Acta Medica

Comparison of countries in the WHO European Region according to noncommunicable disease indicators by multi-criteria decision making methods

Tevfik Bulut — Fri, 20 Jun 2025 00:00:00 +0300

Objective: The aim of this study is to compare the relative risk prevalence of noncommunicable diseases (NCDs) in the countries of the European Region as defined by WHO (World Health Organization) using WASPAS (Weighted Aggregated Sum Product Assessment) and MULTIMOORA (Multi-Objective Optimization by Ratio Analysis plus the full Multiplicative Form) multi-criteria decision-making (MCDM) methods.

Materials and Methods: The cross-sectional study’s target population consisted of 50 countries in the WHO European Region with complete observations. The study utilizes NCDs data that the WHO publicly released. Analysis was performed using the R programming language and Microsoft Excel.

Results: Based on the CRITIC (CRiteria Importance Through Intercorrelated Corrected) weighted WASPAS analysis, it was observed that 24 European countries exhibited Q scores above the average, while 26 countries displayed Q scores below the average. Finland, Cyprus, Switzerland, Spain, Iceland, Iceland, Sweden, Slovenia, Italy, Norway, Latvia, Portugal, Luxembourg, Belgium, France, Greece, the Netherlands, Germany, Malta, Austria, Ireland, Israel, Lithuania, Israel, Lithuania and Estonia have the highest Q scores. Twenty-four countries with above-average Q scores have lower NCD prevalence than twenty-six European countries. In Türkiye, the prevalence of NCDs is above the European average. However, Switzerland, Finland, Iceland, Spain, Cyprus, Slovenia, Sweden, Portugal, Norway, and Luxembourg are among the top 10 European countries with the lowest NCD prevalence in the overall MULTIMOORA ranking. According to the overall ranking, Turkmenistan, Tajikistan, and Kyrgyzstan have the highest NCD prevalence.

Conclusions: The findings from the CRITIC based WASPAS method and the CRITIC based MULTIMOORA indicate that the prevalence of NCDs generally varies according to income level. Higher-income countries note a lower prevalence of NCDs compared to those with lower income levels. Nonetheless, the prevalence of NCDs may differ among various socioeconomic groups.

Fibrosis- 4 index and survival in early breast cancer patients

Fri, 20 Jun 2025 00:00:00 +0300

Background: The objective of this study is to assess the correlation between survival outcomes and fibrosis-4 (FIB-4) index in patients with non-metastatic breast cancer treated with anthracyclines

Methods: This study was conducted on individuals with non-metastatic breast cancer who were treated with at least one dose of anthracycline from 2018 to 2023. The FIB-4 index was calculated based on the following parameters: age, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) serum levels, and platelet count for each patient before anthracycline treatment.

Results: A total of 208 patients were included in the study. Patients below 35 years of age (n=28) and those above 65 years of age (n=11) were excluded from the study as the FIB-4 index is less reliable in these age groups. Patients were then divided into two subgroups, low and high, according to the pre-defined cut-off value of 1.45, which is obtained from the primary reference. In univariate analysis, hemoglobin (p=0.03), FIB-4 index (p=0.02), and diagnosis at stage (p=0.01) were statistically related to overall survival (OS). In multivariate analysis, patients with higher FIB-4 index (HR: 4.36, 95% CI 1.38-13.78 p=0.012), anemia (HR: 3.32, 95% CI 1.32-8.34, p=0.011), and stage 3 (HR: 4.53, 95% CI 1.22-16.76, p=0.024) had decreased OS. An additional aim was to evaluate the association between anthracycline-induced cardiotoxicity and the FIB-4 index. Our study showed no relationship (p=0.738).

Conclusions: The FIB-4 index, a marker easily obtained through routine biochemistry testing at low cost, could serve as an independent predictor of OS patients with non-metastatic breast cancer treated with anthracyclines. Routine lab tests performed for cancer patients may help clinicians identify high-risk patients in whom closer follow-up or protective measures should be considered.

The relationship between perfectionism, depressive symptom severity, rumination and burnout in physicians

Emre Mısır, Buket Kuruçay Yazar — Fri, 20 Jun 2025 00:00:00 +0300

Objective: A large number of studies indicate that clinicians are at risk for burnout. However, literature on the relationship between burnout and personal traits is limited. Perfectionism may play a role in the development of burnout by increasing ruminative thoughts and depressive symptoms. This study aimed to investigate the relationship between burnout and perfectionism, rumination and depressive symptoms.

Materials and Methods: This study included 317 physicians who completed online surveys between May 2024 and September 2024. The questionnaires included sociodemographic and work environment characteristics, as well as the Maslach Burnout Inventory, Frost Multidimensional Perfectionism Scale, the Patient Health Questionnaire-9, and the Ruminative Response Scale - Short Form self-report scales. Work-related ruminative thoughts and ruminative thoughts related to other life domains were assessed separately.

Results: The results of our study showed that being unmarried, having a history of mobbing, taking the primary responsibility for household chores, being a resident, and working night shifts were associated with burnout. According to the results of regression analysis, emotional exhaustion and depersonalization were predicted by depressive symptom severity and work-related rumination, whereas perfectionism scores were significantly predicted personal accomplishment. The likelihood of being in the suicide risk group was associated with low personal accomplishment in addition to depressive symptom severity. Mediator analysis revealed that the relationship between perfectionism and burnout was fully mediated by depressive symptom severity and rumination.

Conclusion: Perfectionism leads to an increase in burnout through ruminative thoughts and an increase in depressive symptoms. Although small sample size of the study, our results have an important potential to guide interventions for perfectionism in physicians to reduce burnout and associated suicide risk.

Comparison of two main fragmentation methods of amyloid beta fibrils for establishing an Alzheimer disease model in cell culture

Elham Bahador Zırh, Hare Yazgı, Hilal Akyel, Cahide Banu Tel, Selim Zırh — Fri, 20 Jun 2025 00:00:00 +0300

Aim: Amyloid beta fibrils have been shown to play a role in plaque formation and aggregation in Alzheimer’s disease. Obtaining these fibrils using two main methods and applying them to Alzheimer’s modelling is crucial in understanding the pathology of the disease at the molecular level and identify in therapeutic targets. The aim of our study is to determine the optimum sonication parameters using probe and ultrasonic bath sonication laboratory methods and to demonstrate Alzheimer’s disease modelling at the cellular level.

Methods: Lyophilized human peptide amyloid beta_1-42 fibrils (fAβ_1-42) were subjected to probe sonication for 1 minute with 1, 3 and 5 second on/off pulse applications at varying ambient temperatures (room temperature, ice and ice surrounded by dry ice [ISDI]) for 20, 40 and 60 cycles, respectively. Then, ultrasonic bath sonication was performed in 10 °C water for 1 hour. The length of the fragmented fibrils was quantified by transmission electron microscopy (TEM). fAβ_1-42 at different concentrations was applied to SH-SY5Y cell line. The non-toxic dose and time of fAβ_1-42 application were analysed using the WST-1 assay. Intracellular and extracellular fibrils were visualized with immunofluorescence (IF) labelling.

Results: Although, fragmentation was observed under all conditions, it was observed that fibrillar lengths decreased as the on/off pulse times increased, regardless of the number of cycles with ice and dry ice. Additionally, decreasing the temperature increased fibrillar fragmentation.

Conclusion: We anticipate that our study will contribute to the literature by developing an effective and economical sonication method for fibrillar fragmentation with two main laboratory methods and obtaining fAβ_1-42 that can be used in cells at optimum concentration.

Evaluation of outcomes of replantation, acute repair, and revision amputation for digital amputations: A 5-year retrospective study

Fri, 20 Jun 2025 00:00:00 +0300

Objective: This study aims to objectively assess postoperative hand function by categorizing patients into three groups: replantation, acute stump repair, and revision amputation after unsuccessful replantation. Additionally, functional evaluation questionnaires were used to assess patient satisfaction among these groups.

Materials and Methods: A total of 150 patients were included in the study, 50 patients in each group. Patients’ age, gender, comorbidities, dominant hand, the level of amputation, injured fingers and the mechanism of trauma were recorded. Afterwards, the patients were administered the EQ-5D-5L quality of life scale, the Quick DASH test, the Cold Intolerance and the Semmes–Weinstein monofilament test.

Results: A total of 167 finger amputations in 150 patients, 82% of whom were male and 18% were female. Their ages ranged from 19 to 92, and the mean age was 45.5. The mean score in patients who underwent acute repair was higher than in patients who underwent replantation and revision amputation in the EQ-5D-5L scale, the score of the replantation group was minimally lower than in the other two groups for the Quick DASH scoring, sensory results were minimally decreased in the replantation group compared to the revision amputation and acute repair groups. Cold intolerance was reported in 39% of replantation cases compared to 30.3% in revision amputation and 20% in acute repair (p<0.05).

Conclusion: Digital amputations were most frequently seen in male patients, in the 3rd finger and at the level of the distal interphalangeal joint. According to the EQ-5D-5L scale, Semmes-Weinstein monofilament test and cold intolerance assessment, the results were worse in the replantation group compared to the other two groups, and better in the Quick DASH score. The advantages and disadvantages of possible treatment options should be explained to the patient and their expectations should be taken into consideration in choosing the treatment for finger amputations.

Anemia in the patients with acute myeloid leukemia revisited: Prognostic importance of anemia on treatment-naïve patients

Fri, 20 Jun 2025 00:00:00 +0300

Objective: To determine the independent prognostic influence of pre-treatment anemia severity in patients with acute myeloid leukemia.

Patients and Methods: This was a retrospective evaluation of AML patients between January 2002 and May 2018 at a university hospital hematology clinic. The patients were divided into four groups: intensive treatment achieving complete remission (CR), intensive treatment without CR, non-intensive treatment, and supportive treatment. Baseline clinicodemographic features, laboratory data including serum hemoglobin levels, were collected. Baseline and post-treatment hemoglobin levels were compared according to treatment and across groups. A logistic regression analysis was also made to evaluate the influence of anemia on achieving a complete remission.

Results: The mean hemoglobin level at the time of diagnosis was 8.5 g/dL (6.4 – 14.4). Although hemoglobin value was lower in the secondary AML subgroup, there was no significant difference between the groups at the time of diagnosis (p = 0.082). Hemoglobin values after induction chemotherapy were significantly different between treatment groups (p <0.001). When the variables predicting complete remission are examined by logistic regression, per 1 gr/dL increase in hemoglobin level at the time of diagnosis increased the probability of remission significantly (p = 0.047, OR = 1.13, 95% CI 1.07 - 1.24).

Conclusion: A patient’s baseline pre-treatment serum hemoglobin level can predict the achievement of complete remission in AML patients. Anemia improves with induction chemotherapy, even without complete remission.

Utility of serum galactomannan in diagnosing invasive aspergillosis among hematology patients: a meta-analysis

Ayşe Dikmeer, Mine Durusu Tanrıöver, Sibel Aşçıoğlu — Wed, 26 Mar 2025 00:00:00 +0300

Objective: In immunocompromised patients, invasive aspergillosis (IA) is a leading cause of morbidity and mortality. The serum galactomannan (GM) assay is a non-invasive test that may assist in IA diagnosis. The purpose of this meta-analysis is to determine the diagnostic accuracy of the serum GM in patients with hematological malignancies.

Materials and Methods: A search was conducted in the MEDLINE database through PubMed. After selection process and data extraction, 2x2 tables were constructed for patients with proven/probable IA and no IA, as well as for patients with proven IA and no IA. The pooled sensitivity and specificity were established using meta-analysis for the cut-off values of 0.5,1.0 and 1.5 ODI. Inter-study heterogeneity was assessed utilizing the inconsistency test (I²). The receiver operating characteristic (ROC) curve was generated, and the area under the curve (AUC) was calculated. The data analysis was conducted using the Meta-DiSc 1.4 software.

Results: A total of 26 articles, 4502 patients and controls, together with 4761 IA episodes, were included in the meta-analysis. The total number of patients with proven and probable IA was 633 (13.3%). In the group with proven/probable IA versus no-IA, the overall pooled sensitivity and specificity were 80% and 78% (AUC: 0.892) for 0.5 ODI, 74% and 96% (AUC: 0.959) for 1.0 ODI, and 70% and 96% (AUC: 0.964) for 1.5 ODI, respectively. In the group with proven versus no-IA, the overall pooled sensitivity and specificity were 94% and 76% (AUC: 0.922) for 0.5 ODI, 86% and 96% (AUC: 0.979) for 1.0 ODI and 70% and 96% (AUC: 0.974) for 1.5 ODI, respectively.

Conclusion: Our findings indicate that the most appropriate cut-off value for Serum GM in diagnosing IA is 1.0 ODI.