Uğur Ergün

Background: Irritable bowel syndrome (IBS) is a disorder of gut–brain interaction frequently accompanied by anxiety, depression, and low‐grade systemic inflammation. Intestinal dysbiosis and vitamin D deficiency may contribute to disease severity. This study evaluated the effects of probiotic supplementation, vitamin D replacement, and their combination on inflammatory biomarkers, IBS symptom severity, and psychological outcomes. Methods: In this single‐center retrospective cohort study, 120 adults with IBS diagnosed according to the Rome IV criteria (January 2023–December 2025) received probiotic monotherapy, vitamin D monotherapy, or combined therapy. Clinical characteristics, inflammatory biomarkers, serum 25‐hydroxyvitamin D levels, Hospital Anxiety and Depression Scale (HADS) scores, and IBS Severity Scoring System (IBS‐SSS) scores were assessed before and after treatment. Correlation and multivariable logistic regression analyses were performed. Results: The mean age was 41.8 ± 12.6 years, and 62% of participants were female. Combined therapy achieved the greatest reductions in C‐reactive protein, neutrophil‐to‐lymphocyte ratio, platelet‐to‐lymphocyte ratio, anxiety, depression, and IBS symptom severity. Serum 25‐hydroxyvitamin D levels were inversely correlated with depressive symptoms ( r = −0.31, p = 0.01). Combined therapy independently predicted psychological improvement after adjustment for age, sex, body mass index, and IBS subtype (OR 1.92, 95% CI 1.14–3.26, p = 0.01). Conclusions: Combined probiotic and vitamin D supplementation was associated with greater improvements in psychological symptoms and inflammatory biomarkers than either monotherapy. These findings support targeting the gut–brain axis and vitamin D deficiency as complementary therapeutic strategies for IBS. Prospective randomized multicenter studies are warranted.

Plasma cell mucositis is a rare, benign, chronic inflammatory disease that is typically localized in the mucosa of the oral cavity. In this case report, a 28-year-old woman presented with a painless swelling in the corner of her lip for three months, and histopathological examination revealed a diagnosis of plasma cell mucositis. The lesion's isolation to the corner of the lip suggests a rare variant of plasma cell mucositis. In the differential diagnosis, malignant plasma cell disorders, infections, and autoimmune diseases were considered. However, laboratory tests and imaging methods ruled out underlying systemic plasma cell dyscrasia. Clinical improvement was achieved after surgical excision, and no recurrence was observed during the follow-up period. This case report aims to raise awareness that the rare localization of plasma cell mucositis on the lip should not be confused with malignancy.

This study aimed to evaluate the effect of hypertension-related knowledge level on blood pressure control and treatment adherence in individuals followed with a diagnosis of essential hypertension. In this cross-sectional analytical study, 200 patients aged 18–80 years who had been diagnosed with hypertension for at least 6 months and were receiving at least one antihypertensive medication were included. Hypertension knowledge level was assessed using the validated Turkish version of the Hypertension Knowledge-Level Scale (HK-LS). Blood pressure measurements were performed according to standardized protocols, and patients were classified as having controlled or uncontrolled hypertension. Treatment adherence was evaluated using a structured medication adherence questionnaire. The mean age of participants was 59.8±11.6 years, and blood pressure was controlled in 47% of patients. The mean HK-LS score was 14.3±4.2 and was significantly higher in the controlled hypertension group (p<0.001). HK-LS scores showed a significant negative correlation with systolic (r=-0.32, p<0.001) and diastolic blood pressure (r=-0.24, p=0.002). Quartile analysis demonstrated a stepwise increase in blood pressure control rates with increasing knowledge levels (p for trend <0.001). ROC analysis identified an HK-LS cut-off value of ≥15 points with good discriminative ability for predicting blood pressure control (AUC=0.76). In multivariate analysis, hypertension knowledge level, medication adherence, and home blood pressure monitoring were independent predictors of blood pressure control. These findings indicate that higher hypertension knowledge is significantly and independently associated with better blood pressure control, suggesting that improving patient education and health literacy may enhance clinical outcomes. Prospective interventional studies are needed to clarify causality.

Objective: Varicella zoster virus (VZV), a member of the Herpesviridae family, is known as the causative agent of chickenpox (varicella). Following primary infection, VZV can remain latent for life and may reactivate over time to cause herpes zoster (shingles). Advanced age, immunodeficiency, and certain chronic illnesses are major risk factors for the development of herpes zoster. To prevent herpes zoster, a live zoster vaccine was licensed in 2006, followed by a recombinant zoster vaccine with higher efficacy in 2018. In Türkiye, the recombinant zoster vaccine was licensed in 2024. Raising awareness among healthcare workers is important both for their own health and the safety of vulnerable patients. This study aimed to evaluate healthcare workers’ knowledge and awareness of herpes zoster infection and zoster vaccines across the country, as well as to determine the prevalence of prior herpes zoster infection among them. Methods: After obtaining ethical approval, a nationwide multicenter survey was conducted. A questionnaire was distributed to healthcare workers via an online link. Participation was entirely voluntary. The survey collected demographic information (age, sex, profession, years of experience) and included questions on knowledge of herpes zoster, history of zoster infection, symptoms and severity (if applicable), awareness of the zoster vaccine, and vaccination attitudes. Results: A total of 5180 healthcare workers participated, of whom 3505 were female. The participants ranged in age from 18 to 79 years (mean age: 34.24 ± 11.52). Regarding professions: 47.9% were physicians, 21.3% were nurses or midwives, 0.8% were dentists or dental technicians, and 30% were from other healthcare professions. Among participants, 54.4% had ≤10 years of professional experience, 20% had comorbidities, and 10.5% were using immunosuppressive medications. It was found that 9.6% had previously had herpes zoster, 8.8% had no knowledge of the disease, 39.6% were aware of the vaccine, and 20.1% were unwilling to pay for vaccination. Multivariate binary logistic regression analysis revealed that being a physician significantly increased the likelihood of having correct knowledge by 1.961 times compared to other professions (p < 0.001, CI: 1.608–2.392). Similarly, those who had heard of herpes zoster were 3.191 times more likely to answer correctly than those who had not (p = 0.011, CI: 1.650–6.172). Male gender was significantly associated with a lower likelihood of having accurate knowledge compared to females (p = 0.001, OR = 0.720, CI: 0.594–0.874). Conclusions: This study revealed that healthcare workers’ knowledge and awareness regarding herpes zoster and its vaccines are generally insufficient. The recent licensing of the vaccine in Türkiye may explain this, but it is critical for healthcare professionals to be more informed about risk groups and vaccination indications in order to enhance the effectiveness of preventive healthcare services. Given the potential for serious complications of herpes zoster in elderly and immunocompromised individuals, the importance of vaccination should be emphasized more strongly to healthcare workers. Furthermore, the finding that 20.1% of those aware of the vaccine were deterred by its cost highlights the need to improve vaccine accessibility. Economic barriers preventing healthcare workers from being vaccinated emphasize the importance of making the vaccine widely available through public support to protect both healthcare workers and patient safety.

Background/aims: This study was conducted to identify the mortality risk factors in patients hospitalized due to pneumonia and to evaluate the prognostic power of clinical and biochemical markers. Pneumonia is a significant cause of morbidity and mortality worldwide. The clinical condition of patients is influenced by various factors such as age, comorbidities, performance score, and biochemical markers. Methods: The study was designed retrospectively, analyzing the medical records of 233 pneumonia patients. Clinical (age, gender, length of hospital stay, comorbidities, etc.) and biochemical (CRP, LDH, procalcitonin, pH, etc.) data were assessed using statistical methods such as logistic regression and ROC analysis. Results: Statistical analyses revealed that high CRP and procalcitonin levels, as well as low serum albumin and pH levels, were significantly associated with mortality. The ECOG performance score and the need for ventilation were correlated with a poor prognosis. Age and comorbidities (DM, hypertension, etc.) showed a weaker-than-expected relationship with mortality. Conclusion: Evaluating the markers influencing mortality in pneumonia patients is important for improving clinical management and developing more effective treatment strategies. Biochemical parameters such as CRP, procalcitonin, and pH, along with the ECOG score, are crucial in pneumonia prognosis. Further research with larger sample sizes is required to validate these findings.

Amaç: Bu çalışmanın amacı, insülin tedavisi alan tip 1 ve tip 2 diyabet hastalarında insülin kalemi kullanımının hasta memnuniyeti, glisemik kontrol (özellikle HbA1c düzeyleri) ve yaşam kalitesi üzerindeki etkilerini değerlendirmektir. Yöntem: Kesitsel ve tanımlayıcı nitelikteki bu çalışma, Balıkesir'de bir kamu hastanesinin iç hastalıkları polikliniğine başvuran ve en az 3 aydır insülin tedavisi gören 200 diyabet hastasıyla gerçekleştirilmiştir. Veriler, yapılandırılmış anket formu aracılığıyla yüz yüze görüşmelerle toplanmış ve IBM SPSS Statistics 27 programı ile analiz edilmiştir. İstatistiksel analizlerde Pearson ki-kare ve Spearman korelasyon testleri kullanılmıştır (p<0,05 anlamlı kabul edilmiştir). Bulgular: Katılımcıların %81’i regüle kan şekeri değerlerine, %67’si ise hedef HbA1c düzeyine ulaşmıştır. Katılımcıların %41’i insülin kalemi kullanımını zor olarak değerlendirmiş, yalnızca %9,5’i kolay bulmuştur. Eğitim düzeyi arttıkça insülin kalemi kullanım süresi anlamlı şekilde artarken (p<0,05), teknik sorun yaşanma sıklığında anlamlı fark saptanmamıştır. İnsülin kalemi kullanım süresi ile HbA1c hedef düzeyde olma durumu arasında anlamlı ilişki bulunmamıştır. Katılımcıların %82,5’i kısa iğne ucunu tercih etmiştir. Eğitimin %75’i orta düzeyde yeterli bulunmuş, yaşam kalitesi üzerindeki etkisi ise katılımcıların büyük çoğunluğu tarafından "nötr" olarak değerlendirilmiştir. Sonuç: İnsülin kalemleri hasta konforunu artırma potansiyeline sahip olsa da, bu çalışmada glisemik kontrol ve yaşam kalitesi üzerinde sınırlı etkili olduğu görülmüştür. Kullanım kolaylığı açısından yaşanan güçlükler, eğitim içeriği ve hasta desteği konularında iyileştirme gereksinimi olduğunu göstermektedir. Daha kapsamlı ve çok merkezli çalışmalarla bu bulguların desteklenmesi gerekmektedir. Anahtar Kelimeler: Diyabetes mellitus, İnsülin kalemi, Hasta memnuniyeti, HbA1c, Glisemik kontrol, Yaşam kalitesi ABSTRACT Objective: This study aims to evaluate the effects of insulin pen use on patient satisfaction, glycemic control (particularly HbA1c levels), and quality of life in patients with type 1 and type 2 diabetes receiving insulin therapy. Methods: This cross-sectional and descriptive study was conducted with 200 diabetic patients who had been receiving insulin therapy for at least three months and presented to the internal medicine outpatient clinic of a public hospital in Balıkesir. Data were collected through face-to-face interviews using a structured questionnaire and analyzed using IBM SPSS Statistics 27. Pearson's chi-square test and Spearman's correlation analysis were used for statistical evaluation (p<0.05 was considered statistically significant). Results: Of the participants, 81% had regulated blood glucose levels, and 67% had HbA1c levels within the target range. While 41% of participants found insulin pen use difficult, only 9.5% considered it easy. A significant positive relationship was found between educational level and duration of insulin pen use (p<0.05), but there was no significant difference regarding the frequency of technical problems experienced. No statistically significant association was observed between the duration of insulin pen use and achieving target HbA1c levels. A majority (82.5%) preferred short needle tips. The insulin use training was rated as moderately sufficient by 75% of participants, and 76.5% reported a neutral impact on quality of life. Conclusion: Although insulin pens have the potential to enhance patient comfort and adherence, this study found limited effects on glycemic control and quality of life. The challenges related to ease of use highlight the need for improved patient education and support. Further large-scale, multicenter prospective studies are required to confirm these findings.

Background/Aims: Diabetes mellitus is a chronic disease characterized by disorders of carbohydrate, lipid, and protein metabolism, as well as vascular abnormalities caused by insulin deficiency or resistance. It may progress with severe complications and lead to early mortality. For diabetic patients, it is essential to be able to measure their own blood glucose levels at home to detect any increases or decreases and take necessary precautions. To evaluate treatment satisfaction and the quality of glucose monitoring devices, Polonsky et al. developed the Glucose Monitoring System Satisfaction (GMSS) Scale, which consists of 4 factors and 15 items. In this study, we investigated the validity and reliability of the Turkish version of the GMSS Scale and examined its association with HbA1c levels, sociodemographic characteristics, and related variables. Methods: A research questionnaire developed by the authors and the GMSS Scale were used. The questionnaire consisted of a sociodemographic section and 52 items in total—37 items assessing the GMSS Scale and 15 items constituting the scale itself. Patients who attended the Internal Medicine and Endocrinology Outpatient Clinics of Katip Çelebi University between April 1, 2018, and September 31, 2018, were voluntarily included in the study. Results: The study included 152 patients with Type 1 diabetes (102 females and 50 males). The Cronbach’s alpha coefficient of the scale was 0.814, indicating high internal consistency. The overall correlation of the scale was positive and significant ( r = 0.927, p < 0.0001). Factor loadings for the Turkish adaptation ranged from 0.38 to 0.76, demonstrating acceptable validity. Patients who perceived their diabetes education quality as higher had significantly greater satisfaction scores. Regression analysis showed that insulin type, HbA1c level, quality of life, and educational well‐being significantly predicted overall satisfaction (adjusted R ² = 0.265). A significant inverse correlation was observed between HbA1c levels and total satisfaction scores ( p < 0.0001, r = −0.389). Conclusion: The results of our study indicate that the GMSS Scale, developed by Polonsky et al. and consisting of 4 factors and 15 items, is a valid and reliable tool for use in Turkish populations. This scale provides an effective method for evaluating treatment satisfaction and the quality of glucose monitoring devices. Moreover, diabetes education plays a critically important role in achieving optimal glycemic control.

Objective: This study investigated the effects of time-restricted feeding (TRF) without calorie restriction on renal function in patients with stage 3–5 chronic kidney disease (CKD). Study design and setting: An analytical study conducted at Balıkesir University Faculty of Medicine, Türkiye, between December 2021 and December 2022. Methodology: Eighty-four CKD patients (18–70 years) were divided into a TRF group (n = 42) and a control group (n = 42) with free feeding. Baseline and follow-up measurements at 3 and 6 months included height, weight, waist circumference, blood pressure, eGFR, and urine protein-creatinine ratio. Statistical significance was set at p < 0.05. Results: Renal function remained stable in the TRF group (p = 0.07), while the control group showed a significant decline (p < 0.01). There was no significant difference between groups in eGFR, urea, and creatinine changes, except for the urine protein–creatinine ratio (p = 0.04). A significant reduction in waist circumference was observed in the TRF group (p < 0.01). Conclusion: TRF may serve as a non-pharmacological strategy to preserve renal function and reduce central obesity in moderate to advanced CKD patients not receiving renal replacement therapy. Given the increasing prevalence of CKD, TRF could be a simple, cost-effective addition to current management strategies. Further research is needed to validate its long-term benefits.

İmmün sistemin önemli özelliklerinden biri, değişik çok sayıda mikroorganizmaya karşı vücudu savunurken, öz antijenlerimize, doku ve organlarımıza karşı yanıtsız kalmasıdır. Öz antijenlere yanıtsızlık durumu immünolojik tolerans olarak da tanımlanmaktadır. Öz antijenleri tanıyabilen lenfositler, öz antijenlere yönelik immün yanıtları önleyecek mekanizmalar ile ortadan kaldırılmaktadır. Bu mekanizmalardaki bir aksaklık, immün sistemin öz antijenlere, doku ve organlara saldırmasına neden olmaktadır. Bu tür yanıtlara otoimmünite ve oluşturdukları hastalıklara da otoimmün hastalıklar denilmektedir.