20250326090757 20250326090757 Selcuk Medical Journal sinandemircioglumd@gmail.com Prof. Dr. Sinan DEMİRCİOĞLU Selcuk Medical Journal Selcuk Med J 2149-8059 03 26 2025 41 1 Ahmet AKKOCA https://orcid.org/0000-0001-8269-9385 SELİM KUTLU AYSU ŞEN https://orcid.org/0000-0002-5271-7359 ABSTRACT Aim: Duloxetine is an active ingredient prescribed to patients for a wide range of conditions. Although the information with purchased drugs containing duloxetine mention various side effects on different muscle tissues, there is limited research available on the potential effects on the skeletal muscle of the diaphragm, which plays an important role in respiratory functions. In this study, the potential effects of different doses of duloxetine on in vitro mechanical activities of the diaphragm muscle were examined. Additionally, the impact of these activities on the diaphragm muscle was discussed in terms of the respiratory functions of patients prescribed duloxetine. Materials and Methods: Sixteen adult Wistar-Albino rats, each 24 weeks old, were randomly divided into two groups: duloxetine(DLXT ) and vehicle( VHC). Diaphragm muscles were isolated from rats in both groups under anesthesia and transferred to a 5mL volume isolated organ bath, in which muscle strips were adjusted to a 2g preload. For DLXT group, the diaphragm muscles were cumulatively treated with duloxetine at concentrations of 1, 10, 20, 30, and 40 µg/mL, while VHC group received the same volume of the vehicle. Contractions were induced using square pulses of 0.5 Hz frequency and 1 ms duration. Results: From the contraction curves, data was obtained on contraction force(g.mg-1), contraction time(s), relaxation time(s), under area curve(g.mg-1.s), +dF/dtmax(g. mg-1·s-1), and -dF/dtmax(g.mg-1.s-1). In DLXT group, relaxation time, area under the curve, +dF/dtmax, and -dF/dtmax parameters showed significant differences compared to the VHC group with the application of 10 µg/mL duloxetine. Similar difference was observed in contraction force and contraction time with the application of 30 µg/mL duloxetine. Conclusions: The effects of duloxetine on diaphragm muscle contraction parameters observed in this study suggest that duloxetine may adversely affect respiratory functions. It is therefore important that the respiratory functions in patients prescribed duloxetine be closely monitored. Keywords: Antidepressants, diaphragm, duloxetine, isometric contraction, respiratory 03 22 2025 19 23 10.30733/std.2024.01753 https://selcukmedj.org/en-us/the-dose-dependent-effects-of-duloxetine-on-the-mechanical-muscle-activities-of-rat-diaphragms/ https://app.selcukmedj.org/uploads/makale-pdf/the-dose-dependent-effects-of-duloxetine-on-the-mechanical-muscle-activities-of-rat-diaphr-D1Led9.pdf BAHAR KELEŞ Yavuz Uyar https://orcid.org/0000-0001-8732-4208 Mehmet Öz https://orcid.org/0000-0003-4167-2623 Mehmet Akif DÜNDAR https://orcid.org/0000-0001-9004-8400 ABSTRACT Aim: To investigate the potential protective effects of melatonin and alpha-lipoic acid against cisplatin-induced ototoxicity in a rat model using brainstem auditory evoked potentials. Materials and Methods: Sixty Sprague-Dawley rats were randomly divided into six groups: control, cisplatin-only, melatonin-only, alpha-lipoic acid-only, cisplatin+melatonin, and cisplatin+alpha-lipoic acid. Cisplatin was administered as a single intraperitoneal injection (10 mg/kg). Melatonin (4 mg/kg) and alpha-lipoic acid (100 mg/kg) were administered daily for eight days, starting one day before cisplatin. Brainstem Auditory Evoked Potentials were measured at baseline and on days 3, 7, and 15. Wave latencies, interpeak latencies, hearing thresholds, and waveform morphology were analyzed. Results: Cisplatin administration resulted in significant prolongation of wave V latency and increased hearing thresholds. Melatonin treatment significantly mitigated cisplatin-induced changes in wave V latency and hearing thresholds compared to cisplatin alone (p<0.05). Alpha-lipoic acid did not demonstrate significant protection against cisplatin-induced changes. Both melatonin and alpha-lipoic acid groups showed alterations in wave latencies when administered alone. Waveform distortions were most prevalent in the cisplatin group, with lower incidence in melatonin and alpha-lipoic acid treatment groups. Conclusions: Treatment with melatonin significantly mitigates cisplatin-induced ototoxicity in rats, likely due to its potent antioxidant properties. This finding supports the potential of melatonin as a therapeutic strategy to prevent or minimize hearing loss in patients receiving cisplatin chemotherapy. However, alpha-lipoic acid did not exhibit significant protection in this study, warranting further investigation. Keywords: Cisplatin, ototoxicity, melatonin, alpha-lipoic acid, antioxidants 03 22 2025 36 41 10.30733/std.2025.01770 https://selcukmedj.org/en-us/protective-effects-of-melatonin-and-alpha-lipoic-acid-against-cisplatin-induced-ototoxicity/ https://app.selcukmedj.org/uploads/makale-pdf/protective-effects-of-melatonin-and-alpha-lipoic-acid-against-cisplatin-induced-ototoxicit-cM5139.pdf GÜNSU MİRZA Refik OLTULU GÜNHAL ŞATIRTAV HÜRKAN KERİMOĞLU SELMAN BELVİRANLI https://orcid.org/0000-0003-0272-7345 MEHMET OKKA ENVER MİRZA ABSTRACT Aim: Retinal artery occlusion (RAO) is one of the most important emergencies of ophthalmologic diseases. Thromboembolism is the main etiological factor in RAO. Monocyte to HDL cholesterol ratio (MHR) is a novel prognostic biomarker in several inflammatory disorders, various cardiovascular and cerebrovascular diseases. In this study, it was aimed to investigate MHR in RAO patients. Materials and Methods: In this retrospective study, the record files of subjects who were examined between January 2015 and May 2019 were reviewed. Seventy-six subjects were enrolled in the groups. Thirty-eight patients with RAO were considered as group 1, 38 participants were considered as group 2 (control group). In group 1, 23 patients were classified as central retinal artery occlusion (CRAO), and 15 patients were classified as branch retinal artery occlusion (BRAO). Results: There was no difference in terms of gender and age among the groups (p=0.231 and p=0.685). As well, the groups were similar in terms of cardiovascular diseases, systemic hypertension, and diabetes mellitus (p=0.341, p=0.427, p=0.554, respectively). The mean MHR was higher in group 1 compared to the group 2, significantly (14.9±5.5 vs 7.9±1.9, p<0.001). The area under the curve for MHR was 0.908 in receiver operating characteristics analysis and an MHR of > 9.95 predicted RAO with a specificity of 84.2% and sensitivity of 89.5%. In univariate logistic regression, MHR was found to be an independent predictor of RAO (OR=1,892; 95% CI=1,398-2,561; p<0,001). Conclusions: MHR has been shown to be a simple, useful and inexpensive predictive biomarker for systemic inflammation and vascular-occlusive diseases. Our study showed that increased MHR was significantly associated with RAO. Also, we have researched the level of MHR in patients with RAO and presented that MHR is higher in both CRAO and BRAO. Therefore, MHR may be a predictive biomarker for the emergence of RAO in risky patients. Keywords: Monocyte to high-density lipoprotein cholesterol ratio, central retinal artery occlusion, branch retinal artery occlusion, atherosclerosis, inflammation 03 22 2025 7 11 10.30733/std.2025.01754 https://selcukmedj.org/en-us/monocyte-to-high-density-lipoprotein-cholesterol-ratio-in-patients-with-retinal-artery-occlusion/ https://app.selcukmedj.org/uploads/makale-pdf/monocyte-to-high-density-lipoprotein-cholesterol-ratio-in-patients-with-retinal-artery-occ-e1aPWg.pdf Sevim Şahin ABSTRACT Objective: Although the adverse effects of anti-seizure medications (ASMs), like leukopenia and neutropenia, are widely recognized, little is known about how they affect leukocyte subsets. Changes in leukocyte subsets are also used to assess the inflammation status during diseases. The neutrophil-to-lymphocyte ratio (NLR) is widely used for this purpose. This study aims to evaluate the effects of valproate (VPA) and carbamazepine (CBZ) monotherapy on leukocyte subsets and NLR and to determine the relationship of these effects with serum drug levels. Material and Methods: The data of children with idiopathic epilepsy who began CBZ (n=25) or VPA monotherapy (n=62) and underwent complete blood count examinations before treatment and at 1–6 months (T1) and 9–18 months (T2) after treatment, with at least one concurrent serum ASM level, were collected retrospectively. The data included the number and percentages of leukocytes, neutrophils, lymphocytes, and monocytes, as well as simultaneously measured serum ASM levels. The relationships between serum ASM levels and variables were evaluated with 130 simultaneous measurements in the VPA and 30 in the CBZ groups. Results: In the VPA group, when compared to baseline, neutrophil count and NLR decreased (p=0.026, p=0.038, respectively), and lymphocyte and monocyte percentages increased (p=0.015, p<0.001, respectively). There were no significant changes in the CBZ group. Serum VPA levels were positively correlated with monocyte counts (r=0.2, p=0.022). Serum CBZ levels were negatively correlated with neutrophil counts (r= -0.574, p=0.001) and NLR (r= -0.413, p=0.023). Conclusion: VPA monotherapy significantly decreased NLR, supporting its anti-inflammatory effects. The negative correlation of serum CBZ levels with NLR suggested that CBZ may have a dose-related effect on NLR. Consideration of these results may be beneficial in choosing an appropriate ASM for patients with epilepsy. Keywords: Carbamazepine, leukocyte subsets, neutrophil-lymphocyte ratio, valproate 03 22 2025 12 18 10.30733/std.2025.01806 https://selcukmedj.org/en-us/effects-of-valproate-and-carbamazepine-monotherapy-on-leukocyte-subsets-and-neutrophil-lymphocyte-ratio-in-children/ https://app.selcukmedj.org/uploads/makale-pdf/effects-of-valproate-and-carbamazepine-monotherapy-on-leukocyte-subsets-and-neutrophil-lym-ttw3LB.pdf FATİH AKKUŞ https://orcid.org/0000-0001-7037-9165 Emin Dönmez https://orcid.org/0000-0001-9231-9075 SITKI ÖZBİLGEÇ https://orcid.org/0000-0002-4776-4791 ABSTRACT Objective: This study investigates the predictive role of the Neutrophil Percentage to Albumin Ratio (NPAR), Platelet-to-Lymphocyte Ratio (PLR), and Systemic Immune-Inflammation Index (SII) in determining methotrexate (MTX) treatment outcomes in patients with ectopic pregnancy (EP). Materials and Methods: We conducted a retrospective analysis of 166 patients with ectopic pregnancy treated with MTX at a tertiary hospital between January 1, 2020, and May 1, 2024. Patients were categorized into two groups: those achieving successful MTX treatment and those experiencing treatment failure, necessitating additional MTX doses or surgical intervention. NPAR, PLR, and SII values were calculated from baseline blood parameters and analyzed to assess their predictive value. Statistical analyses included logistic regression and ROC curve analysis to determine optimal cutoff values. Results: NPAR and PLR were significant predictors of MTX treatment outcomes, with higher values correlating with increased likelihood of MTX failure (p <0.05). In contrast, SII did not show a significant association with treatment outcomes. ROC analysis showed that NPAR and PLR had satisfactory predictive performance, with AUC values of 0.777 (95% CI: 0.690-0.864) and 0.659 AUC (95% CI: 0.548-0.770), respectively. Optimal cutoff values for NPAR and PLR were determined to guide clinical decision-making. Conclusion: This study identified NPAR and PLR as valuable markers for predicting MTX treatment outcomes in ectopic pregnancy, whereas SII was not predictive in this context. NPAR and PLR may aid in early identification of patients at risk for MTX treatment failure, enabling more personalized and effective management of ectopic pregnancy. Further research is needed to validate these findings in larger, prospective studies. Keywords: Ectopic pregnancy, methotrexate treatment, neutrophil percentage to albumin ratio (NPAR), platelet-to-lymphocyte ratio (PLR), systemic Inflammatory markers 03 22 2025 24 28 10.30733/std.2025.01810 https://selcukmedj.org/en-us/predictive-value-of-neutrophil-percentage-to-albumin-ratio-npar-and-platelet-to-lymphocyte-ratio-plr-in-methotrexate-treatment-outcomes-for-ectop/ https://app.selcukmedj.org/uploads/makale-pdf/predictive-value-of-neutrophil-percentage-to-albumin-ratio-npar-and-platelet-to-lymphocyte-r4hoKT.pdf Özlem Doğan ABSTRACT Objective: Osteoporosis is a disease in which the bone mass and structure are weakened as a result of the decrease in the mineral density in the bones, and the bones become brittle. In addition to the use of adequate calcium and vitamin D in the treatment of osteoporosis, drugs that prevent bone resorption and increase bone formation are used. The aim of this study was to evaluate the efficacy and safety of denosumab after the use of bisphosphonates in the Turkish population with osteoporosis. Materials and Methods: Patients diagnosed with osteoporosis and using denosumab between 2018-2022 were involved in the study. Demographic, clinical, bone mineral density, and treatment characteristics of the patients were recorded. The patient's bone mineral density values after denosumab were compared with the baseline values. Results: Analysis of the study was performed with data from 55 patients. All patients involved in the study were female, and the median age was 69 (46-90). The most common cause of osteoporosis was postmenopausal (56.4%), and the most common cause among secondary causes was primary hyperparathyroidism (14.5%). Fourteen (25.5%) patients had a history of fracture. After denosumab treatment, a statistically significant decrease was detected in the phosphorus (p=0.022) and alkaline phosphatase (p<0.001) levels of the patients. Improvement was observed in BMD (gr/cm2) values of L1-L4 (from 0.887 to 0.933), femoral neck (from 0.693 to 0.727), and total hip (from 0.762 to 0.782) regions with denosumab treatment. Similarly, the patients’ BMD Z scores and T scores were improved. Also, the denosumabrelated adverse event was not observed. Conclusions: In this study, treatment characteristics of osteoporosis patients were retrospectively examined. Denosumab was well tolerated in patients, and no serious treatment-related side effects were detected. After bisphosphonate use, denosumab was shown to be an effective and safe treatment option in the treatment of osteoporosis. Keywords: Osteoporosis, bisphosphonate, denosumab 03 22 2025 1 6 10.30733/std.2025.01814 https://selcukmedj.org/en-us/evaluation-of-denosumab-efficacy-after-bisphosphonate-use-in-patients-with-osteoporosis-a-single-center-experience/ https://app.selcukmedj.org/uploads/makale-pdf/evaluation-of-denosumab-efficacy-after-bisphosphonate-use-in-patients-with-osteoporosis-a--Heuy75.pdf NECİP KARA SERHAT AYLA https://orcid.org/0000-0002-2661-5383 ABSTRACT Objective: To report the first documented case of infectious keratitis following small-incision lenticule extraction (SMILE) surgery in Türkiye. SMILE is a laser refractive procedure designed to correct refractive errors by creating a stromal lenticule with a femtosecond laser, which is then removed through a small incision. Case: A 22-year-old male patient presented to our clinic with keratitis in the right eye, which developed 15 days after undergoing SMILE surgery. The patient reported severe pain, decreased vision, and sensitivity to light (photophobia) in the affected eye. Examination findings included conjunctival injection, diffuse corneal edema, and dense infiltrative lesions in both the central and paracentral cornea. Initial empirical therapy with fortified antibiotics was ineffective as the condition progressed, leading us to add antifungal agents to the treatment regimen.: Following the revised treatment approach, the patient experienced significant relief from symptoms, with a marked resolution of corneal edema and epithelial defects within one month. Although culture results from corneal scrapings were negative, the patient’s favorable response to antifungal treatment suggested a possible fungal etiology. Conclusion: This case highlights the importance of considering fungal pathogens as potential culprits in culture-negative infectious keratitis following SMILE surgery. Prompt intervention and careful adjustment of empirical therapy play a critical role in managing similar cases effectively. Keywords: Refractive surgery, small incision lenticule extraction, infectious keratitis 03 22 2025 49 51 10.30733/std.2025.01803 https://selcukmedj.org/en-us/infectious-keratitis-after-small-incision-lenticule-extraction-first-reported-case-from-turkey/ https://app.selcukmedj.org/uploads/makale-pdf/infectious-keratitis-after-small-incision-lenticule-extraction-first-reported-case-from-tu-1fNEDH.pdf Selçuk Teke Yasin Ergen Edibe Başaran Kübra Koçaklı ABSTRACT Celiac disease is an enteropathy characterised by a series of autoimmune reactions against dietary gluten in genetically predisposed individuals. The disease is reported to have a prevalence of between 0.49 % and 0.97 % in Turkiye. Duchenne muscular dystrophy is a genetically transmitted neuromuscular disease resulting from mutations in the dystrophin gene. Since the disease is X-linked recessive, the incidence in boys varies between 1/ 3 500 –5 000. Autism spectrum disorder is a clinically defined neurodevelopmental disorder that is characterised by deficits in social communication and restricted, repetitive behaviours. The current prevalence of the disease in Turkiye is not definitively established. Two cases showing duchenne muscular dystrophy-celiac disease coexistence have been reported in the literature. However, there is no case in the literature in which duchenne muscular dystrophy, celiac disease and autism spectrum disorder coexist. In this article, a two-year-old male patient with celiac disease, duchenne muscular dystrophy and autism spectrum disorder is presented. The interrelationship between these three diseases with a genetic basis is examined in the context of existing literature. Keywords: Autism spectrum disorder, Celiac Disease, Duchenne Muscular Dystrophy 03 22 2025 52 54 10.30733/std.2025.01834 https://selcukmedj.org/en-us/association-of-duchenne-muscular-dystrophy-autism-spectrum-disorder-and-celiac-disease-case-report/ https://app.selcukmedj.org/uploads/makale-pdf/coexistence-of-celiac-disease-autism-spectrum-disorder-and-duchenne-muscular-dystrophy-a-r-XK5Q1b.pdf Nilufer Bulut https://orcid.org/0000-0002-2406-1946 Gokmen Erdem https://orcid.org/0000-0002-3375-9465 Tanju Kapagan https://orcid.org/0000-0001-9381-1934 ABSTRACT Aim: Non-small cell lung cancer (NSCLC) is a commonly occurring and potentially fatal type of cancer. The aim of this study is to investigate the effects of clinical, laboratory, and systemic inflammatory response data on progression-free survival (PFS) and overall survival (OS) in metastatic NSCLC patients who were treated with nivolumab as a second-line treatment following platinum-based therapy. Materials and Methods: The sample of this retrospective single-center study consisted of 84 adult patients with metastatic NSCLC receiving nivolumab as second-line treatment. Demographic data, cancer diagnosis-related characteristics and laboratory parameters of the patients just before nivolumab was started were recorded. The C-reactive protein/albumin ratio (CAR), aspartate aminotransferase/alanine aminotransferase (De Ritis) ratio, Glasgow prognostic score (GPS), neutrophil/ lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), prognostic nutritional index (PNI), and systemic immune-inflammation index (SII) parameters were calculated for each patient. Results: The mean age for all participants was 62.08 ± 8.43 years. The median PFS and OS were 6.4 and 13 months, respectively. In the univariate risk analysis for PFS, Eastern Cooperative Oncology Group Performance Status (ECOG PS) (p=0.05), and CAR (p=0.046) were identified as significant prognostic risk factors for PFS. However, the multivariate analysis did not confirm these two parameters as prognostic factors for PFS. In the multivariate analysis, ECOG PS (HR=0.45, 95% CI 0.22–0.94, p=0.035), bone metastasis (HR=0.38, 95% CI 0.19–0.78, p=0.008), and the De Ritis ratio (HR=0.47, 95% CI 0.23–0.96, p=0.037) remained independent prognostic risk factors of OS. Conclusion: In this study, in patients with metastatic NSCLC receiving nivolumab as second-line treatment, poor ECOG performance status, bone metastasis, and a high De Ritis ratio were identified as independent prognostic factors associated with shorter overall survival OS. These factors may help in evaluating patients' prognosis in clinical practice. Keywords: Lung cancer, nivolumab, prognostic factors, CAR, Deritis ratio 03 22 2025 29 35 10.30733/std.2025.01800 https://selcukmedj.org/en-us/prognostic-risk-factors-predicting-survival-in-metastatic-non-small-cell-lung-cancer-patients-treated-with-nivolumab/ https://app.selcukmedj.org/uploads/makale-pdf/prognostic-risk-factors-predicting-survival-in-metastatic-non-small-cell-lung-cancer-patie-wY6vN1.pdf Ömer ACAT https://orcid.org/0000-0002-8239-4896 Mustafa KARAAĞAÇ https://orcid.org/0000-0001-5737-5880 Fatih EKİCİ https://orcid.org/0000-0003-4000-7429 Rahim Kocabaş Okan İMRE https://orcid.org/0000-0002-2142-4916 ABSTRACT Aim: Mild cognitive impairment (MCI) is a disorder in which there is a decrease in cognitive functions and a loss of functionality is experienced unless early intervention is made. Our aim in this study was to compare neutrophil/high-density lipoprotein cholesterol (HDLc) levels ratio (NHR), monocyte/HDLc ratio (MHR), uric acid/HDLc ratio (UHR) between MCI and the control group and to investigate whether these parameters can be used as a predictive biomarker for MCI. Materials and Methods: In this cross-sectional study, 68 people over the age of 65 who were diagnosed with MCI according to ICD-10 constituted the patient group. The control group was selected from individuals over the age of 65 who underwent the mental competence assessment and did not have MCI as a result of this assessment. Results: Monocyte, UHR, and MHR were found to be higher in the MCI group (p= 0.036, p= 0.007, p= 0.004; respectively). A positive relationship was found between the Mini-Mental State Examination (MMSE) score and HDLc (p= 0.032) and a negative relationship was seen between UHR (p= 0.019). When the UHR cut-off value of 0.1285 was taken as a predictor of the diagnostic status, the sensitivity was found to be 41.9% and the specificity was 80.3%. When the cut-off value for MHR was taken as 0.125, the sensitivity was found to be 40.3% and the specificity was 78.9%. Conclusion: Although they had low sensitivity and specificity, UHR and MHR were found to be significant in predicting the diagnosis of MCI. The positive relationship between the MMSE score and HDLc levels shows that HDLc may be protective against any deterioration in cognitive functions. The decrease in MMSE score while UHR increases may indicate that UHR can be used in prognosis. Our study results should be supported by prospective studies. Keywords: Geriatrics, mini-mental state, cognitive function, monocyte/HDLc ratio, uric acid/HDLc ratio 03 22 2025 42 48 10.30733/std.2025.01771 https://selcukmedj.org/en-us/peripheral-biomarkers-that-may-be-associated-with-mild-cognitive-impairment-in-geriatric-patients/ https://app.selcukmedj.org/uploads/makale-pdf/peripheral-biomarkers-that-may-be-associated-with-mild-cognitive-impairment-in-geriatric-p-2MJR5U.pdf