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Purpose: Gastric intestinal metaplasia (IM) is a recognized premalignant lesion in the Correa cascade and a key risk factor for gastric adenocarcinoma. Selenium, an essential trace element with antioxidant and immunomodulatory properties, has been implicated in gastric carcinogenesis, but its association with intestinal metaplasia remains incompletely understood.Material and Methods: This cross-sectional observational study included 114 adult patients who underwent diagnostic upper gastrointestinal endoscopy. Gastric biopsy specimens were evaluated for intestinal metaplasia and atrophy according to the updated Sydney System. Logistic regression analyses were performed to identify factors associated with intestinal metaplasia.Results: Gastric intestinal metaplasia was identified in 23 patients (20.2%). Patients with and without IM were comparable in terms of age, sex, and Helicobacter pylori prevalence. Mean serum selenium levels did not differ significantly between groups; however, selenium deficiency was more frequent in patients with IM (34.8% vs. 12.1%, p=0.024). In multivariable analysis, selenium deficiency was independently associated with intestinal metaplasia (OR 4.01, 95% CI 1.37–11.74, p=0.011), whereas Helicobacter pylori infection was not. Conclusion: Impaired selenium status may contribute to early gastric mucosal alterations and could represent a modifiable risk factor in gastric precancerous conditions.

Point-of-care ultrasound (POCUS) is increasingly recognized as an essential tool in internal medicine; however, its real-world adoption remains variable. This study aimed to evaluate the current landscape of POCUS use, training, and barriers among internal medicine physicians in Türkiye. We conducted a nationwide, cross-sectional survey between January and June 2025, including 1678 physicians across diverse healthcare settings. The questionnaire assessed POCUS availability, training, clinical use, perceptions, and barriers. POCUS was perceived as necessary by 98.7% of participants; however, 73.4% reported no personal implementation, and only 50.3% reported any lifetime POCUS experience. Prior training was reported by 12.8% and was associated with higher self-reported competency (median score 3 [2–5] vs. 1 [1, 2], p < 0.001). A substantial perception–practice gap was observed across all domains, particularly in abdominal (− 62.7%) and thyroid applications (− 58.0%). Clinical observation was limited, with 54.4% of participants never having witnessed POCUS being performed. When present, it was positively correlated with both personal implementation (r = 0.500, p < 0.001) and self-reported competency (r = 0.450, p < 0.001). The most frequently reported barriers were lack of qualified trainers (65.8%), limited access to equipment (56.4%), and time constraints (41.5%). Multivariable analysis linked prior training and career stage to integration readiness, whereas actual implementation was associated with clinical observation, prior training, equipment availability, and inversely with seniority. These findings suggest that similar gaps may exist in other healthcare systems undergoing POCUS integration, highlighting the importance of structured education and system-level support.

Background: Glucagon-like peptide-1 (GLP-1) receptor agonists have been shown to improve metabolic parameters and may reduce Cardiovascular risk profile of individuals diagnosed with obesity and/or type 2 diabetes. This study aimed to evaluate the effects of semaglutide on anthropometric, metabolic, and cardiovascular risk parameters over three months of treatment.Methods: A total of 187 patients received semaglutide therapy and were assessed at baseline (0th month) and after three months (3rd month). Anthropometric measurements, laboratory parameters, and cardiovascular Score-2 were recorded. Changes were analyzed using the Wilcoxon signed-rank test, and percentage changes over the study period were calculated.Results: After three months, considerable declines were observed in body weight (−4.9%, p < 0.001), BMI (−0.6%, p < 0.001), systolic blood pressure (−4.7%, p < 0.001), diastolic blood pressure (−4.6%, p < 0.001), fasting blood glucose (−5.6%, p < 0.001), HbA1c (−0.4%, p < 0.001), and LDL cholesterol (−10.5%, p < 0.001). No significant changes were noted in ALT, AST, creatinine, or HDL levels. Cardiovascular Score-2 significantly decreased from 8.8 ± 5.2 to 7.4 ± 4.7 (p < 0.001). Risk distribution changed markedly, reflecting an expansion of the low-risk group from 27 to 47 alongside a contraction of the high-risk group from 83 to 46.Conclusions: Three months of semaglutide treatment significantly improved metabolic parameters and resulted in a favorable decline in cardiovascular risk among patients. Collectively, the data point toward a beneficial cardiovascular impact of GLP-1 receptor agonists in real-world practice.Keywords: GLP-1 agonist, semaglutide, cardiovascular risk, obesity, HbA1c

Objectives: Although obesity is known to cause low-grade chronic inflammation, the extent to which body mass index (BMI) reflects this remains questionable. To investigate this, we classified a national obesity cohort by BMI and evaluated its association with complete blood count (CBC)-derived systemic inflammatory indices. Methods: This retrospective, multi-center study included 6499 adults from the OBREDI-TR cohort with available laboratory data. Patients were categorized by BMI into Class I (30.0–34.9 kg/m², n = 2751), Class II (35.0–39.9 kg/m², n = 1804), and Class III (≥40.0 kg/m², n = 1944) obesity. We compared demographic, clinical, and laboratory parameters, especially in terms of CBC-derived inflammation parameters: neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI). Results: The Class III group was younger (42.73 ± 13.21 vs. 45.14 ± 14.12 in Class I) and predominantly female (p < 0.001 for both). None of the evaluated inflammatory indices showed significant differences across the groups (NLR, p = 0.435; PLR, p = 0.141; LMR, p = 0.520; SII, p = 0.326; SIRI, p = 0.459). Interestingly, hypertension was less common in the Class III obesity group (49.0% vs. 53.5% in Class I, p = 0.009). Conclusions: The failure of increasing inflammatory indices to parallel BMI, creating a “ceiling effect,” reflects the inadequacy of BMI in determining inflammatory burden. Evaluating the inflammatory burden of obesity through visceral adiposity and metabolic phenotyping (metabolically healthy (MHO) vs. metabolically unhealthy obesity (MUO) rather than BMI will provide a more accurate basis for objective clinical evaluation and personalized treatment.

Background: Hypertension remains the single most important modifiable risk factor for cardiovascular disease, stroke, and premature mortality worldwide. Despite major pharmacological advances, awareness, treatment, and control rates remain globally inadequate, particularly in low- and middle-income settings. Türkiye occupies a unique epidemiological position at the intersection of European and Asian cardiovascular risk patterns, with national surveys documenting a stable hypertension prevalence of approximately 30% but persistent deficits in disease control. Methods: This cross-sectional study was conducted on World Hypertension Day (17 May 2025) across nine provinces in Türkiye representing five geographic regions (Marmara, Aegean, Mediterranean, Black Sea, and Southeastern Anatolia). A total of 1967 adult volunteers were enrolled. Blood pressure was measured following standardized protocols and classified per ESH 2023 guidelines. A structured questionnaire captured sociodemographic data, lifestyle factors, medication adherence, and hypertension-related awareness. Results: The median participant age was 51 years; 55.4% were female. Screening-detected hypertension (BP ≥ 140/90 mmHg) was identified in 26.6% and above-optimal blood pressure in 41.6%. A prior hypertension diagnosis was reported by 35.1%. Among the 1277 participants without a known diagnosis, 51.1% had above-optimal or hypertension-range blood pressure readings, including 11.6% with screening-detected hypertension-range blood pressure. Independent predictors in multivariate analysis included age (OR = 1.048), male sex (OR = 1.528), BMI (OR = 1.096), and alcohol consumption (OR = 1.536); regular exercise was protective (OR = 0.796). Among known hypertensive patients, only 50% monitored blood pressure regularly, 30% skipped doses, and awareness of renal (40.4%) and visual (30.6%) complications was notably low. Conclusions: This large multi-center screening study reveals a substantial proportion of previously undetected hypertension-range blood pressure readings and persistent management gaps in a volunteer-based Turkish community sample. The observed screening rate below national prevalence averages likely reflects a healthy volunteer effect inherent to this study design. World Hypertension Day offers an effective framework for simultaneous multi-center screening. Targeted interventions should address non-cardiovascular complication awareness, sodium intake, and medication adherence.

Objective: To determine the prevalence of dysglycemia, including impaired glucose tolerance (IGT) and newly diagnosed diabetes mellitus (NDDM), in individuals visiting healthcare centers across Türkiye on World Diabetes Day and to assess the associated demographic and clinical risk factors.Methods: This multicenter cross-sectional study included 5353 participants from ten provinces. Random capillary blood glucose levels were measured, and the individuals were categorized as normoglycemic, IGT, NDDM, or known diabetes mellitus (KDM). Sociodemographic characteristics, anthropometrics, comorbidities, and smoking status were analyzed across the glycemic groups.Results: Among all participants, 14.7% had IGT, 3% were newly diagnosed with diabetes, and 19.5% had known diabetes. Dysglycemia was significantly associated with older age, higher BMI, and increased prevalence of hypertension and cardiovascular disease (p<0.001). Educational attainment was inversely correlated with deteriorating glycemic levels. Marked interregional differences were observed in the distribution of dysglycemia. Gender-specific disparities were also noted, with a higher proportion of NDDM in men and KDM in women. Smoking was more prevalent among individuals with IGT and NDDM than among those with diabetes or normal glucose tolerance.Conclusion: Dysglycemia, including undiagnosed diabetes, is highly prevalent in the Turkish population. These findings underscore the importance of cost-effective population-based screening strategies, particularly those targeting older, overweight, and underrepresented individuals. Regional tailoring and gender-sensitive approaches may enhance the effectiveness of diabetes prevention programs in the future.

Background/Objectives: Non-invasive fibrosis scores are widely used for risk stratification in metabolic dysfunction-associated steatotic liver disease (MASLD); however, their performance in obese individuals remains controversial. The Fibrosis-4 (FIB-4) index is commonly recommended as a first-line tool, yet it may underestimate fibrosis risk in severe obesity. The BAST score, which incorporates metabolic and anthropometric parameters, has been proposed as an alternative. This study aimed to characterize both the degree and direction of discordance between FIB-4 and BAST in obese patients with MASLD. Methods: This predefined secondary analysis included 2950 adults with obesity (BMI ≥ 30 kg/m²) and MASLD from the multicenter OBREDI-TR cohort. Fibrosis risk categories were assigned using standard cut-offs for FIB-4 and BAST, and agreement was assessed using weighted Cohen’s kappa. Associations among discordance patterns, obesity class, and the visceral adiposity index (VAI) were evaluated using chi-square tests and general linear models. Results: Overall agreement between FIB-4 and BAST was very poor (κ = 0.041, p < 0.001). Discordance was observed in 22.3% of patients and increased markedly with obesity severity. In class III obesity, discordance was predominantly driven by low-risk classification according to FIB-4 despite high-risk classification according to BAST. Patients with this discordant pattern exhibited significantly higher VAI values than concordant cases (p < 0.001), independently of the study center. Conclusions: In obese patients with MASLD, particularly those with morbid obesity, FIB-4 frequently classifies patients as low risk, while BAST identifies elevated fibrosis risk. This systematic discordance suggests that FIB-4 may underestimate fibrosis burden in the context of severe obesity and visceral adiposity, supporting the need for a phenotype-oriented, multimodal approach to fibrosis risk assessment.

Background/Objectives: Non-invasive fibrosis scores are widely used for risk stratification in metabolic dysfunction–associated steatotic liver disease (MASLD); however, their performance in obese individuals remains controversial. The Fibrosis-4 index (FIB-4) is commonly recommended as a first-line tool, yet may underestimate fibrosis risk in severe obesity. The BAST score, which incorporates metabolic and anthropometric parameters, has been proposed as an alternative. This study aimed to characterize both the degree and direction of discordance between FIB-4 and BAST in obese patients with MASLD. Methods: This predefined secondary analysis included 2,950 adults with obesity (BMI ≥30 kg/m²) and MASLD from the multicenter OBREDI-TR cohort. Fibrosis risk categories were assigned using standard cut-offs for FIB-4 and BAST. Agreement was assessed using weighted Cohen’s kappa. Associations between discordance patterns, obesity class, and visceral adiposity index (VAI) were evaluated using chi-square tests and general linear models. Results: Overall agreement between FIB-4 and BAST was very poor (κ = 0.041, p < 0.001). Discordance was observed in 22.3% of patients and increased markedly with obesity severity. In class III obesity, discordance was predominantly driven by low-risk classification according to FIB-4 despite high-risk classification by BAST. Patients with this discordant pattern exhibited significantly higher VAI values compared with concordant cases (p < 0.001), independent of study center. Conclusions: In obese patients with MASLD, particularly those with morbid obesity, FIB-4 frequently classifies patients as low risk while BAST identifies elevated fibrosis risk. This systematic discordance suggests that FIB-4 may underestimate fibrosis burden in the context of severe obesity and visceral adiposity, supporting the need for a phenotype-oriented, multimodal approach to fibrosis risk assessment.

Background: Handgrip strength (HGS) is an emerging non-invasive biomarker that reflects neuromuscular integrity, physiological reserve, and nutritional status. While reduced HGS has been linked to adverse outcomes in various clinical populations, its prognostic value in critically ill ICU patients remains underexplored. Given these considerations, this study aims to rigorously evaluate the potential of admission HGS as a prognostic marker for in-hospital mortality among critically ill ICU patients. Methods: We conducted a prospective observational cohort study in a tertiary care ICU to evaluate whether the HGS at admission predicts in-hospital mortality. Adult patients (≥18 years) with evaluable HGS were included in the study. HGS was measured within 24 hours of admission using a standardized dynamometry protocol and expressed as sex-specific z scores. Multivariable penalized logistic regression was used to assess the association between HGS and mortality, adjusting for demographic, clinical, inflammatory (CRP), and renal (creatinine and urea) markers. The model performance was evaluated using the AUC, calibration plots, and Brier score. Results: A total of 200 patients from the ICU were enrolled; 98 (49.0%) died during hospitalization. Admission HGS was significantly lower among non-survivors (mean 4.7 ± 2.8 kg vs. 14.6 ± 4.8 kg, p