Introduction: Primary immunodeficiency diseases (PIDs), also referred to as inborn errors of immunity, are a heterogeneous group of genetic disorders associated with recurrent infections, immune dysregulation, and increased morbidity and mortality when diagnosis is delayed. Primary care physicians (PCPs) play a critical role in early recognition; however, data on PCPs’ knowledge and preparedness regarding PID remain limited. This study aimed to evaluate PCPs’ knowledge, clinical approaches, and preparedness regarding PIDs across Türkiye. Methods: This nationwide, cross-sectional study included 385 PCPs – general practitioners (GPs), family medicine residents (FMRs), and family medicine specialists (FMSs) – working in Family Health Centers in Türkiye. Participants completed a structured online questionnaire assessing sociodemographic characteristics, educational background, clinical experience, self-perceived PID knowledge, and performance on 15 PID-related multiple-choice questions based on international guidelines. Total knowledge scores (range: 0–15) were calculated. Correct response rates for individual items and total scores were compared across professional groups and according to educational and clinical variables. Multivariable logistic regression analyses were performed to identify factors independently associated with higher knowledge scores. Results: The mean total knowledge score was 9.09 ± 2.46 (range 0–15). FMSs demonstrated significantly higher total scores than FMRs and GPs (GPs 8.67 ± 2.47; FMRs 8.82 ± 2.63; FMSs 9.83 ± 2.03; p < 0.001). In multivariable analysis, being an FMS was independently associated with scoring above the mean (OR = 2.02, 95% CI: 1.26–3.23; p = 0.004). Regular participation in general medical educational activities was associated with significantly higher total scores (9.74 ± 2.31 vs. 8.23 ± 2.38; p < 0.001). PCPs who participated in PID-related educational activities within the past 5 years were also associated with higher total scores (9.43 ± 2.58 vs. 8.87 ± 2.47; p = 0.027). PCPs who reported requesting immunoglobulin testing or referring patients with recurrent lower respiratory tract infections achieved significantly higher total scores (9.18 ± 2.43 vs. 7.52 ± 2.42; p = 0.001). PCPs who self-perceived their PID knowledge as moderate or good had substantially higher total knowledge scores compared to those who self-perceived their knowledge as low (low: 8.36 ± 2.55; moderate: 9.41 ± 2.26; good: 10.09 ± 2.50; p < 0.001). Conclusion: PID-related knowledge scores among PCPs differed across professional groups, with GPs demonstrating lower scores. Higher knowledge scores were significantly associated with being an FMS and with participation in regular general medical education and past 5-year PID-related education. Strengthening targeted educational strategies, particularly for GPs in primary care settings, may improve early recognition and management of PIDs.

Background/Objectives: Whether the loss of fat-free mass (FFM) during tirzepatide treatment exceeds the proportion expected in negative energy balance is debated, and the earliest weeks of treatment are the least characterized. We described the body-composition trajectory over the first 12 weeks of treatment in routine care. Methods: In this retrospective cohort of adults with obesity starting tirzepatide monotherapy, body weight, fat mass, FFM, total body water (TBW), and waist circumference were measured by single-frequency, foot-to-foot bioelectrical impedance analysis (BIA) at baseline and at approximately 4, 8, and 12 weeks, and were analyzed with linear mixed-effects models; follow-up values are available-data, on-treatment estimates. Results: Of 476 patients (mean age 40 years, 66% female, mean body-mass index 38.7 kg/m²), 268 had follow-up data and 111 were measured at 12 weeks. Estimated marginal body weight fell by 11.22 kg (10.4%), fat mass by 7.90 kg (16.8%), and BIA-derived FFM by 3.35 kg (5.4%) at 12 weeks (all p < 0.001); assuming 5-kg-less loss in patients without a 12-week measurement, the mean loss remained 7.4 kg. Of patients measured at 12 weeks, 89.2% had lost at least 5% and 57.7% at least 10% of body weight. In patients with complete data at baseline and 12 weeks (n = 85), fat mass accounted for 68.3% (95% CI 56.1 to 80.8) of the weight lost. Conclusions: Early weight loss during tirzepatide treatment was predominantly fat mass, with a BIA-derived FFM fraction numerically close to the commonly cited one-fourth. Because device-FFM equaled TBW divided by a fixed coefficient of 0.731 at every visit, it cannot separate water from lean tissue and is best read as an upper bound on lean tissue loss rather than a measure of muscle.

Background/Objectives: Major depressive disorder (MDD) frequently coexists with chronic diseases and inflammatory processes, particularly in primary care. The primary aim of this study was to investigate the association between MDD and multimorbidity burden (≥2 chronic diseases), while the secondary aim was to examine the relationship between MDD and routinely available inflammatory biomarkers. Methods: This retrospective cross-sectional study used electronic medical records from a Family Health Center in Türkiye between 1 January 2025 and 31 December 2025. Individuals aged ≥18 years with accessible records, complete laboratory data, and recorded sociodemographic/lifestyle variables were included. Patients were considered to have MDD if a psychiatrist-diagnosed MDD according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), was recorded in the electronic medical system within the past year. Multimorbidity burden was defined as the total number of chronic diseases and was further dichotomized as ≥2 versus <2 for multivariable regression analysis. Inflammatory biomarkers were calculated from routine blood tests: neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune–inflammation index (SII), and monocyte-to-HDL cholesterol ratio (MHR). Group comparisons and logistic regression were performed to evaluate associations with MDD. Results: A total of 3006 patients were analyzed; 375 (12.5%) had MDD. Participants with MDD were older and more frequently female, had higher body mass index and waist circumference, and exhibited a substantially higher burden of chronic comorbidities. PLR was higher in the MDD group (p = 0.019), whereas MHR was lower (p = 0.004); NLR, MLR, and SII did not differ significantly. In multivariable analysis, increasing age (OR 1.029, 95% CI 1.019–1.039, p < 0.001), female sex (OR 2.659, 95% CI 1.949–3.636, p < 0.001), and multimorbidity (OR 2.162, 95% CI 1.650–2.833, p < 0.001) were independently associated with MDD, whereas PLR and MHR were not independently associated after adjustment. Conclusions: In this large real-world primary care cohort, MDD was common and strongly linked to multimorbidity. Although PLR and MHR differed significantly between groups, they were not independently associated with MDD after adjustment, suggesting that these differences may be driven by multimorbidity and related clinical factors rather than independent disease-specific effects.

Background and aim. The controlling nutritional status (CONUT) score and prognostic nutritional index (PNI) are albumin-based composite indices widely used as prognostic markers whose interpretation in patients with ascites remains uncertain. We examined their associations with ascites etiology and cirrhosis severity. Materials and methods. We retrospectively studied 91 adults hospitalized for evaluation of newly detected ascites between January 2021 and June 2023. Both indices were calculated from laboratory values. Exploratory receiver operating characteristic (ROC) thresholds underwent bootstrap internal validation. Logistic regression models adjusted for age, sex, and C-reactive protein for cirrhotic ascites and for age and sex for malignant ascites. Results. Ascites was cirrhotic in 57 patients (62.6%), malignant in 20 (22.0%), cardiac in 8 (8.8%), and other in 6 (6.6%). The CONUT score differed across etiologies (global p = 0.017) and was higher in cirrhotic than malignant ascites (7.0 ± 2.8 vs. 4.8 ± 2.4; pairwise p = 0.002). Serum albumin (p = 0.021) and total cholesterol (p < 0.001) showed parallel differences, whereas total lymphocyte count did not (p = 0.363). The PNI did not differ significantly across groups (p = 0.099). For cirrhotic ascites, the CONUT score ≥6 and PNI ≤33.2 had AUCs of 0.68 and 0.65 and adjusted odds ratios of 3.77 and 10.25, respectively. The indices correlated with Child–Pugh and MELD-Na scores and were strongly inversely correlated (r = −0.88). Conclusion. Both indices were associated with cirrhotic etiology and measures of cirrhosis severity, but showed only modest, internally derived discrimination. Their associations cannot distinguish hepatic dysfunction from nutritional impairment without objective nutritional assessment. External validation is needed.

Background and Objectives: In this study, it was aimed to investigate the relationship between the Bovine Aortic Arch–Dolichoarteriopathy (B.A.D.) score and the procedural characteristics of mechanical thrombectomy, recanalization success, and 90-day functional outcomes in patients with acute ischemic stroke with proximal M1 occlusion of the middle cerebral artery (MCA). Materials and Methods: A total of 220 adult patients who underwent mechanical thrombectomy for proximal MCA M1 occlusion were included in this retrospective, single-center cohort study. The patients were divided into good B.A.D. (<2; n = 143) and poor B.A.D. (≥2; n = 77) groups. Admission National Institutes of Health Stroke Scale (NIHSS) and Alberta Stroke Program Early CT Score (ASPECTS) scores, collateral status, thrombectomy time intervals, number of passes, first-pass effect (FPE), and Modified Thrombolysis in Cerebral Infarction (mTICI) recanalization grades were evaluated. The primary outcome was functional independence at day 90 (mRS 0–2). Associations with procedural and clinical outcomes were evaluated using multivariable logistic and linear regression analyses. Results: The puncture-to-recanalization time was significantly longer in the poor B.A.D. group [67 (50.5–88.0) min vs. 43 (32.0–65.0) min, p < 0.001], and the FPE rate was lower (37.7% vs. 51.7%, p = 0.046). After adjustment for thrombectomy technique and clinical covariates, poor B.A.D. remained independently associated with lower odds of FPE success (aOR = 0.439, 95% CI: 0.229–0.839; p = 0.013). In the procedurally adjusted linear regression model, poor B.A.D. also remained independently associated with longer puncture-to-recanalization time after additional adjustment for the number of thrombectomy passes and thrombectomy technique (B = 0.294, 95% CI: 0.188–0.400; p < 0.001). Final mTICI ≥ 2b, ≥2c, and 3 recanalization rates did not differ between the groups. Although 90-day functional independence was lower in the poor B.A.D. group, the difference was not significant (51.9% vs. 63.6%, p = 0.092), and no statistically significant independent association between B.A.D. status and 90-day functional independence was observed in the multivariable analysis. Conclusions: Poor B.A.D. anatomy was associated with greater procedural complexity during mechanical thrombectomy for proximal MCA M1 occlusion, including longer puncture-to-recanalization time and lower odds of FPE success, even after adjustment for available procedural and clinical factors. However, no statistically significant independent association was demonstrated between B.A.D. status and 90-day functional independence, and final recanalization rates did not differ significantly between the groups. These findings suggest that the B.A.D. score may have potential value as a preprocedural marker of vascular access complexity; however, prospective external validation is required before its use for procedural planning can be recommended.

Concerns about inappropriate drug use are increasing in geriatric patients. Potentially inappropriate medication (PIM) lists are being updated accordingly. The aim of this study is to determine the prevalence of PIM in elderly Turkish hemodialysis patients and to assess the association of patient’s characteristic as risk factors for PIMs in this population. Patients aged 65 years and over who were treated at two different hemodialysis centers were included in the study. Medical and sociodemographic information of the patients was obtained from patient’s files and medical records. Patients’ files and SGK-Online Medulla System were used to identify medications used by patients. PIMs were defined by using the modified Beers’ criteria independent of diagnosis and Beers’ Kidney-List. A total of 110 patients (mean age 73.31±6.4 years) were included in the study. 69 of the patients were male (62.7%) and 41 female (37.3%). Only 47.3% of the patients were independent in daily functioning. The average number of medications received by the patients was 7.3. When the charts in the patient files were examined, it was determined that 54.5% of all patients used PIM. However, when all prescribed drugs were scanned online from the Medulla-SGK system, it was found that inappropriate drugs were prescribed in 70.9% of the patients. A statistically significant relationship was found between the use of PIM and the total number of drugs used and the number of hospital admissions. The prevalence rate of PIM in elderly Turkish hemodialysis patients was higher. It is necessary to raise awareness of this in terms of reducing unwanted drug interactions and contributing economically.