Acta Medica

Pseudomonas-driven amyloid storm: a tale of two cases with rapidly progressive kidney injury

Saliha Yıldırım, Betül Öğüt, İpek Işık Gönül, Özant Helvacı, Yasemin Erten — Tue, 30 Sep 2025 00:00:00 +0300

AA amyloidosis is a significant cause of chronic kidney disease and, if untreated, often leads to progressive kidney damage. This study aims to illustrate how AA amyloidosis can manifest as both slowly progressing chronic kidney injury and rapidly progressive acute kidney injury triggered by secondary conditions.

We describe two patients experiencing an amyloid storm related to Pseudomonas aeruginosa infection: one with bronchiectasis-related amyloidosis and another with paraplegia and decubitus ulcer-related amyloidosis. Clinical, laboratory, and kidney biopsy findings were analyzed.

Both cases demonstrated accelerated kidney failure within two weeks. The first case involved chronic decubitus ulcers and osteomyelitis, while the second had bronchiectasis with pneumonia. Despite infection control and colchicine therapy, both patients experienced irreversible renal damage.

These cases underscore the importance of aggressive infection control in preventing amyloid storm and highlight the interplay between chronic inflammation and acute infections in AA amyloidosis.

A case of tadalafil-induced fixed drug eruption

Ecem Bostan, Fulya Gökalp — Tue, 30 Sep 2025 00:00:00 +0300

Fixed drug eruption is a variant of adverse cutaneous drug eruptions which is characterized by the formation of dusky patches and plaques involving the skin and mucosa, following the ingestion of certain drugs such as non-steroidal anti-inflammatory drugs, metronidazole and cotrimoxazole. Herein, we would like to report an unusual case of tadalafil-induced fixed drug eruption.

Impact of generative artificial intelligence tools on the academic performance of Iraqi medical students in cross-sectional study

Tue, 30 Sep 2025 00:00:00 +0300

Background: Artificial intelligence (AI) has emerged as a transformative tool in medical education, offering significant potential to enhance student learning and engagement. However, its integration also raises challenges, including over-reliance, ethical concerns, and variability in accuracy.

Objective: This study aims to assess the impact of AI tools on the academic performance, knowledge, attitudes, and practices of medical students in Baghdad, Iraq.

Methods: A cross-sectional survey was conducted among 1,340 undergraduate medical students in Baghdad in 2024. The primary measurement tool was a structured, self-administered questionnaire designed to assess multiple domains. These included demographic characteristics, students’ knowledge of artificial intelligence, attitudes toward its application in medical education, and the academic impact of AI tool usage. Knowledge was evaluated through binary-response items, while attitudes were measured using a Likert-scale format to capture perspectives on AI’s utility, ethical implications, and future role in medicine. Data were analyzed using SPSS version 25.0, employing frequency tables and chi-square tests to determine associations between variables.

Results: The majority of participants (56.9%) expressed positive attitudes toward AI, and 47% demonstrated adequate knowledge of its applications. Significant associations were observed between AI usage and improvements in subject understanding (χ² = 15.165, p < .001) and grades (χ² = 24.808, p < .001). ChatGPT was the most frequently used AI tool (80.8%), followed by Canva (21.3%). Participants highlighted AI’s ease of use (85% agreed or strongly agreed) and time-saving benefits (82.8% agreed or strongly agreed), though concerns about reliability and critical thinking persisted.

Conclusion: AI tools have positively influenced the academic outcomes of Iraqi medical students, particularly in subject understanding and grades. However, ensuring ethical and balanced integration of AI into curricula is essential to maximize its potential while addressing limitations.

In silico prediction of rhabdomyolysis-inducing drugs utilizing a supervised machine learning model

Feyza Kelleci Çelik — Tue, 30 Sep 2025 00:00:00 +0300

Objective: Rhabdomyolysis is a life-threatening syndrome characterized by the release of myocyte components into the bloodstream and can be induced by pharmaceutical agents. Although quantitative structure-activity relationship (QSAR) models are widely used for assessing adverse drug reactions, studies in computational toxicology focusing on rare and serious side effects, such as rhabdomyolysis, are still relatively limited. Due to this gap, this study aims to build an in silico QSAR model for early prediction of drugs at risk of rhabdomyolysis.

Materials and Methods: A binary dataset was developed by gathering 187 pharmaceutical compounds from the Drug-Induced Rhabdomyolysis Atlas (DIRA), and classification models were developed in the research. Machine learning (ML) algorithms, such as Instance-Based Learning with k-Nearest Neighbors (IBk), Simple Logistic (SL), and BayesNet (BN), were employed. Additionally, post-hoc model explanations and importance rankings of molecular descriptors were provided using Permutation Feature Importance (PFI).

Result: The performances of the ML classifiers ranged from 82.00% to 85.33% in the training set and from 75.67% to 81.08% in the test set. The highest success rate for the test set was achieved by the IBk model, with a rate of 81.08%. The most significant feature in the post-hoc IBk model explanation using PFI was highlighted as the JGI6 descriptor. The descriptor class with the most identifiers was the Electrotopological State Atom Type (E-State) Descriptors.

Conclusion: The physicochemical properties presented in this study regarding rhabdomyolysis and the developed models are anticipated to serve as effective tools for assessing the risk of rhabdomyolysis in drug molecules.

Linking eveningness to depression and anxiety: the mediating role of impulsivity and resilience

İpek Özönder Ünal, Miray Pirinççi Aytaç, Derya Adalı Aker, Tonguç Demir Berkol — Tue, 30 Sep 2025 00:00:00 +0300

Objective: This study investigated the interrelationships between chronotype, impulsivity, resilience, and affective symptomatology in individuals with Major Depressive Disorder (MDD) in remission. Specifically, it examined whether impulsivity and resilience mediate the association between eveningness and depressive and anxiety symptoms, and whether sleep quality moderates these pathways.

Materials and Methods: This cross-sectional study was conducted between February and April 2025 at Istanbul Tuzla State Hospital, Türkiye, and included 203 patients diagnosed with MDD in remission. Participants were assessed using validated psychometric instruments, including the Morningness-Eveningness Questionnaire (MEQ), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Psychological Resilience Scale (PRS-33), Barratt Impulsiveness Scale (BIS-11), and the Pittsburgh Sleep Quality Index (PSQI). Analyses were conducted using SPSS 22.0, including correlations, multiple linear regression, and PROCESS-based mediation and moderation models.

Results: Eveningness was significantly associated with increased severity of both depressive and anxiety symptoms. Non-planning and attentional impulsivity partially mediated the relationship between eveningness and depressive symptoms. Resilience also partially mediated the link between eveningness and depression, indicating a protective psychological buffer. Sleep quality moderated the chronotype–depression association, such that poor sleep exacerbated depressive symptoms in evening types, but it did not moderate the chronotype–anxiety link.

Conclusion: Chronotype influences mental health outcomes through intricate cognitive-affective pathways. Evening-type individuals are more vulnerable to affective symptoms due to heightened impulsivity and reduced resilience. These findings emphasize the need for multidimensional interventions that address not only circadian misalignment but also impulsivity regulation and resilience enhancement to improve psychological outcomes in mood disorder populations.

Treatment outcomes of postoperative abdominal bleeding after oncologic surgery: a retrospective comparative study of surgical and interventional radiologic treatments

Tue, 30 Sep 2025 00:00:00 +0300

Objective: Postoperative abdominal bleeding (POB) is a rare but life-threatening complication after abdominal oncologic surgery. POB can increase mortality by up to sixfold. Surgical treatment (ST) is generally preferred for early bleeding, while interventional radiologic treatment (IRT) is often favored for late bleeding; however, the literature remains inconclusive. This study aimed to compare the outcomes of ST and IRT in patients who developed POB after abdominal surgery for malignancy.

Methods: Patients who underwent abdominal surgery for malignancy between January 1, 2014, and December 31, 2024, were retrospectively reviewed. Bleeding occurring within 24 hours postoperatively was defined as early, while bleeding after 24 hours was considered late. Demographic data, clinical characteristics, treatment modalities, and outcomes were analyzed.

Results: Of 2,266 patients, 35 (1.54%) developed POB and were included. Seventeen (48.57%) had early bleeding, and 18 (51.43%) had late bleeding. ST was performed in 18 patients (51.43%), and IRT in 17 (48.57%). Median time from surgery to bleeding was significantly shorter in the ST group (1 vs. 14 days, p<0.001). The ST group also had lower median red blood cell transfusion requirements (6 vs. 25 units, p<0.001) and shorter hospital stays (15.5 vs. 33 days, p=0.008). Among four late-bleeding patients treated surgically, three (75%) died. Rebleeding occurred in three IRT patients (17.65%), two of whom had bleeding from pancreaticojejunal anastomosis. Overall mortality was 31.4%, with no significant difference between groups (p=0.54).

Conclusion: POB after malignant abdominal surgery is a serious condition. ST for early bleeding and IRT for late bleeding offer comparable success and mortality rates. However, IRT is associated with higher rate of rebleeding in cases of pancreaticojejunal anastomotic hemorrhage, while ST for late bleeding carries a high mortality risk. Major abdominal surgeries should be performed in centers equipped for IRT, and treatment decisions should be made within a multidisciplinary framework.

Neuropsychological response to ventriculoperitoneal shunting in idiopatic normal pressure hydrocephalus: early gains and the importance of baseline cognition

Tue, 30 Sep 2025 00:00:00 +0300

Objective: Idiopathic normal pressure hydrocephalus (iNPH) is a reversible cause of cognitive impairment in older adults, characterized by gait disturbance, urinary incontinence, and cognitive decline. While ventriculoperitoneal (VP) shunt surgery can improve the classical triad, its cognitive and emotional effects remain under characterized. In this study we aim to investigate neuropsychiatric outcomes following VP shunt surgery in iNPH patients and to identify predictors of postoperative cognitive improvement.

Material and Methods: This retrospective single-center study included 55 patients with iNPH who underwent VP shunt surgery between 2020 and 2024. Neuropsychological testing was conducted preoperatively and at a median of 11 months postoperatively, evaluating global cognition, memory, attention, executive and visuospatial functions, and mood. Pre- and postoperative performances were compared, and multivariate regression models were used to determine independent predictors of cognitive gain.

Results: Significant postoperative improvements were observed in MMSE (median 24.0 to 27.0, p < 0.001), memory scores (ERCT: 40.0 to 45.0, p < 0.001), attention/executive functions and depression severity (BDI: 12.0 to 9.0, p < 0.001). Stratified regression analysis showed that patients in the lowest baseline MMSE and ERCT tertile experienced the greatest improvement shortly after surgery, with longer follow-up associated with diminishing gains (MMSE: β = –0.76, p < 0.001, ERCT: β = –0.76, p < 0.001).

Conclusion: Cognitive improvement after VP shunt surgery in iNPH is strongly influenced by baseline cognitive status and the timing of follow-up. Patients with lower preoperative scores benefit the most when evaluated in the early postoperative phase. These findings emphasize the need for timely intervention and tailored neuropsychological monitoring to optimize outcomes.

The lactate dehydrogenase-to-albumin ratio is a prognostic biomarker in extensive-stage small-cell lung cancer

Tue, 30 Sep 2025 00:00:00 +0300

Background: The lactate dehydrogenase-to-albumin ratio (LAR) is a promising prognostic marker in various malignancies. However, its clinical relevance in extensive-disease small-cell lung cancer (ED-SCLC) remains unclear.

Methods: We analyzed a total of 221 patients diagnosed with ED-SCLC between January 2008 and December 2021. Patients without treatment response data (n=8), those who did not receive systemic therapy (n=37), and those who lacked baseline LDH values (n=48) were excluded. The LAR was calculated by dividing baseline serum LDH (U/L) by albumin (g/L) and, using ROC analysis, the optimal cut-off level was determined to be 5.71 (sensitivity: 81.5%, specificity: 77.8%). Kaplan–Meier and Cox regression analyses were used to evaluate both progression-free (PFS) and overall survival (OS).

Results: A total of 128 patients diagnosed with ED-SCLC were included in our analysis. Patients with an LAR ≥5.71 had significantly shorter median OS (8.1 vs. 20.2 months, p<0.001) and PFS (5.9 vs. 9.4 months, p=0.003) compared to those with an LAR <5.71. In multivariate analysis, a high LAR was an independent predictor of a shorter OS (HR: 3.60; 95% CI: 1.35–9.60; p=0.010) and had a strong association with a shorter PFS (HR: 2.61; 95% CI: 0.95–7.14; p=0.063).

Conclusion: The LAR is a simple, cost-effective, and independent prognostic biomarker in patients with ED-SCLC. It could assist in risk stratification and guide treatment decisions in clinical practice.

Predictors of secondary traumatic stress: traumatic experience, psychiatric symptoms and gender vs. mindfulness and mortality awareness

Zehra Sena Giray, Talat Demirsöz — Tue, 30 Sep 2025 00:00:00 +0300

Objective: The present study mainly aimed to examine the relationship between mindfulness, mortality awareness, and the emergence of secondary traumatic stress (STS) symptoms in young adults who had been indirectly exposed to social media content related to the 6 February 2023 Kahramanmaraş earthquakes.

Materials and Methods: Data were collected online between June 2023 and May 2024 from 96 participants aged 18–26 (83% female). Exclusion criteria included direct exposure to the earthquake, residing in the affected provinces, bereavement of close relatives, or engagement in rescue operations. Measures included the Brief Symptom Scale-25, Multidimensional Mortality Awareness Measure, Secondary Traumatic Stress Scale for Social Media Users, and the Five Facet Mindfulness Questionnaire-Short Form. Hierarchical Regression Analysis was used to investigate predictive roles of mindfulness and mortality awareness for secondary traumatic stress symptoms, controlling the effects of gender, past traumatic experience, and the effect of general psychiatric symptomatology.

Results: Gender, psychiatric symptoms, and past trauma history significantly predicted STS, accounting for 30% of the variance. Being female, having more psychiatric symptoms, and a history of trauma were associated with higher STS levels. Adding mindfulness and mortality awareness increased the explained variance to 46%. Specifically, mortality fearfulness and mortality legacy positively predicted STS symptoms, suggesting that fear of death and the need to leave a legacy may heighten vulnerability. Conversely, the mindfulness sub-dimension of nonjudging inner experience negatively predicted STS, indicating a protective role. Independent-samples t tests indicated that STS scores were higher among participants with a past trauma history than those without (M=52.00 vs 43.30), t(94)=2.58, p=.011, and among females versus males (M=47.24 vs 36.20), t(93)=2.80, p=.006.

Conclusion: Controlling for established predictors (female gender, psychiatric symptomatology, and past trauma), mortality fearfulness and mortality legacy remained positive predictors of STS, whereas nonjudging of inner experience remained a negative predictor. This pattern suggests that mortality awareness and mindfulness facets contribute unique variance to STS beyond core risk factors.