Ufuk University

Background Rosacea is a chronic inflammatory skin disease, commonly affecting the central part of the face, characterized by erythema, flushing, telangiectasias, papules, and pustules. It may also involve sensations of burning, tingling, and occasionally fibrous changes. Aim This study aims to compare the efficacy, side effect profiles, and patient satisfaction of topical 20% azelaic acid and 7.5% dapsone in the treatment of mild‐to‐moderate papulopustular rosacea (Stage 2). Methods Ethics approval was obtained. A retrospective analysis was conducted on the medical records of 76 patients, including 44 in the azelaic acid group and 32 in the dapsone group, all diagnosed with mild‐to‐moderate papulopustular rosacea. These patients were treated with either topical azelaic acid or dapsone at the dermatology outpatient clinic between August 1, 2022 and December 31, 2022. Demographic characteristics, Investigator's Global Assessment scores, lesion counts, erythema scores, side effects, and patient satisfaction data were analyzed in the study. Results No statistically significant differences were found between groups based on pretreatment IGA values, separate IGA scores (2–4), lesion counts, average erythema scores, or separate erythema scores (p > 0.05 for all). Within each group, comparisons of pre‐ and posttreatment IGA values, lesion counts, and erythema scores revealed statistically significant differences (p < 0.001 for all), indicating that both treatments were effective. When comparing the groups based on posttreatment IGA values, separate IGA scores (0–3), improvement percentages in IGA values, lesion counts, improvement percentages in lesion counts, average erythema scores, separate erythema scores (0–2), and improvement percentages in erythema scores, no significant differences were observed (p > 0.05 for all). Conclusion Topical dapsone is as effective as azelaic acid in treating mild‐to‐moderate papulopustular rosacea and is associated with fewer side effects, making it a safer option.

Warts are benign intraepidermal proliferations commonly seen in children and adults caused by Papillomavirus. Invasive and non-invasive methods such as salicylic acid, cryotherapy, imiquimod, intralesional 5-fluorouracil, and electrocauterization take part in the treatment. In this study, we present 4 cryotherapy-resistant verruca cases treated successfully with 18% aluminum chloride solution. It is thought that the aluminum chloride solution acts by desquamation of the epidermis with its intraepidermal keratinolytic effect in the virus-infected epidermis. As a result of treatment, clinical improvement was seen in all cases. This treatment option can be used because it is painless, leaves no scarring, the frequency of hospital admission is low and the results are fast.

Objective The objective of this study is to develop a conceptual framework for use cases applicable to the development of an Internet of Things (IoT) system, designed for intelligent environments capable of managing the pandemic. Methods To achieve this objective, a comprehensive content analysis of scholarly articles from MDPI, PubMed, and Google Scholar was conducted. Best practices were identified, and various application examples were synthesized to establish an IoT-based framework. Results The study proposes measures for the implementation of technologically advanced environments and services while ensuring public compliance with these developments. Based on the identified use cases and enabled applications, a conceptual framework was formulated. The key use cases for IoT applications include traffic management, patient health monitoring, early virus detection, remote work facilitation, smart hygiene solutions, tracking infected individuals, monitoring social distancing, enhancing health care facilities, and ensuring quarantine compliance. To ensure rapid and effective implementation of policies, regulations, and government orders, robust architecture, applications, and technological infrastructures must be developed. Conclusions This study explores new architectural frameworks, potential use cases, and avenues for future advancements in IoT-based applications. The use cases are categorized as near-field measures, hybrid measures, centralized control mechanisms, and their integration in the defense against COVID-19.

Background Serum uric acid (SUA) has been associated with an increased risk of cardiovascular disease (CVD) in both the general population and individuals with type 2 diabetes (T2DM). Identification of high‐risk individuals is crucial for the primary prevention of CVD. A growing array of newly discovered biomarkers has been identified for predicting CVD. Galectin‐3 (Gal‐3) is linked to inflammatory and fibrotic processes and has been suggested as a biomarker in patients with heart failure. Aims Our aim is to investigate whether Gal‐3 is a marker that may predict the risk of CVD caused by asymptomatic hyperuricemia in patients with uncomplicated T2DM. Methods Twenty patients (male/female: 10/10) with T2DM with high SUA levels and 20 controls (male/female: 10/10) matched for age and gender with T2DM with normal SUA levels were involved. Results SUA and Gal‐3 levels exhibited a statistically significant correlation ( r s = 0.33, P = 0.03). Although the high SUA group had higher Gal‐3 levels than the normal SUA group, the observed difference did not achieve statistical significance (mean: 18 (95% confidence interval (CI): 10.7–29)) vs 14.4 (95% CI: 10.4–30), P = 0.33)). Conclusions The present study is the first to show a correlation between the level of SUA and Gal‐3 in patients with uncomplicated T2DM. This result suggests that Gal‐3 could potentially serve as a marker to predict the risk of CVD in patients with uncomplicated T2DM with high SUA levels.

Background Early detection and intervention for fetal hemolytic disease are essential to prevent severe complications. This study evaluates the antenatal and postnatal clinical and laboratory characteristics of newborns who underwent intrauterine intravascular transfusion due to anti‐D‐induced hemolytic disease. Study Design and Methods Twenty newborns who received intrauterine transfusions between 18 and 35 weeks of gestation were included. Data on maternal history, transfusion frequency, birth anthropometrics, ABO blood group, D typing, laboratory findings, morbidities, and hospitalization duration were analyzed. Results Thirteen cases (65%) had anti‐D antibody titers ≥1:1024. Intrauterine transfusions were administered once in 55% of cases, twice in 15%, and three or more times in 30%, with a mean gestational age of 29.6 ± 2.3 weeks. The mean birth weight and gestational age were 2478.7 ± 222.03 g and 35.6 ± 2.08 weeks, respectively. Severe hyperbilirubinemia requiring treatment was present in 50% of newborns, while 50% exhibited anemia‐related complications. Hypoxic–ischemic encephalopathy and intracranial hemorrhage were observed in 55% and 45% of cases, respectively. Exchange transfusions were required in 65% (once) and 10% (twice) of cases. All newborns received standard hemolytic disease treatments, including high‐intensity phototherapy (94.3 ± 22.4 h), infusion therapy (packed red cell transfusions, 10 mL/kg, 8 ± 2 times), and intravenous immunoglobulin (0.5–1 g/kg, 6 ± 1 times). Conclusion Newborns with anti‐D‐alloimmunization‐induced hemolytic disease requiring intrauterine transfusion demand intensive neonatal care to manage anemia, hyperbilirubinemia, hypoxic–ischemic encephalopathy, and intracranial hemorrhage.

Artificial intelligence (AI) is increasingly improving the processes such as emergency patient care and emergency medicine education. This scoping review aims to map the use and performance of AI models in emergency medicine regarding AI concepts. The findings show that AI-based medical imaging systems provide disease detection with 85%–90% accuracy in imaging techniques such as X-ray and computed tomography scans. In addition, AI-supported triage systems were found to be successful in correctly classifying low- and high-urgency patients. In education, large language models have provided high accuracy rates in evaluating emergency medicine exams. However, there are still challenges in the integration of AI into clinical workflows and model generalization capacity. These findings demonstrate the potential of updated AI models, but larger-scale studies are still needed.

Background: Cerebral protection during aortic surgery is crucial for improving surgical outcomes and reducing neurological complications. Selective antegrade cerebral perfusion (SACP) is increasingly used, and innominate artery (IA) side graft cannulation presents an innovative alternative to conventional axillary artery cannulation, with the potential to reduce complications associated with the latter. Methods: In this retrospective study, 196 patients who underwent proximal aortic surgery with IA graft cannulation for SACP between January 2021 and June 2024 were analyzed. Demographic data, intraoperative parameters, and postoperative outcomes were evaluated. Complications such as new stroke, postoperative delirium, mortality, and acute renal failure (ARF) were assessed. Results: The median age of the patients was 63 years, and 18.37% underwent emergency surgery for Type A acute aortic dissection (TAAAD). The most frequently performed surgical procedure was ascending aorta and hemiarch replacement (36.74%). The median cardiopulmonary bypass, cross-clamp, and SACP durations were 120.5, 93, and 23 min, respectively. The postoperative mortality rate was 3.06%, stroke rate was 2.04%, delirium rate was 9.18%, and ARF rate was 3.06%. All cases of delirium resolved spontaneously within 2–3 days. The mortality rate among Marfan syndrome (MFS) patients was 4.35%, with no reported stroke cases in this group. Conclusions: IA graft cannulation is a safe and effective method for providing SACP in aortic surgery, particularly in high-risk patient groups such as those with TAAAD and MFS. This technique ensures optimal cerebral perfusion, minimizes neurological and systemic complications, and enhances surgical efficiency by reducing operative duration. However, large-scale, multicenter, and prospective studies are needed to evaluate its long-term efficacy and safety.

Developmental dysplasia of the hip, particularly Crowe type IV, presents significant challenges in orthopedic surgery due to severe anatomical deformities and biomechanical instability. This study focuses on evaluating the biomechanical performance of a prosthesis–femur–derotation plate system designed to address these challenges. Using FEA, a comprehensive assessment of stress distribution, displacement, and safety factors was conducted under physiological loading conditions. The derotation plate was specifically engineered to stabilize the femur and restore the anatomical and biomechanical axis of the limb. Results demonstrated that the derotation plate effectively eliminated rotational and axial displacement, with a peak displacement of 0.08 mm, and maintained sufficient strength reserves, with a minimum safety factor of 3.63. The maximum von Mises stress in the plate was 76 MPa, significantly below the yield strength of the titanium alloy, ensuring long-term durability and reliability. The system as a whole exhibited favorable biomechanical properties, confirming its ability to manage high stress loads without the risk of material failure or instability. These findings underscore the potential of this novel system to improve surgical outcomes in complex cases of hip dysplasia. Future clinical trials will further validate its practical utility, providing valuable insights for advancing orthopedic implant design and patient care.

Background Musculoskeletal symptoms are common in chronic kidney disease, which negatively affects quality of life. Aim We aimed to evaluate the relationship between osteoporosis and fibromyalgia in hemodialysis patients. Methods The study included 170 patients on hemodialysis for more than 3 months. Demographic characteristics, complete blood count, and biochemistry values were recorded. Bone densitometry was measured by X-ray dual-energy absorptiometry. T score ≤ −2.5 was reported as osteoporosis. Groups were formed as those with and without lumbar osteoporosis and those with and without femoral neck osteoporosis. For fibromyalgia assessment, the widespread pain scale and symptom severity scale were recorded based on the American College of Rheumatology data. A fibromyalgia impact questionnaire was used to determine the level of physical disability (FIQ). P < 0.05 was considered significant. Results A total of 170 patients, with a median age of 55 years, were studied. Females constituted 52.4% of the participants. Age and ferritin levels were higher in patients with lumbar and femoral neck osteoporosis than in patients without osteoporosis. Body mass index (BMI) and parathormone levels were lower in patients with femoral neck osteoporosis. Fibromyalgia score was significantly higher in patients with lumbar and femoral neck osteoporosis, and there was a negative correlation. Age ( P < 0.002) and ferritin ( P < 0.001) were found to be associated with lumbar osteoporosis. Similarly, age ( P < 0.001), BMI ( P < 0.013), and ferritin ( P < 0.015) were found to be associated with femoral neck osteoporosis. Conclusion Fibromyalgia score was high in patients with both lumbar and femoral neck osteoporosis. The fibromyalgia score is an essential guide for early diagnosis, guidance to treatment, and prevention of complications.

Introduction Just as it is important to recommend lifestyle changes such as exercise, diet and smoking cessation to patients in the low-medium-risk group for protection from cardiovascular diseases, it is also important to identify patients in the high-risk group and reduce cardiovascular risk with lifestyle changes and, when necessary, pharmacological treatment. Aim This study evaluated the treatment and lifestyle change recommendations given by cardiologists to patients. Material and methods Our study was shared with cardiologists via e-mail from January 2024 to February 2024, and the surveys were answered online. Our questionnaire, consisting of 30 questions, covers topics related to cardiovascular protection, diet, nutritional habits, lifestyle, and diagnosis and treatment strategies of coronary artery disease, heart failure, arrhythmia, and dyslipidemia. Results Of the 104 participants included in the analysis, 37 (35.58%) were female, and 67 (64.42%) were male. The proportion of participants who recommended regular exercise to all of their patients was low at 25 (24.04%). It was determined that 60 (57.69%) participants were recommended to use aspirin in primary prevention in patients with moderate-severe cardiovascular risk. Achieving the target LDL value remains at a very low rate (2.88%). Conclusions The rate of recommending lifestyle changes, diet and exercise to patients in cardiology outpatient clinics is very low. SGLT2 inhibitors (SGLT2i) and angiotensin receptor-neprilysin inhibitors (ARNI) have become highly regarded drugs in heart failure patients. The rate of achieving the target low-density lipoprotein cholesterol value in patients admitted to the cardiology outpatient clinic remains very low.

This study aims to investigate the course of international relations and the factors affecting the use of power in Kyrgyzstan’s interactions with major powers, with particular emphasis on the power dynamics of small states in the field of international relations. Historically, power interactions between states have been an important factor in a field dominated by major powers, serving as a key component in shaping how states establish their positions on the global stage. In this context, small states have often been viewed as ineffective participants in the international arena and have largely been excluded from power dynamics. However, in contemporary conditions, small states have significant potential to assert their identities and prioritize their interests, thus becoming integrated into the power dynamics at play. Consequently, analyzing the power dynamics of Kyrgyzstan, located in the heart of Central Asia, in its interactions with major powers constitutes an important area of research. This study investigates Kyrgyzstan’s ability to use force to achieve its goals and protect its interests in the context of its relations with major contemporary global powers such as Russia, China, and the United States. To this end, the four-part analysis will examine the concept of power in international relations in relation to small states, the power dynamics among small states within the international system, and provide a comprehensive examination of Kyrgyzstan in this context.

Background/Aims There are studies with different results on improving effectiveness and patient comfort by increasing lumen distention through positioning during colonoscopy. In our study, we aimed to compare colonoscopy outcomes and post-procedural patient comfort in the left-lateral and right-lateral positions. Materials and Methods A total of 231 patients who underwent screening colonoscopy were included. Patients were randomized to either the left-lateral or the right-lateral position. Patient age, sex, comorbidities, body mass index (BMI) values, times to reach the cecum, ileum intubation rates, total procedure times, and colonoscopy findings were compared. Pain and discomfort after the procedure were evaluated and compared with the visual analog scale (VAS) scores at 30 minutes, 6 hours, and 24 hours. Results Colonoscopy was performed in the left-lateral position in 129 patients and in the right-lateral position in 102. The distributions of age, sex, comorbidities, and BMI values were similar in both groups. The time to reach the cecum and the total procedure time were similar in both groups. There were no significant differences in the findings detected by colonoscopy. There was no significant difference in the post-procedural VAS scores. Conclusion This study failed to show a difference in colonoscopy outcomes and postprocedural discomfort between the left- and right lateral positions.

Objective The purpose of this research is to determine the readiness of family physicians to prevent cyberchondria. Methods The Family Physicians’ Cyberchondria Levels Assessment Questionnaire was applied to 124 family physicians to determine readiness. ResultsFamily physicians mention that there can be accurate data on diagnosis and treatments on the internet (62%), but patients’ anxiety increases (88%); reach physicians and find answers on the websites of family physicians. Individuals with low health literacy research on the internet are concerned about family physicians (84.6%). Family physicians declare patients have medication with Internet information (84%), diagnose themselves with research on the internet (85.2%), and have high anxiety levels (83.2%). The family physicians use WhatsApp (90.3%) to answer patients’ questions and increase cyberchondria awareness. The family physicians have knowledge about cyberchondria, accept cyberchondria as a health problem, and have computer literacy. Conclusions The Internet provides individuals with a low-cost and easily accessible source of health information. The patients researching the internet have high anxiety and low health literacy. To prevent cyberchondria, direct communication with family physicians, development of health literacy, and facilitating access to communication and counseling services on the internet by central health authorities are essential.

Background: The role of Cystatin C (CysC) in the diagnosis and prognosis of cardiovascular disease, particularly acute coronary syndrome (ACS), is increasingly significant. The goal of this meta-analysis was to assess the diagnostic and prognostic value of CysC in patients with ACS, as well as its association with major adverse cardiovascular events (MACE), defined as mortality, myocardial infarction, heart failure, and stroke. Methods: The present study is a systematic review and meta-analysis. Using PubMed, Web of Science, Cochrane Library, and Embase, a literature review of cohort and case control studies reporting MACE and using the terms ACS and Cystatin C was conducted, excluding studies published after August 1, 2024. the meta-analysis using a random effects model. Results: CysC concentrations were significantly higher in patients with ACS compared to controls [mean difference (MD) = 0.36, p < 0.001], and in acute myocardial infarction (AMI) vs. unstable angina (MD = 0.18, p < 0.001). No significant differences were observed between ST elevation myocardial infarction (STEMI) and Non-ST elevation myocardial infarction (NSTEMI). Patients with MACE had higher CysC levels than those without (MD = 0.25, p < 0.001). Hospital survivors had lower CysC levels compared to those who died (MD = -0.25, p < 0.001). Higher CysC concentrations were associated with increased risks of MACE, cardiac death, overall mortality, myocardial reinfarction, and stroke, both during hospitalization and beyond. Conclusions: CysC is a promising biomarker for both diagnosis and prognosis in patients with ACS, especially in the context of predicting MACE, mortality and heart failure risk. The use of CysC may improve risk stratification and support therapeutic decision-making in clinical practice.

Background ADAMTSs are extracellular matrix metalloproteinases that mainly process extracellular matrix components and closely related tumorigenesis. ADAMTS-8 is an anti-angiogenic member of the family and is dysregulated in common cancers. The tumor suppressor function of the ADAMTS-8 has been demonstrated in colorectal cancer. Although ADAMTS-8 plays a critical role in tumor progression, transcriptional regulatory features haven’t been studied yet. Materials and methods The human ADAMTS-8 promoter was cloned into the pMetLuc Reporter vector. Basal promoter activity and the effect of the IL-6 on ADAMTS-8 promoter activity were determined by transient transfection assays in SW480 cells. QRT-PCR and Western blot analyses assessed the impact of IL-6 on ADAMTS-8 mRNA and protein expressions. Functional binding of the specific transcription factors to the ADAMTS-8 promoter region was evaluated by ChIP qPCR and EMSA. Results Our results demonstrated that the ADAMTS-8 promoter includes multiple binding sites for transcription factors that could be activated in the inflammatory pathways. IL-6 stimulation increased ADAMTS-8 promoter activity, also mRNA, and protein expressions. Pathway inhibition studies showed that IL-6-mediated induction of ADAMTS-8 was achieved through p38/MAPK, NF-κB, PI3K, and SAPK/JNK pathways. STATs, Elk-1, and c-Jun functionally bind to the ADAMTS-8 promoter region. Conclusion It can be concluded that inflammation is a strong positive regulator of the ADAMTS-8 gene.