Acta Medica

The relationship between sleep posture and subacromial impingement syndrome

Alper Yatağanbaba — 2026-03-15

Objective: Subacromial impingement syndrome is the most common cause of shoulder pain. One of the possible etiological factors of subacromial impingement syndrome is sleep posture. This study, it is aimed to evaluate the relationship between subacromial impingement syndrome and sleep posture.

Materials and Methods: This study received approval from the Institutional Clinical Research Ethics Committee. (No: 2021/04-54). It included 71 patients who underwent polysomnography at the Ear-Nose-Throat Sleep Laboratory between February and June 2021, meeting the study’s inclusion and exclusion criteria. Patients were divided into two groups: 34 who met both diagnostic criteria for subacromial impingement syndrome and 37 who did not meet either criterion. The two groups were compared in terms of demographics, sleep postures, and polysomnography results. Additionally, the relationship between lateral decubitus posture and the affected shoulder was examined in the impingement group.

Results: No significant differences were found between the groups in terms of demographic data, except for smoking (p=0.006). The subacromial impingiment syndrome group spent significantly more time in the lateral decubitus posture than the control group (p=0.003), and they also spent significantly more of their sleep time in the lateral decubitusposition on the painful shoulder (p<0.001). Furthermore, the control group had a significantly higher number of posture changes during sleep (p=0.002).

Conclusion: This study objectively demonstrated the relationship between sleep posture and subacromial impingement syndrome using polysomnography. With this feature, it differs from the limited number of studies that have been done on this subject before. With this study, it has been shown that the lateral decubitus posture during sleeping is a risk factor for subacromial impingement syndrome, and the posture changes during sleep may also be a protective factor for subacromial impingement syndrome.

Internal valve graft technique versus spreader graft/autospreader flap in functional rhinoplasty: A prospective cohort study

Süleyman Yıldızdal — 2026-03-15

Objective: To compare a novel internal nasal valve graft technique with conventional spreader graft and autospreader flap methods in functional rhinoplasty, with respect to both functional and aesthetic outcomes.

Materials and Methods: Forty patients undergoing primary rhinoplasty were prospectively enrolled and randomly allocated into two groups (n = 20 per group). Group 1 received a conventional spreader graft or autospreader flap, whereas Group 2 underwent the internal nasal valve graft technique, in which cartilage was positioned caudal to the conventional spreader graft line to augment the internal nasal valve without increasing dorsal width.

Results: Preoperative dorsal widths and NOSE scores were comparable between the two groups. At 1-year follow-up, Group 1 demonstrated a statistically significant increase in dorsal width, whereas no significant change was observed in Group 2. NOSE scores improved significantly within both groups, with no statistically significant difference between the groups.

Conclusion: The internal nasal valve graft technique provides functional improvement comparable to that of conventional methods while preventing dorsal widening, thereby representing an effective alternative in functional rhinoplasty that preserves the natural dorsal contour.

Structural changes of pelvic/hip entheses and their evolution over time in psoriatic arthritis patients starting bDMARDs

Gizem Ayan — 2026-03-15

Objective: This study aimed to investigate the frequency and progression of pelvic and hip entheseal structural changes in PsA patients initiating biologic therapy.

Methods: Records from the Hacettepe University Rheumatology Biologic Therapy Registry (HUR-BIO) were retrospectively reviewed. PsA patients with pelvic radiographs obtained within ±1 year of biologic therapy initiation were included. Radiographs were assessed according to the modified New York criteria, and entheseal involvement at the ischium, symphysis pubis, iliac wings and greater/ lesses trochanter was graded from 0 (none) to 4 (florid new bone formation). Grade 2 or higher was considered clinically relevant. Demographic and clincal characteristics were compared between patients with/ without structural changes and progression of these lesions were assessed.

Results: A total of 108 patients (68.5% female; mean age 41.5 ± 11.6 years; mean PsA duration 2.2 years) were included. Baseline mNY positivity was detected in 45.4%. Bilateral relevant entheseal involvement was observed in 21.9% at the ischium, 15.3% at the symphysis pubis, and 7.7% at the iliac wings. Greater trochanteric enthesopathy was 2% on the right side. Male patients, with higher BMI and older age with family history tended to have more structural lesions. After a mean follow-up of 38.6 months, data from 48 patients were available. Most progression was limited to a one-grade increase at the ischium (28%).

Conclusion: Major pelvic entheseal lesions, predominantly at the ischium and symphysis pubis, are relatively common in PsA but show minimal radiographic progression under biologic therapy.

Retrospective analysis of quality of life after trans-sacral epiduroscopic laser neural decompression for chronic back pain

İskender Karakulak — 2026-03-15

Objective: Low back pain is a common health problem that most adults experience at least once in their lifetime and significantly impacts healthcare costs, workforce productivity, and overall quality of life. Trans-Sacral Epiduroscopic Laser Neural Decompression (ELND) is a minimally invasive technique often used for patients with lumbar disc herniation. ELND offers advantages such as shorter operation times, faster recovery, and continuous communication with the patient during the procedure which reduces the risk of accidental nerve damage. We aimed to analyze the effects of ELND on pain and quality of life.

Materials and Methods: A cohort of 89 patients diagnosed with lumbar disc herniation underwent the ELND procedure. The Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) was used to evaluate the quality of life of 89 patients before and six months after the ELND procedure.

Results: The analysis established a statistically significant increase in general health perception, physical functioning, physical role limitation, social functioning, vitality, pain, and general mental health subscales of the SF-36 questionnaire. However, the score for role limitation due to emotional problems decreased post-procedure. The median scores for general health perception increased from 54.3 to 68.3, physical functioning from 45.0 to 65.0, and pain from 10.6 to 63.0, among other subscales. The greatest improvement was observed in the physical role difficulty subscale.

Conclusion: As a result, the ELND procedure is an effective treatment for patients with chronic low back pain, as demonstrated by significant reductions in pain scores and improvements in patient-reported quality of life. Specifically, the study found statistically significant enhancements in general health perception, physical functioning, physical role limitation, social functioning, vitality, and general mental health six months after the procedure. These findings indicate that ELND not only alleviates pain but also contributes to better physical mobility, daily functioning, and overall well-being.

The investigation of the inflammation hypothesis in children diagnosed with ASD and ADHD using complete blood count variables

Cihan Aslan — 2026-03-15

Objective: This study aims to compare the inflammation-related complete blood count (CBC) variables in children diagnosed with Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD).

Materials and Methods: Retrospective data on CBC values and Childhood Autism Rating Scale (CARS) scores for 30 children with ASD and 30 with ADHD, aged 60-108 months, were retrieved from hospital automation systems. Inflammatory-related CBC parameters, including hemoglobin (Hb), red cell distribution width (RDW), neutrophil, lymphocyte, monocyte, and platelet counts, mean cell volume (MCV), mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR), were compared between the two diagnostic groups. This study has a retrospective and cross-sectional design.

Results: Children with ASD exhibited significantly higher platelet counts (p=0.003; t=3.052; d=0.788) and PLR (p = 0.044; Z = -2.011; r = 0.259), whereas MPV was significantly lower (p=0.029; t=-2.241; d=-0.579) compared to children with ADHD. No significant differences were observed in other parameters. Additionally, a negative correlation was identified between CARS scores and RDW values in children with ASD (p = 0.035, r = -0.387).

Conclusion: Although ASD and ADHD are two neurodevelopmental disorders in which inflammation has been investigated in their pathophysiology, the inflammatory processes may differ between the two conditions. Future genetic and biochemical studies related to platelets in ASD may provide further insights into this area.

Clinical and cytogenetic characteristics of patients with Triple X syndrome: Experience from a tertiary center

Gizem Ürel Demir — 2026-03-15

Background: Triple X syndrome is the most common sex chromosome aneuploidy in females; however, due to the subtlety of clinical findings, only a small proportion of affected individuals are diagnosed. This study presents the demographic, clinical, and cytogenetic characteristics of patients with Triple X syndrome followed at a single center.

Methods: We retrospectively reviewed the medical records of patients diagnosed with Triple X syndrome at our department between 2008 and 2025. Demographic characteristics, clinical findings including anthropometric measurements, dysmorphic features, associated anomalies, endocrine and neurodevelopmental findings, and cytogenetic results were analyzed.

Results: The study included a total of 20 patients diagnosed with Triple X syndrome, 13 of whom (65%) had a non-mosaic 47,XXX karyotype and 7 (35%) had mosaic chromosomal abnormalities. Four patients received a prenatal diagnosis, four were diagnosed in adulthood, and the remaining patients were diagnosed during childhood. Dysmorphic features; neurodevelopmental problems such as developmental delay, intellectual disability, and attention-deficit/ hyperactivity disorder; as well as cardiac defects and endocrine disorders were the main characteristics observed in the patients.

Conclusion: Triple X syndrome is a relatively common chromosomal disorder, which should be considered in patients who experience congenital anomalies, neurodevelopmental abnormalities, and reproductive problems. Variable and subtle findings should be carefully considered, bearing in mind that mosaic cases may present with diverse and overlapping phenotypes.

Subclinical inflammation, endothelial dysfunction and atrial electrical remodeling in early-onset paroxysmal atrial fibrillation without comorbidities

Ayşegül Ülgen Kunak — 2026-03-15

Objective: Early-onset paroxysmal atrial fibrillation (PAF) in individuals without conventional cardiovascular risk factors has traditionally been labeled as “lone AF.” Recent evidence suggests that subtle structural, electrical, and functional abnormalities may still exist. This study evaluated atrial conduction, diastolic function, endothelial function, and systemic inflammation in early-onset PAF patients without structural heart disease or overt comorbidities.

Methods: In this cross-sectional study, 40 patients aged 18–65 years with documented early-onset PAF were compared with 40 age and sex matched healthy individuals in sinus rhythm. All subjects underwent measurement of P wave dispersion and signal-averaged P wave duration, echocardiographic assessment of diastolic parameters, evaluation of endothelial function using flow-mediated dilation (FMD), and analysis of systemic inflammation via high-sensitivity C-reactive protein (hsCRP).

Results: Patients with PAF demonstrated significantly increased P wave dispersion (51.63 ± 11.17 ms vs. 35.13 ± 6.15 ms; p < 0.001) and prolonged signal-averaged P wave duration (146.75 ± 19.68 ms vs. 124.40 ± 9.05 ms; p < 0.001). Diastolic dysfunction was evident, characterized by a reduced E/A ratio and elevated septal E/E′. Left atrial volume index was significantly higher in the PAF group (29.79 ± 3.94 mL/m² vs. 28.23 ± 1.74 mL/m²; p = 0.025). Endothelial function was impaired, as reflected by lower FMD values (5.27 ± 1.94% vs. 6.65 ± 1.78%; p = 0.001), while hsCRP levels were significantly higher in the PAF group (0.40 [0.30–0.55] vs. 0.24 [0.20–0.30] mg/dL; p < 0.001). Multivariate analysis identified signal-averaged P wave duration, P wave dispersion, mitral E wave velocity, septal E/E′, and left atrial volume index as independent predictors of PAF.

Conclusion: Even in the absence of overt cardiovascular disease, early-onset PAF is associated with meaningful disturbances in atrial conduction, diastolic performance, endothelial function, and systemic inflammation. These findings support the presence of early atrial cardiomyopathy and underscore the need for comprehensive cardiovascular evaluation in younger PAF patients.

Single-center real-world data on the efficacy, safety, and current availability of pegylated interferon-α in hematologic neoplasms

Adile Begüm Bahçecioğlu — 2026-03-15

Aims: Pegylated interferon-α (PEG-IFN-α) offers improved pharmacokinetics compared with conventional interferon-α (IFN-α), yet real-world data on its clinical activity and safety across heterogeneous hematologic neoplasms are limited. This study aimed to evaluate the real-world efficacy, durability of response, and toxicity of PEG-IFN-α in patients with diverse hematologic neoplasms.

Methods: This retrospective study evaluated the efficacy, duration of response, and toxicity of PEG-IFN-α using patient medical records and hospital electronic registries. Thirty patients were included: polycythemia vera (PV, n=12), essential thrombocytosis (ET, n=6), chronic myeloid leukemia (n=2), primary myelofibrosis (n=1), systemic mastocytosis (SM,n=3), hypereosinophilic syndrome (HES, n=1), Erdheim–Chester disease (ECD, n=4), and lymphomatoid granulomatosis (LYG, n=1).

Results: PEG-IFN-α was initiated due to resistance to prior therapies in 12 patients (40%), intolerance or toxicity in 10 patients (33.3%), and as first-line treatment in 8 patients (26.7%). Among PV patients, a complete response was achieved in 41.6% and a partial response in 50%. In ET patients, 83.3% achieved a complete response, while 16.7% showed no response. All patients with SM demonstrated clinical improvement when PEG-IFN-α was used as first-line therapy. In ECD patients, follow-up PET imaging showed stable disease in two patients, partial response in one, and no response in one. Partial responses were also observed in patients with HES and LYG. Treatment-related toxicity occurred in 8 patients (26.6%) and led to treatment discontinuation in 6 patients (20%) (including cytopenias, influenza-like symptoms, and elevated liver enzymes).

Conclusion: In this real-world cohort, PEG-IFN-α showed encouraging activity across several hematologic neoplasms, with toxicity and discontinuation rates in line with previously published series of conventional interferon-α; however, its clinical use remains limited by regulatory and access constraints.

Reconstructive strategies following Fournier’s gangrene: A retrospective analysis of outcomes

Etkin Boynuyoğun — 2026-03-15

Objective: Fournier’s gangrene is a rapidly progressive and necrotizing infection of the perianal region and scrotum. Once clinical stabilization is achieved, the delayed reconstruction of the resultant defects can be planned. This study presents our institutional experience with reconstruction after Fournier’s gangrene and discusses various surgical approaches along with their respective advantages and limitations.

Materials and Methods: A total of 21 patients were included in the study. The patients included in this study were older than 18 years with Fournier’s gangrene and a minimal follow-up of 6 months postoperatively. Demographic and clinical variables, including mean age, defect size and location, comorbid conditions, time interval between initial debridement and reconstruction, type of reconstructive method used, postoperative hospital stay, and complication rates were analyzed.

Results: A total of 21 male patients aged 42-76 years with previously performed reconstruction following Fournier’s gangrene. The defect most commonly involved the scrotum, and 68% of the scrotal skin was defective (38%–100%). Two patients had perineal involvement. Comorbidities were present in 86% of patients, most commonly diabetes mellitus. All patients received delayed surgical reconstruction after the appearance of healthy granulation tissue at the base of the wound. The mean time to reconstruction was 28.4 days (range, 15–56 days). The most commonly used reconstruction method was the scrotal flap alone (57%). The mean hospital stay after reconstruction was 7.2 days.

Conclusion: Fournier’s gangrene is a rapidly progressive and fulminant necrotizing infection that requires prompt antibiotic therapy and aggressive surgical debridement. Reconstruction of soft tissue defects is essential for restoring functional and aesthetic integrity. The optimal approach should be individualized based on patient characteristics and defect features. Further comparative studies are required to refine the reconstructive strategies and improve the long-term outcomes.

Coercion in psychiatric inpatients with psychotic and mood disorders: Associations with trauma history, clinical characteristics, and short-term outcomes

Simge Ergün — 2026-03-15

Objectives: Coercive measures are interventions imposed against an individual’s will and may be experienced as traumatic by psychiatric inpatients. This study aimed to examine the association between exposure to coercive measures and trauma burden in psychiatric inpatients, and to investigate the short-term relationship between coercive measures, posttraumatic stress symptoms, and treatment adherence.

Methods: The study included 60 patients hospitalized in a psychiatric ward. Trauma burden was assessed using the Childhood Trauma Questionnaire (CTQ) and the Cumulative Trauma Scale (CTS). Perceived social support, illness severity, and functioning were evaluated using standardized clinician-rated and self-report measures. One month after discharge, follow-up interviews were conducted to assess posttraumatic stress symptoms and treatment adherence. Patients exposed to coercive measures were compared with those not exposed.

Results: Patients exposed to coercive measures had significantly higher levels of childhood trauma and lifetime cumulative trauma burden. They also demonstrated more severe psychopathology, lower functioning, and lower perceived social support compared to patients not exposed to coercive measures. No significant differences were observed between the groups in posttraumatic stress symptoms or treatment adherence at short-term follow-up.

Conclusion: Psychiatric inpatients exposed to coercive measures represent a subgroup characterized by higher trauma burden and greater clinical vulnerability. Assessing trauma history and clinical characteristics may contribute to the identification of patients at increased risk for coercive interventions and support the implementation of trauma-informed care approaches.

Pulmonary thromboembolism presenting with multiple cavitary infarcts: A diagnostic challenge with overlap to granulomatous vasculitis

Bilge Sezin Akhan — 2026-03-15

Pulmonary embolism (PE) is a life-threatening condition that can present with a wide range of symptoms, often complicating its diagnosis. Pulmonary infarction (PI), a rare consequence of PE, may mimic other conditions such as pneumonia, malignancy, or vasculitis. A 65-year-old woman presented with progressive dyspnoea, chest pain, and haemoptysis. She was initially diagnosed with pneumonia; however, imaging revealed cavitating pulmonary infarcts. Further investigations excluded tuberculosis, fungal and viral infections, as well as granulomatosis with polyangiitis presenting with multiple cavitary lesions. Contrast-enhanced CT pulmonary angiography confirmed the diagnosis of PE with multiple cavitary infarcts. The patient was treated with anticoagulation and broad-spectrum antibiotics, resulting in complete clinical and radiological resolution within eight months. This case highlights the importance of considering infected cavitary pulmonary infarction in the differential diagnosis of rapidly cavitating pulmonary lesions, particularly in the presence of clinical signs of infection, to avoid misdiagnosis and ensure appropriate management.