Sedat Yildiz

Background/Objectives: Urge incontinence (UI) is a condition defined as the involuntary loss of urine, affecting both women and men. The underlying pathophysiology is not completely understood, but it might involve the functioning of the autonomic nervous system (ANS) and the hypothalamic–pituitary–adrenal (HPA) axis, i.e., two main stress axes of the body. Therefore, the present study aimed to investigate the association of ANS and HPA axis activities with urge incontinence in female and male genders. Methods: For this purpose, four groups were established: (i) female patients with UI (n = 57), (ii) female control participants (n = 56), (iii) male patients with UI (n = 57), and (iv) male control participants (n = 57). ANS activity was assessed by heart rate variability (HRV) derived from a 5-min electrocardiogram (ECG) recording, and HPA activity was evaluated by salivary cortisol levels. HRV parameters consisted of both time- and frequency-domain parameters, notably the low frequency/high frequency (LF/HF) ratio, which is commonly interpreted as an index of sympathovagal balance. Results: Body mass index and age were higher in UI patients (p < 0.001). Cortisol levels did not differ significantly between groups (p > 0.05), whereas frequency-domain parameters of HRV (including LF/HF) were significantly lower in patient groups (p < 0.05). Conclusions: The data suggest that incontinence might be associated with altered ANS activity, with no effect on HPA axis dysregulation. Decreased LF/HF might be associated with a decreased sympathetic urine retention mechanism with increasing age in UI patients. Moreover, the data also suggest that cardiac autonomic control (assessed by HRV) might be a sensitive, non-invasive, and cost-effective tool for studying autonomic control of bladder function.

Aim: It is known that phasic social and behavioral changes occur during the menstrual cycle. As a stress marker, cortisol rises in the morning (cortisol awakening response, CAR) and decreases around midnight. Therefore, the present study aimed to establish a link between perceived symptom severity and diurnal cortisol levels during the menstrual cycles of cyclic women. Materials and Methods: Healthy, cycling women (18–31 years old, n=15) had salivary cortisol tested at 12:00 pm, 05:00 pm, and 10:00 pm (for diurnal rhythm) after waking (0, 15, 30, and 60 min, CAR). The same subjects were tested during menses, luteal, and premenstrual periods of a single menstrual cycle. Participants recorded perceived problem severity during the test. The STAI-T and Karolinska Sleep Scale measured trait anxiety and sleep quality. CAR and diurnal cortisol area under curve (AUC) were calculated. Results: The phases did not differ in cortisol concentration or CAR AUC (p>0.05). CAR was significantly higher than diurnal cortisol throughout all phases (p<0.05). Additionally, Diurnal AUCg of cortisol was higher during menses than luteal and premenstrual phases (p<0.05). The diurnal AUC and the CAR-AUC showed a strong positive correlation across all phases (rho=0.210; p=0.002). Problem scores and diurnal AUCg correlated negatively (rho=- 0.648; p=0.01). STAI-T points were negatively correlated with menses and premenstrual diurnal AUCg (rho=-0.638; p=0.014, -0.744; p=0.002). Conclusion: In conclusion, the findings suggest that the pattern of cortisol secretion during the hours of the day is higher in the menses than in luteal and premenstrual phases. Potential changes in cortisol secretion patterns can trigger cycle-specific behavioral issues. Keywords: Cortisol awakening response, diurnal cortisol, Hypothalamuspituitary- adrenal (HPA) axis, menstrual cycle, premenstrual symptoms, state trait anxiety inventory score.

Background: Allergy and autoantibody production are two abnormal conditions of the immune system, resulting from hypersensitivity. It remains unclear whether autoantibodies are also present in association with allergies that begin during early childhood. This study aims to evaluate the presence of antinuclear antibodies (ANA) in allergic children under the age of three. Methods: Allergic children (age < 3 years; n=40) were diagnosed by a specialist based on clinical and laboratory findings. ANA levels were measured using a commercial ELISA test. Demographic data, total and specific (egg, milk) IgE levels, and blood eosinophil percentages were obtained from hospital records. The control group was composed of healthy individuals without allergies. Results: In the healthy control group, 8 individuals (8/40, 20%) were ANA positive, while 17 allergic children (17/40, 42.5%) tested positive for ANA (p0.05). Additionally, no relationship was found between ANA levels and the presence of itching or eczema in allergic children. Conclusions: This study suggests that the relationship between allergies and ANA positivity begins in early childhood and recommends that future studies on the potential interactions of these two conditions should focus on this critical period. Additionally, further research is needed to determine whether both immune anomalies are regulated by similar mechanisms.

Objective Psychological stress has been widely investigated in periodontal diseases, however, its association with peri-implant conditions remains unclear. This study aimed to evaluate peri-implant crevicular fluid (PICF) levels of cortisol, dehydroepiandrosterone (DHEA) and interleukin-6 (IL-6) in peri-implant health and disease, together with anxiety and depression scores. Materials and methods In this cross-sectional study, sixty-two individuals were classified as peri-implant healthy (Group H, n = 18), peri-implant mucositis (Group PM, n = 22), and peri-implantitis (Group PI, n = 22). Clinical parameters; gingival index (GI), probing depth (PD), bleeding on probing (BOP), keratinized tissue width (KTW), and marginal bone loss (MBL) were recorded. Psychological status was assessed using Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI). PICF cortisol, DHEA and IL-6 levels were quantified by enzyme linked immunosorbent assay (ELISA). Results GI, PD, and BOP differed significantly among groups (p< 0.01), with the highest values in Group PI; suppuration and MBL were detected only in this group. Peri-implantitis patients exhibited higher BDI scores and total amounts of cortisol in PICF than Group H (p<0.05), whereas cortisol concentrations were lower (p<0.01). IL-6 concentrations progressively declined from health to peri-implantitis (p< 0.01). Clinical parameters correlated positively with total cortisol and negatively with IL-6. Conclusion Within the limitations of this study, peri-implantitis was associated with elevated PICF cortisol levels and higher depression scores, indicating a possible relationship between psychological factors and peri-implant inflammation. Clinical relevance Psychological stress may modulate inflammatory responses in peri-implant diseases. Elevated cortisol in peri-implantitis highlights the importance of psychosocial assessment for maintaining long-term peri-implant health.

Aim: The study aimed to determine whether alternating day–night and night–day shift schedules differentially affect inflammatory markers, endocrine and stress responses, sleep characteristics, and visual attention performance compared with regular daytime work in female health-care professionals. Materials and Methods: Thirty female health-care professionals were included in the study and classified into three groups: alternating day-to-night shift workers (n=10), alternating night-to-day shift workers (n=10), and regular day-to-day workers (n=10). Vital signs (blood pressure, respiratory rate, skin temperature), hematological parameters, blood leptin, melatonin and sex hormone levels, proinflammatory cytokines (IL-1β, TNF-α, IL-6), sleep duration and quality, visual attention performance, and stress-related parameters (perceived stress scores, salivary cortisol, corticosterone, and alpha-amylase) were assessed and compared between groups. Results: The number of white blood cells, lymphocytes and monocytes was higher in day-to-night compared to day-to-day shifts (p<0.05); leptin, IL-6, IL-1β, TNF-α levels were lower in night-to-day group compared to day-to-day and day-to-night groups (p<0.05); Alternating shift programs decreased sleep duration and quality (P0.05). Conclusion: Most parameters measured in women working alternating shifts were comparable to those of day workers. However, higher leucocyte counts and IL-1β levels in alternating shift workers suggest the need for careful health monitoring and preventive measures. Keywords: Sleep, Alternating shifts, Cytokine, Hormone, Hematological parameters

Systemic Lupus Erythematosus (SLE) is a chronic connective tissue disease of unclear etiopathogenesis characterized by affecting multiple organs and systems. Survivin, an apoptosis inhibitor protein (IAP) family member is involved in apoptosis, cell division, development and differentiation. In the pathogenesis of SLE, increased apoptosis is thought to play a significant role. Therefore, this study aims to investigate the relationship between survivin levels and disease activity, etiopathogenesis, and biomarkers related to apoptosis and inflammation in patients with SLE. The study included 36 patients with SLE, 17 patients with Sjögren’s syndrome (SjS) and 29 healthy controls who applied to the department, met the eligibility criteria and were non-consecutively enrolled between September 2019 and March 2020. Blood and urine samples were collected and analyzed using enzyme-linked immunoassay (ELISA) method. SLE activity was assessed using SLE Disease Activity Index (SLEDAI) and Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) criteria. SjS activity was assessed using EULAR Sjögren’s Syndrome Disease Activity Index (ESSDAI). Plasma survivin levels were significantly lower in SLE patients compared to healthy controls (p 0.05). This study shows that survivin holds significant potential in the diagnosis, disease monitoring, and pathophysiological understanding of SLE, providing foundational data for future research.

Objective: SARS-CoV-2 infection induces virus-specific antibody production, and in some cases, these antibodies may cross-react with self-antigens, contributing to the development of autoantibodies. This raises the possibility that the magnitude of the antibody response may be associated with the emergence of antinuclear antibodies (ANAs). This study aimed to investigate the relationship between SARS-CoV-2 antibody levels and ANA positivity. Materials and Methods: SARS-CoV-2 antibodies were quantified using an enzyme-linked immunosorbent assay (ELISA) kit with a dynamic range of 1–475 RU/mL. The positivity threshold was 10 RU/mL, and high SARS-CoV-2 antibody levels were defined as >235 RU/mL (>75% Bo/B in the calibration curve). Samples from individuals with chronic diseases were excluded. Because the number of highly positive samples was limited, these samples were identified first, and negative and moderately positive groups were then formed through random selection. Antinuclear antibodies, including anti–double-stranded DNA (anti-dsDNA), anti–extractable nuclear antigens (anti-ENA), and anti–HEp-2 nucleus antibodies, were measured using commercial ELISA kits. Results: A total of 1222 samples were screened. After excluding 246 samples, 976 remained eligible. The mean ANA levels and positivity rates for the negative, positive, and high-positive groups were as follows: dsDNA, 0.75 (14.9%), 0.55 (7.5%), 0.85 (29.9%); ENA, 0.75 (14.9%), 0.55 (7.5), 0.85 (29.9%); and Hep-2 nucleus, 0.75 (14.9%), 0.55 (7.5%), 0.85 (29.9%). The high-positive group had significantly higher ANA levels and ANA positivity rates compared with the negative and moderate-positive groups (p<0.001). Notably, the moderately positive group had lower ANA levels and positivity rates than the negative group (p<0.001). Conclusion: The findings suggest that ANA production may increase in individuals with a very high SARS-CoV-2 antibody response, while lower ANA levels were observed in those with a moderate antibody response. These results indicate that the relationship between virus-specific antibody magnitude and autoantibody development is more complex than expected. Given the clinical and immunological implications, further comprehensive studies are needed to clarify the underlying mechanisms.