Mustafa Kahraman

Objective: This study evaluated the effects of a mobile application and integrated Synchronized Medication Tracking System (SMTs) on prospective memory and quality of life to enhance self-management in individuals undergoing pharmacotherapy for chronic conditions.Materials and Methods: Fifty participants were enrolled across two pilot stages (Stage 1: n=40, Stage 2: n=10). Stage 1 engaged with the mobile application for 15 days, while Stage 2 tested the integrated SMTs over 24 hours in hospitalized patients. Prospective memory was assessed via Prospective Memory Questionnaire-4 (PMQ-4), health-related quality of life via Short Form-36 (SF-36), and user satisfaction through structured surveys. Baseline and post-intervention outcomes were compared using paired and between-group analyses.Results: Stage 1 showed improvements in prospective memory (PMQ-4: 14.7±2.1 to 12.5±1.9, p≤0.01). Stage 2 showed no statistically significant changes. SF-36 results indicated improvements in role limitations, emotional well-being, and general health in Stage 1 (p≤0.05 for each), and favorable changes in role limitations due to emotional problems and emotional well-being in Stage 2 (p≤0.05 for each). User feedback indicated high acceptability, with 95% of mobile application users and 90% of integrated system users reporting effective reminders and 80% overall satisfaction in both groups.Conclusion: The mobile application was associated with short-term improvements in prospective memory and psychosocial quality of life. The integrated system demonstrated technical feasibility and high user satisfaction in a hospital setting. The mobile application stage was associated with observable short-term changes in patient-reported outcomes under real-world conditions. Mobile digital systems may support medication-taking by improving cognitive and behavioral determinants.

Introduction: Prolonged sitting is associated with impaired glucose regulation and increased cardiometabolic risk, particularly among individuals with sedentary occupational lifestyles. This study aimed to investigate the acute effects of intermittent Soleus Push-up (SPU) exercises performed during a postprandial period on glucose, blood pressure, and heart rate responses in sedentary office workers.Methods: Twelve healthy adult civil servants with predominantly desk-based occupations participated in this pilot study. Participants were allocated to intervention (n=6) and control (n=6) groups. Following baseline fasting measurements, including blood glucose, blood pressure, and heart rate, all participants underwent a 75-g oral glucose tolerance test after an overnight fast. The intervention group performed intermittent SPU exercises for 30 seconds followed by 90 seconds of rest during a 120-minute postprandial period, while the control group remained seated. Measurements were repeated at the end of the experimental period (120-min after glucose ingestion).Results: The groups demonstrated comparable baseline characteristics, including fasting glucose, blood pressure, and heart rate values (p>0.05). However, postprandial blood glucose levels were significantly lower in the intervention group than in the control group (p=0.030). Similarly, postprandial heart rate was significantly lower in the intervention group (p=0.045). In contrast, postprandial systolic and diastolic blood pressure values were comparable between the groups (p=0.148 and p=0.572, respectively).Conclusion: Intermittent SPU performed during prolonged sitting may be associated with lower acute postprandial glucose concentrations and heart rate responses. Larger and longer-term studies are required to determine the clinical relevance of this approach.

This study aimed to evaluate the association of medical mud-pack therapy with changes in gene expression of key inflammatory markers, miRNA and clinical outcomes in patients with knee osteoarthritis. Thirty-two patients with knee osteoarthritis were assigned to a medical mud-pack therapy (MMT) group (n = 16) or control group (n = 16). Molecular assessments used quantitative PCR for key cytokines and miRNA expressions. Clinical outcomes were evaluated with the VAS for pain and WOMAC for function. Pre- and post-treatment measurements were obtained, with the MMT group receiving mud-pack therapy plus standard care, while controls performed exercise only. The MMT group showed significant reductions in gene expression of TNF-α (1.90 ± 0.41 to 1.43 ± 0.33, p < 0.05), IL-6 (1.34 ± 0.31 to 0.93 ± 0.27, p < 0.05), and IL-1β (2.20 ± 0.40 to 1.81 ± 0.34, p < 0.05), whereas the control group showed no significant molecular changes. Between-group comparisons showed greater reductions in the MMT group for all cytokines (Δ difference: −0.38 to − 0.51, 95% CI not crossing zero, p < 0.05) with large effect sizes (d = 0.88–1.12). miR-140 expression remained unchanged in both groups (p > 0.05). Clinically, the MMT group showed significant VAS pain reduction after adjustment for baseline values (ANCOVA: post-treatment and first-month VAS both p < 0.001), while the control group showed minimal change. Groups were similar in age and sex distribution. Medical mud-pack therapy combined with exercise was associated with reduced expression of key inflammatory cytokines and pain relief in knee osteoarthritis. Further studies are required to explore underlying molecular mechanisms of mud-pack interventions.

SUMMARY OBJECTIVE: The Rational Drug Use Support System was developed to assist patients in using the right drug, at the right time and at the right dose according to their treatment protocols. The aim of this study was to evaluate the performance of an artificial intelligence-enhanced mobile application designed to support rational drug use and to assess its feasibility and usability through a pilot trial. METHODS: The system includes an artificial intelligence -powered mobile application and a web-based interface integrating convolutional neural networks and object detection algorithms for human activity recognition. To build an image library, real patient videos were recorded in a hospital setting under physician supervision. A total of 357 original medication-intake videos were collected from 31 patients, which were then segmented into 1,626 short clips to train the artificial intelligence model. The system was first tested under controlled laboratory conditions and then evaluated for feasibility in a hospital pilot trial involving eight participants over 15 days. RESULTS: The proposed artificial intelligence model achieved 94% accuracy in recognizing medication intake activities in the test set, suggesting promising performance that warrants further evaluation. Exploratory analyses of the 36-Item Short Form Health Survey Questionnaire administered to patients who utilized the mobile application for 15 days revealed improvements in the domains of social functioning, vitality, and mental health. CONCLUSION: The findings suggest that the "Rational Drug Use Support System" appears feasible for implementation in telemedicine and clinical settings to support rational drug use and patient engagement in chronic disease management. However, larger controlled studies are warranted to confirm these preliminary findings.

Introduction: Even though Istanbul is one of the centers of the world’s fastest-growing tourism and travel sector, there are limited statistics on the knowledge, attitudes, and practices (KAP) of travelers from this region regarding travel-related infectious diseases. This study aimed to determine the passengers’ KAP about contagious diseases and contribute to developing new solutions for the problems people face while traveling abroad. Methods: A questionnaire was administered to 182 Turkish travelers planning on traveling abroad and applied to the Istanbul Travel Health Center and the Istanbul Airport Health Control Center between January and March 2019. Results: The proportion of carrying a vaccination certificate was statistically higher in those who received healthcare services at international terminals (P=0.002), especially those who had yellow fever (P<0.001) and meningococcal vaccine (P=0.011). More than half of the vaccinated passengers did not carry their vaccination certificates, while around half (53.8%) were traveling to Africa. When compared to travelers flying to Europe, vaccination checks were 6.7 times (95% CI: 2.5-17.9) higher in passengers traveling to Africa, 6.1 times (95% CI: 1.5-24.3) higher in passengers traveling to Asia, and 14.8 times (95% CI: 1.3-164.3) higher in passengers traveling to South America. In addition, the vaccination certificate carrying proportion was significantly higher in those with a travel duration of 15 days or more (P=0.028), those who received health services at international terminals (P=0.002), and those vaccinated (P<0.001). Conclusion: Improved knowledge of travel-related infectious diseases and increased adoption of pre-travel health advice and vaccines are urgently needed among Turkish travelers.

Background and aims The alpha-actinin (ACTN) genes are important structural components of the sarcomere. Sarcopenia is a common geriatric syndrome characterized by morbidity and mortality. Our study aimed to examine the relationship between the ACTN3 R577X gene and sarcopenia in community-dwelling Turkish adults. Methods We designed a cross-sectional study among the patients aged ≥ 65 years admitted to the geriatric outpatient clinic. We recorded the general characteristics of the patients. We used the Jamar hand dynamometer to evaluate handgrip strength. Body composition was estimated using bioimpedance analysis. Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People2 criteria with population-specific cutoffs. We performed analyses of low muscle mass (LMM) with skeletal muscle mass index adjusted for body mass index [SMMI(BMI)]. We further categorized the SMMI(BMI) cutoffs into tenths. The analyzes were performed according to the 90th percentile SMMI(BMI) cutoffs. Peripheral blood samples were collected to determine the ACTN3 genotypes. Results 197 participants were included [mean age: 76.3 ± 6.1 years, 151 (76.6%) women]. The proportions of the ACTN3 genotypes were as follows: RX (45.1%) > RR (31%) > XX (23.9%). The significant difference between genotypes was found only for low SMMI(BMI) according to the 90th percentile (p = 0.025). In multivariate analysis, only gender (female) was independently associated with LMM. Conclusion We did not find any association between ACTN3 R577X gene polymorphism and probable sarcopenia, confirmed sarcopenia and LMM. Besides, much more research is needed to reveal how ethnicity affects the muscles of older adults with ACTN3 R577X gene polymorphism.

Objective The aim of this study was to investigate the factors affecting rational drug use habits and the use of technological devices in patients with chronic diseases. Methods Adults who applied to the internal medicine outpatient clinics of a university hospital between March and December 2019, who used medications for chronic disease were included in the study. Using a questionnaire, data on demographic characteristics, technology use, smoking and alcohol use, knowledge and behaviour on rational drug use were collected. Results Of the patients, 73.3% (n = 220) had smartphones, 28.0% (n = 84) tablets, 8.7% (n = 26) smartwatches, 6.0% (n = 18) were using smart bracelets, 52.3% (n = 157) knew the e‐pulse application of the Ministry of Health, 53.3% (n = 160) forgot on occasions the time to take their medications, 51.7% (n = 155) threw away some drugs because the expiration date has passed, 64.0% (n = 192) had at home never‐used or unfinished medications, 21.3% (n = 64) had medications to be used ‘in case’, 19.0% (n = 57) recommend drugs to others and 34.3% (n = 103) were getting advice from their environment on drug use. Women were 2.35 times more likely to use technology than men (95% CI: 1.19‐4.64). Decreasing age was associated with an increased likelihood of using technology. Those with an income of more than twice the minimum wage compared with those with an income of minimum wage and below had 3.41 times (95% CI: 1.06‐10.94) higher possibility of using technological devices, while compared with the illiterate, those with secondary education or university education had 14.96 times (95% GA: 3.67‐60.93) higher possibility of using technological devices. Conclusion The patients with chronic diseases demonstrate crucial deficiencies regarding rational drug use. The widespread use of technological devices may be an opportunity for preventive and remedial projects to be developed through these devices. Smartphone‐based self‐management tools should be developed and introduced to chronic patients.

This study was designed to determine the protective effect of kefir on the oxidative damage, as well as histological and biochemical changes that occur in the kidney tissues of experimental diabetic rats. Forty rats were allocated into four groups as “healthy saline” (SF), “healthy kefir” (KF), and the same groups with experimentally induced diabetes (DSF and DKF). Diabetes was induced by administering 65 mg/kg single-dose streptozotocin. Oral kefir was given 10 ml/kg/day for 35 days to the rats in the groups KF and DKF. The same amount of saline was given to the groups SF and DSF. On the 36th day of the study, blood glucose, urea, and creatinine were measured besides glucose, creatinine, microalbuminuria, and sodium in the urine. Additionally, histological examination was performed on the kidney tissues. Blood glucose, creatinine, and urea levels were significantly lower in the DKF group compared with those of the DSF group (p < 0.001). Also, the creatinine level was significantly decreased (p < 0.001), and microalbuminuria was increased (p < 0.001) in the DKF group compared with that of the DSF group. Histologically, intermittent expansion in the renal glomeruli, reduction of cast formation in the tubules, and improvement in the renal epithelial tissues of the DKF group were observed. Kefir decreased the damage caused by diabetes. These results indicate that kefir supplementation may contribute to better control of oxidative stress, which is related to the improvement of renal functions, suggesting its use to slow down the progression of diabetic nephropathy.