20260318222902 20260318222902 Selcuk Medical Journal sinandemircioglumd@gmail.com Prof. Dr. Sinan DEMİRCİOĞLU Selcuk Medical Journal Selcuk Med J 2149-8059 1017-6616 3 18 2026 42 1 İSMAİL REİSLİ BAHAR GÖKTÜRK 0000-0001-8861-2615 MİNE KIRAÇ 0000-0003-2641-0852 Sevgi KELEŞ Yasemin Kınalı Çetin Objective: This study aimed to gain a better understanding of the features of patients with primary immune deficiency diseases/inborn errors of immunity (PID/IEI) in our region. Materials and Methods: In this study, the medical records of 1163 patients with IEI who had been followed up for 5 years were retrospectively reviewed. Results: Of the patients, 714(61.3%) were boys and 449(38.6%) were girls. The mean age of diagnosis and diagnostic delay were found as 56.5 and 27.4 months, respectively. Immune deficiency linked to antibody deficiency comprised 90.2%(n= 1049)of all patients. The ratio and incidence of severe combined immunodeficiency(SCID) were 2.1% and approximately one in 10000 live-birth, respectively. The Complaints of respiratory tract infection and otitis media were significantly higher (p<0.05). The consanguinity percentage was 31.8%. First-degree cousin marriage was significantly higher in congenital defects of phagocyte, immune dysregulation, and combined immune deficiency than in other IEIs (p<0.05 ). The history of death of a previous sibling was 12.3%, IEI in the family was 10%, and growth and development retardation was 7.3% among our patients. While complete blood cell count(CBC) resulted in frequencies of anemia of 17.2%, neutropenia of 3.2%, lymphopenia of 5%, and thrombocytopenia of 1.9% in all patients, the lymphopenia ratio was 87% in those with SCID. Due to recurrent infections, 95.6% of patients were administered trimethoprim/sulfamethoxazole prophylaxis, and 5.8% received intravenous immunoglobulin replacement therapy. Forty-two percent of all patients were diagnosed with asthma during clinical follow-up, and chronic lung pathology was found in 7.8% of the patients. Conclusion: This study reveals that primary immune deficiency frequency was found higher in Konya city than the stated prevalence in literature and consanguinity among parents may be a remarkable factor and the presence of lymphopenia may be a remarkable feature for SCID. 3 18 2026 1 7 10.30733/std.2026.01768 https://selcukmedj.org/en-us/retrospective-evaluation-of-patients-with-primary-immunodeficiency-five-years-of-experience/ https://app.selcukmedj.org/uploads/makale-pdf/retrospective-evaluation-of-patients-with-primary-immunodeficiency-five-years-of-experienc-29dh4P.pdf İlker Dedeli Bedii Güngör HALİL SEMİZ Şefik Murat Arıkan Yaman Karakoç AHMET KEKEÇ 0000-0003-2045-4686 Objective: The exact treatment of extremity soft tissue sarcomas is extended surgical excision with this chemotherapy and/or radiotherapy. Despite surgical resection with a negative margin and adjuvant radiotherapy, extremity soft tissue sarcomas tend to local recurrence. This study assessed surgical quality by examining shortand long-term local recurrence ratios with the prognostic factors affecting local tumor control. Materials and Methods: A retrospective examination was made of 130 patients treated for a diagnosis of soft tissue sarcoma localized in an extremity. The parameters affecting local recurrence were evaluated, such as the surgical margin, sarcoma size, depth, histotype, grade, the adjuvant/neoadjuvant treatment protocol, and unplanned surgery. Results: The mean follow-up period of the patients was 44 months (range,20-70 months). Of the 118 patients who underwent extremity-sparing surgery, R0 resection was applied to 96, and R1 resection to 32. In the 20-month follow-up period, the local recurrence ratio was 19% in surgical border-negative patients and 28% in surgical border-positive patients. The local recurrence rates during the 3-year follow-up period were 24% in patients undergoing R0 surgical treatment only, 21% in those with R0 surgery+radiotherapy(RT), 34% following re-resection in those with R1, and 38% in those with R1 applied with RT only. Conclusion: The local recurrence-free period is the most important marker of surgical margin quality. To provide optimal surgical quality, sarcoma cases should be discussed in multidisciplinary tumor panels and treatments must be personalized according to the clinical and demographic characteristics of the patient and the histopathological type of the sarcoma. The treatment of extremity soft tissue sarcomas must be performed by a specialized team with good knowledge of the physiopathology of sarcomas for optimal surgical margin and local control. Primary care physician training should be planned beyond direct patient referral to the sarcoma center for early diagnosis and treatment and to avoid unplanned surgery. 3 18 2026 8 14 10.30733/std.2026.01838 https://selcukmedj.org/en-us/evaluation-of-surgical-quality-in-extremity-soft-tissue-sarcomas/ https://app.selcukmedj.org/uploads/makale-pdf/evaluation-of-surgical-quality-in-extremity-soft-tissue-sarcomas-7VziYJ.pdf Tuğba Tehçi 0000-0002-8588-4292 İlkay Kolukırık 0009-0008-8243-1707 Serkan Akoğul 0000-0002-0346-4308 Zuhal Metin Defne Özkoca 0000-0002-4211-2276 MAHMUT METİN 0000-0002-5099-8521 Objective: Acne vulgaris is a prevalent long-term inflammatory skin disorder that notably impacts the quality of life, especially in teenagers and young adults. Although the pathogenesis of acne is influenced by multiple factors, the contribution of micronutrients like magnesium is not yet fully elucidated. This study sought to explore the relationship between serum magnesium concentrations and the severity of acne as assessed by the Global Acne Grading System (GAGS). Materials and Methods: A case-control study with a prospective design was carried out at a single center between March and August 2023, including 60 individuals diagnosed with acne vulgaris and 60 healthy controls matched by age and sex, all between 18 and 30 years old. The severity of acne was evaluated using the GAGS and classified as mild, moderate, or severe. Serum magnesium levels were determined through the Xylidyl Blue colorimetric assay. Data were analyzed using SPSS version 29. For continuous variables not normally distributed, the Kruskal–Wallis H test was employed, with statistical significance defined as p < 0.05. Results: The study included 34 female and 26 male acne patients and 31 female and 29 male healthy controls. No statistically significant differences were observed in serum magnesium levels among acne severity groups or between patients and controls (p > 0.05). Although the moderate acne group had slightly higher mean magnesium levels compared to mild and severe groups, the differences were not statistically significant. Magnesium concentrations remained within normal limits across all groups. Conclusion: Our results indicate that there is no significant association between serum magnesium levels and the severity of acne. While systemic magnesium seems to have a limited role in the pathogenesis of acne, topical magnesium preparations might provide therapeutic advantages due to their anti-inflammatory and antimicrobial properties. Further studies are necessary to better understand its efficacy. 3 18 2026 21 26 10.30733/std.2026.01855 https://selcukmedj.org/en-us/exploring-the-link-between-serum-magnesium-levels-and-acne-vulgaris-severity/ https://app.selcukmedj.org/uploads/makale-pdf/exploring-the-link-between-serum-magnesium-levels-and-acne-vulgaris-severity-LaQxSy.pdf Bülent Kaya Gülsüm ARSLAN 0000-0003-1699-2991 MUHAMMED ERKAM YÜKSEK 0000-0003-0693-9601 Fatih Karataş FATİH KESKİN MUSTAFA ARAÇ 0000-0003-0616-8835 Objective: This study aimed to compare the outcomes of spinal intradural tumor patients treated surgically in our center with the results previously reported in the literature. Materials and Methods: The study was approved by the ethics committee of Necmettin Erbakan University and conducted in accordance with the Declaration of Helsinki. Patient data used in the study were protected according to ethical rules and confidentiality principles. Parameters such as complaints at presentation, age, gender, neurological examination findings, tumor localization, extent of resection, histopathological diagnosis, Modified McCormick Scale (MMS), as well as operation method and complications, were evaluated. The extent of resection was analyzed in three groups as gross total resection (GTR), subtotal resection (STR) and biopsy (Bx). Results: In the sample, 62.1% of the patients were female. The most common complaint was axial pain (41.3%). The most common neurological examination finding at the time of presentation across all patients was motor weakness (60.1%). Pathological examination of the tumors revealed meningiomas in 35 patients (42.6%), schwannomas in 17 patients (20.7%), and ependymomas in 9 patients (10.9%). Most of the identified meningiomas were localized in the thoracic region, while schwannomas were frequently localized in the lumbar region. The mean MMS was the highest (2.5) in patients with thoracally located masses. Partial or complete recovery was observed in 67% of the patients who underwent surgical treatment. The most common postoperative complication was neuropathic pain (10.9%). Conclusion: Spinal tumor surgery is difficult and requires attention. Determining the specific tumor and its exact location is important for the reduction of mortality and morbidity in spinal tumors. Since excessive laminectomy during surgery may increase the risk of developing postoperative kyphosis, caution should be exercised. If more than two levels of laminectomy are required, stabilization may be needed to maintain sagittal balance. Early diagnosis and surgical treatment are important in patients with spinal intradural tumor. 3 18 2026 15 20 10.30733/std.2026.01812 https://selcukmedj.org/en-us/a-single-centre-retrospective-analysis-of-operated-intradural-spinal-tumour-cases/ https://app.selcukmedj.org/uploads/makale-pdf/a-single-centre-retrospective-analysis-of-operated-intradural-spinal-tumour-cases-xn9HPp.pdf Seyran Coşar 0009-0009-4737-6535 Ümmügülsüm Esenkaya 0000-0002-7347-2557 Objective: This study aims to evaluate the relationship between hematological inflammatory markers neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and systemic immune-inflammatory index (SII) and missed abortion, as well as to investigate their potential predictive roles. Materials and Methods: In this retrospective cross-sectional study, the missed group included 150 pregnant women diagnosed with missed abortion between the ages of 18 and 40. This group was compared to a control group of 150 pregnant women with healthy singleton pregnancies, matched according to gestational week. Demographic data and laboratory results for all cases were collected retrospectively from the hospital automation system. Exclusion criteria included multiple pregnancy, recurrent pregnancy loss, chronic illness, history of malignancy, smoking or alcohol use, hereditary thrombophilia, and a history of anhydramnios. Results: The demographic characteristics of the groups were similar (p>0.05). Mean lymphocyte levels were higher in the missed abortion group compared to the control group (p=0.037). The median NLR value was 2.88 (2.26–3.66) in the control group and 2.62 (1.81–3.44) in the missed abortion group, showing a significant difference (p=0.018). No significant differences were observed between the groups in other hematological parameters (WBC, neutrophil count, RBC, platelet count, HCT, MCV, MPV, PDW, RDW, INR, and hemoglobin) or in inflammatory indices such as PLR (p=0.057) and SII (p=0.073). In the subgroup analysis of pregnancies under 12 weeks, WBC and lymphocyte levels were higher in the missed abortion group, whereas PLR was higher in the control group (p<0.05). Conclusion: The etiology of missed abortion remains unexplained in most cases. This study suggests that NLR and lymphocyte levels may have predictive value in the diagnosis of missed abortion. Particularly in early pregnancy, careful evaluation of these parameters may contribute to the identification of high-risk cases. 3 18 2026 27 33 10.30733/std.2026.01876 https://selcukmedj.org/en-us/evaluation-of-hematologic-inflammatory-markers-in-missed-abortus-a-retrospective-case-control-study/ https://app.selcukmedj.org/uploads/makale-pdf/evaluation-of-hematologic-inflammatory-markers-in-missed-abortus-a-retrospective-case-cont-4V2722.pdf Zeynep Yalçınkaya 0000-0002-5568-7116 Nilgun Demirci 0000-0001-6160-3778 Haluk Türktaş 0000-0002-2598-6553 Ayshan Mammadova 0000-0002-8838-7419 Objective: Hypersensitivity pneumonitis (HP) is an interstitial lung disease that can range in its course from reversible inflammation to progressive fibrosis. Identifying reliable biomarkers to predict disease phenotype and prognosis remains a major clinical challenge. This study aimed to evaluate the prognostic significance of the Systemic Inflammatory Response Index (SIRI) in patients with HP and to investigate its association with clinical parameters, pulmonary function, and mortality. Materials and Methods: A retrospective analysis was conducted on 73 patients diagnosed with HP between 2014 and 2022. Patients were classified into fibrotic and non-fibrotic groups based on clinical, radiological, and histopathological criteria. Hematological indices including neutrophil-to-lymphocyte ratio (NLR), monocyteto- lymphocyte ratio (MLR) and SIRI were calculated. Kaplan–Meier and Cox regression analyses assessed survival outcomes and independent predictors of mortality. Results: SIRI levels were significantly higher in patients with fibrotic HP and those who died during follow-up. SIRI correlated positively with inflammatory markers, and negatively with pulmonary function (Forced Vital Capacity), carbon monoxide diffusion capacity (DLCO%)) and 6-minute walk distance. ROC analysis demonstrated high diagnostic accuracy for SIRI in differentiating fibrotic HP (AUC = 0.858) and predicting mortality (AUC = 0.932), with an optimal mortality cut-off of 1.92. Kaplan– Meier survival curves illustrated significantly shorter survival in patients with SIRI >1.92 compared to those with SIRI ≤1.92, with a Log-Rank test confirming this difference (mean survival time 74.6 ± 3.2 months vs. 127.7 ± 2.9 months; p < 0.001). In multivariable Cox analysis, fibrotic phenotype, reduced DLCO%, and SIRI >1.92 were independent predictors of mortality. Conclusion: SIRI, as a quantitative indicator of systemic inflammation, may be regarded as a meaningful biomarker for predicting disease severity and mortality risk in patients with hypersensitivity pneumonitis. While more evidence is needed before integration into routine clinical use, it holds potential as a supportive tool for risk stratification, early detection of fibrotic progression, and long-term management strategy planning. 3 18 2026 34 40 10.30733/std.2026.01870 https://selcukmedj.org/en-us/systemic-inflammatory-response-index-siri-in-hypersensitivity-pneumonitis-association-with-clinical-course-and-mortality/ https://app.selcukmedj.org/uploads/makale-pdf/systemic-inflammatory-response-index-siri-in-hypersensitivity-pneumonitis-association-with-C1mfzY.pdf ZELİHA ÇELİK Endometriosis is defined as the presence of endometrial glands and stroma outside the uterine cavity and musculature. Appendiceal endometriosis was first described in 1860 by von Rokitansky. The pathogenesis of endometriosis is based on three main theories: Retrograde menstruation with implantation and failure of immunologic clearance, coelomic metaplasia, and hematologic or lymphatic metastasis. A 26-year-old female patient presenting with abdominal pain no known medical history and a 50-year-old female patient presenting with menstrual irregularity without any known medical problems are presented. Histopathological examination of their appendectomy specimens revealed foci of endometriosis. Appendiceal endometriosis, while relatively uncommon in patients with endometriosis, is rare in the general population. It not only may cause symptoms of acute and chronic appendicitis but is also known to cause cyclic and chronic right lower quadrant pain, melena, lower intestinal hemorrhage, and cecal intussusception. Appendicitis should be considered in the differential diagnosis. Recognition of this benign entity is essential to avoid misdiagnosis and unnecessary aggressive management. 3 18 2026 90 93 10.30733/std.2026.01905 https://selcukmedj.org/en-us/endometriosis-of-the-appendix-two-rarely-encountered-cases-and-review-of-the-literature/ https://app.selcukmedj.org/uploads/makale-pdf/endometriosis-of-the-appendix-two-rarely-encountered-cases-and-review-of-the-literature-8AV99D.pdf Burak Uzel https://orcid.org/0000-0002-6231-9450 Abdullah ŞAHİN https://orcid.org/0000-0003-0196-2319 Lutz Welker https://orcid.org/0000-0001-7061-9309 Hatice Elmas https://orcid.org/0000-0002-9796-9197 Objective: PD-L1 immunohistochemistry (IHC) is an essential predictive biomarker test guiding immune checkpoint inhibitor (ICI) treatment in individuals with non-small cell lung cancer (NSCLC). However, variability in antibody clones, scoring systems (Tumor Proportion Score (TPS), Combined Positive Score (CPS), Immune Cell scoring (IC)), and pre- analytical/analytical conditions complicates interpretation and reproducibility—especially in small biopsies and cytological specimens in NSCLC. To review current practices, challenges, and advances in PD-L1 testing in NSCLC, with emphasis on tumor heterogeneity, cytological limitations, and the evolving role of artificial intelligence (AI)-based digital pathology tools. We also aimed to explore how multimodal approaches, including radiomics, may complement tissue-based assessment and improve patient selection for ICI therapy. Materials and Methods: A comprehensive literature review was performed, focusing on studies evaluating PD-L1 expression in NSCLC using validated clones (22C3, 28-8, SP263, SP142), cytology– histology concordance, pre-analytical factors, and AI-based PD-L1 scoring platforms. The search covered publications from January 2020 to June 2025. Data were synthesized thematically, addressing technical variables, interpretive variability, and emerging digital solutions. Results: PD-L1 expression in NSCLC is affected by spatial heterogeneity and technical variables, leading to diagnostic inconsistency. Cytological specimens pose unique challenges due to limited architecture and fixation artifacts. Inter-observer variability is highest in the 1– 49% TPS range. AI-assisted algorithms and digital platforms have demonstrated improved reproducibility (κ up to 0.74), accuracy (up to 95%), and potential correlation with clinical outcomes. Commercial AI platforms, such as Lunit SCOPE PD-L1 and HALO Lung PD-L1 AI, achieved up to 92% accuracy and reduced borderline misclassification rates by 18–30%. Radiomics using PETbased imaging—incorporating SUVmax, metabolic tumor volume, and heterogeneity indices—shows promise as a non-invasive adjunct, particularly when tissue sampling is limited. Conclusions: Reliable PD-L1 testing requires clone-specific validation, adherence to standardized protocols, and awareness of sample limitations. Integration of AIbased digital pathology and radiomics can enhance diagnostic precision, particularly in ambiguous or limited samples. 3 18 2026 71 79 10.30733/std.2026.01866 https://selcukmedj.org/en-us/from-microscope-to-machine-a-practical-guide-to-pd-l1-testing-in-nsclc/ https://app.selcukmedj.org/uploads/makale-pdf/from-microscope-to-machine-a-practical-guide-to-pd-l1-testing-in-nsclc-TJTD7H.pdf Ferda SEVİMLİ https://orcid.org/0000-0001-9454-4516 Çiğdem Deniz 0000-0003-4666-7129 Oğuzhan Aksu orcid.org/0000-0003-4666-7129 İLKER CORDAN 0000-0002-5225-4905 Objective: Despite being one of the most common causes of secondary hypertension, primary aldosteronism (PA) is frequently underdiagnosed. This study aimed to evaluate the associations between biochemical markers used in PA screening (plasma aldosterone concentration [PAC], plasma renin activity [PRA], and aldosteroneto- renin ratio) and routinely measured hematological parameters (leukocyte, neutrophil, lymphocyte, and platelet counts), as well as inflammatory indices derived from these parameters (neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], and the Systemic Immune-Inflammation Index [SII]). Materials and Methods: This retrospective study analyzed data from 169 hypertensive patients who underwent PA screening between January 2021 and December 2023. Patients were grouped according to PAC cut-off values of ≥15 ng/dL and ≥30 ng/dL. Associations between PAC, PRA, and hematological parameters were assessed using correlation, multivariable linear regression, and receiver operating characteristic (ROC) curve analyses. Results: Platelet count was significantly higher in patients with PAC ≥15 ng/dL and PAC ≥30 ng/dL (p = 0.041 and p < 0.001, respectively). In multivariable regression analyses, platelet count (p = 0.001), PLR (p = 0.012), and SII (p = 0.044) remained independently associated with PAC. In ROC analysis, platelet count demonstrated statistically significant discriminative performance for PAC ≥30 ng/dL (AUC = 0.727, p = 0.001). Conclusion: Leukocyte-based hematological parameters and inflammatory indices were not significantly associated with PA screening markers. However, the modest association between platelet count and PAC suggests a potential link with aldosterone activity. Further studies are needed to clarify the clinical relevance of this finding. 3 18 2026 41 49 10.30733/std.2026.01865 https://selcukmedj.org/en-us/association-of-aldosterone-excess-with-hematological-parameters-and-inflammatory-indices-in-hypertensive-patients/ https://app.selcukmedj.org/uploads/makale-pdf/association-of-aldosterone-excess-with-hematological-parameters-and-inflammatory-indices-i-8K2kz7.pdf Emre Bayındır 0009-0009-7821-6382 Burhan Engin 0000-0002-5140-1926 Psoriasis vulgaris is a chronic, immune-mediated inflammatory disease in which dysregulation of the TNF-α and IL-23/Th17 axes drives keratinocyte hyperproliferation and systemic comorbidities. Targeted biologic drugs-TNF-α inhibitors, the IL-12/23 p40 inhibitor ustekinumab, IL-23 p19 inhibitors, and IL-17 pathway inhibitorssuccessfully control the disease. Network meta-analyses (NMA) demonstrate that these drugs show high efficacy in the short term and are generally well tolerated. Long-term use, however, raises concerns about serious infection, tuberculosis (TB) and hepatitis B virus (HBV) reactivation, malignancy, inflammatory bowel disease (IBD), major adverse cardiovascular events (MACE), and rare paradoxical reactions. This review integrates randomized trial data, long-term extensions, pharmacovigilance signals and real-world cohorts to appraise the safety of biologic agents in psoriasis vulgaris. TNF-α inhibitors carry class-typical risks of serious infection and opportunistic mycoses, particularly in older or comorbid patients, but large registries demonstrate stable long-term profiles when screening and prophylaxis are optimized. Ustekinumab and IL-23 inhibitors show low serious-infection and TB-reactivation rates, reassuring data in patients with prior TB or cancer, and neutral MACE signals. IL-17-pathway inhibitors are associated with predictable, mostly mild mucocutaneous candidiasis and rare IBD onset or exacerbation, with very high skin-clearance rates and durable safety in trials and real-world studies. Observational data suggest that age, baseline comorbidity and concomitant immunosuppression drive absolute risk more strongly than molecule choice. When agents are selected according to comorbidity profile, supported by structured screening, vaccination and close monitoring, modern biologics for psoriasis vulgaris appear broadly safe, with rare but important class-specific adverse events that require proactive counselling and early recognition. 3 18 2026 80 89 10.30733/std.2026.01920 https://selcukmedj.org/en-us/safety-of-biologic-agents-in-the-treatment-of-psoriasis-vulgaris-an-integrated-review-of-clinical-trials-and-real-world-evidence/ https://app.selcukmedj.org/uploads/makale-pdf/safety-of-biologic-agents-in-the-treatment-of-psoriasis-vulgaris-an-integrated-review-of-c-99awKG.pdf YUSUF ÖZTÜRK 0000-0001-7526-6063 MUHAMMET KOCABAŞ Objective: To evaluate the clinical, ultrasonographic, and cytological characteristics of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) and to identify preoperative factors associated with coexistent papillary thyroid carcinoma (PTC). Materials and Methods: This retrospective study included a total of 115 patients histopathologically diagnosed with NIFTP after thyroidectomy. Demographic, ultrasonographic, cytological, and pathological data were analyzed. Nodules were classified according to the European Thyroid Imaging and Reporting Data System (EU-TIRADS) and the Bethesda cytology categories. The patients were divided into two groups: “NIFTP without coexistent PTC” and “NIFTP with coexistent PTC”. Comparative and logistic regression analyses were performed to identify predictors of concomitant PTC. Results: The mean age was 46.78±13.98 years, and 74.8% were female. The mean size of NIFTP nodules was 23.15±16.70 mm. According to the EU-TIRADS classification, 44.3% of nodules were category 3, 14.8% category 4, and 37.4% category 5. Cytology results were most frequently Bethesda I (27.0%), II (32.2%), and III (24.3%). Coexistent PTC was identified in 33 patients (28.7%). In the results of univariate analysis, smaller nodule size (OR 0.956, 95% CI 0.924-0.990, p = 0.010) was significantly associated with coexistent PTC, while EU-TIRADS category 5 (OR 2.288, 95% CI 1.002-5.228, p = 0.050) showed borderline significance. In multivariate analysis, only smaller nodule size remained an independent predictor (OR 0.951, 95% CI 0.909-0.995, p = 0.030). Conclusion: Smaller nodule size was found to independently predict coexistent PTC in NIFTP, whereas suspicious sonographic features such as solid composition, presence of a halo, or high EU-TIRADS scores were not independent predictors. Careful evaluation of smaller nodules may improve preoperative risk stratification and guide surgical decision-making. 3 18 2026 50 57 10.30733/std.2026.01904 https://selcukmedj.org/en-us/preoperative-predictors-of-coexistent-papillary-thyroid-carcinoma-in-noninvasive-follicular-thyroid-neoplasm-with-papillary-like-nuclear-features/ https://app.selcukmedj.org/uploads/makale-pdf/preoperative-predictors-of-coexistent-papillary-thyroid-carcinoma-in-noninvasive-follicula-emCNS7.pdf MEYDAN TURAN zeynep katipoğlu Objective: The present study aims to evaluate the effect of medical treatment, with and without preservatives, on the ocular surface in patients without dry eye who underwent phacoemulsification surgery. Materials and Methods: The study comprised a total of 70 patients. Following the operation, the patient was administered moxifloxacin 8x1 for a period of one week, followed by a course of steroid treatment spanning four weeks. The initial dosage of the steroids was 8x1, which was then reduced by two drops on a weekly basis. The patients were divided into two groups according to steroid use. Dexasine SE (Group 1, preservative-free) was prescribed to 35 patients, while Dexasine (Group 2, with preservatives) was prescribed to 35 patients. Schirmer’s test and the evaluation of corneal and conjunctival staining were conducted before the operation, and then at one week, one month, and three months post-surgery. Results: The mean age of the study participants was 72.03 years (±6.29) in Group 1 and 71.43 years (±5.12) in Group 2, with no statistically significant difference between the two groups (p=0.66). A comparison between Groups 1 and 2 revealed a significant discrepancy in Schirmer I, Break Up Time scores, and corneal conjunctival staining at the conclusion of the initial week and initial month. However, no substantial difference was observed at the three-month mark. Conclusion: In patients without dry eyes, dry eye tests may deteriorate on the ocular surface for up to the first 3 months preservatives contained in the drops used before and after surgery. Therefore, the use of medication without the concomitant use of a preservative should be the preferred option. 3 18 2026 58 62 10.30733/std.2026.01828 https://selcukmedj.org/en-us/evaluation-of-the-ocular-surface-with-and-without-preservatives-in-the-treatment-of-patients-undergoing-cataract-surgery/ https://app.selcukmedj.org/uploads/makale-pdf/evaluation-of-the-ocular-surface-with-and-without-preservatives-in-the-treatment-of-patien-9K1Gxa.pdf Nihal Canbulat 0000-OOO2-7591-7265 Sena Çelik 0009-0009-4088-2865 ERDAL KALKAN Sabiha Kalkan 0000-0003-0076-9154 Burcu Gültekin 0000-0001-6461-8123 Objective: The intervertebral disc (IVD) is a fibrocartilaginous structure that plays a critical role in transmitting spinal loads and maintaining mobility. Age-related degeneration of the IVD leads to the disruption of structural integrity, reduction in mechanical function, and the development of clinical symptoms such as back and neck pain. During the degenerative process, matrix composition, cellular organization, and mechanical resilience are significantly affected. The aim of this study was to investigate the histological and histochemical changes occurring in IVDs across different age groups using various staining techniques and to evaluate their relationship with the degeneration process. Materials and Methods: This study included 30 patients aged between 40 and 70 years who underwent surgical procedures for disc herniation during which IVD specimens were obtained. Patients were divided into four age groups: Age40s (40–49 years, n=9), Age50s (50–59 years, n=7), Age60s (60–69 years, n=8), and Age70s (70–79 years, n=6). Surgical specimens were fixed in 10% formalin, processed routinely, and embedded in paraffin. Sections of 5 μm in thickness were cut from the paraffin blocks and stained with hematoxylin and eosin, toluidine blue, Masson’s trichrome, Congo red, and the Armed Forces Institute of Pathology method. Histological changes were examined under a light microscope and semi-quantitatively scored. Results: With advancing age, IVD tissues exhibited a marked decrease in proteoglycan content, an increase in collagen fiber density, accumulation of lipofuscin granules, and the presence of amyloid deposits. In the older age groups, the matrix was observed to become denser and more fibrotic, and to show disruption of the lamellar organization. Conclusion: Histochemical staining techniques are effective in the detailed identification of cellular and extracellular matrix changes occurring during IVD aging and degeneration. These methods contribute to the characterization of age-related structural alterations and provide valuable information for comparative histopathological assessments of the degenerative process. 3 18 2026 63 70 10.30733/std.2026.01880 https://selcukmedj.org/en-us/comprehensive-histochemical-evaluation-of-age-related-intervertebral-disc-degeneration/ https://app.selcukmedj.org/uploads/makale-pdf/comprehensive-histochemical-evaluation-of-age-related-intervertebral-disc-degeneration-ZjVHBS.pdf Aswath Manju HARADANAHALLİ KSHAMAA Shruthi Vasishta 0009-0006-4680-5690 Trichotillomania is a compulsive disorder characterized by recurrent hair-pulling, typically beginning in adolescence and showing a marked female predominance. Late-onset cases are rare and frequently associated with psychiatric comorbidity. We report a 62-year-old woman referred from dermatology with a two-year history of scalp itching and repetitive hair-pulling that began shortly after she realized she had used expired hair dye. Despite multiple dermatological consultations, no organic pathology was identified. Psychiatric evaluation revealed a three-year history of persistent low mood, worsening over the preceding two months, along with relapse of alcohol use 20 days prior to presentation after 25 years of abstinence. Psychosocial stressors were significant, and biological and social functioning were impaired. Examination showed patchy alopecia, while dermatoscopy demonstrated broken hairs and perifollicular hemorrhage. Mental status examination revealed agitation, preoccupation with scalp discomfort, and depressive cognitions. She was diagnosed with dysthymia, a current moderate depressive episode with somatic syndrome, and trichotillomania; alcohol use did not meet criteria for dependence. Laboratory investigations and brain MRI were normal. Treatment with escitalopram, short-term anxiolytics, and behavioral interventions resulted in an approximately 25% reduction in symptom severity at six-week follow-up. This case underscores the importance of recognizing psychiatric morbidity underlying persistent dermatological complaints and highlights the need for a multidisciplinary approach in lateonset trichotillomania. 3 18 2026 94 96 10.30733/std.2026.01923 https://selcukmedj.org/en-us/a-case-of-late-onset-trichotillomania-with-coexisting-dysthymia-and-substance-use/ https://app.selcukmedj.org/uploads/makale-pdf/a-case-of-late-onset-trichotillomania-with-coexisting-dysthymia-and-substance-use-b8scRr.pdf Ahmed Halat Emrah Işıklı Evrim Kuş ömer erdoğan 0000-0001-8788-8302 Polyorchidism is an exceptionally rare congenital urogenital anomaly characterized by the presence of three or more testes, whereas testicular leiomyomas are uncommon benign tumors originating from smooth muscle cells and typically demonstrating slow growth. We report the case of a 74-year-old man with congenital polyorchidism who presented with suspected testicular malignancy. The patient was admitted with a complaint of firmness in the left scrotum. Physical examination revealed two normally palpable testes; however, a well-circumscribed, firm mass measuring approximately 3–4 cm in diameter was detected distal to the left inguinal canal. Serum tumor markers were within normal limits. Left inguinal exploration performed under spinal anesthesia demonstrated a normal left testis as well as a separate mass originating from the testicular base and terminating in an additional spermatic cord structure, which was subsequently excised. Histopathological examination confirmed the diagnosis of an intratesticular leiomyoma arising from a supernumerary testis containing a spermatic cord structure. Because intratesticular leiomyomas are rare and may clinically mimic malignant testicular tumors, definitive diagnosis relies solely on histopathological evaluation, often leading to radical orchiectomy in suspected cases. Polyorchidism has been reported in only a limited number of cases in the literature, and to the best of our knowledge, no tumor arising from a third testis has previously been described. 3 18 2026 97 100 10.30733/std.2026.01875 https://selcukmedj.org/en-us/intratesticular-leiomyoma-associated-with-polyorchidism-a-rare-case-report/ https://app.selcukmedj.org/uploads/makale-pdf/intratesticular-leiomyoma-associated-with-polyorchidism-a-rare-case-report-y8MjhD.pdf