.5% were complicated. The common source of fever was upper respiratory tract infection (83%). 10% had a family history of epilepsy and 25% had a history of febrile convulsions. The recurrence rate was 22.5%. Abnormal EEG was detected in 8% of the patients. Patients with recurrence had higher platelet counts and patients with epilepsy had higher C-reactive protein levels. Conclusion: Epilepsy was observed in %13 of febrile convulsions. The rate of epilepsy diagnosis was high in those with abnormal EEG (81%). As a result; monitoring of febrile convulsions is important due to the increased risk of epilepsy and frequent recurrence compared to the general population. Although we found no significant difference between treatment options in preventing recurrence, rectal diazepamand antipyretics may be preferred since it is easy to apply and has few side effects.
Neural therapy in migraine: Clinical evidence for a holistic therapeutic approach - analysis of 464 cases
(Salient Visionary Publications LLC, 2025) Nazlıkul, Hüseyin; Ural Nazlıkul, Fatma Gülçin; Bilgin, Mehmet Dinçer; Acarkan, Tijen; Özkan, Neslihan; Tamam, Yusuf
Background: Migraine is one of the most common neurological disorders and significantly impairs quality of life. While conventional therapies may alleviate symptoms, they often fail to address the underlying causes. Neural therapy is a therapeutic approach in which local anesthetics such as procaine or lidocaine are not primarily used for analgesia but rather to modulate the autonomic nervous system, particularly its sympathetic branch. This method aims to restore functional balance and stabilize dysregulated networks through segmental and systemic reflex pathways, thereby supporting a holistic regulatory effect. Objective: This retrospective study aims to evaluate the effectiveness of neural therapy in 464 migraine patients using a holistic, regulatory medical approach. Methods: Patient history forms were analyzed for hormonal dysregulation, intestinal dysbiosis, temporomandibular dysfunction, C2 vertebral blockage, hydration status, and interference fields. Additionally, clinical treatment progressions were statistically assessed. Results: Over 91% of patients demonstrated clinical improvement, and 60% became symptom-free. The most frequently observed contributing factors were intestinal dysbiosis (89%), hormonal imbalance (71%), and temporomandibular/C2 dysfunctions (43% each). Conclusion: Neural therapy is an effective and regulatory therapeutic option for migraines, particularly in chronic, multifactorial cases. Its integration into a holistic treatment strategy may yield substantial clinical benefits.
Staphylococcus aureus as a signature species of skin microbiome in actinic keratosis and squamous cell carcinoma: A narrative review
(Wolters Kluwer, 2025) Duman, Nilay; Oraloğlu, Göktürk; Ece, Deniz; Caner, Ayşe
Cutaneous squamous cell carcinoma (cSCC) is a common type of skin cancer and the second most common type of nonmelanoma skin cancer. Actinic keratosis (AK) is a premalignant lesion that can progress to cSCC over time. AK and cSCC are associated with microbial dysbiosis and an increased abundance of the bacterium Staphylococcus aureus. Although AK and cSCC are highly colonized with S. aureus, a bacterium of the skin microbiota, it is not yet known whether this bacterium is associated with cancer development. Here, we analyze the studies on the relationship between S. aureus and keratinocytic skin neoplasia, evaluating the contribution of S. aureus to the development and prognosis of cSCC and AK lesions. The overabundance of S. aureus and the compounds secreted by this bacterium can induce cancer‑promoting changes in skin cells. The presence of high amounts of certain S. aureus strains in premalignant skin lesions may constitute a protumorigenic stimulus by inducing oxidative stress and DNA damage and downregulating DNA repair mechanisms. S. aureus associated with AK and cSCC can trigger keratinocytes to produce inflammatory cytokines typically upregulated in cSCC. These circumstances also suggest a potential specific involvement of S. aureus in the progression from AK to cSCC.
Clinical characteristics and development of complications differ between adult-onset and child–adolescent-onset type 1 diabetes: A report from a tertiary medical center in Türkiye
(Wiley, 2025) Çakmak, Ramazan; Telci Çaklılı, Özge; Ok, Ayşe Merve; Mutlu, Ümmü; Sarıbeyliler, Göktuğ; Seferova Nasifova, Vefa; Bilgin, Ersel; Çoşkun, Aylin; Güzey, Damla Yenersu; Satman, İlhan
Background and Aims: The age-at-onset is of great importance in the heterogeneity of Type 1 diabetes mellitus (T1DM). This study was designed to define clinical and laboratory differences between child–adolescent-onset and adult-onset T1DM at presentation and during follow-up and determine the predicting factors for developing microvascular and macrovascular complications. Material and Methods: This retrospective observational study evaluated T1DM patients who were followed in the diabetes outpatient clinic between January 1, 2000, and December 31, 2019. Results: The study cohort included 490 individuals with T1DM (54.3% female, 58.8% adult-onset, and median follow-up: 5 years). In the adult-onset group, baseline C-peptide and GADA prevalence were higher, whereas presentation with ketoacidosis was 2.3-fold lower compared to the child–adolescent-onset group (p < 0.001). During follow-up, the adult-onset group had a 2.4-fold higher overweight/obesity (p < 0.001) and 1.7-fold higher dyslipidemia/hyperlipidemia (p = 0.002) than the child–adolescent-onset group. In multivariate analysis, fasting glucose (p = 0.024) in adult-onset, dyslipidemia/hyperlipidemia (p = 0.037) in child–adolescent-onset, and diabetes duration (p = 0.008 and p = 0.007) and hypertension (p = 0.001 and p = 0.01) in both groups were associated with increased risk of microvascular complications, whereas age-at-onset (p = 0.024), dyslipidemia/hyperlipidemia (p = 0.03), nephropathy (p = 0.003), and neuropathy (p = 0.001) in adult-onset and age (p = 0.002) and triglycerides (p = 0.013) in child–adolescent-onset groups were associated with increased risk of macrovascular complications. The cutoff C-peptide levels at baseline predicted microvascular complications in the whole cohort and adult-onset group were defined as 0.383 ng/mL (p < 0.001) and 0.41 ng/mL (p = 0.001), respectively. In the Kaplan–Meier analysis, C-peptide (< 0.383 ng/mL) but not age-at-onset predicted future development of microvascular and macrovascular complications (p = 0.003 and p = 0.032). Conclusion: Clinical presentation and prognosis differ in adult-onset and child–adolescent-onset T1DM. Low initial C-peptide may predict the development of microvascular and macrovascular complications.
Neural therapy as a key modulator in non-specific low back pain
(Salient Visionary Publications LLC, 2025) Nazlıkul, Hüseyin; Ural Nazlıkul, Fatma Gülçin; Özkan, Neslihan; Tamam, Yusuf; Acarkan, Tijen; Elmacıoğlu, Mehmet Ali; Bilgin, Mehmet Dinçer
Background: Non-specific low back pain (NSLBP) is a widespread musculoskeletal disorder with multifactorial origins, including postural dysfunctions, myofascial imbalances, autonomic dysregulation, and psychosocial influences. Differentiating between functional and degenerative causes is crucial for treatment planning. Conventional therapies often fall short, particularly in chronic cases. This study evaluate the efficacy of neural therapy as a regulatory, minimally invasive treatment option for NSLBP. Methods: This retrospective analysis includes 1,242 patients treated at the Natural Health Clinic between 2017 and 2024. Patients underwent neural therapy targeting modulation of the autonomic nervous system (ANS), resolving interference fields, and treating myofascial trigger points. Treatment duration, symptom severity (VAS, ODI), and functional improvement were assessed, with stratification by age and chronicity. Results: Neural therapy led to complete symptom resolution in 29% of cases and marked improvement in 35%, with only 2% reporting worsening symptoms. Most patients required between 2 and 4 sessions; fewer than 10% needed over 12 sessions. Age and symptom duration correlated with treatment intensity—older and long-term chronic patients often needed more sessions. Combined with manual medicine, neural therapy enhanced outcomes by addressing vegetative dysfunctions, neurogenic inflammation, and segmental restrictions. Conclusion: Neural therapy offers a compelling integrative approach for both functional and degenerative NSLBP. Its ability to regulate autonomic dysfunctions, reduce chronic inflammation, and address underlying interference fields positions it as a practical component of multimodal pain management. The retrospective data from over 1,200 patients underscores its clinical relevance, especially for middle-aged and older adults with chronic symptoms.
The significance of thoracic blockages for the autonomic nervous system – neural therapy and its clinical relevance
(Sci Vision Publishers, 2025) Nazlıkul, Hüseyin; Ural Nazlıkul, Fatma Gülçin; Tamam, Yusuf; Oettmeier, Ralf; Acarkan, Tijen; Reuter, Uwe Rudolf Max
Background: Thoracic blockages not only present as mechanical movement restrictions but also influence a wide range of physiological processes due to their close connection with the autonomic nervous system, particularly the sympathetic nervous system. Persistent sympathetic activation can lead to autonomic dysfunctions, organ disorders, hormonal imbalances, metabolic diseases, myofascial pain syndromes, and circulatory disturbances. Methods: This study analyzes the pathophysiological mechanisms of thoracic blockages and their impact on the spinal and autonomic nervous systems. The primary focus is on the interplay between sympathetic hyperactivity, impaired microcirculation, and the formation of myofascial trigger points. Results: Chronic thoracic blockages can induce reflexive hypertonia of the paravertebral musculature, leading to pain, organ dysfunction, and central nervous system sensitization. This exacerbates muscular imbalances and contributes to the chronicity of pain syndromes. Therapy: Combining neural therapy and manual medicine offers an integrative approach to restoring disrupted physiological balance. While neural therapy targets sympathetic dysregulation and modulates interference fields, manual medicine helps restore mobility and reduce muscular dysfunction. Conclusion: Effective treatment of thoracic blockages requires an interdisciplinary approach that addresses both neurovegetative and mechanical aspects. The combination of neural therapy and manual medicine is an effective method for sustainably regulating structural and functional imbalances while reducing healthcare costs.
Reply to the letter to the editor: 'Coronary atherosclerosis burden and coronary artery tortuosity'
(Kare Publishing, 2025) Özyaşar, Mehmet; Doğduş, Mustafa; Yılmaz, Ahmet; Altıntaş, Mehmet Sait; Yetkin, Ertan
To the Editor, First, we would like to thank the author1 and the editorial team for their attention to and interest in our work. We deeply value your constructive criticism and contributions, which we see as an opportunity for further improvement. Collateral circulation plays a significant role in the prognosis of coronary artery disease.2 We acknowledge the importance of considering the effect of collateral circulation when calculating Gensini scores.3 In our retrospective study, while evaluating cases of chronic coronary syndrome that underwent coronary angiography, the coronary collateral flow assessment (Rentrop) score (3) was 0 in all cases. However, we accept that this detail should have been clarified more explicitly in our article. Our study aimed to minimize confounding factors as much as possible to realistically examine the relationship between coronary artery tortuosity and coronary atherosclerosis. While we acknowledged in the limitations section of our study that this might introduce a potential bias in patient selection,4 we accept that it would have been beneficial to explicitly state that we sought to eliminate the effect of collateral circulation. One of the key strengths of our study is the large patient cohort, along with the meticulous exclusion of other confounding factors. In conclusion, while recognizing the importance of collateral circulation, we believe that our study provides important information about the relationship between coronary artery tortuosity and atherosclerotic plaque burden. We hope this research contributes to a deeper understanding of coronary artery disease and offers a new perspective for future studies.

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