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Özlem Deligöz, Osman Ekinci University of Health Sciences, Haydarpa&scedil;a Numune Training and Research Hospital, Istanbul, TurkeyCorrespondence: Özlem Deligöz, University of Health Sciences, Haydarpa&scedil;a Numune Training and Research Hospital, Istanbul, Turkey, Email ozlem.deligoz@gmail.comObjective: Malnutrition is very commonly encountered in palliative care centers (PCC), especially in geriatric patients. It is known that development of malnutrition increases morbidity and mortality. In this study, we aimed to investigate the effectiveness of commonly used nutritional assessment parameters in predicting prognosis in geriatric patients diagnosed in PCC with malnutrition.Methods: Our study included 1451 patients aged ≥ 65 years, who were diagnosed with malnutrition in PCC between 2016– 2020 and did not yet start receiving nutritional support. Demographic data, comorbidities, The Nutritional Risk Screening 2002 (NRS-2002), body mass index (BMI), albumin, prealbumin and C-reactive protein (CRP) values of the patients were recorded. Prognostic course was evaluated by dividing the patients into 3 groups, namely mortal patients during PCC follow-up, patients transferred from PCC to Intensive Care (ICU) and patients discharged to home from PCC.Results: Logistic Regression analysis showed that low albumin levels affected transfer to ICU (P< 0.05). Elevated NRS-2002 and low albumin and prealbumin levels were found to be factors affecting mortality (P< 0.05). Areas under the ROC Curve were calculated to attain patients’ differential diagnosis. The area under the ROC Curve of low albumin in patients transferred to ICU was found to be significant (P< 0.05). In the differential diagnosis of patients with mortal course, the area under the ROC Curve of low albumin and prealbumin and high CRP was found to be significant (P< 0.05).Conclusion: We found that BMI had no prognostic predictive effects in geriatric PCC patients with malnutrition. We concluded that NRS-2002 and high CRP and low albumin and prealbumin can be used to predict mortality. In addition, we found that low albumin indicates a poor prognosis and predicts patients to be transferred to ICU.Keywords: NRS-2002, malnutrition, albumin, prealbumin, CRP, mortality

Serkan Gunes,1 Ozalp Ekinci,2 Aynur Feyzioglu,3 Nuran Ekinci,4 Merve Kalinli5 1Child and Adolescent Psychiatry Department, Hatay State Hospital, Hatay, Turkey; 2Child and Adolescent Psychiatry Department, Medical Faculty, University of Health Sciences, Istanbul, Turkey; 3Clinical Psychology Department, Institute of Health Sciences, Istanbul, Turkey; 4Child and Adolescent Psychiatry Department, Erenkoy Research and Training Hospital, Istanbul, Turkey; 5Child and Adolescent Psychiatry Department, Faculty of Medicine, Mersin University, Mersin, Turkey Purpose: High prevalence of sleep problems has been reported in children with autism spectrum disorder (ASD). However, there is limited literature about the types and clinical correlates of sleep problems. This study aims to compare sleep disturbances between children with ASD and healthy children and investigate the relationship between sleep difficulties and clinical symptoms of ASD.Materials and methods: The sample consisted of 112 children in ASD patient group and 112 healthy controls, with an age range of 2–18 years. The Children’s Sleep Habits Questionnaire (CSHQ) was used for sleep problems; Turgay DSM-IV Disruptive Behavior Disorders Rating Scale parent form (T-DSM-IV-S) was used to assess hyperactivity/impulsivity and inattentiveness; Childhood Autism Rating Scale (CARS), Autism Behavior Checklist, and Aberrant Behavior Checklist were used to evaluate the severity of autistic symptoms and behavioral problems.Results: Total score, bedtime resistance, and sleep anxiety subscores of CSHQ were significantly higher in children with ASD than the control group. Among ASD children, intellectual capacity was not found to be associated with CSHQ scores. Bedtime resistance and night waking subscores of CSHQ were found to be positively correlated with CARS total score. Inattentiveness subscore of Parent T-DSM-IV-S was significantly higher in children with moderate-to-severe sleep problems.Conclusion: Sleep difficulties in ASD patients may occur independently of intellectual disability. Bedtime resistance and night waking appear to be linked with ASD symptoms. Inattentiveness in ASD children may be associated with moderate-to-severe sleep problems. Keywords: ADHD, ASD, autism, sleep, sleep problems

Abstract Background Cytoplasmic inclusion bodies within hepatocytes may have different etiologies, including the Endoplasmic Reticulum Storage Diseases (ERSDs). ERSD is a pathological condition characterized by abnormal accumulation of proteins destined for secretion in the endoplasmic reticulum of hepatocytes; it may be congenital (primary) or acquired (secondary). Fibrinogen storage disease is a form of ERSD. Case Presentation We present a case of fibrinogen storage disease secondary to estrogen replacement therapy. Its causal relationship to the drug is shown by histological, immunohistochemical and ultrastructural studies of paired liver biopsies obtained during and after the drug therapy. Conclusion The liver biopsies of patients with idiopathic liver enzyme abnormalities should be carefully evaluated for cytoplasmic inclusion bodies and, although rare, fibrinogen deposits.

Objective: Coronavirus Disease 2019 (COVID-19) has affected every aspect of human life and all health care systems globally. The aim of this study was to investigate the effect of COVID-19 pandemic on the frequency, presentation and surgical outcomes of complicated appendicitis., Methods: Patients who underwent appendectomy for acute appendicitis one year before and one year after the declaration of the pandemic were investigated. Demographics and diagnostic findings as well as surgical and histopathological outcomes were recorded and statistically analyzed., Results: The study group of 409 patients was composed of 241 cases in the pre-pandemic group and 168 cases in the pandemic group revealing that the weekly total number of appendectomies decreased during the pandemic [pre-pandemic, median (IQR): 5 (3-6); pandemic, median (IQR): 3 (2-5); p=0.005]. The pandemic group was significantly associated with a longer time from emergency department admission to hospitalization, increased mean blood C-reactive protein levels and increased rate of postoperative complications (p=0.024, p=0.038 and p=0.004, respectively). Most importantly, pathological examinations revealed a higher number of complicated appendicitis cases in the pandemic group when compared to the pre-pandemic group [26 (15.5%) vs. 19 (7.9%), respectively] which corresponded to a 2.1-fold higher risk of being diagnosed with complicated appendicitis during the pandemic [OR: 2.1 (95% CI: 1.1-4.1), p=0.024]., Conclusion: While fewer appendectomies were performed during the pandemic, the incidence of complicated appendicitis and postoperative complications increased considerably., Competing Interests: No conflict of interest was declared by the authors.

Background and Objectives: Acute myeloid leukemia and myelodysplastic syndrome are both clonal hematologic malignancies that primarily affect older adults. Current treatments for AML/MDS are both limited in number and efficacy. This study aims to evaluate venetoclax-based therapies in AML/MDS, focusing on overall survival and recurrence-free survival rates, and to expand real-world data on its use. Materials and Methods: Clinical and laboratory data on patients with AML/MDS aged 18≥ treated with venetoclax between January 2019 and July 2022 were included. Survival analysis was calculated based on the period from 2019 to December 2023. Results: A total of 161 AML and 40 patients with MDS were included. The median age was 63.53 ± 15.30 years for AML and 70.12 ± 10.21 years for MDS. In both groups, over 55% are male. A total of 77.6% of patients with AML and 75% of patients with MDS received treatment prior to venetoclax. Venetoclax was administered in combination with azacitidine to 84.5% of AML and 67.5% of MDS. The relapse rate in AML is approximately 15%. Overall, the 2-year survival rate is 46% and 18.73 months. The overall CR/CRi rate for patients with AML is 49.1%, while for patients with MDS, it is 50%. The 2-year survival rate for patients with MDS is 52.7%. The 2-year RFS rate was 75.5% for AML and 90.9% for MDS. The relapse rate in AML is approximately 15%. The percentage of adverse events leading to treatment discontinuation among those with grade 3-4 toxicity is low; 26.7% for AML ( n = 43) and 15% for MDS ( n = 6). Conclusions: Our real-world data demonstrate that venetoclax has the potential to improve overall survival rates when used in combination with HMAs and supports its use in patients with AML/MDS.

Background: : This study from Istanbul aimed to compare the child and adolescent psychiatric admissions and diagnosis rates between the first 3 months of the pandemic, the previous 3 months in the same year, and the same months in the previous year., Methods: : Children and adolescents were grouped according to the admission dates. Group A, between March 11 and June 1, 2020; Group B, between January 1 and March 11, 2020; and Group C, between March 11 and June 1, 2019. Only clinical interviews and diagnoses according to Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL) interview were included., Results: : Autism spectrum disorder (ASD), obsessive-compulsive disorder (OCD)/tic disorder, and intellectual disability (ID) diagnoses were higher in group A than in groups B and C (for ASD, 6.4%, 4.3%, and 3.6%; for OCD/tic disorder, 2.9%, 1.8%, 1.7%; for ID, 3.7%, 2.5%, and 2.1%, respectively) ( P < .001). Attention-deficit hyperactivity disorder (ADHD) diagnosis was higher in group A than in only group B (59.8% and 49.7%, respectively) ( P < 0.001). Depression was higher in group A than in only group C (4.1% and 2.2%, respectively) ( P < .001). Conduct disorder (CD) diagnosis was lower in group A than in only group B (3.6% and 6.4%, respectively) ( P < .05)., Conclusion: : Child psychiatry diagnosis rates were found to change significantly during the initial phase of the pandemic period. Among the referrals, ASD, OCD, Tic disorder, ID, ADHD, and depression admissions were significantly higher. The rate of pediatric neurodevelopmental disorders, particularly ASD, increased during the initial phase of the COVID-19 pandemic., Competing Interests: Declaration of Interests: The authors have no conflicts of interest to declare., (2024 authors.)

Background: Violence in healthcare is a global issue that healthcare professionals experience. The concerning increase in violent incidents in Turkiye particularly makes it a significant problem to explore by examining the underlying psychological factors. In this sense, this study focuses on the concept of Schadenfreude, the malicious joy of someone else's misfortune, towards doctors, which is an under-researched topic in healthcare violence. Particularly, there is a lack of research on patients' and relatives' perceptions of doctors., Objective: This study aims to determine the level of schadenfreude in Turkish society towards the violence experienced by doctors and to develop a model revealing the underlying causes., Methods: Using a convenience sampling method, we recruited 402 participants, who are not first-degree relatives of healthcare professionals, for this quantitative study. For data collection, we developed a survey instrument to measure the level of schadenfreude and six different psychological factors including empathy, sympathy, anger, aggression, and deservingness. For data analysis, we used structural equation modeling., Results: The results showed that the lower the levels of empathy and sympathy towards doctors were, the higher the levels of both schadenfreude and aggression were. Envy had no significant effect on either schadenfreude or aggression, while deservingness directly affected aggression. The perceptions of participants regarding doctors that they deserve violence increased their aggression levels. Schadenfreude had a positive and significant effect on anger and aggression., Implications: The examination of underlying factors of violence towards doctors points to a lack of mutual understanding between patients and doctors. The results of this study indicate a need for increasing empathy towards health professionals by creating societal awareness of their experiences. Local authorities and healthcare organizations can create environments that bring together the public and health professionals to share their experiences with each other or conduct campaigns to draw public attention to the issue. Moreover, training sessions on effective communication can be offered for health professionals to help improve patient-doctor relationships and healthcare outcomes., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

This study was carried out to determine the effects of cage density and anise extract (AE), thyme extract (TE), and black cumin extract (BCE) supplementation in the diet of laying hens on laying performance, egg quality, and some blood parameters. A total of 288 Lohman White commercial hens were blocked according to the location of their cages. The four dietary treatments included a control, basal diet + 250 mg/kg of AE, basal diet + 250 mg/kg of BCE, and basal diet + 250 mg/kg of TE for 12 weeks. The cage density affected egg production ( p < 0.05), feed consumption ( p < 0.01), and cracked eggs ( p < 0.05). Increasing the cage density caused a linear decrease in egg production and feed consumption. Compared to the control, there was a decrease in feed consumption ( p < 0.01) in the plant extract groups, and in parallel, egg production decreased. An increased cage density did not affect the egg quality traits except the shell strength. The shell strength, yolk color, yolk index, albumen index, and Haught unit were significantly affected by the plant extracts. The cage density and plant extracts had a significant effect on the serum corticosterone and glucose ( p < 0.01). The highest values of corticosterone and glucose were recorded for dietary TE with a cage density of 4 birds/cm 2 . On the other hand, the lowest values of these parameters were recorded for AE addition with a cage density of 3 birds/cm 2 . As a result, an increased cage density was associated with stress and depression in the feed consumption and metabolic profiles. Supplemental AE, BCE, and TE improved the laying performance and metabolic profiles.