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Sex differences in ambulatory blood pressure among patients referred for 24-hour monitoring a retrospective cross-sectional study
(Lippincott Williams and Wilkins Ltd., 2026) Atmaca, Hasan; Gürbüz, Doğaç Çağlar; Erol, Mustafa Kemal; Yetkin, Ertan
Few studies have addressed the differences between hypertensive women and men regarding the diagnosis and control of blood pressure (BP). Accordingly, we aimed to assess the possible discrepancies in BP values between women and men who underwent 24-hour ambulatory blood pressure monitoring. The study population comprised all patients who underwent 24-hour ambulatory blood pressure monitoring, which was retrospectively screened and recorded. Demographic and clinical characteristics of 1204 patients were included in the analysis. Sex-specific analyses of all patients, including those with and without a former diagnosis of hypertension (HT), were performed. Two-thirds of the patients were women. In the general population, both systolic and diastolic BP levels in women were significantly lower than those in men. BP in women was also significantly lower than that in men, both in patients with and without a former diagnosis of HT. Our study demonstrated that women exhibited significantly lower systolic and diastolic BP values than men in this referral cohort, irrespective of a prior diagnosis of HT. While the exact mechanisms remain to be elucidated, this difference highlights the necessity for further research into sex-specific hemodynamic profiles. Consequently, further research is necessary to establish diagnostic thresholds and BP targets to achieve effective and targeted management of BP abnormalities in women.
Long-term seizure outcomes in patients with drug-resistant mesial temporal lobe epilepsy due to hippocampal sclerosis
(Elsevier, 2026) Gül, Günay; Eren, Fulya; Kandemir Yılmaz, Melek; Yandım Kuşcu, Demet; Keskinkılıç, Cahit; Tuğcu, Bekir
Objective: Resective surgery is a significant therapeutic option for patients with drug-resistant mesial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis (HS). Numerous studies have demonstrated the efficacy of epilepsy surgery in the short to median term. However, studies on long-term outcomes are limited in number. The objective of this study was to document the long-term prognosis and associated factors of patients under going resective surgery for MTLE. Methods: A retrospective analysis was conducted on the data of patients with drug-resistant MTLE due to HS who underwent resective surgery between 2001 and 2013 at our epilepsy centre. The demographics and clinical variables of the patients were documented and analysed in order to ascertain their long-term prognosis. The postoperative outcomes were evaluated in accordance with the Engel classification system. Results: Of the 45 patients (mean age: 44.64 ± 8.96, range: 31–67), 31 (68.89%) were male. The age at onset of epilepsy, age at surgery, and the duration of epilepsy at the time of surgery ranged from 0.25 to 26 years (11.51 ± 7.07), from 12 to 47 years (26.82 ± 8.14), and from 2 to 33 years (16.03 ± 7.85), respectively. The patients were followed up for 10–23 years (17.73 ± 2.96). HS was identified in 23 (51.11%) of the patients on the right side and 22 (48.89%) on the left. The pre-operative EEG recordings revealed temporal discharges in 40 (88.89%) patients unilaterally. 22 patients (48.89%) underwent amygdalohippocampectomy with a temporal lobectomy (AH+ATL), while 23 patients (51.11%) underwent selective amygdalohippocampectomy (SAH). 28 (62.22%) patients were classified as Engel I. The patients did not have any statistically significant difference in terms of gender, age at epilepsy onset, age at surgery, duration of epilepsy at surgery, side of HS, and surgical procedure according to Engel classification (p = 0.64, 0.08, 0.60, 0.25, 0.67, 0.10, respectively). Executive and memory functions were improved after surgery at 5th year. Conclusion: 62% of the patients were classified as Engel I. Although previous studies have suggested that certain factors may influence prognosis, our findings did not yield any statistically significant results in this regard. It is crucial that patients undergo surgical evaluation without delay to achieve seizure control and improve cognitive function.
Effects of rifaximin in fructose-induced steatohepatitis in rats
(Kare Publishing, 2026) Kıyak, Mevlüt
To the Editor, I read with interest the recently published article titled “Effects of rifaximin in fructose-induced steatohepatitis in rats.” The article dis cusses how rifaximin may protect against early liver damage caused by fructose. The researchers showed that rifaximin helps reduce cer tain biochemical markers and promote healing in inflamed tissue, providing insight into the interaction between the gut and liver in fatty liver disease, which plays a role in metabolic disorders.
Coronary heart disease in patients with type 2 biabetes: The role of traditional, behavioral and atherogenic risk factors in a large multicenter study
(Oxford University Press, 2026) Telci Çaklılı, Özge; Demirci, İbrahim; Haymana, Cem; Hacışahinoğulları, Hülya; Kılınç, Faruk; Karakoç, Ayhan; Sarı, Ramazan; Taşçı, İlker; Salman, Serpil; Ersoy, Canan; Bayram, Fahri; Satman, İlhan; Sönmez, Alper
Background Type 2 diabetes mellitus (T2DM) substantially increases the risk of coronary artery disease (CAD) through insulin resistance, inflammation, and related complications. In this large, nationally representative multicenter study, we investigated behavioral and metabolic risk factors associated with CAD in T2DM. Materials and Methods This cross-sectional study was conducted across Türkiye, including 70 endocrine clinics in 36 cities. Adults with T2DM followed at the same center for at least one year were included. Sociodemographic, anthropometric, clinical, laboratory, and lifestyle data were recorded using a standardized web-based system. Results A total of 5707 patients with diabetes were recruited, of whom 4956 (86.8%) had T2DM (mean age 58.9 ± 10.0 years; 59.8% women). CAD status was available in 4750 patients, among whom 1061 (22.3%) had CAD. CAD was more frequent in men than women (30.4% vs 16.9%, P < .001). Patients with CAD were older (62.8 ± 8.6 vs 57.8 ± 10.2 years, P < .001) and had longer diabetes duration (16.1 ± 8.8 vs 12.2 ± 7.7 years, P < .001). Body mass index was lower (31.2 ± 5.8 vs 31.8 ± 6.8 kg/m2, P = .005), whereas waist circumference was higher (106.7 ± 13.7 vs 105.1 ± 14.1 cm, P = .004). Lower income was associated with CAD (23.4% vs 19.5%, P = .003), whereas smoking and exercise were not (P = .219 and P = .977). Hypertension was associated with CAD (28.2% vs 14.5%, P < .001). Systolic blood pressure was higher (126.1 ± 13.6 vs 124.3 ± 13.6 mmHg, P = .004), while diastolic pressure did not differ (P = .603). HbA1c was higher in the CAD group (8.27 ± 1.94 vs 7.84 ± 1.89%, P < .001), and hypoglycemia was more frequent (24.6% vs 20.8%, P = .002). In multivariable logistic regression, independent predictors of CAD were older age (OR 1.04, 95% CI 1.03-1.05, P < .001), male sex (OR 0.39, 95% CI 0.33-0.46, P < .001), current smoking (OR 1.37, 95% CI 1.12-1.66, P = .002), hypertension (OR 2.00, 95% CI 1.68-2.38, P < .001), microvascular complications (OR 1.48, 95% CI 1.26-1.74, P < .001), higher HbA1c (OR 1.12 per %, 95% CI 1.07-1.17, P < .001), longer diabetes duration (OR 1.04 per year, 95% CI 1.02-1.05, P < .001), and lower income (OR 0.74, 95% CI 0.62-0.88, P = .001). Exercise, diet, hypoglycemia, education, and body mass index were not independently associated with CAD (all P > .05). Conclusion In this large national cohort of T2DM patients, CAD was independently associated with classical cardiometabolic risk factors, microvascular complications, and lower income, whereas lifestyle factors were not independently associated after adjustment. These findings highlight dominant role of cumulative metabolic burden and vascular damage in determining CAD risk and emphasize the importance of early, sustained, risk factor–targeted management.
Gray zone of hypertension thresholds values can be overcome by individualized symptom-oriented approaches
(Lippincott Williams and Wilkins Ltd., 2026) Yetkin, Ertan; Atmaca, Hasan; Gürbüz, Dogaç Çağlar; Yalta, Kenan; Erol, Mustafa Kemal
Dear Editor, We have read with great interest the recently published article of Chung et al. [1]. Briefly, they reassessed the sensitivity, specificity and diagnostic accuracy of home blood pressure monitoring (HBPM) by changing threshold values for the diagnosis of hypertension from 135/85 to 130/80 mmHg in 646 participants who were suspected of having hypertension (office blood pressure ≥140/90 mmHg). Eventually, they have found that lowering the diagnostic threshold of home hypertension from 135/85–130/80 mmHg significantly enhances the diagnostic sensitivity of HMBP.
A global consensus on the critical care management of acute‑on‑chronic liver failure patients: The APASL ACLF beijing position paper
(Springer Nature Link, 2026) Chen, Tao; Choudhury, Ashok; Liu, Wei; Zhang, Meng; Wu, Wenhui; Xiang, Huiling; Wang, Xiaojing; Abbas, Zaigham; Örmeci, Necati; Ning, Qin
Background and aims Acute-on-chronic liver failure (ACLF) is a severe syndrome in patients with chronic liver disease, marked by rapid multi-organ failure and high short-term mortality. Managing ACLF requires intensive care, but standard ized global guidelines were previously lacking. The APASL ACLF Research Consortium (AARC) developed this position paper to establish a unified, evidence-based consensus for its critical care management. Methods A global collaboration of 109 experts employed a systematic methodology to address key aspects of ACLF care. Sections were drafted by specialist teams, with recommendations developed using the GRADE system. Draft statements underwent iterative review and refinement, followed by an expert panel consensus process consisting of open show-of-hands voting during the APASL Annual Conference in March 2025 in Beijing and a subsequent anonymous online voting round. Results The consensus delivers 104 position statements. Key recommendations include using prognostic scores (AARC, CLIF-C ACLF, GIC) for ICU transfer and treatment decisions, and aggressively managing precipitating factors or complica tions like infections. It details organ-specific support for liver, kidney, and brain failure, advocating for early, targeted antibi otics and careful fluid management. The role of bridging therapies (plasma exchange, artificial liver systems) and nutritional support is emphasized. For transplantation, the guidelines provide criteria for patient selection and timing, particularly for alcohol-related ACLF. Conclusions The APASL ACLF Beijing Position Paper provides a comprehensive, standardized framework for managing critically sick ACLF patients. Integrating multidisciplinary expertise and current evidence, these guidelines aim to optimize care, inform clinical decisions, and improve survival for this high-risk population. As a few recommendations are supported predominantly by data from different continents, they should therefore be interpreted in local contexts.
Turkish cross-sectional survEy of glycemic and other metabolic parameters in patients with type 2 diabetes in 2023: Comparison with 2018 nationwide data (TEMD-2 study)
(Elsevier, 2026) Sönmez, Alper; Haymana, Cem; Demirci, İbrahim; Çetinarslan, Berrin; Gönen, Mustafa Sait; Akbaş, Emin Murat; Yenidünya Yalın, Gülşah; Avcı, Uğur; Taşcı, İlker; Salman, Serpil; Ersoy, Canan; Bayram, Fahri; Satman, İlhan
Aim: Five years after the first “Turkish nationwide survEy of glycemic and other Metabolic parameters of patients with type 2 Diabetes” (TEMD-1), attainment of glycemic, arterial blood pressure (ABP), and LDL-cholesterol (LDL-C) goals was re-investigated in patients with type 2 diabetes mellitus (T2DM), with an additional focus on therapeutic inertia. Methods: This cross-sectional study consecutively enrolled patients from 70 tertiary endocrine centers across Türkiye (November 2022–January 2023). Metabolic targets were HbA1c <7% (<53 mmol/mol), home ABP <135/85 mmHg, and risk-stratified LDL-C <55, <70, or <100 mg/dL (<1.4, <1.8, or <2.6 mmol/L). Thera peutic inertia was defined as failure to intensify treatment at enrollment. Results: Among the 4956 participants (mean age: 58.9 ± 10.0 years, women: 59.8%), HbA1c, ABP, LDL-C and triple metabolic control target attainment rates were 36.7%, 71.1%, 8.7%, and 2.8%, respectively. Glycemic control rate was found lower than the previous survey (40.0% vs. 36.7%, p < 0.001), while LDL-C control rate improved (7.0% vs. 8.7%, p = 0.002). Patients with established cardiovascular disease (CVD) showed worse outcomes, with triple metabolic control rate of 1.6%. The rate of severely uncontrolled diabetes (HbA1c >9%/ 75 mmol/mol) was 23.6%. Therapeutic inertia was observed by 33.5%, persisting uniformly across subgroups. Younger age, male sex, longer diabetes duration, lower socioeconomic status, and microvascular complications were independently associated with poor glycemic control. Conclusions: Metabolic control remains suboptimal in Turkish T2DM patients, and one-third of patients with severe hyperglycemia showed therapeutic inertia. Systematic interventions and intensified strategies are ur gently needed to improve diabetes outcomes and treatment inertia (ClinicalTrials.gov number NCT06347445).
Resmetirom and semaglutide therapy for patients with MAFLD in the MENA region: Expert panel recommendations
(Taylor & Francis, 2026) Fouad, Yasser; AlNaamani, Khalid M.; Alawadi, Fatheya; Al Hassani, Abdulla; Alkhalidi, Nawal; Hotayt, Bilal; Abaalkhail, Faisal; Rouabhia, Samir; Örmeci, Necati; Eslam, Mohammed
Introduction: Metabolic dysfunction–associated fatty liver disease (MAFLD) affects 25–30% of the global population, with the Middle East and North Africa (MENA) region showing some of the highest prevalence rates, reaching up to 40%. MAFLD is a common cause of cirrhosis and hepatocellular carcinoma and is a leading indication for liver transplantation in this region. Hitherto, there have been no specific pharmacotherapies for MAFLD. However, the recent conditional approval of resme tirom and semaglutide by the FDA for the treatment of non-cirrhotic moderate-to-advanced (fibrosis stages 2 or 3) metabolic-associated steatohepatitis (MASH) offers a much-needed therapeutic option for this largely underserved condition. Areas covered: An expert panel from the MENA region conducted a comprehensive literature search via PubMed and Google Scholar, focusing on clinical trials and international guidelines for resmetirom and semaglutide. This review identifies the target treatment population, proposes criteria for cessation of therapy, outlines monitoring protocols, and addresses regional knowledge gaps. Expert opinion: The approval of the first two drugs for MASH is a milestone. Access to and affordability of these therapies will be the crucial determinants of their actual adoption. Future efforts should consider individualized treatment pathways stratified by cost, regulatory status, and healthcare infra structure, while generating further regional evidence.
Parental awareness, knowledge, and hesitancy toward HPV vaccination for adolescents: A cross-sectional study
(Sociedad Argentina de Pediatria, 2026) Güven, Deniz; Köle, Mehmet Tolga; Örün, Emel; Çaylan, Nilgün; Küçük, Elif; Kandemir, İbrahim; Öztürk, Seval; Kondolot, Meda
Background. Human papillomavirus (HPV) is a prevalent sexually transmitted infection and major cause of cervical and anogenital cancers. This study aimed to assess parental knowledge, vaccine hesitancy, and health beliefs concerning HPV infection and vaccination. Methods. This cross-sectional study was conducted using convenience sampling among parents of adolescents aged 9–18 attending outpatient clinics at a tertiary hospital. The study collected sociodemographic characteristics and used the Health Belief Model Scale for HPV Infection and Vaccination to assess health beliefs, in order to identify factors associated with parental perceptions and vaccination attitudes. Results. A total of 320 parents participated in the study; 82.8% were mothers. Self-reported HPV infection was low (1.9%), and only 3.4% of parents and 2.8% of their children had been vaccinated. Awareness about HPV infection was 75%, and that of the HPV vaccine was 67.2%. However, only 30% of parents were willing to vaccinate their children, while 47.5% were uncertain. The most commonly reported barriers were lack of awareness (33.9%) and concerns about side effects (26.4%). Higher parental education, family income, and prior HPV knowledge were positively associated with both awareness and willingness to vaccinate children, whereas having multiple adolescents was associated with increased vaccine hesitancy. Conclusion. Parental awareness of HPV infection and vaccination was 75% and 67.2%, respectively, while vaccination rates among adolescents were very low. Higher parental education, income, and prior HPV knowledge were associated with favorable perceptions of vaccination. Addressing knowledge gaps and reducing perceived barriers through educational interventions may help increase HPV vaccination uptake among adolescents.
A multisociety consensus statement on a new common definition and diagnostic criteria for PSVD or NCPF
(Elsevier, 2026) Hernandez Gea, Virginia; Paradis, Valerie; Guindi, Maha; Alves, Venancio A.F.; Aqul, Amal; Cerda, Eira; Darwish Murad, Sarwa; Das, Prasenjit; Örmeci, Necati; Rautou, Pierre Emmanuel
Noncirrhotic portal hypertension has historically been described using heterogeneous and region-specific terminology—such as idiopathic portal hypertension (IPH), noncirrhotic portal fibrosis (NCPF), obliterative portal venopathy, and nodular regenerative hyperplasia—leading to substantial variability in diagnosis, reporting, and international research collaboration. Differences in guideline definitions from major societies (AASLD, EASL, and APASL), together with the presence of characteristic histologic lesions in patients without clinically overt portal hypertension, have further complicated disease classification. To address these chal lenges, a large, multisociety, international initiative was convened to harmonize nomenclature and diagnos tic criteria. Representatives from liver, pathology, and pediatric hepatology societies across the Americas, Europe, and Asia participated in a structured consensus process that included specialized working groups and external Delphi validation. The initiative produced a globally harmonized and implementable diagnostic framework. Consensus was reached that the terms porto-sinusoidal vascular disorder (PSVD) and NCPF may be used interchangeably when identical diagnostic criteria are applied, and that they should be written as PSVD or NCPF. The diagnosis was defined as fundamentally clinicopathological, requiring integrated assess ment. Core principles include the need for a high-quality liver biopsy (≥ 10 mm), mandatory exclusion of cir rhosis, and systematic exclusion of specific alternative conditions. Importantly, the consensus recognizes that PSVD or NCPF may be diagnosed even without clinical portal hypertension and may coexist with other liver diseases, provided cirrhosis is excluded. Standard-ized major and minor histologic criteria were devel oped collaboratively by expert pathologists and externally validated. Features of portal hypertension were harmonized into specific and nonspecific categories applicable to routine clinical practice. An integrated diagnostic scoring system incorpo-rating histology, clinical features, associated conditions, and concommi tant etiologies was developed and validated using the Delphi method. This consensus provides the first inter nationally endorsed, unified framework for the diagnosis of PSVD or NCPF. Its global implementation is expected to reduce diagnostic variability, improve comparability across regions, and facilitate the develop ment of robust, internationally harmonized clinical and translational research cohorts.
A multisociety consensus statement on a new common definition and diagnostic criteria for PSVD or NCPF
(Elsevier, 2026) Hernandez Gea, Virginia; Paradis, Valerie; Guindi, Maha; Alves, Venancio A.F.; Aqul, Amal; Cerda, Eira; Darwish Murad, Sarwa; Das, Prasenjit; Örmeci, Necati; Rautou, Pierre Emmanuel
Non-cirrhotic portal hypertension has historically been described using heterogeneous and region-specific terminology, such as idiopathic portal hypertension (IPH), non-cirrhotic portal fibrosis (NCPF), obliterative portal venopathy, and nodular regenerative hyperplasia, leading to substantial variability in diagnosis, reporting, and international research collaboration. Differences in guideline definitions from major societies (AASLD, EASL, and APASL), together with the presence of characteristic histologic lesions in patients without clinically overt portal hypertension, have further complicated disease classification. To address these challenges, a large, multisociety, international initiative was convened to harmonize nomenclature and diagnostic criteria. Representatives from liver, pathology, and pediatric hepatology societies across the Americas, Europe, and Asia participated in a structured consensus process that included specialized working groups and external Delphi validation. The initiative produced a globally harmonized and implementable diagnostic framework. Consensus was reached that the terms porto-sinusoidal vascular disorder (PSVD) and NCPF may be used interchangeably when identical diagnostic criteria are applied, and that they should be written as PSVD or NCPF. The diagnosis was defined as fundamentally clinicopathological, requiring integrated assessment. Core principles include the need for a high-quality liver biopsy (> −10 mm), mandatory exclusion of cirrhosis, and systematic exclusion of specific alternative conditions. Importantly, the consensus recognizes that PSVD or NCPF may be diagnosed even without clinical portal hypertension and may coexist with other liver diseases, provided cirrhosis is excluded. Standardized major and minor histologic criteria were developed collaboratively by expert pathologists and externally validated. Features of portal hypertension were harmonized into specific and nonspecific categories applicable to routine clinical practice. An integrated diagnostic scoring system incorporating histology, clinical features, associated conditions, and concommitant etiologies was developed and validated using the Delphi method. This consensus provides the first internationally endorsed, unified framework for the diagnosis of PSVD or NCPF. Its global implementation is expected to reduce diagnostic variability, improve comparability across regions, and facilitate the development of robust, internationally harmonized clinical and translational research cohorts.
A multisociety consensus statement on a new common definition and diagnostic criteria for PSVD or NCPF
(Springer Nature Link, 2026) Hernandez Gea, Virginia; Paradis, Valerie; Guindi, Maha; Alves, Venancio A.F.; Aqul, Amal; Cerda, Eira; Darwish Murad, Sarwa; Das, Prasenjit; Örmeci, Necati; Rautou, Pierre Emmanuel
Noncirrhotic portal hypertension has historically been described using heterogeneous and region-specific terminology—such as idiopathic portal hypertension (IPH), noncirrhotic portal fibrosis (NCPF), obliterative portal venopathy, and nodular regenerative hyperplasia—leading to substantial variability in diagnosis, reporting, and international research collabora tion. Differences in guideline definitions from major societies (AASLD, EASL, and APASL), together with the presence of characteristic histologic lesions in patients without clinically overt portal hypertension, have further complicated disease classification. To address these challenges, a large, multisociety, international initiative was convened to harmonize nomen clature and diagnostic criteria. Representatives from liver, pathology, and pediatric hepatology societies across the Ameri cas, Europe, and Asia participated in a structured consensus process that included specialized working groups and external Delphi validation. The initiative produced a globally harmonized and implementable diagnostic framework. Consensus was reached that the terms porto–sinusoidal vascular disorder (PSVD) and NCPF may be used interchangeably when identical diagnostic criteria are applied, and that they should be written as PSVD or NCPF. The diagnosis was defined as fundamen tally clinicopathological, requiring integrated assessment. Core principles include the need for a high-quality liver biopsy (≥10 mm), mandatory exclusion of cirrhosis, and systematic exclusion of specific alternative conditions. Importantly, the consensus recognizes that PSVD or NCPF may be diagnosed even without clinical portal hypertension and may coexist with other liver diseases, provided cirrhosis is excluded. Standardized major and minor histologic criteria were developed col laboratively by expert pathologists and externally validated. Features of portal hypertension were harmonized into specific and nonspecific categories applicable to routine clinical practice. An integrated diagnostic scoring system incorporating histology, clinical features, associated conditions, and concommitant etiologies was developed and validated using the Delphi method. This consensus provides the first internationally endorsed, unified framework for the diagnosis of PSVD or NCPF. Its global implementation is expected to reduce diagnostic variability, improve comparability across regions, and facilitate the development of robust, internationally harmonized clinical and translational research cohorts.
Juvenile xanthogranuloma in a congenital melanocytic nevus
(Mattioli 1885, 2026) Duman, Nilay; Yaman, Banu; Oraloğlu, Göktürk; Kararaslan, Işıl
A 6-year-old boy was evaluated for a 6-month history of a 2x1mm yellowish papule that developed within a congenital melanocytic nevus (CMN) located on his back. Dermoscopic examination showed a homogeneous yellowish background with localized pigmented struc tures. In vivo reflectance confocal microscopy revealed an area with sharp borders, characterized by thinning of the epidermis and the absence of rete ridges. At the dermo- epidermal junction, the dermal papillae did not exhibit the typical ringed pattern.
Role of S100B, neuron-specific enolase, and adrenomedullin in differentiating central and peripheral vertigo
(Bayrakol Medical Publisher, 2026) Onur, Bahaeddin; Özdemir, Serdar; Koçak, Mehmet; Ünal Akoğlu, Ebru; Demir, Hasan; Cimilli Öztürk, Tuba; Onur, Özge Ecmel
Aim: This study aimed to evaluate S100B, adrenomedullin (ADM), and neuron-specific enolase (NSE) as diagnostic biomarkers to differentiate central and peripheral vertigo in patients with dizziness. Methods: A prospective cohort study was conducted with 88 patients (58% women) presenting with dizziness. Patients were categorized based on MRI findings into two groups: those with acute lesions (central vertigo) and those without lesions (peripheral vertigo). S100B, ADM, and NSE levels were measured and compared between the groups to assess their diagnostic value for central vertigo. Results: Significant differences were found in S100B, NSE, and ADM levels between the central and peripheral vertigo groups (p=0.003, 0.008, and 0.010, respectively). Factors predicting MRI-detected lesions included age, mean arterial pressure, movement-induced and positional vertigo, neurological findings, history of hypertension, lack of response to symptomatic treatment, and elevated S100B, ADM, and NSE levels. Logistic regression analysis identified the lack of response to symptomatic treatment as the only significant predictor (p=0.0148). Conclusion: S100B, ADM, and NSE levels significantly differ between central and peripheral vertigo, suggesting their potential as diagnostic biomarkers. However, only the lack of response to symptomatic treatment was a significant predictor. Further research is needed to validate these biomarkers alongside clinical assessments and imaging.
Suboptimal LDL-cholesterol control under the 2019 ESC/EAS dyslipidemia guidelines: Results from the nationwide TEMD-2 study in type 2 diabetes
(Wiley, 2026) Telci Çaklılı, Özge; Haymana, Cem; Demirci, İbrahim; Kebapçı, Medine Nur; Sarıakçalı, Barış; Evren, Bahri; Dizdar, Oğuzhan Sıtkı; Salman, Serpil; Ersoy, Canan; Satman, İlhan; Bayram, Fahri; Sönmez, Alper
Background: Lowering LDL cholesterol (LDL-C) decreases cardiovascular risk substantially in type 2 diabetes. Despite stricter LDL-cholesterol targets in the 2019 ESC/EAS dyslipidemia guidelines, target achievement in clinical practice remains insuffi cient. TEMD-2 is designed to evaluate LDL-cholesterol target attainment in Turkish patients with type 2 diabetes in the context of the updated 2019 ESC/EAS guidelines. Methods: This multicenter cross-sectional study included adults with type 2 diabetes followed in 70 tertiary endocrine clinics across 36 cities between October 2022 and January 2023. Sociodemographic characteristics, comorbidities, lifestyle factors, com plications, laboratory measurements, and lipid-lowering therapies were assessed using standardized questionnaires and clinical evaluations. LDL-C target was assigned according to cardiovascular risk categories. Independent predictors of goal attainment were identified using multivariable logistic regression. Results: Among 4956 adults with type 2 diabetes, 99.5% required statin therapy, whereas 37.1% were on treatment. Overall, 8.3% of the cohort achieved LDL-cholesterol targets, with attainment lowest in those at very high risk (5.8%). Target achievement among statin users was 57.7% in moderate-risk, 18.1% in high-risk, and 9.4% in very-high-risk patients. Individuals on target had lower body mass index, haemoglobin A1c (HbA1c), triglycerides, and a lower prevalence of microvascular complications. Statin therapy was the strongest positive predictor of success (odds ratio 2.39), while smoking, presence of neuropathy, nephropathy, female sex, older age, and higher HbA1c were associated with lower likelihood of achieving LDL-cholesterol goals. Therapeutic inertia was present in 87.2% of patients, defined as no intensification of lipid-lowering therapy despite LDL-cholesterol levels above target.
A multisociety consensus statement on a new common definition and diagnostic criteria for PSVD or NCPF
(AASLD, 2026) Hernandez Gea, Virginia; Paradis, Valerie; Guindi, Maha; Alves, Venancio A.F.; Aqul, Amal; Cerda, Eira; Darwish Murad, Sarwa; Das, Prasenjit; Örmeci, Necati; Rautou, Pierre Emmanuel
Noncirrhotic portal hypertension has historically been described using heterogeneous and region-specific terminology—such as idiopathic portal hypertension (IPH), noncirrhotic portal fibrosis (NCPF), obliterative portal venopathy, and nodular regenerative hyperplasia—leading to substantial variability in diagnosis, reporting, and international research collaboration. Differences in guideline definitions from major societies (AASLD, EASL, and APASL), together with the presence of characteristic histologic lesions in patients without clinically overt portal hypertension, have further complicated disease classification. To address these challenges, a large, multisociety, international initiative was convened to harmonize nomenclature and diagnostic criteria. Representatives from liver, pathology, and pediatric hepatology societies across the Americas, Europe, and Asia participated in a structured consensus process that included specialized working groups and external Delphi validation. The initiative produced a globally harmonized and implementable diagnostic framework. Consensus was reached that the terms porto-sinusoidal vascular disorder (PSVD) and NCPF may be used interchangeably when identical diagnostic criteria are applied, and that they should be written as PSVD or NCPF. The diagnosis was defined as fundamentally clinicopathological, requiring integrated assessment. Core principles include the need for a high-quality liver biopsy ( ≥ 10 mm), mandatory exclusion of cirrhosis, and systematic exclusion of specific alternative conditions. Importantly, the consensus recognizes that PSVD or NCPF may be diagnosed even without clinical portal hypertension and may coexist with other liver diseases, provided cirrhosis is excluded. Standard ized major and minor histologic criteria were developed collaboratively by expert pathologists and externally validated. Features of portal hypertension were harmonized into specific and nonspecific categories applicable to routine clinical practice. An integrated diagnostic scoring system incorpo rating histology, clinical features, associated conditions, and concommitant etiologies was developed and validated using the Delphi method. This consensus provides the first internationally endorsed, unified framework for the diagnosis of PSVD or NCPF. Its global implementation is expected to reduce diagnostic variability, improve comparability across regions, and facilitate the development of robust, internationally harmonized clinical and translational research cohorts.
Real-world comparison of short-term adverse events, treatment persistence, and efficacy of semaglutide and tirzepatide: A nationwide multicenter study
(Karger, 2026) Hepşen, Sema; Haymana, Cem; Ertepe Küçükgöde, Gizem; Özcan, Büşra; Özbaş, Burak; Or Koca, Arzu; Aydoğan, Berna İmge; Tura Bahadır, Çiğdem; Salman, Serpil; Sönmez, Alper
Introduction: Real-world data directly comparing the safety, tolerability, and effectiveness of semaglutide and tirzepatide in patients with obesity remain limited. This nationwide multicenter observational study compared short-term adverse events, treatment discontinuation, body weight loss (BWL), and metabolic outcomes between the two treatments. Methods: This study included 2,549 patients with obesity treated with semaglutide (n=1,434) or tirzepatide (n=1,115). Adverse events, including time to onset, dose at occurrence, and related discontinuation, were evaluated. Changes in BWL and metabolic parameters up to 6 months were assessed. Subgroup analyses were performed in patients with and without type 2 diabetes mellitus (T2DM). Results: At least one adverse event occurred in 50.9% in the semaglutide group and 51.0% in the tirzepatide group (p=0.524), with gastrointestinal events the most frequently reported. Overall adverse event rates were comparable between groups; however, musculoskeletal and allergic reactions were more common in the tirzepatide group. The onset of gastrointestinal, neuropsychiatric, musculoskeletal symptoms, and hypoglycemia occurred earlier in the tirzepatide group. Discontinuation due to adverse events was similar between groups, except for pancreatic events, which were more frequent in the semaglutide group (p=0.006). Tirzepatide was associated with greater early BWL at all time points. At 6 months, median percentage BWL was 12.6% with semaglutide and 14.4% with tirzepatide. HbA1c reductions were comparable between groups in patients with T2DM. Conclusion: In real-world clinical practice, semaglutide and tirzepatide show similar short-term tolerability and treatment persistence, although tirzepatide is associated with a higher incidence of musculoskeletal and allergic reactions and greater early BWL.
The impact of home-based telerehabilitation pranayama on sleep quality and wellbeing in mild to moderate obstructive sleep apnea syndrome. A randomized controlled trial
(BioMed Central, 2026) Kaçar Akkoç, Zeynep; Demir, Rengin; Mustafaoğlu, Rüstem; Önder, Ömer Önder; Naci, Baha; Atahan, Ersan
Background Obstructive sleep apnea syndrome (OSAS) is a common disorder that causes repeated airway obstruction, disrupted breathing, and fragmented sleep. This study aimed to investigate the effects of Pranayama on sleep quality, daytime sleepiness, quality of life, fatigue, depression, and anxiety in patients with OSAS. Methods This study was designed as an open-label, prospective, randomized controlled trial. OSAS patients meeting the inclusion criteria were randomly assigned to either an Intervention group or a Control group. Pranayama training was applied to the Intervention group for 8 weeks, 7 days a week, and 3 times a day for 15 min. In addition, a single 15-minute session, 3 days a week, was conducted online under the supervision of a physiotherapist. The control group did not receive any intervention. Primary outcome was sleep quality (Pittsburgh Sleep Quality Index, PSQI). Secondary outcomes included daytime sleepiness (Epworth Sleepiness Scale, ESS), Fatigue Severity Scale (FSS), Functional Outcomes of Sleep Questionnaire (FOSQ), Nottingham Health Profile (NHP), and Hospital Anxiety and Depression Scale (HADS). All outcome measures were assessed at baseline and reassessed after the 8-week intervention period. Results Thirty-eight OSAS patients meeting the inclusion criteria were randomly assigned to either an Intervention group (n = 19) or a Control group (n = 19). Four participants (two in each group) were lost to follow-up, leaving the data of 34 participants (17 per group) available for inclusion in the final analysis. In the intervention group, PSQI scores decreased from 9.12 ± 4.71 to 6.88 ± 4.45 (p < 0.001), whereas no improvement was observed in the control group. Regarding the primary outcome, the reduction in PSQI scores was significantly greater in the intervention group than in the control group (p < 0.001). The ESS scores also decreased significantly in the intervention group, from 9.41 ± 6.15 to 7.41 ± 6.18 (p = 0.006, with a significant between-group difference (p < 0.001). Fatigue severity decreased in the intervention group (FSS change: 0.53 ± 0.70; p = 0.006), with a significant between-group difference (p = 0.037). The FOSQ score improved markedly, with significant gains in FOSQ total score (− 0.38 ± 0.25 vs. 0.14 ± 0.22 in controls; p < 0.001) and in activity level and vigilance subdomains (both p < 0.001). The HADS-anxiety scores decreased by 1.94 ± 3.94 (p = 0.059) and depression scores by 3.06 ± 2.05 (p < 0.001) in the intervention group, with significant between-group differences for both anxiety (p = 0.008) and depression (p < 0.001). Conclusion Pranayama was an effective adjunct therapy for these OSAS patients, and incorporating it into treatment strategies may enhance patient outcomes. Clinical trial registration number/date NCT04632147/22.10.2020.
The use of bispectral index for monitorization of the depth of sedation in procedural sedoanalgesia in the emergency department
(Bayrakol Medical Publisher, 2026) Gökdağ, Eren; Sarı Doğan, Fatma; Yılmaz, Sarper
Aim: To determine the effectiveness of the Bispectral Index (BIS) measurement as an objective criterion for measuring the depth of sedation in the emergency department (ED) by comparing it with the Modified Ramsey Sedation Scale (MRSS), which is a clinical scale for measuring sedation depth. Methods: In this study, the compatibility of BIS values and MRSS values at the moment when the patients reached clinically appropriate sedation depth for intervention in those requiring sedation-analgesia in the ED due to extremity trauma were compared. Results: No statistically significant correlation was found between patients’ initial MRSS scores at the time of intervention and either their initial or minimum BIS values (p>0.05). A moderate negative correlation (r=-0.432, p=0.022) was observed between the MRSS values and the minimum BIS readings. No statistically significant difference was observed in minimum BIS values based on the sedative agent administered (p>0.05). Conclusion: In this study, a moderate correlation was found between the lowest BIS values and the MRSS scores corresponding to those BIS values. Although further comprehensive and detailed studies are necessary to establish the limitations and optimal use of BIS monitoring during procedural sedation-analgesia in the ED—especially considering both existing literature and the limitations of this study—BIS appears to be a promising alternative to clinical sedation scales for monitoring sedation depth.
Evaluation of the psychosocial aspects of the patients applying to the university cosmetology unit
(Unico's Medicine, 2026) Oraloğlu, Göktürk; Kuman Tunçel, Özlem; Elbi, Hayriye; Sağduyu, Ahmet Afşin; Ertam Sağduyu, İlgen
Objective: It is important to evaluate cosmetic patients psychologically and thus minimize potential adverse psychological outcomes that may occur after the procedure. This study aimed to investigate the psychosocial parameters in cosmetic patients. Materials and methods: Female patients (≥18 years old) who applied to the Ege University Dermatology and Venereal Diseases Department Cosmetology Unit were selected. ''Hospital Anxiety and Depression Scale'', ''Body Image Coping Strategies Inventory'', ''Temperament and Character Inventory'', ''Dermatology Quality of Life Index'' and ''Life Events' Checklist-5 '' forms were applied to the patients. The obtained data were analyzed statistically. Results: There were 36 people in the case group and 34 participants in the control group. A statistically significant difference was not found regarding life quality, anxiety, body image disturbance, and personally experienced life events between the two groups. Reward dependence, empathy, and purposefulness were significantly higher in the cosmetic group. Conclusion: The life quality was not negatively affected, the incidence of anxiety and depression was low, traumatic events were rare, and positive rational acceptance was mostly chosen as the main method of coping with body image negativities in cosmetic patients. Compared with controls, cosmetic patients demonstrated higher reward dependence, empathy, and purposefulness scores, without evidence of increased psychopathology.

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