Current Issue

Abstract
Objective and Aim
Approximately 80% of patients followed by home health care services receive anticoagulant therapy. These anticoagulants include acetylsalicylate, heparin, warfarin, and direct oral anticoagulants (DOACs). However, a significant portion of patients still utilize warfarin. Due to its narrow therapeutic index, warfarin can lead to severe morbidity and mortality. For home health care patients who face challenges accessing hospital facilities, it is vital to have home-based blood sampling and maintain the INR within the target range. Unfortunately, patients on long-term warfarin therapy and their caregivers often lack the desired level of awareness regarding the medication. This deficiency can lead to serious, preventable side effects. Determining the correct and incorrect knowledge of patients and caregivers is the primary step toward correcting misconceptions. This study aims to evaluate the knowledge status regarding warfarin, exposure to side effects, and associated factors among patients or their relatives followed by home health care services.
Materials and Methods
The study was conducted by screening the archives of the University of Health Sciences (UHS) Adana City Hospital Home Health Care Services between February 1, 2025, and February 1, 2026. This is a retrospective study. Approval was obtained from the UHS Adana City Training and Research Hospital Scientific Research Ethics Committee. Inclusion criteria were being aged 18 or older, being registered with home health care services during the specified dates, and having used warfarin for at least 3 months. The investigated data evaluated sociodemographic status, warfarin utilization patterns, and the knowledge levels of patients and/or their relatives regarding warfarin.
Results
Of the participants, 68.9% (n=31) were female and 31.1% (n=14) were male. The mean age of the participants was 75.4 years. All participants had comorbid diseases. The average daily medication use, excluding warfarin, was 5.17. The most common comorbidities were hypertension, diabetes mellitus, coronary artery disease, and Alzheimer’s disease. Warfarin indications were as follows: 48.9% (n=22) heart valve replacement, 8.9% (n=4) deep vein thrombosis, 8.9% (n=4) atrial fibrillation, 8.9% (n=4) pulmonary embolism, and 24.4% (n=11) cerebrovascular disease. Warfarin-related adverse effects occurred in 37.8% (n=17) of the participants. These side effects included intraocular hemorrhage, gastrointestinal bleeding, gingival bleeding, epistaxis, and hematuria. Additionally, 64.4% (n=29) of participants reported no knowledge of warfarin-drug interactions, and 75.6% (n=34) stated they did not follow any specific diet related to warfarin use. While 24.4% (n=11) of patients administered the medication themselves at home, for others, it was administered by a daughter, son, spouse, or caregiver. A history of warfarin side effects, dietary compliance, and knowledge of drug interactions were compared based on the last measured INR value; the p-values were 0.109, 0.805, and 0.030, respectively. No significant correlation was found between participants’ age and the number of non-warfarin medications, duration of warfarin use, or duration of registration in home health care services (p-values: 0.313, 0.314, and 0.228, respectively).
Conclusion
Patients receiving home health care services and their caregivers are not sufficiently informed about the effects, side effects, and precautions associated with warfarin. To minimize adverse effects in these patients, it is crucial to provide regular follow-up and comprehensive education regarding warfarin’s effects and necessary precautions.
Keywords: Warfarin, Home Health Care Services, Knowledge Level.

Abstract
Objective and Aim
Respiratory syncytial virus (RSV) is a leading cause of acute respiratory tract infections across all age groups and represents the most common etiological agent of lower respiratory tract infections in children under one year of age. The majority of children are infected with RSV by the age of two years. This study aimed to evaluate the epidemiological and clinical characteristics, as well as the treatment modalities and treatment responses, of pediatric patients aged 0–18 years who presented to our hospital with respiratory symptoms and were diagnosed with RSV infection.
Materials and Methods
This retrospective study was conducted in pediatric patients aged 0–18 years at Çukurova University Faculty of Medicine, Balcalı Hospital, between January 2022 and January 2025. Patients who presented with symptoms of lower respiratory tract infection during the study period and were found to be RSV-positive by multiplex real-time polymerase chain reaction (RT-PCR) testing of nasopharyngeal swab specimens were included in the study.
Results
A total of 26 patients were included in the study, of whom 22 were male (84.6%). The median age was 19.5 months (min–max: 1–186 months). A history of prematurity was present in 7 patients (26.9%), and 16 patients (61.5%) had underlying chronic diseases. When the presenting complaints were evaluated, cough was present in 76.9%, fever in 53.8%, and respiratory distress in 61.5% of the patients.
When chest radiographs were examined, bilateral infiltration was observed in 46.1%, unilateral infiltration in 11.6%, and hyperinflation in 15.3% of the patients. RSV was identified as the sole pathogen in 15 patients, while among co-infections, RSV–rhinovirus co-infection was the most common.
A total of 19 patients (73%) required oxygen support; of these, 52.6% received nasal cannula, 10.5% reservoir mask, 21.1% high-flow nasal cannula oxygen (HFNC), and 15.8% invasive mechanical ventilation support. Complications developed in 2 patients during treatment, 5 patients were admitted to the pediatric intensive care unit, and 1 patient died.
Conclusion
Respiratory syncytial virus (RSV) is one of the most common causes of acute lower respiratory tract infections, particularly in children under two years of age, and in our study, the majority of cases were also observed in the younger age group. Prematurity and the presence of underlying diseases stand out as important risk factors for a more severe course of the disease. In our study, the presence of oxygen requirement in a significant proportion of patients supports that RSV infections can lead to severe clinical conditions. Therefore, in addition to early diagnosis and appropriate treatment, it is of great importance to raise awareness among families regarding hygiene measures, avoidance of household cigarette smoke exposure, and adherence to the national immunization schedule.
Keywords: Respiratory Syncytial Virus, Child, Lower Respiratory Tract İnfection.

Abstract
Objective and Aim
The study aims to evaluate the accuracy and reliability levels of artificial intelligence (AI) models in diagnosing dermatological lesions and determining the prognosis of the disease using clinical case images.
Materials and Methods
The images of 34 dermatological cases in the book “Approach to Dermatological Diseases in Family Medicine” published by Türkiye Klinikleri Press were used with permission. In March 2025, the images were uploaded to ChatGPT-4, Grok-3, and Gemini-2.0 models. Their response and accuracy rates were analyzed comparatively.
Results
The images of 34 cases were presented to the AI models. ChatGPT responded to all cases, Grok to 28, and Gemini to 22. The accuracy rates were 41.2% for ChatGPT, 38.2% for Grok, and 29.4% for Gemini. When evaluating the 21 cases in common, the accuracy rates were found to be 43% for ChatGPT, 52.4% for Grok, and 47.6% for Gemini. There was no statistically significant difference between the correct answer scores of the AI models (p=0.829). The correct diagnosis was consistent across all models in eight cases (verruca vulgaris (n=2), melanoma (n=2), urticaria, onychomycosis, acne vulgaris, and vitiligo). All nine cases (molluscum, HSV, lichen planus, herpangina, orf, monkeypox, Behçet’s disease, pityriasis alba, felon) were misdiagnosed. In cases with a correct diagnosis, the distinction between malignancy and benignity was clear.
Conclusion
This study demonstrated the limitations of using ChatGPT-4, Grok-3, and Gemini-2.0 models as independent diagnostic tools in dermatological cases. However, it was observed that they could potentially be beneficial as decision support tools for specific lesions. AI models can be developed to increase their future applications.
Keywords: Artificial Intelligence, Skin Lesions, Primary Care, Large Language Models.

Abstract
Objective and Aim
To investigate the associations of the triglyceride–glucose (TyG) index, systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) with SCORE2-based cardiovascular risk and to evaluate their incremental predictive value beyond conventional clinical factors in patients with dyslipidemia.
Materials and Methods
In this retrospective cross-sectional study, 111 adults with dyslipidemia managed in a primary care setting were included. Cardiovascular risk was assessed using the SCORE2 algorithm, and participants were categorized into low–moderate and high–very high-risk groups. The TyG index, SII, and SIRI were calculated using routine laboratory parameters. Binary logistic regression models were constructed to determine the incremental contribution of these biomarkers to cardiovascular risk stratification. Model performance was evaluated using receiver operating characteristic (ROC) curve analysis.
Results
Patients with high–very high cardiovascular risk had significantly higher TyG index values compared with those at low–moderate risk (9.00 ± 0.64 vs. 8.66 ± 0.57, p=0.014). No significant differences were observed for SII (p=0.405) or SIRI (p=0.908). In multivariable analysis, TyG was independently associated with high cardiovascular risk (OR=2.21, 95% CI: 1.08–4.52, p=0.030), whereas SII and SIRI were not. The addition of TyG to the clinical model improved discrimination for high cardiovascular risk (AUC: 0.639 to 0.689), while subsequent inclusion of SII and SIRI resulted in only marginal improvement (AUC: 0.692).
Conclusion
The TyG index was independently associated with SCORE2-based cardiovascular risk and provided incremental predictive value beyond conventional clinical variables in patients with dyslipidemia. In contrast, SII and SIRI showed limited utility for cardiovascular risk stratification. Larger prospective studies are warranted to confirm these findings.
Keywords: Dyslipidemia, Triglyceride-Glucose Index, Systemic Immune-Inflammation Index, Cardiovascular Risk.

Abstract
Objective and Aim
Gender perceptions and sociocultural factors may influence patients’ attitudes and preferences when choosing a physician. This study aimed to explore the role of gender perceptions and sociocultural differences in individuals’ attitudes and behaviors regarding physician gender preferences.
Materials and Methods
This qualitative study was conducted among 18 participants (9 men and 9 women) with diverse socioeconomic characteristics living in different socioeconomic regions of Denizli, Türkiye. Data were collected through semi-structured, in-depth interviews exploring participants’ preferences and perceptions regarding physician gender. The interviews were analyzed qualitatively to identify recurring themes and factors influencing physician gender preferences.
Results
Participants expressed the clearest preference for physicians of the same gender when seeking care for sex-specific health conditions. Participants who emphasized detailed explanations, comprehensive history-taking, thorough physical examinations, and a biopsychosocial approach predominantly associated these characteristics with female physicians. Female physicians were also more frequently perceived as being likely to consult or refer patients when necessary. However, several participants expressed a preference for male physicians based on the belief that women, because of their roles as mothers and spouses, may be less able to devote sufficient time to their professional responsibilities. When participants were asked to draw the image of a physician as they imagined one, 13 participants (72.2%) depicted a physician of their own gender.
Conclusion
This study demonstrates that physician gender preferences are influenced by both gender-specific healthcare needs and socially constructed perceptions of professional roles and characteristics. Participants tended to prefer physicians of their own gender for sex-specific conditions, male physicians in surgical specialties, and female physicians in specialties perceived as more traditionally feminine, such as pediatrics, family medicine, and dermatology. These findings highlight the potential influence of gender stereotypes and sociocultural expectations on patient–physician interactions and physician selection.
Keywords: Gender Perceptions, Sociocultural Differences, Physician Gender Preferences.

Abstract
Objective and Aim
The One Health approach constitutes an interdisciplinary framework grounded in the fundamental premise that human, animal, and environmental health are inextricably interconnected. Family physicians and primary care practitioners occupy a central position in the operationalization of the One Health paradigm, both as the initial point of diagnosis for zoonotic infections and as the clinicians most directly observing the health impacts of antimicrobial resistance (AMR), climate change, and environmental exposures. This systematic review aimed to map the literature addressing One Health within the context of family medicine and primary care settings, and to conduct a qualitative synthesis thereof.
Materials and Methods
Two separate searches were conducted in the Web of Science Core Collection database using strategic keywords encompassing family medicine and One Health concepts, yielding a total of 1,736 records. In accordance with the PRISMA 2020 guidelines, records were sequentially subjected to duplicate screening, title-abstract screening, and full-text eligibility assessment. Studies focusing on the family medicine/primary care domain and addressing One Health-related concepts (antimicrobial resistance, zoonotic disease, climate/environmental health, veterinary-medicine collaboration, foodborne/waterborne pathologies) were included. Editorials, letters, and meeting abstracts were excluded at the full-text stage.
Results
A total of 1,735 unique records were screened; 1,281 records were excluded at the title/abstract stage for failing to meet the thematic intersection criteria; 454 records underwent full-text eligibility assessment; and following the exclusion of 23 records on the basis of publication type, the final synthesis set comprised 431 studies. The largest proportion of studies pertained to antimicrobial resistance/stewardship (n=314; 72.9%), followed by environment-climate-planetary health (n=53), zoonotic diseases (n=45), and the general One Health framework (n=19). A marked increase in publication volume was observed over time, particularly during the 2020–2025 period following the COVID-19 pandemic.
Conclusion
The One Health literature within the family medicine setting continues to develop predominantly along the axis of rational antibiotic use/AMR; however, climate change and planetary health, early diagnosis and management of zoonotic diseases, and veterinary-medical collaboration have gained considerable momentum in recent years. The integration of the primary care role within the One Health framework into curricula, clinical decision-support tools, and health system-level stewardship policies constitutes a priority requirement.
Keywords: Family Medicine, Primary Care, One Health, Antimicrobial Resistance, Zoonosis, Climate Change, Planetary Health, PRISMA.

Abstract
Objective and Aim
Stigma toward individuals with schizophrenia is common in the general population and may also occur among healthcare professionals, potentially affecting access to care and treatment quality. This study aimed to compare attitudes toward schizophrenia among nurses working in general medical services and healthy individuals from the general population.
Materials and Methods
This comparative cross-sectional study included 122 participants: 65 nurses working in general hospital services and 57 healthy individuals from the general population. Sociodemographic characteristics were collected using a structured data form. Attitudes toward schizophrenia were assessed using the 32-item schizophrenia section of the Attitudes Toward Psychiatric Illness Questionnaire developed by the Psychiatric Research and Education Center (PAREM). Responses were categorized as agreement or disagreement, while “no opinion” responses were excluded from the analysis. Statistical analyses were performed using IBM SPSS Statistics version 26, with p<0.05 considered statistically significant. The study was approved by the hospital Ethics Committee (20.07.2023; decision no. 2710), and written informed consent was obtained from all participants.
Results
The groups were comparable in terms of age, gender, and educational level. Significant differences were observed for four questionnaire items. Compared with nurses, participants from the general population were more likely to agree that schizophrenia is a condition experienced by everyone from time to time (χ²=3.842, p=0.050), considered schizophrenia more treatable (χ²=12.25, p<0.001), and had more positive attitudes toward the effectiveness of medication (χ²=8.52, p=0.004). Nurses were more likely to express negative attitudes toward the benefit of psychotherapy (χ²=4.73, p=0.030). Both groups demonstrated substantial stigmatizing beliefs. Schizophrenia was perceived as a sign of mental weakness by 68.9% of nurses and 83.0% of the general population. Furthermore, 72.6% of nurses and 57.1% of the general population believed that individuals with schizophrenia never fully recover. High levels of social distance were also evident, particularly regarding marriage, employment, and renting a house. Both groups frequently perceived individuals with schizophrenia as aggressive or unable to make appropriate decisions about their lives.
Conclusion
Nurses working in general medical services did not demonstrate more positive attitudes toward schizophrenia than the general population and showed particularly negative perceptions regarding treatment effectiveness and recovery. These findings indicate that stigma toward schizophrenia may persist within general healthcare settings. Strengthening mental health education, increasing contact with individuals with mental disorders, and incorporating psychiatric rotations or experiential learning into general nursing education may help reduce stigma and improve the quality of care provided to individuals with schizophrenia.
Keywords: Schizophrenia, Stigma, Attitudes, Nurses, Mental Health.

Abstract
Objective and Aim
Functional constipation (FC) is the most common gastrointestinal complaint in childhood. Dermatoglyphics are epidermal ridges used to study the role of genetic factors in various diseases. As they originate from ectoderm during same embryonic period with enteric nervous system, a potential ontogenetic link may exist. It was aimed to investigate the relationship between FC and dermatoglyphics, and to illuminate the etiology.
Materials and Methods
This prospective case-control study was conducted on children aged 2-12 years who applied to our hospital pediatric surgery polyclinic. The case group was included 86 children with FC, while control group was consisted of 86 without constipation. Children’s dermatoglyphic sample patterns, the ridge counts, and palmar angles were taken with the help of a printer, digitized, and the findings were compared using SPSS vers.23.0. A p value <0.05 was accepted statistically significant.
Results
An increase in the number of whorl pattern on the left hand’s V. finger was detected in FC (p=0.024). In girls’ first finger on the left hand, an increase in the number of whorls and a decrease in the number of ulnar loops were observed (p=0.025). In boys with FC, the right hand “dat” angle was lower (p=0.048), but the number of whorls was similar. In terms of arch positivity, no significant difference was found between the groups.
Conclusion
No direct relationship was found between dermatoglyphics and FC. However, the “dat” angle, the number of whorl and ulnar loops patterns may be used as additional markers to aid in elucidating the etiology of FC.
Keywords: Child, Constipation, Dermatoglyphics, Etiology, Ontogenetic.