Fatih Öner Kaya

Background: Familial Mediterranean Fever (FMF) and Celiac Disease (CD) are two distinct inflammatory disorders that arise through different immunological pathways, yet they show a notable tendency to coexist, particularly in Mediterranean populations. The immunological consequences of this coexistence have not been adequately characterized. Objective: We set out to compare serum cytokine profiles and explore potential genetic interactions in patients with both FMF and CD versus those with FMF alone or CD alone. One hundred adult patients were enrolled and divided into three groups: 40 with coexistent FMF and CD, 30 with FMF only, and 30 with CD only. Serum concentrations of IL-1β, IL-6, TNF-α, and IL-10 were quantified by ELISA; CRP and SAA were measured using routine laboratory methods. MEFV mutations and HLA-DQ2/DQ8 genotypes were determined by PCR. Statistical evaluations included one-way ANOVA with Bonferroni correction, multivariable linear regression incorporating a formal interaction term, and principal component analysis to visualize cytokine clustering patterns. Results: Patients with both diseases exhibited significantly higher serum levels of IL-1β, IL-6, TNF-α, and CRP than those in either single-disease group (all p < 0.001), while IL-10 levels were notably lower (p = 0.02). Serum amyloid A levels were also significantly elevated in the coexistence group compared with both single-disease groups (p < 0.001) and correlated strongly with CRP (r = 0.69, p < 0.001). IL-6 emerged as the strongest independent predictor of CRP elevation (adjusted β = 0.47, 95% CI 0.31–0.63, p < 0.001). Principal component analysis identified a distinct pro-inflammatory cytokine cluster unique to the coexistence group. The simultaneous presence of HLA-DQ2 and the MEFV M694V variant was associated with a significant rise in IL-6 production (p < 0.001). Conclusion: When FMF and CD coexist, the resulting inflammatory state is substantially amplified and dysregulated, characterized by markedly elevated IL-6 and associated with a possible interaction between MEFV and HLA loci that requires confirmation in larger, independently sampled cohorts. These observations emphasize the importance of recognizing this overlap syndrome in clinical practice.

Background: Pancreatic atrophy (PA) is a progressive reduction in pancreatic parenchymal volume, accompanied by acinar cell loss, fibrosis, and fatty infiltration. It is an important radiological marker of glandular damage associated with physiological aging, chronic inflammatory diseases, and metabolic disturbances, such as diabetes mellitus and obesity. However, PA is still reported mainly using subjective terms, which leads to inter-observer variability and limits reliable clinical correlation and longitudinal follow-up. Purpose: This study aimed to introduce and validate the İstanbul Morphometric Pancreatic Atrophy Classification (IM-PAC), a four-tier morphometric grading system based on CT and MRI measurements, and to evaluate its association with graded CP severity features (CP). Methods: In this retrospective single-center study, 280 abdominal CT and MRI examinations performed in 2023 were analyzed. Pancreatic head, body, and tail thicknesses were measured at standardized anatomical landmarks. Chronic pancreatitis (CP)–related imaging features were graded using predefined ordinal severity scales for ductal abnormalities and MRI-defined fibrosis. Analyses used true modality-specific denominators (CT n = 168; MRI n = 112). Inter-observer reproducibility was assessed using intra-class correlation coefficients (ICC) and quadratic weighted Cohen’s kappa. Results: IM-PAC grades were distributed as Grade 0 (n = 54, 19.3%), Grade 1 (n = 119, 42.5%), Grade 2 (n = 93, 33.2%), and Grade 3 (n = 14, 5.0%). Increasing IM-PAC grade was significantly and monotonically associated with ductal abnormality severity (Spearman ρ = 0.52, p < 0.001) and MRI-defined fibrosis severity (ρ = 0.48, p < 0.001). Calcifications assessed in the CT subgroup (n = 168) showed progressive enrichment across grades (p < 0.001). Inter-observer agreement was excellent for thickness measurements (ICC = 0.89; 95% CI: 0.84–0.92) and substantial for ordinal ductal and fibrosis grading (weighted κ = 0.81 and 0.78, respectively). Conclusion: By integrating severity-based CP grading, IM-PAC provides a reproducible and clinically relevant morphometric framework for quantifying pancreatic atrophy.

Methotrexate (MTX) is a widely used treatment for conditions such as rheumatoid arthritis and psoriasis. Although its potential for hepatotoxicity is known, there is limited research on how to prevent this adverse effect, and despite this risk, MTX continues to be frequently prescribed. We present the case of a 56-year-old male with a history of alcohol abuse who developed acute jaundice, malaise, and a positive Murphy’s sign after starting MTX therapy for inflammatory rheumatoid arthritis. The patient was advised to abstain from alcohol due to the shared hepatic first-pass metabolism of both alcohol and MTX, and although he successfully stopped heavy drinking, he continued to consume alcohol occasionally in small amounts. After one month of treatment, the patient developed symptomatic grade 2 hepatic steatosis, requiring emergent plasmapheresis. This case highlights the lack of data on the effects of MTX in patients with prior alcohol abuse and demonstrates how a brief period of MTX use can result in the progression of hepatotoxicity in patients with pre-existing liver damage.

Background: Pressure ulcers (PUs) remain a prevalent and serious complication in palliative care settings, often resulting from a combination of immobility, systemic illness, and inadequate preventive strategies. Understanding the multifactorial risk landscape is essential for developing effective interventions. Objective: This study aimed to determine the prevalence of pressure ulcers and to identify clinical and systemic risk factors associated with PU development in a palliative care population. Methods: A retrospective, single-center study was conducted by reviewing medical records of 339 adult patients hospitalized for more than 24 h in the palliative care unit of Maltepe University Hospital between June 2021 and November 2023. Demographic data, comorbidities, Braden and Care Dependency Scale (CDS) scores, and PU characteristics were analyzed. Multivariable logistic regression was used to identify independent risk and protective factors. Results: The overall prevalence of pressure ulcers was 33.6%. A total of 385 ulcers were recorded among 114 patients, with deep tissue injury (26%) being the most common type. Significant independent risk factors included stroke (OR: 4.89), gastrointestinal diseases (OR: 8.72), paraplegia (OR: 17.65), recent confusion (OR: 148.00), hypertension (OR: 2.98), coronary artery disease (OR: 3.42), arrhythmia (OR: 3.05), and heart failure (OR: 3.88). Longer hospital stay also increased PU risk (OR: 1.04 per day). In contrast, adherence to PU prevention protocols (OR: 0.18) and complete care dependency (OR: 0.02) were significant protective factors. Conclusion: Pressure ulcers are alarmingly common in palliative care patients and are closely linked to multiple comorbid conditions. Targeted preventive measures focusing on cardiovascular and neurological stability, nutritional support, cognitive function, and strict adherence to care protocols are vital. Proactive, multidisciplinary management and individualized risk assessment should be integrated into routine care to reduce PU burden and improve patient outcomes.

Aim: This study aimed to assess the level of trust in medical information shared on social media among different professional groups in the healthcare field, and to examine how this trust varies by age, gender, and professional role. Material and Methods: A total of 350 participants, including 200 medical students, 75 pharmacists, 75 nurses, and 50 physicians, were included in this cross-sectional survey study. The 30-item questionnaire covered demographics, usage patterns, trust, and misinformation. Exploratory factor analysis identified a nine-item Trust and Attitudes toward Online Medical Information Scale (TAOMIS) with acceptable reliability (Cronbach’s α=0.742). Scores (1–4) were rescaled to 0–100. Results: All respondents reported daily social media use. Students and nurses more often spent >2 hours/day, while physicians and pharmacists used 1–2 hours (p

Aim: This study aimed to evaluate the clinical characteristics, treatment approaches, and outcomes in patients diagnosed with urinary tract infections (UTIs) caused by Raoultella planticola. Material and Methods: This retrospective study included 25 adult patients with culture-confirmed Raoultella planticola UTIs admitted between January 2010 to January 2021. Clinical data such as demographics, presenting symptoms, comorbidities, laboratory findings, antibiotic treatments, and patient outcomes were retrospectively analyzed. Results: The mean patient age was 67.8 ± 16.8 years. The most frequent comorbidities included diabetes mellitus (28%), chronic heart failure (24%) and chronic renal failure (24%). Anemia (64%), bacteriuria (60%), arthritis (56%), and altered sensorium (52%) were the most common clinical presentations. Bacteremia was identified in all patients. Acute cystitis was diagnosed in 80% of cases, while sepsis was identified in 20%. Ceftriaxone (32%) and ciprofloxacin (24%) were the most frequently administered antibiotics. The median hospital stay was 5 days (IQR: 3-14). Two patients died during hospitalization (8% mortality); both had bacteremia without sepsis criteria, and one had underlying pancreatic cancer. Conclusion: Raoultella planticola UTIs predominantly affect older adults with significant comorbidities. While generally responsive to standard antimicrobial therapy, mortality may occur, particularly in patients with bacteremia and severe underlying diseases.

Behçet’s disease (BD) is traditionally diagnosed based on clinical symptoms such as recurrent oral and genital ulcerations, eye and skin lesions, and, in some cases, a positive pathergy test. However, the clinical presentation of BD has evolved, with recent reports highlighting a broader spectrum of manifestations, including vascular involvement in nearly half of affected patients. Our report presents a unique case of a 42-year-old male with BD and atypical vascular involvement. This case is noteworthy due to the atypical vascular dilations, which extend beyond the vascular sites commonly observed in BD. It underscores the complex and diverse presentations of BD and highlights the importance of maintaining a high index of suspicion for atypical vascular involvement. The patient’s symptoms were effectively managed with immunomodulatory therapy, demonstrating the need for individualised treatment strategies. This report calls for further research to improve the understanding and management of such rare BD presentations, contributing valuable insights to the existing literature.

Behcet's disease is a chronic systemic inflammatory disorder that is characterized by recurrent oral and genital aphthous ulcers, skin lesions, uveitis, as well as the involvement of different organs, including the central nervous system (CNS) [1]. Neurological manifestations, better known as neuro-Behcet's (NB), occur in about 5-10% of cases, ranging from headaches and impaired cognition to severe neurological deficits [2,3]. This case report describes a unique case of neuro-Behcet's disease in a patient with substance use in the background, and it adds to knowledge while enhancing further understanding of this complex interplay and its implications regarding management

Background: Identifying undiagnosed cases of metabolic syndrome (MetS) is important because timely recognition may help reduce the risk of associated complications, including cardiovascular disease (CVD), Type 2 diabetes mellitus (T2DM), stroke, nonalcoholic fatty liver disease (NAFLD), and chronic kidney disease (CKD). This study aims to provide a comprehensive evaluation of MetS and obesity levels among patients attending an outpatient clinic. Methods: This cross‐sectional study was conducted at the outpatient clinics of Istanbul, Maltepe University Hospital, Türkiye, between January 2018 and December 2019, involving adults between the ages of 18 and 70. Demographic and lifestyle information (age, sex, marital status, education, employment, smoking, and comorbidities) was collected through a structured questionnaire. Weight, height, waist circumference, and blood pressure were recorded for all participants. Body mass index (BMI), fasting glucose, HDL cholesterol, triglyceride levels, extractable nuclear antigen (ENA) profiles, and fluorescent antinuclear antibody (FANA) levels were assessed. The Turkish Endocrinology and Metabolism Society’s criteria were used to diagnose MetS. Results: Of the 504 study participants, 55.9% ( n = 282) were female, with a mean age of 52.2 ± 10.8 years. The overall prevalence of MetS was 32.7% ( n = 165), with 32.9% ( n = 93) in females and 32.4% ( n = 72) in males. Despite similar MetS rates between sexes, lower education and unemployment were associated with higher prevalence. High BMI and a high prevalence of obesity were associated with MetS. Key indicators for MetS diagnosis among participants included weight, height, triglyceride, and HDL levels. The relationship between ENA profiles, FANA levels, and MetS showed significance upon analysis. Conclusion: In this study, one‐third of adults were diagnosed with MetS, with no significant difference in overall prevalence between sexes. Men had lower HDL‐C and higher triglycerides, while women showed higher abdominal obesity. In addition, 15.5% of participants were positive for ENA and FANA antibodies despite no clinical autoimmune disease. Socioeconomic disparities, including lower education and unemployment, were also associated with higher MetS prevalence. These findings highlight the importance of integrating both sex‐related and socioeconomic factors into targeted screening strategies.

Zona zoster genellikle tek taraflı dermatomal alanda vesiküller ve duysal semptomlarla seyreder. Nadiren motor paralizilere yol açar. Tip II diyabet hastası olan bu olguda, alçı ile stabilize edilen fibula kırığından altı hafta sonra L4-L5 dermatomunda vesiküller, peroneal, tibial ve femoral sinirleri içeren distalde daha belirgin motor paralizi gelişmiştir. Lomber MR görüntülemede sol lomber bölgede lomber pleksitis ile uyumlu kontrast tutulumu saptanmıştır. Zona zosterin travma sonrası tetiklenebilmesi ve pleksus tutulumuna yol açabilmesini hatırlatması açısından sunulmaya değer bulunmuştur.