Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) prevalence data in Türkiye is limited. We aimed to determine the nationwide prevalence of MASLD and advanced hepatic fibrosis risk in subjects with cardiometabolic risk factors (CMRF). Despite recent international consensus redefining fatty liver disease terminology, no nationwide MASLD study has been reported in Türkiye. Methods: This cross-sectional study included 14,371 adults with ≥1 CMRF from 44 centers across 31 cities. MASLD was diagnosed using liver ultrasonography plus cardiometabolic criteria. Advanced fibrosis risk was assessed by fibrosis-4 (FIB-4) score (≥1.3 for ≤65 years; ≥2.0 for >65 years). Logistic regression was used to identify independent predictors of high FIB-4. Results: A total of 61.4% of participants were women, the mean age was 51.3 ± 14.4 years, and the mean BMI was 31.4 ± 6.0 kg/m². MASLD prevalence was 75.7% (n = 10,873), rising with the number of CMRFs (56.5% with one factor vs. 83.4% with all). The prevalence of high FIB-4 scores was 12.0% overall, being lower in MASLD patients than non-MASLD patients (11.2% vs. 14.4%, p < 0.001). FIB-4 scores decreased with increasing BMI (28.1% underweight vs. 8.7% class III obesity). Male sex, T2DM, and hypertension independently predicted high FIB-4 scores, while smoking, higher BMI, and MASLD were inversely associated. Conclusions: Three-quarters of Turkish adults with CMRF have MASLD. Standard FIB-4 thresholds may underestimate fibrosis risk in obese and smoking populations, underscoring the need for adjusted cut-offs or alternative tools. This study is the first to provide nationwide MASLD prevalence data in Türkiye.

Hyponatremia is a common electrolyte disorder in the emergency department (ED), but its clinical burden is not evenly distributed across the sodium spectrum. We conducted a retrospective observational cohort study of adult ED encounters at a tertiary referral hospital between July 2019 and July 2024 to identify a data‐driven threshold for extreme hyponatremia and evaluate its association with 28‐day mortality. Encounters with simultaneous sodium and glucose measurements were included, and sodium values were corrected for hyperglycemia. Kernel density estimation identified a distinct local minimum defining distribution‐derived extreme hyponatremia (DDEH). Propensity score matching based on age and sex was used to compare DDEH with nonextreme hyponatremia and normonatremia. Among 227,027 eligible ED patients, density modeling identified an inflection point at 110 mmol/L. Sixty‐one patients (0.027%) met criteria for DDEH. In matched analyses ( n = 61 per group), 28‐day mortality was highest in the DDEH group (36.1%), compared with nonextreme hyponatremia (18.0%) and normonatremia (6.6%) ( p < 0.001). Kaplan–Meier analysis showed significantly reduced survival in patients with DDEH (log‐rank p < 0.001). A distribution‐derived sodium threshold of 110 mmol/L identified a rare but high‐risk phenotype of extreme hyponatremia in ED patients. This cohort‐derived boundary identified a rare extreme‐tail phenotype associated with systemic physiological vulnerability and increased short‐term mortality risk, but external validation is required before broader clinical implementation.

Hereby we report a 55-year-old female patient having the association of non-radiographic axial spondyloarthritis (nr-AxSpA), systemic lupus erythematosus (SLE), secondary antiphospholipid antibody syndrome (APS), and Sjögren's Syndrome (SjS). Diagnosis of nr-AxSpA was made based upon the presence inflammatory low-back pain, human leukocyte antigen B27 positivity, and presence of sacroiliitis only in magnetic resonance imaging (MRI). SLE was diagnosed with butterfly-shaped rash on her cheeks, inflammatory arthritis, photosensitivity, erythema involving dorsal inter-joint area of hand fingers, alopecia together with antinuclear antibody (ANA) and anti-dsDNA positivity, low serum complement levels, leucopenia and thrombocytopenia. Additional presence of sicca symptoms, low Schirmer I test, anti SSA/Ro and anti-SSB/La positivity, supported by positive labial salivary gland biopsy led to the diagnosis of SjS. Furthermore, this patient also had miscarriage at 16th week and cerebral vascular disease at 33 years. Besides, IgG and IgM anticardiolipin antibodies were found to be positive twice. Therefore, she was also diagnosed as secondary APS. She fulfilled the relevant classification criteria for AxSpA, SLE, SjS and APS. To our knowledge, this is the first case report showing the association of these four diseases, with different genetic, etiopathogenetic and clinical systemic inflammatory diseases.

Red cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), and the hemoglobin–albumin–lymphocyte–platelet (HALP) score are easily accessible inflammatory and nutritional biomarkers associated with prognosis in various malignancies; however, their role in metastatic castration-resistant prostate cancer (mCRPC) remains unclear. This study evaluated the prognostic significance of RDW, NLR, and the HALP score in patients with mCRPC treated with androgen receptor pathway inhibitors. In this retrospective study, 47 patients with mCRPC treated with abiraterone or enzalutamide were analyzed. Baseline RDW, NLR, and HALP values were recorded, and progression-free survival (PFS) and overall survival (OS) were evaluated using Kaplan–Meier and Cox regression analyses. Patients with higher HALP scores demonstrated longer median PFS (16.0 vs 10.0 months) and OS (16.0 vs 10.0 months); however, these differences were not statistically significant (PFS: hazard ratio (HR) = 0.681, 95% CI: 0.361–1.284; p = 0.236; OS: HR = 0.566, 95% CI: 0.298–1.078; p = 0.083). Lower NLR values were associated with longer PFS (14.0 vs 9.0 months) and OS (16.0 vs 10.0 months), without statistical significance (PFS: HR = 1.694, 95% CI: 0.903–3.180; p = 0.101; OS: HR = 1.232, 95% CI: 0.654–2.321; p = 0.518). RDW was not associated with PFS but was significantly associated with OS, with better survival in patients with lower RDW (29 vs 9 months; HR = 0.397, 95% CI: 0.207–0.763; p = 0.006). These findings suggest that inflammatory and nutritional biomarkers such as RDW and HALP may provide clinically meaningful prognostic information in mCRPC; however, larger prospective studies are needed to validate these results.

Metformin is the most commonly used drug in antihyperglycemic treatment in patients with type 2 diabetes mellitus (T2 DM). In recent years, there have been many studies reporting B12 deficiency in diabetic individuals using metformin drug. This study evaluates B12 deficiency in individuals with T2 DM diagnosis using metformin in our hospital. This study is a cross-sectional and descriptive research. In this study, the data of 786 patients who applied to the Mugla Education and Research Hospital Internal Medicine outpatient clinic with T2DM diagnosis and used metformin between January 01, 2018 and March 01, 2019 were evaluated. Demographic data, vitamin B12, HbA1c levels of the patients were obtained retrospectively from the hospital information system records. Patients with missing data were excluded from the study.347 (44.1%) male and 439 (55.9%) female patients were included in the study. Metformin dose of 248 (31.6%) of the patients was 1000 mg or less, 123 (15.6%) was 1700 mg, 414 (52.8%) was 2000 mg or more. According to the distribution of medication use, 161 (20.5%) patients were receiving metformin only, 322 (41%) patients were receiving metformin + other oral antidiabetic agents (OAD), and 303 (38.5%) patients were receiving metformin + insulin treatment. Vitamin B12 deficiency (57.8%) was higher in patients aged 60 years old and was over who used metformin (p<0.001). 347 (44.1%) of the patients included in the study received vitamin B12 replacement. We detected serious B12 deficiency in patients with T2DM who used metformin, especially in patients aged over 60 years old. Therefore, we emphasize the importance to monitor vitamin B12 levels in patients who are started on metformin and to perform B12 replacement in patients who are found to be deficient.

Objective: This study aims to clarify the effects of intravenous iron supplementation on biomarkers for oxidative stress in women with iron deficiency anemia. Methods: This is a cross-sectional review of 40 healthy women and 40 women who underwent intravenous iron treatment due to anemia. Biochemical markers for oxidative stress were determined for both healthy controls and anemic patients. These markers were also evaluated at hour 1 and day 30 of intravenous iron treatment. Results: The patients with anemia had significantly higher catalase activity and total oxidant status (TOS) but significantly lower nitrate and total anti-oxidant status (TAS) than the healthy controls (p=0.0245, p<0.0001, p=0.0437 and p<0.0001 respectively). At hour 1 of intravenous iron treatment, nitrate, nitrite, nitric oxide, total thiol and TAS values were significantly lower and TOS values were significantly higher than those before the administration of treatment (p=0.0322, p=0.0003, p=0.0005, p<0.0001, p<0.0001 and p=0.004). At day 30 of intravenous iron treatment, catalase activity, nitrate, total thiol and TOS values were significantly lower than those before the administration of treatment (p=0.0332, p=0.0015, p=0.0391 and p<0.0001 respectively) and at hour 1 of treatment (p=0.0498, p<0.0001, p=0.0004 and p<0.0001 respectively). At day 30 of intravenous iron treatment, nitric oxide and TAS values were significantly higher than those before the administration of treatment (p=0.0480 and p=0.001 respectively) and at hour 1 of treatment (p<0.0001 for both). Conclusion: Intravenous iron replacement prompts oxidative stress at hour 1 of infusion in adults with anemia but this increase resolves partially in the following 30 days.