Background/Objectives: The ketogenic diet (KD) is a dietary model that can impact metabolic health and microbiota and has been widely discussed in recent years. This study aimed to evaluate the effects of a 6-week KD on biochemical parameters, gut microbiota, and fecal short-chain fatty acids (SCFAs) in women with overweight/obesity. Methods: Overall, 15 women aged 26–46 years were included in this study. Blood samples, fecal samples, and anthropometric measurements were evaluated at the beginning and end of this study. Results: After KD, the mean body mass index decreased from 29.81 ± 4.74 to 27.12 ± 4.23 kg/m², and all decreases in anthropometric measurements were significant (p < 0.05). Fasting glucose, insulin, homeostasis model assessment of insulin resistance, hemoglobin A1C, urea, and creatinine levels decreased, whereas uric acid levels increased (p < 0.05). Furthermore, increased serum zonulin levels were noted (p = 0.001), whereas fecal butyrate, propionate, acetate, and total SCFA levels decreased (p < 0.05). When the changes in microbiota composition were examined, a decrease in beta diversity (p = 0.001) was observed. After the intervention, a statistically significant increase was noted in the Firmicutes/Bacteroidetes ratio (p = 0.001). Although Oscilibacter, Blautia, and Akkermensia relative abundances increased, Prevotella relative abundance and Bifidobacter abundance, which were the dominant genera before the KD, decreased. Moreover, the abundance of some pathogenic genera, including Escherichia, Klebsilella, and Listeria, increased. Conclusions: In healthy individuals, KD may cause significant changes in microbial composition, leading to dysbiosis and long-term adverse outcomes with changes in serum zonulin and fecal SCFA levels.

Objectives: Sex-based disparities in COVID-19 outcomes are well-documented, with men experiencing greater acute severity and women showing increased vulnerability to post-viral syndromes. However, longitudinal immunometabolic trajectories in vaccinated individuals remain underexplored. In this study, sex-based differences in long-term metabolic, endocrine, renal, cardiovascular, and inflammatory responses were investigated among vaccinated individuals recovering from SARS-CoV-2 infection. Methods: This retrospective single-center cohort study included 426 adults (199 females, 227 males) with PCR-confirmed symptomatic COVID-19 and at least two vaccine doses. Serial assessments were conducted at baseline, 18-, 24-, and 30-month post-infection. Parameters included fasting glucose, HbA1c, lipid profile, thyroid function, renal markers, CRP, D-dimer, fibrinogen, troponin, and hematologic indices. Statistical analyses assessed longitudinal changes and sex-stratified correlations. Results: Fasting glucose and HbA1c levels significantly declined over time, more prominently in males. Glucose correlated with age and BMI only in females. Lipid levels remained largely unchanged, although males had higher baseline triglycerides. Females showed rising TSH levels and persistently lower free T3; males exhibited higher creatinine, urea, and troponin levels throughout. Inflammatory markers declined significantly in both sexes, with males displaying higher CRP and troponin, and females showing sustained fibrinogen elevation and a temporary lymphocyte surge. D-dimer was elevated in females at the 30-month point. Conclusions: Sex-specific physiological recovery patterns were evident among vaccinated COVID-19 survivors. Males exhibited earlier metabolic and cardiac alterations, while females had more persistent endocrine and inflammatory shifts. These findings underscore the need for sex-tailored long-term monitoring strategies prioritizing early metabolic and cardiac screening in men and prolonged immunoendocrine surveillance in women.

Background/Objectives: Totally implantable venous access ports (TIVAPs) are commonly used in oncology for long-term venous access, but catheter tip malpositioning can lead to complications. Intracavitary electrocardiography (IC-ECG) provides real-time tip guidance, although data on clinical outcomes and patient satisfaction remain limited. This study evaluates postoperative complications, catheter function, and patient comfort and satisfaction after TIVAP implantation using ultrasound and IC-ECG guidance. Methods: This retrospective single-center study included adults with solid cancers who received TIVAP implants for chemotherapy from June 2021 to September 2024. Procedures used the right internal jugular vein, with ultrasound guidance and the Seldinger technique; catheter tip placement was guided by IC-ECG. Chest X-rays were obtained to assess for early complications and tip position. Primary outcomes were comfort and satisfaction; secondary outcomes included catheter tip position, catheter complications, and usability. Results: Among 213 screened patients, 192 were included (79 females, 113 males; mean age 60.83 ± 12.19 years). The catheter tip was located within the target zone in 149 patients (77.6%). Success rates were 98.44% (n = 189/192) for blood aspiration, 97.90% (n = 186/190) for port ease of use, 98.95% (n = 189/191) for overall satisfaction, and 98.43% (n = 188/191) for willingness to recommend. Discomfort occurred in 6.25% (n = 12/192) of patients. Comfort improved significantly from day1 to day7 (p < 0.001). Complication rates included hematoma (1.56%, n = 3), pneumothorax (0.52%, n = 1), venous thrombosis (1.56%, n = 3), local infection (2.08%, n = 4), systemic infection (0.52%, n = 1), and catheter occlusion (2.08%, n = 4). Catheter blood aspiration success was 93.75% (n = 180/192). Conclusions: In this retrospective cohort, TIVAP implantation via the right internal jugular vein under ultrasound and IC-ECG guidance was associated with low complication rates, favorable catheter function, and high patient satisfaction. Prospective, multicenter, and comparative studies are needed to determine whether ECG-guided tip positioning improves long-term clinical and patient-centered outcomes.

The coronavirus disease 2019 (COVID-19) affects multiple body systems, causing lasting effects on metabolic, endocrine, renal, and hematological functions.

Palliative Care in the Age of Artificial Intelligence: Evaluation of Healthcare Workers’ Awareness and Attitudes - Bagcilar Medical Bulletin

Background and Objectives: Adults diagnosed with type 2 diabetes mellitus (T2DM) frequently exhibit diminished sleep quality, which is affected by their glycemic control. Both poor sleep and inadequate glycemic management increase the risk of complications worldwide. However, the relationship between sleep quality, daytime dysfunction, and glycemic control in adults with T2DM is not well understood. To address this gap, this study aimed to examine the association between overall sleep quality, including daytime dysfunction, and glycemic control in adults with T2DM. Materials and Methods: A hospital-based cross-sectional study included 200 T2DM patients (103 females, 97 males) from January 2019 to January 2020. The Pittsburgh Sleep Quality Index (PSQI) was administered to each participant to assess sleep quality, including daytime dysfunction. Glycemic control was assessed by measuring hemoglobin A1c (HbA1c) and fasting blood glucose (FBG) levels. The associations among sleep quality, daytime dysfunction, and glycemic metrics were examined utilizing both conventional statistical methods and Bayesian analytical approaches. Results: A total of 32% of patients had poor sleep quality (PSQI > 5), and 43.5% reported daytime dysfunction. Higher HbA1c and fasting blood glucose were each correlated with longer sleep-onset latency and greater daytime dysfunction. In multivariable analyses, higher HbA1c and longer sleep-onset latency were independently associated with poor sleep quality (generalized linear model, R² = 0.602), whereas higher fasting blood glucose and longer sleep-onset latency were associated with greater daytime dysfunction severity (R² = 0.378). Conclusions: Sleep quality and delay in falling asleep are interdependent with impaired glycemic control and daytime dysfunction in T2DM. Future randomized trials targeting sleep-onset latency are warranted to determine causal effects on glycemic outcomes.