Necip Nas

Background: Metabolic syndrome (MetS) is characterized by a cluster of cardiometabolic abnormalities associated with endothelial dysfunction, oxidative stress, and chronic low-grade inflammation. Disturbances in the arginine–nitric oxide (NO) pathway and alterations in trace element homeostasis have independently been implicated in the pathogenesis of MetS. However, the associations between essential and potentially toxic trace elements and biomarkers of arginine metabolism remain poorly understood. This study aimed to investigate the associations between serum trace element concentrations and arginine metabolism biomarkers in individuals with metabolic syndrome. Methods: This cross-sectional study included 72 adults with MetS diagnosed according to International Diabetes Federation criteria. Serum concentrations of manganese (Mn), selenium (Se), copper (Cu), zinc (Zn), antimony (Sb), molybdenum (Mo), and thallium (Tl) were determined by inductively coupled plasma mass spectrometry (ICP-MS). Asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), N-monomethyl-L-arginine (L-NMMA), and citrulline were quantified in all samples by liquid chromatography-tandem mass spectrometry (LC-MS/MS), and all reported analyses are based on these LC-MS/MS values. The study was not powered for multivariable modeling, and the findings are therefore hypothesis-generating. Results: Citrulline correlated positively with Zn (ρ = 0.514, q < 0.001), Se (ρ = 0.428, q = 0.002), and Cu (ρ = 0.370, q = 0.008) and inversely with Mn (ρ = −0.505, q < 0.001). SDMA correlated inversely with Mn (ρ = −0.379, q = 0.007). The HC3-robust SDMA model was significant overall (R² = 0.219, p = 0.005), whereas the adjusted Mn coefficient did not reach conventional statistical significance and its 95% CI included zero (B = −0.00475, 95% CI, −0.00955 to 0.00004; p = 0.052). An increase of one interquartile range in Mn corresponded to a predicted SDMA change of −0.0414 µmol/L (95% CI, −0.0832 to 0.0003). The citrulline model was significant overall (R² = 0.271, p < 0.001). Conclusions: Zn, Se, Cu, and Mn were associated with citrulline and SDMA; however, the adjusted estimates were imprecise. These exploratory cross-sectional findings do not establish causality, specificity to MetS, or clinical benefit and require confirmation in controlled prospective studies.

Objective: Given the strong correlation between metabolic dysfunction–associated fatty liver disease (MAFLD) and elevated cardiovascular risk, this study sought to investigate how hepatic steatosis influences subclinical atherosclerosis in a young patient cohort by assessing carotid intima–media thickness (CIMT). Methods: The study involved 108 patients (aged 18-45 years) diagnosed with hepatic steatosis via ultrasonography and 36 healthy controls, recruited between April 2023 and September 2025. Results: Findings revealed that CIMT values were notably higher in the MAFLD group compared to the control group (0.67 ± 0.15 mm vs. 0.54 ± 0.13 mm; P < .05). Patients with MAFLD exhibited significantly higher body mass index, triglyceride levels, and liver dimensions, alongside reduced HDL cholesterol. A strong positive correlation was identified between CIMT and liver size (r = 0.639; P < .05). Furthermore, CIMT values tended to increase with higher grades of hepatic steatosis; however, the difference between grade 1 and grade 2/3 steatosis was not statistically significant. Conclusion: In young patients with MAFLD, both the presence and the degree of hepatic steatosis are closely linked to subclinical atherosclerosis. Consequently, CIMT measurements represent a valuable, noninvasive approach for early cardiovascular risk stratification in this demographic. Cite this article as: Nas N, Sağlık S. Relationship between hepatosteatosis and early atherosclerotic changes in young patients with metabolic dysfunction–associated fatty liver disease. Cerrahpaşa Med J 2026, 50, 0060, doi: 10.5152/cjm.2026.26060.

Background and Objectives: Inborn errors of immunity (IEI), also referred to as primary immunodeficiencies, are chronic conditions characterized by recurrent infections and long-term treatment requirements that may adversely affect psychological well-being. Although mental health outcomes in patients with IEI have been increasingly recognized, data regarding the psychological impact on family members remain limited. This study aimed to evaluate anxiety and depressive symptoms in patients with IEI and their family members compared with healthy controls and to examine the association of sociodemographic and clinical factors with anxiety and depressive symptom scores. Materials and Methods: A total of 375 participants were included, comprising 34 patients with IEI, 102 family members, and 239 healthy controls. Anxiety and depressive symptoms were assessed using the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI). Group comparisons were performed using non-parametric statistical tests. Multivariable linear regression analyses were conducted to identify independent predictors of anxiety and depressive symptoms. The internal consistency of the scales was evaluated using Cronbach’s alpha, McDonald’s omega, and Guttman’s lambda-2 coefficients. Results: Both patients with IEI and their family members demonstrated significantly higher BAI and BDI scores than healthy volunteers in the unadjusted comparisons (all p < 0.001), with no statistically significant differences between patients and relatives. After multivariable adjustment using HC3 robust standard errors, healthy volunteers had significantly lower BAI and BDI scores than patients with IEI. Patient relatives had significantly lower BDI scores, but their adjusted BAI scores did not differ significantly from those of patients. Female sex remained independently associated only with higher BAI scores. The BAI and BDI showed excellent internal consistency, with all reliability coefficients exceeding 0.90. Conclusions: Patients with IEI and their family members had higher anxiety and depressive symptom scores than healthy volunteers. Although patients and relatives had comparable BAI and BDI scores in the unadjusted comparisons, adjusted analyses showed significantly lower BDI scores among relatives, whereas the adjusted BAI difference was not statistically significant. Healthy volunteers had significantly lower adjusted BAI and BDI scores than patients, and female sex was independently associated with higher BAI scores. These findings support consideration of psychological well-being at both the patient and family levels in IEI, although the cross-sectional design precludes causal inference.

Background: Diabetes mellitus (DM) management is influenced by both physiological and psychosocial factors. Personality traits and psychiatric symptoms may affect glycemic control, but their exact relationship remains unclear. This study aimed to evaluate the association between glycemic control, personality traits, and psychological symptoms such as depression, anxiety, and stress in patients with DM. Methods: A total of 174 adult patients with Type 2 DM (T2DM) were included. Glycemic control was assessed via HbA1c values over one and five years. Personality traits were measured using the Personality Belief Questionnaire-Short Form (PBQ-SF), and psychiatric symptoms were evaluated with the Symptom Checklist-90-Revised (SCL-90-R). Patients were grouped based on HbA1c levels: good (9%) control. Results: Significant differences were found in several personality traits, including obsessive-compulsive, histrionic, paranoid, passive-aggressive, antisocial, and schizoid traits, between groups, with higher scores in patients with moderate glycemic control compared to those with poor control. No significant relationship was observed between psychiatric symptoms and glycemic control. The proportion of patients meeting the predefined HbA1c follow-up frequency threshold was lowest in the poor control group. Conclusions: General psychiatric symptoms did not show significant differences across glycemic control groups. Several maladaptive personality traits differed between groups in univariate analyses; however, after adjustment for potential confounders, only passive-aggressive personality traits remained independently associated with HbA1c levels. These findings indicate a possible association between specific personality characteristics and glycemic control, although no direct clinical utility can be inferred from the present data. Further longitudinal studies are required to clarify these relationships.

Background: Substance use disorder (SUD) is associated with systemic inflammatory activation and may influence hematological and coagulation-related pathways. Chronic exposure to psychoactive substances may promote immune activation, endothelial dysfunction, and increased platelet reactivity, thereby contributing to inflammation–coagulation crosstalk. Routine laboratory markers derived from complete blood count and coagulation tests have recently gained attention as potential indicators of these biological alterations. Objective: This study aimed to evaluate hematological inflammatory indices, platelet-related parameters, and coagulation markers in individuals with SUD compared with healthy controls. Methods: This cross-sectional study included individuals diagnosed with SUD (n = 55) and age- and sex-matched healthy controls (n = 40). Hematological parameters, including neutrophil, lymphocyte, monocyte, platelet indices, and derived inflammatory ratios, were analyzed. Coagulation parameters, including prothrombin time (PT), activated partial thromboplastin time (aPTT), international normalized ratio (INR), fibrinogen, and D-dimer levels, were also evaluated. Statistical analyses were performed to compare laboratory findings between groups. Results: Significant alterations were observed in several hematological and fibrinolytic parameters in individuals with SUD. Specifically, the neutrophil-to-lymphocyte ratio (NLR), platelet count (PLT), and D-dimer levels were significantly higher in the study group compared with the controls, suggesting increased inflammatory activity, platelet activation, and fibrinolysis. In contrast, the fibrinogen levels did not show clinically meaningful differences between the groups. Conclusions: Individuals with SUD exhibit alterations in hematological inflammatory indices, platelet-related parameters, and fibrinolytic markers. Routine hematological and coagulation parameters may provide accessible indicators of systemic inflammatory and hemostatic disturbances associated with SUD and may support future research aimed at identifying potential biological markers of addiction.

Parotid gland agenesis (PGA) is a rare congenital anomaly, often detected incidentally due to its typically asymptomatic nature. We report a 44-year-old woman referred for a neck CT scan because of dysphagia, which revealed complete absence of the left parotid gland, confirmed by ultrasound. The remaining salivary glands were normal. The patient had no facial asymmetry, syndromic features, recurrent infections, or xerostomia. Physical and oral examinations were unremarkable except for the absence of the left parotid papilla. Parotid agenesis may occur sporadically or in association with genetic syndromes. Asymptomatic unilateral agenesis generally requires no intervention, while symptomatic cases are managed with supportive oral care. Awareness of this rare anomaly is important to prevent misdiagnosis and unnecessary procedures, especially given the prevalence of parotid-origin salivary gland malignancies.

Objective: Epilepsy is increasingly recognized as a condition associated with elevated cardiovascular risk, potentially influenced by both the disease itself and long-term antiseizure medication (ASM) use. Atherogenic lipid indices enable a more detailed evaluation of cardiovascular risk that may not be evident through conventional lipid measurements. Methods: In this retrospective analysis, 71 patients with epilepsy and 50 age- and sex-matched healthy individuals were recruited from the Neurology and Cardiology outpatient departments of Siirt Training and Research Hospital between January 1, 2024, and January 1, 2025. According to the criteria established by the International League Against Epilepsy (ILAE), patients were classified into two subgroups: drug-sensitive epilepsy (DSE, n=52) and drug-resistant epilepsy (DRE, n=19). Demographic, clinical, and biochemical data were collected. Atherogenic indices were calculated and compared across groups. The relationships between treatment duration and lipid-based risk indicators were examined using correlation analysis and multivariate linear regression, accounting for potential covariates. Results: Compared with healthy controls, the DRE group exhibited significantly lower high-density lipoprotein cholesterol (HDL-C) levels (p=0.030) and higher Castelli Risk Index II (CRI-II) values (p=0.01). In multivariate regression models, longer epilepsy duration and higher body mass index (BMI) were independently associated with increased CRI-II (p=0.023 and p=0.003, respectively) and Cholesterol Index (CHOLIndex) (p=0.026 and p=0.009, respectively). Conclusions: Epilepsy patients, particularly those with DRE or prolonged treatment duration, demonstrate unfavorable shifts in lipid-based cardiovascular risk markers.

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) prevalence data in Türkiye is limited. We aimed to determine the nationwide prevalence of MASLD and advanced hepatic fibrosis risk in subjects with cardiometabolic risk factors (CMRF). Despite recent international consensus redefining fatty liver disease terminology, no nationwide MASLD study has been reported in Türkiye. Methods: This cross-sectional study included 14,371 adults with ≥1 CMRF from 44 centers across 31 cities. MASLD was diagnosed using liver ultrasonography plus cardiometabolic criteria. Advanced fibrosis risk was assessed by fibrosis-4 (FIB-4) score (≥1.3 for ≤65 years; ≥2.0 for >65 years). Logistic regression was used to identify independent predictors of high FIB-4. Results: A total of 61.4% of participants were women, the mean age was 51.3 ± 14.4 years, and the mean BMI was 31.4 ± 6.0 kg/m². MASLD prevalence was 75.7% (n = 10,873), rising with the number of CMRFs (56.5% with one factor vs. 83.4% with all). The prevalence of high FIB-4 scores was 12.0% overall, being lower in MASLD patients than non-MASLD patients (11.2% vs. 14.4%, p < 0.001). FIB-4 scores decreased with increasing BMI (28.1% underweight vs. 8.7% class III obesity). Male sex, T2DM, and hypertension independently predicted high FIB-4 scores, while smoking, higher BMI, and MASLD were inversely associated. Conclusions: Three-quarters of Turkish adults with CMRF have MASLD. Standard FIB-4 thresholds may underestimate fibrosis risk in obese and smoking populations, underscoring the need for adjusted cut-offs or alternative tools. This study is the first to provide nationwide MASLD prevalence data in Türkiye.

Background and Objectives: The myocardial performance index (MPI) is a diagnostic tool that assesses both the systolic and diastolic function of ventricles. The MPI provides a comprehensive view of the overall efficiency of the heart’s pumping ability, making it a valuable tool for detecting early signs of heart dysfunction, even in the absence of overt symptoms. In this regard, we aimed to explore the relationship between the triglyceride–glucose (TyG) index and subclinical heart failure (HF), as well as its correlation with the MPI, in asymptomatic patients visiting a routine cardiology outpatient clinic. The study specifically excluded individuals with known diabetes, hypertension, and HF, focusing instead on those who had undergone 12 h fasting blood glucose (FBG) and triglyceride (TG) tests. Materials and Methods: The study included 125 patients with FBG, TG, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) data after the exclusion criteria were applied. Results: When asymptomatic patients were categorized as MPI normal or MPI (+) subjects, significant differences were found between the groups in terms of body mass index (BMI), metabolic syndrome (MetS) components, and serum TG values. Pearson correlation analysis revealed a significant and positive correlation between the MPI and TyG index (r = 0.358, p < 0.001). Regression analysis was used to determine the effective parameters in subclinical left ventricular dysfunction (SCLVD). In univariate regression analysis, obesity, the presence of MetS, serum TG, and the TyG index were identified as risk factors. In multivariate regression analysis, the TyG index was found to be the independent risk factor. Conclusions: The positive association found between the MPI and TyG index suggests a link with metabolic disorders and myocardial performance. Obesity, the presence of MetS, serum TG, and the TyG index were identified as risk factors for SCLVD in asymptomatic patients. Notably, the TyG index was identified as an independent risk factor for SCLVD, highlighting its potential role in the early identification and risk stratification of individuals at risk for cardiac dysfunction. These findings suggest that monitoring the TyG index could provide valuable insights into subclinical heart dysfunction, particularly in patients with metabolic abnormalities.

Aims: Polycystic ovary syndrome (PCOS) is a common endocrine disorder associated with increased cardiovascular risk and potential subclinical ventricular dysfunction. Isovolumic acceleration (IVA) is a novel echocardiographic parameter sensitive to myocardial contractility and less influenced by preload and afterload, making it a promising tool for early detection of cardiac dysfunction. This study aimed to assess the utility of IVA and other echocardiographic markers in identifying subclinical ventricular dysfunction in PCOS patients. Methods: This cross-sectional study analyzed echocardiographic parameters of 59 PCOS patients and 60 age-and BMI-matched controls. Echocardiographic measurements included IVA, myocardial performance index (MPI), and additional indices of right and left ventricular function. Results: PCOS patients exhibited significantly higher BMI and fasting glucose levels (p