Türkkan Öztürk Kaygusuz

This study compared the effects of systemic Levofloxacin and Cephalexin on bone healing in a rat tibial fracture model. The subjects were divided into six groups (n=7 each): healthy control, fracture control, healthy Levofloxacin, healthy Cephalexin, fractured Levofloxacin, and fractured Cephalexin. In total, 42 Sprague–Dawley rats were used. In the fractured groups, a transverse fracture was created in the right tibial diaphysis, and the bone fragments were stabilized with Kirschner wire. No surgical intervention was performed in the healthy control and healthy antibiotic groups. The antibiotic groups received systemic Levofloxacin (25 mg/kg) or Cephalexin (20 mg/kg) three times a week for 4 weeks, starting on the same day as the fractured subjects. At the end of the experimental process, all animals were euthanised. After the decalcification process, the obtained samples were evaluated histopathologically, and bone filling ratio percentages were analyzed using histomorphometric methods. In the statistical analysis, differences between groups were examined using one- way analysis of variance. In cases where the variances were not homogeneous, pairwise comparisons were performed using the Games–Howell post-hoc test. Bone formation ratios (%) showed significant differences between the groups (P < 0.05). In this study, bone formation rates were found to be 90.71 in the healthy control group, 67.86 in the fracture control group, 61 in the fracture cefelaxin group, 51.14 in the fracture levofloxacin group, 90.29 in the healthy cefelaxin group, and 90.43 in the healthy levofloxacin group. While there was no difference in bone formation among the healthy groups, it was determined that bone formation was reduced in the fractured groups. Among the fractured groups, bone formation in the group treated with Levofloxacin was found to be significantly lower compared to the groups treated with only fracture and Cephalexin (P < 0.05). Considering the results of this study, it is thought that levofloxacin, in particular, has a bone formation-suppressing effect.

Purpose: Mucormycosis is a rapidly progressive angioinvasive fungal infection with limited large-scale outcome data. We aimed to describe the epidemiology, clinical spectrum, treatment strategies, and predictors of outcomes in adult patients with proven mucormycosis in Türkiye. Methods: We conducted a nationwide, retrospective study of 280 adults diagnosed with proven mucormycosis between 2004 and 2024 across 27 tertiary centers. Case definitions were applied according to the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Clinical characteristics, antifungal management, surgical interventions, and outcomes were systematically analyzed. Results: The median age of the cohort was 60 years, and diabetes mellitus, frequently complicated by ketoacidosis, was the most common underlying condition. Rhino-orbital-cerebral disease represented the predominant clinical form, whereas pulmonary, gastrointestinal, and disseminated presentations were less frequent but carried less favorable prognoses. Liposomal amphotericin B was the main first-line therapy, often combined with surgery, although antifungal treatment was initiated at a median of five days after symptom onset. Ninety-day mortality was 42.1% by Kaplan–Meier estimation (crude 49.3%) and reached 49.3% (crude 55.0%) at 365 days. Crude mortality was lowest in patients who did not undergo surgery; however, this association was not significant in the time-dependent Cox regression analysis, suggesting confounding by baseline severity. Poor outcomes were associated with corticosteroid exposure, prolonged neutropenia, and neurological manifestations, while a history of sinusitis appeared to be associated with improved survival. Conclusion: In this multicenter study, survival was mainly determined by host-related factors rather than the choice of antifungal agent. Corticosteroid exposure, prolonged neutropenia, and neurological involvement independently predicted poor outcomes, whereas a prior history of sinusitis was linked to improved survival, likely reflecting earlier diagnosis and intervention. These findings reinforce the need for heightened clinical awareness, rapid recognition, and prompt multidisciplinary management to improve outcomes in patients with mucormycosis.

Introduction: Understanding how physicians interpret their societal and institutional contexts remains crucial for addressing the complexities of professional identity. This study explores professional identity formation (PIF) in clinical medical education through learners’ narratives and the perspectives of their role models. Methods: Using a multi-center qualitative narrative design, data were collected from clinical-year medical students across accredited state and private medical faculties representing diverse geographical regions. Reflective narrative writing and in-depth interviews were analyzed through a staged contextual qualitative approach. Results: Findings indicate that PIF is shaped through the dynamic interplay between clinical environments, societal and systemic structures, role modelling, and learners’ reflective engagement. Narratives framed professional identity not only in terms of technical competence but also through relational, ethical, and humanistic dimensions. Contextual analysis revealed that tensions between service demands and educational engagement, hierarchy and learner agency, and technical efficiency and humanistic care significantly influenced identity development. Reflection and narrative meaning-making emerged as mediating processes through which learners interpreted and internalized these experiences. Discussion: Drawing on a socio-cultural paradigm informed by activity theory, the study proposes a conceptual framework positioning PIF as a relational and contextually mediated construction shaped by both planned and implicit learning processes. The findings underscore the need for medical education programs to intentionally integrate reflective, narrative, and context-sensitive approaches to support sustainable professional identity development.

In this multicenter, retrospective study involving 62 patients, we investigated whether switching from entecavir (ETV) or tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) represents a superior treatment strategy for patients with chronic hepatitis B (CHB) experiencing low-level viremia (LLV). The study determined that TAF significantly improved both virological and biochemical outcomes. At 48 weeks, the complete virological response (CVR) rate was 77.8% for those who switched from ETV and 81.8% for those who switched from TDF, with Hepatitis B virus deoxyribonucleic acid (HBV DNA) negativity reaching 81% by month 12. Additionally, significant normalization of liver enzymes, albumin, and platelet counts was observed across the cohort. While the switch from TDF was associated with a significant increase in triglycerides and high-density lipoprotein (HDL) and a decrease in estimated glomerular filtration rate (eGFR), no such changes were detected in the ETV group. This evidence suggests that TAF provides robust virological control in LLV patients and is associated with favorable biochemical improvements. However, due to the study’s limitations, the strong assertion that TAF promotes the regression of liver fibrosis and reduces the risk of hepatocellular carcinoma (HCC) must be interpreted with caution.

In a multicenter, retrospective study of 62 patients, we aimed to investigate whether switching from entecavir (ETV) or tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) is a superior treatment strategy for patients with chronic hepatitis B (CHB) experiencing low-level viremia (LLV). The study found that TAF significantly improved virological and biochemical outcomes. At 48 weeks, the sustained virological response was 77.8% for those who switched from ETV and 81.8% for those who switched from TDF, with HBV DNA negativity reaching 81% by month 12. Significant normalization of liver enzymes, albumin, and platelets was also observed. While switching from TDF was associated with a significant increase in triglycerides and HDL and a decrease in eGFR, no such changes were noted in the ETV group. This evidence suggests that TAF provides better virological control, promotes the regression of liver fibrosis, and may reduce the risk of hepatocellular carcinoma (HCC), making it a more advantageous option than continuing prior monotherapy.

Experience with the effect of antiviral therapy on HBsAg seroconversion in acute hepatitis B is limited. We aimed to evaluate the factors affecting HBsAg seroconversion in patients with acute hepatitis B (AHB) receiving antiviral treatment. We performed a retrospective and multicenter study involving 107 adult patients who received antiviral treatment for AHB between January 2018 and December 2023. The median age was 48 (min–max, 18–91) years, and 66.3% of the patients were male; 70 patients with 24-week follow-up (15 patients without HBsAg seroconversion versus 55 patients with HBsAg seroconversion) were compared based on HBsAg seroconversion status. Multivariate logistic regression analysis revealed that age was independently associated with HBsAg seroconversion (odds ratio = 0.926; 95% confidence interval (CI) 0.874 to 0.981; p = 0.009). A one-year increase in age was associated with a 0.926-fold decrease in HBsAg seroconversion. In conclusion, age was an independent predictor of HBsAg seroconversion following acute hepatitis B virus infection.

Objective: Brucellosis affects many organs and tissues; its clinical course and severity vary greatly. This may lead to an increase in the frequency of complications due to late diagnosis and late initiation of treatment. Osteoarticular involvement is the most common complication. Complications due to brucellosis result in serious morbidity and mortality. We planned to evaluate brucellosis and detect laboratory markers that can predict complications. Methods: Patients diagnosed with brucellosis and who applied to our hospital between January 01, 2013 and October 31, 2023 were included in the study. Detection of infectious findings in an anatomical region of the patient as a result of radiological imaging and physical examination was defined as a “complication”. Patient data were obtained by retrospective screening of patient files. Results: 237 patients were included in the study. 133 (56.1%) of these patients were male. 125 (52.7%) of the patients had local involvement, and the most common was bone-joint involvement with a rate of 80% (n=100). White blood cell, C-reactive protein and C-reactive protein/albumin levels were significantly increased in the patient group with local involvement compared to the patient group without any involvement, and there was a significant decrease in the albumin levels. Doxycycline/rifampicin treatment was most frequently used in patients with local involvement; treatment duration was significantly longer in patients with complications, especially those with osteoarticular involvement, and the recurrence rate was 10.4%. Conclusion: Brucellosis is an infectious disease that still maintains its importance for our country, especially in endemic regions. This study will contribute to patient management and reduce morbidity and mortality by identifying laboratory markers that can predict complications.

Leptospirosis is a globally prevalent zoonotic infection. Cardiac involvement in leptospirosis, including myocarditis, can be easily missed due to non-specific symptoms and concurrent multiorgan dysfunction. A 46-year-old male presented to the emergency department with weakness, fever, palpitations, and widespread joint and muscle pain. His temperature was 40°C, and his blood pressure dropped to 50/30 mm Hg. The patient, with elevated high-sensitivity troponin levels in laboratory findings, was referred to the cardiology department. Anti-ischemic treatment was started for a preliminary diagnosis of acute coronary syndrome. The leptospirosis polymerase chain reaction (PCR) test in serum was positive, whereas the urine Leptospira PCR test was negative. The patient presented with septic shock and elevated cardiac biomarkers and was re-evaluated based on electrocardiogram and echocardiogram findings. Considering these clinical and laboratory results, acute coronary syndrome was ruled out, and myocardial involvement due to leptospirosis was considered. This case highlights the importance of recognizing cardiac involvement in leptospirosis.