The fear of malpractice is a significant factor influencing physicians' decision-making processes in modern medical practice. This can cause defensive medicine, which involves behaviors such as requesting unnecessary tests and imaging, avoiding high-risk patients, and applying cautious but sometimes medically unnecessary treatments. The aim of this study is to evaluate the effect of surgical and internal medicine residents' fear of malpractice on defensive medicine attitudes, while examining the mediating role of working hours on this relationship. This study is a cross-sectional investigation designed to examine the impact of surgical and internal medicine residents' fear of malpractice on defensive medical practices. The Fear of Malpractice Scale and the Defensive Medical Practices Attitude Scales were used to collect data. Years of residency, working hours, and opinions on the subject were also included during data collection. The findings revealed a statistically significant and strong positive correlation between fear of malpractice and defensive medical practices. The total score on the Malpractice Fear Scale showed a strong positive correlation with the total score on the Defensive Medicine Practices Attitude Scale. However, work variables such as average weekly working hours and length of residency do not play a mediating role in the relationship between fear of malpractice and defensive medical practices. This study supports the notion that fear of malpractice is a central factor influencing physicians' decision-making processes and increases positive defensive behaviors, such as requesting unnecessary tests, and negative defensive behaviors, such as avoiding high-risk patients.   Cite this article as: Kasali K, Kahramanlar AA, Yılmaz MA, .zg.dek HB, Şenocak E. The mediating role of working hours in the effect of surgical and internal medicine residents' fear of malpractice on defensive medical practices. Eurasian J Med. 2026, 58(1), 1279, doi:10.5152/eurasianjmed.2026.251279.
Medical malpractice occurring in primary health care settings may have significant consequences for patient safety, quality of care, and the legal liability of health care professionals. This study aimed to retrospectively examine malpractice cases alleged to have occurred in primary health care institutions in Türkiye and adjudicated by the Court of Cassation, in order to describe the types of errors, case outcomes, characteristics of the judicial process, and decision patterns. Using the official decision search system of the Presidency of the Court of Cassation of the Republic of Türkiye, 22 decisions meeting the inclusion and exclusion criteria were identified and included. Data were evaluated with respect to the type of action (civil compensation vs. criminal), the profession of the defendant, the alleged type of error, the outcome of the incident, the status of the expert report, and judicial decisions. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 22.0 (IBM SPSS Corp.; Armonk, NY, USA). Of the decisions reviewed, 54.5% concerned compensation claims and 45.5% were criminal proceedings. Nurses constituted the most frequently prosecuted professional group (40.9%), and the most common malpractice allegation was incorrect injection administration (31.8%). The vast majority of incidents occurred in health centers/family health centers. In primary health care, medical malpractice allegations primarily cluster around nursing practices and injection procedures. Strengthening training, supervision, record-keeping systems, and intra-team allocation of responsibilities will play a critical role in reducing malpractice in primary care. Cite this article as: Sancı GT, Sancı A, Vural T. Evaluation of medical malpractice in primary healthcare: A 20-year retrospective analysis of supreme court decisions. Eurasian J Med. 2026, 58(3), 1360, doi: 10.5152/eurasianjmed.2026.261360.
Atherosclerotic cardiovascular disease (ASCVD) is one of the leading causes of global morbidity and mortality. The current study provides a systematic review of the use of artificial intelligence (AI) technologies applied to the prediction and management of ASCVD. Traditional risk assessment approaches have their restrictions, leading to a growing preference for AI and machine learning techniques in risk assessment. First, this study tackles the complex pathophysiology of ASCVD and the problems associated with the current diagnosis, followed by an in-depth analysis of the wide variety of AI models that can be applied to electronic health records, medical imaging data, and other biomarkers. Special attention will be paid toward the potential of natural language processing models like bidirectional encoder representations from transformers in predicting risk from textual clinical data, and the overwhelming success of convolutional neural networks such as residual neural network and visual geometry group in plaque-based analysis through imaging modalities. Although the research results show that these models have a lot to offer in the clinical world, the authors also describe some serious disadvantages: data bias, interpretability of the model, and computational needs. It highlights, in particular, the need for multicenter validation studies as well as developing explainable AI techniques. Overall, AI-based approaches may pave the way for a new paradigm in ASCVD management. Nevertheless, deploying these technologies in everyday clinical practice will require overcoming technical, ethical, and regulatory challenges. As such, interdisciplinary collaboration and thorough clinical validation studies are essential for fulfilling the promise of these novel strategies to enhance patient outcomes. Cite this article as: Şakiroğlu F, Çolak C, Çolak MC. Pre-trained artificial intelligence models in the prediction and classification of atherosclerotic cardiovascular disease. Eurasian J Med. 2025, 57(3), 0937, doi:10.5152/eurasianjmed.2025.25937.
Metabolic shift is one of the hallmarks of cancer cells. Due to mutations in oncogenes such as Kirsten Rat Sarcoma Viral Oncogene (KRAS), cancer cells can adapt to stress-induced conditions. One of the adaptations that is commonly observed in non-small cell lung cancer (NSCLC) cells is glutaminolysis, where they exhibit high dependency on the presence of glutamine. Metformin is used for its anti-tumor effects, which inhibit mitochondrial complex I. This study aimed to investigate how glucose and glutamine availability affect the proliferation of three KRAS mutant NSCLC cells under metformin pressure. Using gene expression datasets, it was observed that glutamine was the second most affected metabolite upon metformin-treated A549 cells. Based on this, several 3-(4,5-dimethyltiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assays were done by using high and low glucose conditions having different concentrations of glutamine at different time points. Moreover, metformin was added to the setup to observe the flexibility of the cancer cells in terms of metabolic switches. Addition of glutamine resulted in a decrease in metformin's antiproliferative effect especially in high glucose conditions at later time points. A significantly higher proliferation rate in low glucose conditions compared to high glucose conditions was observed, which is especially pronounced with the addition of glutamine. These observations were supported by the gene expression analysis of the GSE dataset, which revealed upregulation of apoptosis related genes and downregulation of proliferation-related genes in metformin-treated A549 cells. Taken together, the results highlight the importance of targeting different metabolites and metabolic pathways in cancer therapy.   Cite this article as: K.ker ŞC, Tura.lı İD. Dependency of non-small cell lung cancer (NSCLC) cells on glutamine and glucose levels in the presence of metformin. Eurasian J Med. 2026, 58(2), 1018, doi:10.5152/eurasianjmed.2026.251018.
Stroke is a clinical condition in which blood flow to a brain area is interrupted by occlusion or hemorrhage. At present, the diagnosis and treatment of stroke are based on the use of biochemical markers and imaging methods. The degree of inflammation in the vessel wall may be reflected by changes in endocan levels. The aim of this study was the investigation of the role of endocan blood levels in the determination of large- and small-vessel occlusion in acute ischemic stroke. This was a prospective, single-center clinical study. Sociodemographic characteristics, physical examination, laboratory findings, and endocan levels were recorded. Patients with ischemic stroke were categorized as large-vessel occlusive (LVO) or small-vessel occlusive (SVO) on computed tomography (CT) angiography. Blood endocan levels were compared between the 2 groups. A total of 110 patients were included in the study; the mean age of these patients was 69.2 years and 50.5% were male. Large-vessel occlusive was present in 33.3% (n = 31) of these patients, and endocan levels were higher in the LVO group but without statistical significance (P > .05). Modified Rankin Score was higher in the LVO group while Glasgow Coma Score was lower and both were statistically significant (P < .001). The area under the receiver-operating characteristic (ROC) curve for troponin was 0.762 and statistically significant (P = .001). Serum endocan levels did not differ significantly between LVO patients and controls. However, more research is needed to determine how significant these high endocan levels are in diagnosing major artery disease.   Cite this article as: Tekin E, Çelik M, Tortum F, et al. The role of endocan level in determining large and small vessel occlusion in acute ischemic stroke. Eurasian J Med. 2026, 58(2), 1094, doi: 10.5152/ eurasianjmed.2026.251094.
Background: The aim is to create a new classification according to the contact and effect of dermatochalasis on the eyelashes and to examine the effect of blepharoplasty surgery on the visual field (VF) in these stages. Methods: Demographic characteristics of cases that were staged as dermatochalasis (group 1) (stage 1), (group 2) (stage 2), and (group 3) (stage 3) between February 2025 and April 2025 were examined, and changes in the VF before and after blepharoplasty were evaluated. Stage 1 was accepted as dermatochalasis only; stage 2 as dermatochalasis with eyelash contact but no eyelash inversion; and stage 3 as dermatochalasis creating inversion in the eyelashes. The Humphrey 30-2 test was applied in the VF. Mean deviation (MD), pattern standard deviation (PSD), visual field index (VFI), and upper half VF sensitivity were evaluated. Those with refractive error and additional eye diseases were not included in the study. Results: A total of 60 cases were examined, 20 in each group. The mean age of the cases was 42.7 ± 14.9 (28-75). Forty of the cases were female and 20 were male. The mean age was higher in group 3, and there was a statistically significant difference (P < 0.05). The changes in the VF in group 1 and group 2 were not statistically significant preoperatively and in the first month postoperatively (P > 0.05). In group 3, MD was -2.88 ± 1.20 (-3.63-2.10) dB, VFI was 97.45 ± 1.61 (89-92) dB, upper half VF sensitivity was 22.21 ± 1.54 (17-18.40) dB, and PSD was 2.19 ± 0.87 (1.2-2.02) dB at postoperative first month. The changes in group 3 were statistically significant preoperatively and in the first month postoperatively (P < 0.05). Conclusion: Dermatochalasis staging can predict the effect of dermatochalasis on the VF. This new dermatochalasis classification can be used in cases of equipment shortage. Visual field defects due to dermatochalasis can be corrected with blepharoplasty surgery.
The aim of this study is to determine the prevalence of carotid stenosis (CS) in isolated coronary artery bypass grafting (CABG) and isolated heart valve surgery in the center, identify associated risk factors, and discuss the necessity of routine screening. Between 2020 and 2023, a total of 834 patients who had undergone isolated CABG and heart valve surgery were included in the study. The patients were divided into 2 groups: group A (n = 640, isolated CABG) and group B (n = 194, isolated valvular surgery). Subgroups were then created based on age. Group 1 (n = 431, ≥ 60 years), group 2 (n = 371, 40-60 years) and group 3 (n = 32, <40 years). Prevalence of CS, preoperative and postoperative outcomes were compared between groups. The prevalence of CS ≥ mild, ≥ moderate, and ≥ severe was all higher in group A than in group B. There was no significant difference in cerebrovascular accident (CVA) between groups A and B 9 (1.4%) vs. 1 (0.5%). A positive significant association was found between advanced age (≥ 60 years), CABG, and CS (OR = 2.105 and OR = 1.899) respectively. Carotid stenosis was not found in any patients under the age of 40. In isolated heart valve surgery patients aged 60 and over, the prevalence of mild or higher CS was 15 (16.9%), moderate or higher CS was 13 (14.6%), and severe or higher CS was 2 (2.2%). In isolated valvular surgery patients aged 40-60, the prevalence of mild or above CS was 5 (6.3%), moderate or above CS was 3 (3.8%), and severe or above CS was 2 (2.5%). A significant prevalence of CS in patients over the age of 60 undergoing isolated heart valve surgery was found. Screening for CS should be conducted in this patient population, especially in individuals over 60. Screening could also be beneficial for patients over 40, while routine screening is likely unnecessary for those under 40 without cardiovascular risk factors. Cite this article as: Beyazal OF, Kayalar N, Yanartaş M. Prevalence of carotid stenosis in heart valve surgery and the role of routine screening. Eurasian J Med. 2026, 58(3), 1286, doi: 10.5152/eurasianjmed.2026.251286.
Chronic sinusitis with nasal polyp (CSwNP) is a common disease that can be recurrent at a rate of up to 40-60%. Various markers are being investigated to determine the prognosis in the treatment of nasal polyp (NP). Resistin is an inflammatory cytokine that may play a role in the etiology of NP. The aim of the study was to determine the resistin expression in NP epithelium and compare the resistin expression both in normal respiratory epithelium and NP epithelium. The patients who were operated for CSwNP were included as the study group, and the patients without nasal pathology were included as the control group. The operation specimens of the patients were stained with immunohistochemical methods, and the expression of resistin was examined and scored. Specimens of the 115 patients were included in the study. It was determined that the frequency  of asthma (P =. 006), resistin staining percentage (P = .004), resistin staining score (P = .026) and eosinophil percentage (P < .001) were statistically significantly higher in the NP patients than in the control group. It was observed that resistin expression was higher in NP epithelium than in normal respiratory epithelium, and this is the first known study, to the authors' knowledge, on this subject.   Cite this article as: Torun MT, Yılmaz GT. Analysis of resistin expression in nasal polyp tissue. Eurasian J Med. 2025, 57(4), 1130, doi: 10.5152/eurasianjmed.2025.251130.
The increasing antibiotic resistance of Helicobacter pylori (H. pylori) underscores the urgent need for alternative, nonantibiotic therapeutic strategies. This conceptual framework hypothesizes that Nitrosotalea devanaterra (N. devanaterra), an ammonia-oxidizing acidophile, could function as a biological competitor to H. pylori by reducing local ammonia availability, a critical factor for its survival and colonization in the gastric environment. To explore this hypothesis, a stepwise experimental framework is proposed. Initially, in vitro coculture models using gastric epithelial cells under microaerophilic conditions were employed to investigate potential interactions, metabolic competition, and impacts on H. pylori viability. Prospective in vivo validation could subsequently be performed using Mongolian gerbils, a model that closely mimics human gastric physiology, to assess the microbial load, histopathological changes, and host immune responses under controlled conditions. While direct empirical evidence for N. devanaterra survival and activity in the highly acidic gastric milieu is currently lacking, preliminary theoretical analysis suggests that ammonia competition could influence H. pylori persistence and pathogenesis. This hypothesis-driven approach emphasizes a microbiome-inspired strategy that does not rely on antibiotics, potentially reducing selective pressure for resistance. By introducing the concept of targeted nutrient competition as a therapeutic modality, this framework aims to stimulate further research into the feasibility of employing environmental acidophiles as modulators of pathogenicm bacteria in the stomach. The proposed strategy provides a foundation for future studies evaluating N. devanaterra or related ammonia-oxidizing microorganisms as innovative, nonantibiotic interventions against H. pylori infection.   Cite this article as: Warda M, Adıgüzel MC, Tekin S, Çelebi F, Abd El-Aty AM. Hypothesizing the biotherapeutic potential of Nitrosotalea devanaterra: targeting ammonia dependency to disrupt Helicobacter pylori survival strategies in gastritis. Eurasian J Med. 2026, 58(1), 1203, doi: 10.5152/eurasianjmed.2026.251203.
The aim of the study is to investigate whether long-term calorie restriction and physical activity have an effect on body weight and metabolism in obese individuals with different body mass indexes (BMIs). Fifty-four obese women who were not receiving any obesity treatment were included in the study. Participants received 12 weeks of low-calorie diet and physical activity training appropriate to their age, gender, and BMI. Body weights were measured at the initial visit and after the intervention. Venous blood samples were collected twice: before and after the intervention. Baseline glucose, insulin, total cholesterol (TC), triglyceride (TG), HbA1c, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) levels were measured using a Beckman Coulter AU 5800 clinical chemistry autoanalyzer. Hemoglobin A1c (HbA1c) levels were determined using boronate affinity and HPLC techniques using a Tirinity Biotech Premier 9210 autoanalyzer. Homeostatic model assessment of insulin resistance (HOMA-IR) was calculated using the formula (fasting insulin [μU/mL] Å~ fasting glucose [mg/dL])/405). In the study, insulin and HOMA-IR levels increased significantly as the degree of obesity increased (P < .05). Obese individuals lost an average of 8.6% weight after the combined treatment, and when repeated measurement results were compared, insulin levels in all obese groups decreased significantly (P < .05). HbA1c levels decreased significantly only in moderately obese individuals after the treatment (P < .05). In the first group (those who lost between 5% and 9.9% of their weight), TG and insulin levels decreased while TC, LDL-C, and glucose levels increased (P < .05). In the second group (those who lost more than 10% of their weight), only insulin levels decreased (P < .05). As obesity increased HOMA-IR levels an indicator of insulin resistance increased significantly. Participants lost an average of 8.6% of their weight and insulin levels decreased significantly after the intervention. Long-term lifestyle interventions produced relatively similar effects on metabolism across different obesity levels.   Cite this article as: Alyar G, Umudum FZ. Effects of long-term calorie restriction and physical activity on body weight and metabolism applied to different degrees of obesity. Eurasian J Med. 2026, 58(1),1020, doi: 10.5152/eurasianjmed.2026.251020.
Mercury is a heavy metal that has the potential to exert a deleterious effect on human health. The purpose of this article is threefold: firstly, to raise awareness of the issue; secondly, to offer solutions; and thirdly, to contribute to the existing literature on the subject by examining cases of elemental mercury poisoning that occurred in a primary school. In 2019, 34 cases of mercury poisoning due to mercury bottle (used in the laboratory) spillage in a primary school were examined, and control examinations were performed in 2024. The demographic composition of the cases was as follows: 58.8% of the subjects were male, with an average age of 9 years. The research revealed that 47.1% of cases were exposed to elemental mercury for a period of 4 days, 76.5% of cases involved manual contact with mercury, 82.4% of cases presented symptoms, the mean blood mercury level was 46.62 μg/L, and 2,3-dimercaptopropane-1-sulfonic acid (DMPS) treat ment was administered to the cases. Elevated blood mercury levels were found to be associated with more severe clinical mani festations. The study concluded that a 7-day intravenous administration of DMPS exhibited a high degree of therapeutic efficacy. In order to prevent poisoning from mercury and similar substances in educational establishments, it is essential to raise awareness of toxic substances, establish emergency chemical safety and medical health protocols, and prohibit the use of toxic substances such as mercury and devices containing these substances.   Cite this article as: Vural T, Kök AN, Ural B,Kılınç BB. Danger in the classroom: elemental mercury poisoning in primary school students. Eurasian J Med. 2025, 57(4), 1062, doi: 10.5152/ eurasianjmed.2025.251062.
The aim of this study is to evaluate the risk of osteonecrosis of the jaw in patients receiving osteoporosis treatment using C-terminal cross-linked telopeptide of type 1 collagen (CTX-1) values, to analyze follow-ups after drug holidays, and to compare treatment agents and other risk factors to determine the association with CTX-1 results. A total of 273 patients (266 female and 7 male) who received bisphosphonate and denosumab treatment for osteoporosis were included in this retrospective study. Sociodemographic characteristics, vitamin D levels, serum CTX-1 level, presence of diseases affecting CTX-1 levels, type of bisphosphonate, duration of use, presence of drug holidays, and duration of denosumab use (if any) were recorded. The effects of bisphosphonates and denosumab on CTX-1 levels were compared, and differences in the risk of osteonecrosis between them were evaluated. In this study, a meaningful association was not identified between serum CTX-1 levels and the measured vitamin D values (P = .232). Patients who underwent a drug holiday had significantly higher mean serum CTX-1 levels (266.2 Å} 175.1 pg/mL) compared to those without a drug holiday (199.9 Å} 138.5 pg/ mL; P = .009). Higher CTX-1 levels were observed in individuals receiving ibandronate and alendronate, whereas the lowest values were detected in patients treated with denosumab. Serum CTX-1 levels appeared unaffected by vitamin D. Although the denosumab group exhibited the highest risk of osteonecrosis, the difference compared to zoledronic acid was not statistically significant. These results suggest caution during jaw-related procedures and consideration of drug holidays when necessary.   Cite this article as: Ergül EE, Laçin O, Kılıçaslan HÖ, et al. Evaluation of osteonecrosis risk using serum C-terminal cross-linked telopeptide of type 1 collagen (CTX-1) levels in osteoporotic patients: Effects of drug holidays and risk factors. Eurasian J Med. 2026, 58(1), 1104, doi:10.5152/eurasianjmed.2026.251104.
The purpose was to assess the impact of septorhinoplasty on psychopathology and well-being and to demonstrate the effectiveness of septorhinoplasty and emphasize the importance of considering psychopathological status when selecting patients. Seventy patients scheduled for septorhinoplasty were evaluated prospectively. Following patient selection, participants were asked to complete a sociodemographic questionnaire, the Beck Anxiety Inventory (BAI), the Beck Depression Inventory, the Nasal Obstruction Symptom Evaluation Scale (NOSE), the Short Form-36 (SF-36), and the Rhinoplasty Outcome Evaluation Questionnaire (ROE) preoperatively and at 6 months postoperatively. The mean age in the study was calculated as 26.14 Å} 6.80. The postoperative NOSE and BAI scores of the patients decrease, while ROE score increases (P < .05). An increase in physical role, physical function, general health, and social functioning scores was also found in SF-36 subscales (P < .05). There was an inverse correlation between preoperative depression levels and postoperative satisfaction. Septorhinoplasty has a positive effect on quality of life and anxiety. When selecting a patient, attention should be paid to the level of depression.   Cite this article as: Tekin P, Toplu Y, G.nenir Erbay L. The effect of septorhinoplasty on psychopathology and quality of life. Eurasian J Med. 2026, 58(1), 1146, doi:10.5152/eurasianjmed.2026.251146.
Malignant ventricular arrhythmias are serious complications of non-ST-elevation myocardial infarction. The plasma atherogenic index, derived from triglyceride and high-density lipoprotein cholesterol, reflects atherogenic dyslipidemia. Its role in predicting malignant arrhythmias is unclear. The primary aim of this study was to determine whether the plasma atherogenic index independently predicts malignant ventricular arrhythmias in patients with non-ST-elevation myocardial infarction. A total of 502 patients with non-ST-elevation myocardial infarction admitted between January 2024 and January 2025 were retrospectively analyzed. Patients were grouped by arrhythmia occurrence and tertiles of the plasma atherogenic index. Logistic regression identified predictors of arrhythmias. Cox regression identified predictors of malignant arrhythmias. Receiver operating characteristic analysis assessed discriminative performance, and Kaplan-Meier analysis evaluated survival. Malignant ventricular arrhythmias occurred in 47 patients (9.4%). They had significantly higher plasma atherogenic index values (0.48 Å} 0.35 vs. 0.21 Å} 0.29, P < .001). In multivariable analysis, multivessel disease, neutrophil, troponin T, low-density lipoprotein cholesterol, reduced ejection fraction, and the plasma atherogenic index independently predicted arrhythmias. For mortality, no-reflow, troponin T, malignant arrhythmia, and the plasma atherogenic index (hazard ratio 1.342, 95% confidence interval 1.211-1.487, P = .006) were independent predictors. The plasma atherogenic index had the highest discriminative value (area under the curve 0.721 for arrhythmias; 0.709 for mortality) with a cut-off of 0.32 (sensitivity 68%, specificity 68%). Kaplan-Meier analysis showed lower survival in the highest tertile. Elevated plasma atherogenic index independently predicts malignant arrhythmias and shortterm mortality in non-ST-elevation myocardial infarction. As a simple, widely available lipid marker, it may improve risk stratification in high-risk patients. Cite this article as: Taş A, Ateş MS, Tunca .. Plasma atherogenic index predicts malignant arrhythmias in non-ST-elevation myocardial infarction. Eurasian J Med. 2026, 58(3), 1315, doi: 10.5152/eurasianjmed.2026.251315.
Schizophrenia is a mental condition characterized by abnormalities in emotional reactivity, thought processes, and perception. Recent studies have suggested a possible connection between the pathophysiology of schizophrenia and the CLOCK gene, a key element of the biological circadian rhythm. The CLOCK rs1801260 polymorphism has not yet been studied in a Turkish population with schizophrenia, and the existing data are contradictory. This study aimed to compare and interpret the CLOCK rs1801260 polymorphism in terms of demographic characteristics, genotype, and allele distribution in patients with schizophrenia and healthy controls. Deoxyribonucleic acid was purified from peripheral blood samples of 50 schizophrenia patients and 50 healthy control subjects, matched for age and sex. Genotyping was conducted by real-time polymerase chain reaction using the TaqMan Kit. The odds of having the risk-associated TC or CC genotypes vs. the TT genotype were significantly higher in patients with schizophrenia compared to healthy controls (odds ratio (OR) = 2.92), and the risk C allele was also twice as prevalent in schizophrenia patients (OR = 2.00). The distributions of CLOCK rs1801260 genotypes (TT, TC, and CC) in the schizophrenia and the healthy control groups were independent of age and sex. The presence of the TC or CC genotypes, or having the homozygous or heterozygous C allele, may pose a risk for schizophrenia in the Turkish population. If confirmed in larger and more diverse samples, the CLOCK rs1801260 polymorphism may serve as a genetic marker for identifying at-risk individuals and guiding individualized treatment strategies aimed at stabilizing circadian rhythm. Cite this article as: Yekayeva P, Türkgenç B, Gözler T, Yüksel I, Ulucan K, Tarhan N. Investigation of CLOCK rs1801260 polymorphism of circadian genes in schizophrenia patients. Eurasian J Med. 2026, 58(4), 1049, doi: 10.5152/eurasianjmed.2026.251049.
Intranasal mucosal contact points (MCPs) can exacerbate primary headaches or give rise to secondary headaches. In this study, the prevalence of intranasal MCPs and their relationship with migraine features were investigated in patients diagnosed with episodic migraine. Fifty migraineurs were enrolled in the migraine group, and 50 without migraine in the control group in this retrospective study. Visual Analog Scale (VAS), Migraine Disability Assessment (MIDAS), and Headache Impact Scale (HIT-6) scores were retrieved from the patient files. Coronal and axial computed tomography sections were scanned, and intranasal MCP and anatomical variations within these were recorded. The prevalence of MCP was then compared across the 2 groups. The patient group had a considerably higher prevalence of MCP than the control group (P=.018). No meaningful correlations were detected between mucosal contact and age, sex, migraine aura, menstruation, frequency of migraine attacks, duration of attacks, pain severity (VAS), or the effect of migraine on daily living (MIDAS) and quality of life (HIT-6). The findings indicate that an increased prevalence of migraine is associated with intranasal mucosal contact, which occurs particularly between the middle concha and septum. Further clinical studies researching the role of intranasal mucosal contact in migraine are now needed.
Deaths due to lightning strikes are rare but of great forensic importance because of their sudden and fatal nature. This study aimed to evaluate the demographic characteristics, scene findings, and autopsy results of fatal lightning strike cases examined in Kars and Ardahan provinces. This retrospective study included 13 cases of death by lightning strike, identified from 847 autopsies performed in 2 climatically similar provinces between 2019 and 2025 via the National Judicial Network Project (UYAP) database. The research evaluates the victims' demographic data, incident location characteristics, and macroscopic autopsy findings, alongside negative toxicological and histopathological examination results. The data were analyzed using the SPSS software, utilizing descriptive statistical methods such as frequency, percentage distribution, and mean values. Between 2019 and 2025, 1.53% (n = 13) of forensic autopsies in Kars and Ardahan were attributed to lightning strikes, with all cases involving male victims and a mean age of 31.3 years. The majority of cases were shepherds (69.2%), and deaths occurred most frequently in rural pastures during the spring and summer months, particularly in May and June. While all cases exhibited first- and second-degree burns and singed body hair, characteristic Lichtenberg figures were detected in 46.1% of the victims alongside various internal hemorrhages in some instances. Crime scene investigations provided critical diagnostic evidence, including the presence of deceased livestock near the victims and partially burned or torn personal belongings. Lightning-related deaths show a strong association with seasonal, occupational, and environmental factors. Scene investigation and the recognition of Lichtenberg figures play a crucial role in the forensic diagnosis of lightning strike fatalities. Cite this article as: Sancı A, Karaalp E, Baltacı AS, Vural T. Evaluation of lightning strike fatalities: a retrospective autopsy study from 2 centers in eastern Türkiye. Eurasian J Med. 2026, 58(4), 1359, doi: 10.5152/eurasianjmed.2026.261359.
This study investigates the effect of pelvimetric measurements on intraoperative and postoperative outcomes in the open perineal radical prostatectomy procedure. Distance of the ischial spines (ISD), angle of symphysis pubis (ASP), angle of symphysis pubisseminal vesicles (ASS), distance between the prostate apex and anus (DAA), distance between seminal vesicles and anus (DSA), distance of pelvic outlet (DPO) measurements were determined in multiparametric magnetic resonance imaging. The effects of these pelvimetric measurements on perioperative factors were analyzed. A total of 71 patients were included. Distance of the ischial spines was 9.0 Å} 0.82 mm, DPO 8.2 Å} 0.86 cm, DAA 4.8 Å} 1.2 cm, DSA 7.8 Å} 1.3 cm, ASP 63.7 Å} 7.2 degrees and ASS 44.9 Å} 6.5 degrees. It was found that a 1-cm increase in the ISD value resulted in a decrease of 9.19 minutes in the operation duration, a 1-cm increase in the DSA value caused an increase of 4.55 minutes in the operation duration, and a 1-cm increase in the ASS value caused a decrease of 0.76 minutes in the operation duration. A 1-cm increase in ASP resulted in 6.5 cm3 less blood loss and 1 unit increase in ASS resulted in 15.15 cm3 less blood loss. A 1-cm increase in ISD decreased anastomosis time by 1.7 minutes, whereas a 1-cm increase in DAA increased to 1.03 minutes. In the postoperative pathologic findings of the patients after radical prostatectomy, Gleason score 3 + 4 was the most common finding with 56.3%. Seminal vesicle invasion positivity was observed in 2 (2.8%) and extraprostatic invasion positivity in 18 (25.4%). Six parameters were examined with pelvimetric measurements had particular effects on operation duration, blood loss, anastomosis time, and complication development.   Cite this article as: Arıkan Y, Danacıoğlu YO, Özcan A., et al. Relationship of pelvimetric diameters with peroperative outcomes, complications, and surgical success in patients undergoing perineal radical prostatectomy. Eurasian J Med. 2025, 57(4), 0877, doi:10.5152/eurasianjmed.2025.25877.
Hereditary hemochromatosis (HH) is a common genetic disorder of iron metabolism, most frequently associated with pathogenic variants in the HFE gene. The distribution of HFE variants shows marked population-specific differences. This study aimed to evaluate the frequency and genotype distribution of major HFE variants in a large Turkish cohort. A total of 643 patients who underwent HFE gene sequencing at a single tertiary center were retrospectively analyzed. Genotype and allele frequencies of common HFE variants, including p.Cys282Tyr, p.His63Asp, and p.Ser65Cys, as well as rare variants were calculated. Clinical and biochemical parameters were not included, and the analysis focused exclusively on genetic frequency data. Among the 643 patients, 424 (65.9%) were wild-type for HFE. The most frequent variant was H63D heterozygosity, detected in 166 patients (25.8%). p.Cys282Tyr homozygosity was identified in only 4 patients (0.6%). Compound heterozygosity for p.Cys282Tyr and p.His63Asp was observed in 1 patient, while another patient showed homozygous His63Asp with heterozygous p.Arg224Trp. In terms of allele frequencies, p.His63Asp was the most common with 0.183, followed by p.Cys282Tyr with a frequency of 0.012. The findings demonstrate a distinct HFE genetic profile in the Turkish population, characterized by a low frequency of p.Cys282Tyr and a high prevalence of p.His63Asp heterozygosity. These results highlight the importance of population-specific genetic data for accurate interpretation of HFE testing and HH risk assessment. Cite this article as: Kablan A, Sezer A, Bakır A, et al. Distribution of HFE gene variants in patients undergoing genetic testing in Türkiye: A retrospective analysis of 643 cases. Eurasian J Med. 2026, 58(3), 1390, doi: 10.5152/eurasianjmed.2026.261390.
Cognitive flexibility (CF) is an ability to adapt to a changing environment, which is a prominent skill in children at school age. ADHD is a common disorder of childhood and can be accompanied by cognitivedisengagement syndrome (CDS, previously referred to as "sluggish cognitive tempo"). This study aimed to assess CDS's effect on CF in children with ADHD by using neuropsychological tests. The study sample consisted of 100 ADHD children aged between 6 and 12 years, including 2groups: 60 ADHD-only and 40 CDS+ADHD. ADHD diagnosis and CDS symptoms in participants wereassessed by Diagnostic and Statistical Manual of Mental Disorder Fifth Edition Text Revision (DSM-5-TR)based psychiatric interviews and rating scales. The Neuropsychological Battery, consisting of 4 different tests,Wisconsin Card Sorting Test (WCST), Stroop Color-Word Test, Verbal Fluency Test (VFT), and Color TrailTest, was applied to participants to compare CF of the ADHD-only group to CDS+ADHD. It was found that the CDS+ADHD group showed lower performance than the ADHD-only groupin the WCST and the Semantic Fluency Test-a subtest of the VFT. However, no significant performancedifferences were found between the groups in other tests. It was revealed that CDS co-occurrence causes lower CF performance in ADHD-diagnosedchildren. A more comprehensive approach is required to understand the nature of this difficulty. Cite this article as: Adak İ, Varan E., Ekinci ., et al. Does cognitive disengagement syndrome affectthe cognitive flexibility of children with ADHD?Eurasian J Med. 2025, 57(4), 1160, doi: 10.5152/eurasianjmed.2025.251160.