INTRODUCTION: Multimorbidity combining hypertension (HTN), type 2 diabetes mellitus (T2D), and obesity adversely affects health-related quality of life (HRQoL). Ambulatory circadian phenotypes (dipper/non-dipper/riser) and average real variability (ARV) may relate to mental well-being. We aimed to find whether ambulatory BP phenotypes and ARV are associated with the SF-36 mental component summary (MCS) in HTN+T2D+obesity.

METHODS: In an observational cohort, 314 participants with HTN+T2D+obesity (mean age 58.9±9.7 years; 54% men), 262 had evaluable ABPM (dipper 34%, non-dipper 50%, riser 16%); completed the 36-Item Short-Form Health Survey (SF-36) and underwent 24-hour ambulatory BP monitoring (ABPM). Primary outcome was MCS. 24-h systolic ARV was computed from consecutive valid readings. Receiver-operating characteristic (ROC) analyses identified an ARV threshold for low MCS (lowest quartile).
RESULTS: Adjusted MCS showed a graded decrement across phenotypes: dipper 48.8 (95% CI 47.5–50.1), non-dipper 46.1 (45.1–47.2), riser 44.0 (42.5–45.6); p<0.001. ARV was independently and inversely associated with MCS; for low MCS, ARV discriminated better than SD and mean 24-h SBP (AUC 0.69 vs 0.63 and 0.58). The Youden-derived ARV cut-off ~12.5 mmHg yielded a sensitivity of 0.66 and specificity of 0.62. Simultaneous attainment of 24-h BP and HbA1c targets related to higher MCS (+3.1 points; p<0.001) and a greater high-MCS responder rate (52% vs 31%).

DISCUSSION AND CONCLUSION: In HTN+T2D+obesity, abnormal circadian BP phenotypes and higher ARV identify patients with lower MCS beyond mean BP and may flag risk of low mental HRQoL and support integrated management toward dual control of 24-h BP and HbA1c.

INTRODUCTION: Gastroesophageal reflux disease (GERD) is a common gastrointestinal condition that can impair quality of life and lead to complications. Research assistant physicians are especially at risk due to factors such as long working hours, high workload, irregular eating habits, and stress. This study aimed to assess the prevalence of GERD and its relationship with sleep quality among research assistant physicians.

METHODS: This cross-sectional study included 446 research assistant physicians working at Selçuk University Faculty of Medicine Hospital between 2024 and 2025. Data were collected using a sociodemographic questionnaire, the Reflux Disease Questionnaire (RDQ), the Pittsburgh Sleep Quality Index (PSQI), and body composition analysis via bioelectrical impedance (BIA). Only participants meeting the inclusion criteria and providing informed consent were included. Ethical approval was obtained.

RESULTS: The mean age was 28.82 years, with 43.9% male participants. GERD prevalence was found to be 42.6%. GERD was significantly associated with marital status, consumption of fatty and spicy foods, obesity, visceral fat, and poor sleep quality (p<0.05). Poor sleep quality was also linked to nighttime eating, light exposure at night, obesity, and shift work. Participants with GERD had significantly worse sleep quality (p<0.001).


DISCUSSION AND CONCLUSION: GERD and poor sleep quality are prevalent among research assistant physicians and are influenced by occupational and lifestyle factors. Preventive measures, early diagnosis, and improvements in working conditions and sleep hygiene should be emphasised in health policy planning.

INTRODUCTION: This study aimed to investigate the relationship between pregnancy-specific distress and hair loss in women in their third trimester.
METHODS: This cross-sectional prospective study included 138 pregnant women in their third trimester who attended the İstanbul Medipol University Hospital Gynaecology and Obstetrics Clinics. Data were collected through a face-to-face interview using an information form (covering sociodemographic and obstetric history, and hair loss status) and the Tilburg Pregnancy Distress Scale. Results of hematologic and hormonal parameters measured during follow-up were also recorded.
RESULTS: Hair loss during pregnancy was reported by 41 participants (29.7%). Based on TPDS total scores, 17 women (12.3%) were classified as at-risk for distress, and 8 (5.8%) according to the Negative Affect (NA) subscale. Women reporting hair loss had higher TPDS total and subscale scores compared to those without hair loss. No significant differences were observed between hair loss and laboratory parameters, suggesting a potential independent role of distress. Number of pregnancies was positively correlated with PI scores (r=0.284, p=0.001), while age showed a negative correlation with NA scores (r=–0.184, p=0.03).
DISCUSSION AND CONCLUSION: Pregnant women who complain of hair loss should be screened for pregnancy-specific distress, even in the absence of laboratory abnormalities. Incorporating psychological assessment and support into routine prenatal care may reduce distress-related somatic complaints and improve maternal well-being.

INTRODUCTION: This study aimed to examine the association between internet addiction, e-healthy diet literacy (e-HDL), and body mass index (BMI) in adults aged 18–65 years.
METHODS: A cross-sectional study was conducted with 378 patients attending a university hospital Family Medicine Outpatient Clinic. Data were collected using a sociodemographic questionnaire, the Internet Addiction Scale (IAS), and the e-Healthy Diet Literacy Questionnaire (e-HDLQ). Statistical analyses were performed using IBM SPSS 22.0.
RESULTS: Participants were 52.9% female and 47.1% male, with a mean age of 35.4 ± 12.2 years. BMI was positively correlated with age (r=0.410; p<0.001). No significant association was found between IAS scores and BMI (p=0.180). e-HDLQ scores were significantly higher in overweight individuals than in obese individuals (p=0.004). Participants who consumed snacks and main meals while using technological devices had significantly higher IAS scores (p<0.001). Snack consumption during device use was most frequent in the overweight group (p=0.001).
DISCUSSION AND CONCLUSION: Internet addiction was not directly associated with BMI; however, digital behaviours were linked to eating patterns and screen-based meal consumption. Enhancing e-healthy diet literacy and promoting balanced digital habits may support healthier weight management.

INTRODUCTION: This study aimed to establish the connection between health literacy and the appropriate use of medications among individuals suffering from chronic diseases.
METHODS: This descriptive and correlational study examined individuals with at least one chronic disease who presented to family medicine units in the Bucak district of Türkiye. The required sample size was calculated at 95% confidence and a 5% margin of error, and 386 participants were needed. Ultimately, data were collected from 488 participants. Data were obtained using the 'Health Literacy Scale' and the ' Rational Use of Medicines Scale'.
RESULTS: A mean score of 35.89±5.38 was achieved on the rational use of medicines, indicating a moderate level of awareness. The mean Health Literacy Scale score was 104.66 ± 15.49, indicating a high level of health literacy among participants. A test of the connection between health literacy and sensible drug use showed a strong link (r=0.60, p<.001). Health literacy and rational use of medicines scores differed significantly according to age, educational status, and occupation (p<.001).
DISCUSSION AND CONCLUSION: Increased health literacy among people with chronic diseases positively influences rational use of medicines behaviours. In this context, the implementation and dissemination of education programs and counselling services aimed at improving health literacy in primary healthcare settings are recommended to promote rational use of medicines, support treatment adherence, and reduce preventable medication-related problems.

INTRODUCTION: Fatigue is characterised as a feeling of exhaustion that arises with a reduction in the ability to engage in physical or mental activities. This study aims to examine the root causes of fatigue symptoms and associated demographic characteristics among persons devoid of any underlying medical disorders.
METHODS: The study included 125 patients who visited the outpatient neurology clinic reporting fatigue. Data was collected using the Chalder Fatigue Scale (CFS), the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale, the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI).
RESULTS: The mean age of the patients was 46.01 ± 12.10 years, with 67.2% (n=84) being female. The prevalence of individuals who were married (p=0.002), employed (p=0.004), and possessed a university degree (p=0.033) was greater among women compared to men. Elevated BDI scores were (OR: 1.192, 95% CI: 1.057–1.337, p=0.003) and PSQI scores (OR: 1.782, 95% CI: 1.376–2.192, p<0.001) significantly associated with higher fatigue severity. The CFS ratings were significantly elevated in individuals with a university degree relative to those with primary education (OR: 3.032, 95% CI: 1.099–8.122, p=0.031). Unemployment was associated with a markedly reduced probability of experiencing fatigue (OR: 0.083, 95% CI: 0.032-0.232, p<0.001).
DISCUSSION AND CONCLUSION: Our study demonstrated that elevated educational attainment, unemployment, compromised sleep quality, and heightened depression were associated with fatigue symptoms. The data demonstrate that weariness is associated not only with physiological aspects but also highly impacted by psychological and social factors.

INTRODUCTION: Heart rate variability has been associated with autonomic neuropathy, which is seen in diabetes. Cardiac autonomic neuropathy is found to be related to a poor prognosis in diabetic patients. It is thought that neuropathy that develops in diabetic patients begins in the early stages. We aimed to assess heart rate variability (HRV) in prediabetic patients to explore whether autonomic changes may begin during the prediabetes stage.
METHODS: This retrospective study included prediabetic patients who underwent 24-hour Holter ECG monitoring. Patients were identified based on fasting plasma glucose (FPG) and HbA1c values extracted from medical records. Prediabetes was defined as HbA1c 5.7–6.4% and fasting plasma glucose 100–126 mg/dL. Patients with thyroid dysfunction, overt diabetes, arrhythmias or those using drugs affecting heart rate were excluded. HRV parameters, including SDNN, SDANN, rMSSD, pNN50, triangular index, and frequency-domain measures (LF, HF, VLF, LF/HF), were analysed.


RESULTS: Fifty participants were included (25 prediabetic, 25 controls). The groups were similar in age and sex. All HRV parameters were lower in prediabetic patients compared to controls. Time-domain measures SDANN, rMSSD, pNN50, and triangular index and frequency-domain measures HF, VLF, and LF/HF ratio were significantly reduced (p < 0.05). Effect sizes and 95% confidence intervals were reported, and sensitivity analyses adjusted for age and sex confirmed findings.
DISCUSSION AND CONCLUSION: HRV is reduced in prediabetic patients, consistent with early autonomic dysfunction. These findings suggest that cardiac autonomic neuropathy may begin in prediabetic patients. All HRV parameters were lower than those of the control group and can serve as non-invasive indicators of early autonomic dysfunction and cardiac autonomic neuropathy.

INTRODUCTION: The green zone covers patients with stable vital signs who do not require urgent intervention; however, due to the high number of presentations, this group constitutes a significant portion of the emergency department workload. This study aimed to determine the characteristics of consultations requested for green zone patients in the emergency department and to reveal their impact on emergency department operations.
METHODS: Our study was conducted retrospectively on adult patients who visited the emergency department green zone between June 2024 and May 2025. The demographic characteristics of patients who required consultation, the speciality for which consultation is requested, the time of consultation, the diagnosis code, and patient outcomes were analysed.
RESULTS: In our study, 75,011 green zone applications were reviewed, and it was determined that consultations were requested for 237 patients (0.32%). The most frequently requested speciality was orthopaedics (47.3%), followed by plastic surgery (8.0%), ear, nose, and throat (6.3%), and paediatrics (5.9%). 70% of patients for whom consultations were requested were admitted, and 29.5% were discharged. The rate of admission to the intensive care unit was significantly higher in patients who were consulted by cardiology (p<0.001).
DISCUSSION AND CONCLUSION: Although the consultation rate among green zone patients is low, the majority of these patients have serious clinical conditions requiring hospitalisation. Proper management of the consultation process is important for both patient safety and the efficient use of emergency department resources. Strengthening primary care services may play an important role in the management of low-acuity patients in emergency departments.

INTRODUCTION: Prehospital delay in acute ischemic stroke is driven by decision delay between symptom recognition and taking action. Although witnesses recognize symptoms early, the value of translating witness-reported symptoms into standardized stroke assessment tools remains unclear. This study aimed to evaluate the predictive value of witness-derived, physician-administered secondary Cincinnati Prehospital Stroke Scale (CPSS) scores for identifying ischemic stroke in the emergency department (ED) and their association with decision delay.
METHODS: This prospective, cross-sectional validation study was conducted in a tertiary ED between August and November 2025. Secondary CPSS scores were independently assigned by two blinded emergency physicians using the three-item CPSS, based on structured interviews with untrained witnesses of stroke-like patients. Predictive validity was assessed using final ED diagnoses, and decision delay was derived from standardized prehospital timelines. Statistical analyses included Cohen’s kappa, diagnostic accuracy metrics, and chi-square tests.
RESULTS: A total of 235 patient–witness pairs were included. More than 70% of witnesses delayed action for over 30 minutes, accounting for 56.3% of prehospital delay. Interrater reliability was substantial (κ = 0.788). Secondary CPSS scores showed low sensitivity and negative predictive value but high specificity and positive predictive value indicating limited rule-in utility. Scores ≥1 were not associated with shorter decision delay (p = 0.789).
DISCUSSION AND CONCLUSION: Secondary CPSS based on witness reports is reliably scored but has limited diagnostic accuracy and does not facilitate faster decision-making, limiting its utility as a standalone tool for prehospital stroke triage. Future studies should address cognitive barriers and improve witness response.

Aripiprazole is a widely used second-generation antipsychotic known for its favourable side effect profile. Although generally well-tolerated, rare adverse reactions, such as hiccups, have been documented. We present the case of a 28-year-old male with autism spectrum disorder and psychosis with catatonic features who developed acute, persistent hiccups shortly after starting aripiprazole treatment. The patient, hospitalised for catatonia and psychotic symptoms, was initially treated with benzodiazepines and later with aripiprazole. Within 24 hours of the dose increase to 10 mg/day, he developed continuous hiccups that significantly interfered with oral intake. Aripiprazole was identified as the most likely cause; thus, the medication was discontinued, and chlorpromazine 25 mg twice daily was administered for symptomatic relief. The hiccups completely resolved within 48 hours. This case highlights that hiccups may occur across a range of aripiprazole doses and typically subside after discontinuation. Young male patients with developmental disorders and those concurrently receiving benzodiazepines may be at greater risk. Chlorpromazine may serve as an effective symptomatic option for managing aripiprazole-induced hiccups when benzodiazepine dose reduction is not feasible.

Familial hypobetalipoproteinemia (FHBL) is a rare, genetically inherited cause of hypocholesterolemia. Although it usually presents asymptomatically, it can occasionally lead to clinical outcomes such as hepatic steatosis. In this case, a 37-year-old male patient presented to a family medicine outpatient clinic for a routine health check. His physical examination and vital signs were within normal limits. Laboratory investigations revealed markedly low LDL and total cholesterol levels and elevated triglycerides. Additionally, mild elevations in liver enzymes and grade 1–2 hepatic steatosis on abdominal ultrasonography were detected. A presumptive diagnosis of heterozygous familial hypobetalipoproteinemia was considered, and the patient was referred to the endocrinology clinic for further evaluation. This case demonstrates how periodic health screening in asymptomatic individuals can contribute to the early detection of rare metabolic disorders. Family physicians are competent in evaluating patients holistically and initiating appropriate referrals based on clinical and laboratory findings.