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    Establishing continuous reference intervals for liver function analytes using fractional polynomial regression
    (Walter De Gruyter Gmbh, 2025) Yildirim, Didem Derici; Fidanci, Senay Balci; Sengul, Merve Turkegun; Cimen, M. Burak Y.; Tamer, Lulufer
    Objectives Reference intervals (RIs) play a crucial role in contemporary healthcare by providing critical support for clinical decision-making. RI calculation methods have certain limitations. They cannot capture age-related variations in laboratory values and non-linear relations between variables. Therefore, alternative methods that preserve the continuous type of age and consider non-linear relations must be explored. This study aimed to suggest an alternative method, namely, fractional polynomial (FP) regression models, to overcome these limitations and estimate the reference limits based on this method for ALT and AST markers.Methods This retrospective study is conducted on a large hospital database to establish continuous age and sex-specific RIs for ALT and AST in a Turkish population. The study included 4,386 and 2,834 individuals for ALT and AST, respectively, aged 18-92 years. FP models and a non-parametric approach are used to calculate RIs.Results For AST in females, a linear model indicated the relationship between age and AST in females (p=0.673). However, more complex models (m0=4) were explored for female ALT values. After several comparisons, the FP3 model was chosen as the best fit (p=0.098). For male ALT and AST, FP analysis showed no significant age-related effects (p=0.679 and p=0.507, respectively). Therefore, traditional non-parametric methods were used to calculate RIs.Conclusions Compared with discrete RIs, continuous RIs are more accurate. Laboratories should determine RIs that reflect their population. Future research could explore the application of FP models in the pediatric population.
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    Evaluation of caffeic acid fenethyl ester in testicular damage caused by fluoxetine hydrochloride in rats: effects of fluoxetine hydrochloride on testes
    (Springer, 2025) Asoglu, Zehra Demiray; Balli, Ebru; Bayrak, Gulsen; Yalin, Serap; Ozturk, Ayla Batu; Kaya, Merih Akkapulu; Sengul, Merve Turkegun
    In our study, the aim was to investigate the protective effect of caffeic acid phenethyl ester, which has a wide spectrum of activity, against testicular damage caused by fluoxetine hydrochloride. In our study, 25 male Wistar Albino rats were used, and the rats were divided into five groups with an equal number of rats in each group: control 1 (saline), control 2 (dimethyl sulfoxide-DMSO), fluoxetine group (FLX), caffeic acid phenethyl ester group (CAPE), and fluoxetine + caffeic acid phenethyl ester group (FLX + CAPE). After a 4-week experiment, blood samples were collected, and testicular tissues were excised. For light microscopic evaluation, hematoxylin-eosin (H&E) and toluidine blue (TB) staining were performed. Immunohistochemical examinations were carried out with caspase-3, Bcl-2, and PCNA immunostaining. As a result of statistical evaluation of the morphologic and immunohistochemical examinations, it was determined tubule diameter (p < 0.001, eta(2) = 0.798), germinal epithelium thickness (p = 0.0001, eta(2) = 0.573), and Johnsen score (p < 0.001, eta(2) = 0.928) decreased in the FLX group compared to all groups, while these valuesincreased in the FLX + CAPE group compared to the FLX group. Similarly, body weight and right testicular weight too. Caspase-3 expression in Leydig cells and Bcl-2 expression in seminiferous tubules were increased in FLX group compared to SF, DMSO, and CAPE groups, while they were decreased in FLX + CAPE group compared to FLX group. PCNA index was decreased in FLX group compared to SF, DMSO, and CAPE groups, while it was increased in FLX + CAPE group compared to FLX group. In biochemical analyses, MDA level was increased in the FLX group, while this value was decreased in the FLX + CAPE group. No apparent change was observed in SOD and CAT levels. Our findings showed that FLX induced apoptosis by causing structural damage in the testis through oxidative effects, while CAPE, with its antioxidant effect, repaired this damage, reducing lipid peroxidation and oxidative stress.
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    Healthcare-associated Candida infections in neonates: A clinical perspective on risk and outcome
    (Sage Publications Inc, 2025) Ozmen, Berfin Ozgokce; Sengul, Merve Turkegun; Ozdem, Suna; Aldas, Sefika; Akcali, Mustafa; Simsek, Huseyin
    Objective: Healthcare-associated infections (HAIs) remain a major cause of morbidity and mortality in neonatal intensive care units (NICUs), particularly in preterm and low birth weight infants. Candida species are among the most frequently isolated fungal pathogens in this vulnerable population. Study Design: This retrospective study was conducted in a tertiary NICU in Turkey between January 1, 2015, and December 31, 2023. Daily active surveillance was used to detect HAIs. Neonates with Candida-positive blood cultures were identified. Demographic characteristics, clinical risk factors, laboratory findings, and treatment outcomes were analyzed. Results: Among 9065 neonates admitted to the NICU during the 9-year study period, 26 (0.28%) developed Candida bloodstream infections. The majority of affected infants were premature (84.6%) and had a birth weight <= 2500 g (80%), with 30.8% weighing <1000 g. Predisposing risk factors included: central venous catheter use (92.3%), total parenteral nutrition (96.2%), and exposure to broad-spectrum antibiotics (88.4%). The most frequently isolated species were Candida parapsilosis (46.2%) and Candida albicans (42.3%), while fluconazole resistance was detected in 15.4% of isolates. The overall mortality rate was 38.5%. The median hospital stay was 14.5 days. Conclusions: Candida bloodstream infections are a serious complication in NICUs, particularly among extremely low birth weight and premature infants. Invasive procedures and parenteral nutrition remain major risk factors. The observed high mortality rate and resistance patterns underscore the need for enhanced infection control measures and antifungal stewardship programs in NICUs.
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    Risk factors for white matter lesions in migraine patients: Insights for prevention and management
    (Asean Neurological Assoc, 2024) Yilmaz, Gulcan Gocmez; Yilmaz, Ibrahim Arda; Ozge, Aynur; Sengul, Merve Turkegun
    Background & Objective: White matter lesions (WML) are commonly observed in cerebral Magnetic Resonance Imaging scans of individuals with migraine. However, the exact causes of these lesions in migraine patients remain unclear. This study aims to identify and assess risk factors associated with WML in migraine patients. Methods: Our study included 63 migraine patients with and 64 patients without WML. We compared clinical characteristics and laboratory data between the two groups, including age, gender, age of migraine onset, duration of migraine disease, history of cigarette smoking, presence of hypertension, presence of an aura, attack frequency, photophobia and phonophobia. Results: Multivariate analysis revealed that the risk of developing WML increased two times with age (odds ratio [OR] = 2.00; 95% confidence interval [CI] for OR = 1.24-3.19) and was nearly five times higher in women (OR = 4.92; 95% CI = 1.14-21.11). Compared to patients experiencing a single attack a month, those with 2-5 attacks per month had a seven-fold higher risk, while those with more than five attacks per month had a nine-fold higher risk of developing WML (OR = 7.82; 95% Cl = 1.40-43.64, 9.17; 95% CI = 1.59-52.54). Additionally, a 100-unit increase in TG levels doubled the chances of developing WML (OR = 2.22; 95% CI = 1.23-4.00). Conclusion: This study identifies age, female gender, attack frequency, and elevated TG levels as significant risk factors for the development of WML in migraine patients. These findings provide insights for the prevention and management of WML in individuals with migraine.
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    The relationship between maternal alexithymia and cognitive flexibility, children's emotional eating, and childhood obesity
    (Academic Press Ltd- Elsevier Science Ltd, 2026) Avsar, Pinar Aydogan; Caliskan, Duygu; Sengul, Merve Turkegun
    Objectives: Childhood obesity is one of the major health challenges of the 21st century, a chronic and complicated condition that requires medical intervention. The goal of this study was to investigate the emotional eating levels of children with obesity as well as their mothers' alexithymia and cognitive flexibility, which we hypothesized to contribute to childhood obesity. Methods: This is a cross-sectional, case-control study of age-, sex-, and ethnicity-matched 100 dyads. All mothers completed the Toronto Alexithymia Scale (TAS-20) and the Cognitive Flexibility Inventory (CFI), and the children completed the Emotional Eating Scale-Children (EES-C). In addition, researchers administered a clinical and sociodemographic questionnaire. Results: The childhood obesity group exhibited significantly higher levels of emotional eating and maternal alexithymia, but also significantly lower levels of maternal cognitive flexibility compared to those in the healthy control group. Further analyses revealed a significant association between childhood obesity, maternal alexithymia, and irregular sleep patterns in children. Conclusion: Our results indicate that elevated levels of alexithymia in mothers of children diagnosed with obesity may influence childhood obesity. The aims of early interventions in managing pediatric obesity may include evaluations of families and mothers.