Acta Medica Ruha

Monoclonal Gammopathy with Isolated CA 19-9 Elevation: A Rare Case

Uğur Ergün — 2025-09-20

Objective: CA 19-9 is a tumor marker used in the diagnosis of pancreatic and gastrointestinal cancers, but its isolated elevation can also be seen in benign conditions.

Method and Result: A 48-year-old man presented with complaints of abdominal pain and malaise and a CA 19-9 level of 500 U/mL. Imaging studies did not show malignancy. Serum protein electrophoresis revealed IgG class monoclonal protein and bone marrow biopsy was normal. The patient was diagnosed with monoclonal gammopathy of unknown significance. Six months later, CA 19-9 level decreased to 300 U/mL and no malignancy developed.

Conclusion: Isolated CA 19-9 elevation may be associated with causes other than malignancy and may be related to monoclonal gammopathy. In such cases, careful evaluation and unnecessary procedures should be avoided.

A Rare Case: Purple Urine Bag Syndrome

Pınar Baydar Yucel — 2025-09-20

Purple Urine Bag Syndrome (PUBS) is a rare condition resulting from the interaction of indigo (blue) and indirubin (red) pigments—produced via various metabolic pathways from tryptophan—with polyvinyl chloride (PVC) in urinary catheters. Constipation plays a significant role in the pathogenesis. In addition, it may occur in patients with urinary tract infections or those with long-term indwelling bladder catheters. Although it is generally a benign clinical condition, it may be an early indicator of a serious urinary tract infection.

Emerging Paradigms in Cardiovascular Medicine: The Role of Biomarkers, Artificial Intelligence, and Gut Microbiota in Personalized Therapy — The Evolving Landscape of Cardiovascular Care

Ezhar Ersöz — 2025-09-20

Introduction: Cardiovascular diseases (CVDs) remain one of the leading causes of morbidity and mortality worldwide. While conventional diagnostic and therapeutic methods have made significant contributions, they may fall short in detecting the disease at early stages and in developing personalized treament strategies.

Objective: This review discusses three innovative approaches—biomarker-based analyses, artificial intelligence (AI)-assisted decision systems, and gut microbiota-focused applications—that have rapidly advanced in recent years and are expanding in their potential clinical applications.

Methods: With the advent of next-generation biomarkers (e.g., soluble urokinase-type plasminogen activator receptor [suPAR], suppression of tumorigenicity 2 [ST2], galectin-3, and growth differentiation factor-15 [GDF-15]), processes such as heart failure, myocardial injury, and vascular inflammation can now be assessed more sensitively and at earlier stages.

Results: AI algorithms accelerate and enhance diagnostic accuracy by analyzing imaging data, electrocardiogram (ECG) signals, and multivariate clinical parameters. Meanwhile, the influence of gut microbiota on cardiovascular pathophysiology is increasingly understood, with microbial metabolites such as trimethylamine-N-oxide (TMAO) shown to play a significant role in atherosclerotic processes.

Conclusion: A comprehensive evaluation of these three approaches offers new perspectives for the development of personalized cardiology practices and lays the groundwork for more effective strategies in diagnosis, monitoring, and treatment.

The Effect of Breast Milk and Breastfeeding Education Given to Prenatal Mothers on Postnatal Breastfeeding Behaviors and Attitudes

Özlem Öztürk — 2025-09-20

Introduction: Antenatal breastfeeding education plays a crucial role in positively shaping mothers' postnatal attitudes and practices, thereby promoting sustained breastfeeding and enhancing neonatal health outcomes.

Objective: This study aimed to evaluate the effects of breast milk and breastfeeding education provided to antenatal mothers on their postnatal breastfeeding behaviors and attitudes.

Methods: A descriptive and cross-sectional study was conducted at the Department of Obstetrics and Gynecology at Ankara University Cebeci Research and Practice Hospital between August 2021 and August 2023. In the study, data were collected from 199 mothers who gave birth at 36 weeks or more in the Obstetrics and Gynecology clinic, who were not separated from their babies for any reason after birth, who did not have any health problems that could prevent breastfeeding, and who agreed to participate in the study, using the Descriptive Characteristics Form, the Effects of Breast Milk and Breastfeeding Education on Postpartum Breastfeeding Behaviors Form, and the Breastfeeding Attitude Assessment Scale questionnaires 6 months after birth. Descriptive analysis, one-way ANOVA test, and independent groups t-test were used for statistical analysis.

Results: Among the 199 mothers, 100 received prenatal education on breastfeeding, while 99 did not. Notably, 97% of mothers who received training planned to breastfeed for over two years, compared to only 8.1% of those without training (p<0.01). Additionally, the average score on the breastfeeding attitude scale was significantly higher in the educated group (132.14±8.42) than in the uneducated group (68.28±10.85) (p<0.01).

Conclusion: It was found that mothers who received antenatal breast milk and breastfeeding education had better postnatal breastfeeding attitudes and breastfed longer than mothers who did not receive education. There was no difference in duration of first breastfeeding or duration of first skin-to-skin contact between mothers who received education and those who did not.

Religious Coping, Hopelessness and Quality of Life in Mothers of Children in Pediatric Cardiac Surgery Intensive Care Unit

Fatma Bozdag — 2025-09-20

Introduction: Congenital heart diseases are among the leading causes of infant mortality.

Objective: This research investigated the religious coping, hopelessness and quality of life in mothers of children who underwent open heart surgery and were hospitalized in the Pediatric Cardiac Surgery Intensive Care Unit.

Methods: In the study, data were collected from 225 mothers whose children underwent open-heart surgery using a Demographic Form, Religious and Spiritual Coping Scale, Beck Hopelessness Scale, and Quality of Life Scale.

Results: It was found that while the hopelessness sub-dimension and total score and the negative religious coping scale sub-dimension mean scores were low, the positive religious coping scale sub-dimension mean scores were high and the quality of life scale mean scores were moderate. It was determined that there was a negative relationship between the negative religious coping sub-dimension and the quality of life scale's general health status, social relations, and environment sub-dimensions, and between the quality of life scale and the hopelessness scale.

Conclusion: It can be said that more studies are needed to understand the relationship between the religious coping styles of mothers with children with congenital heart disease and their levels of hope and quality of life, and to eliminate the contradictions in the literature.

Is Preoperative Upper Gastrointestinal Endoscopy Necessary Before Cholecystectomy?

Murat Aba — 2025-09-20

Introduction: Cholecystectomy is one of the most frequently performed surgical procedures for the treatment of gallbladder diseases. However, the persistence of symptoms or the emergence of new gastrointestinal complaints in some patients post-cholecystectomy remains a notable concern. The literature indicates an increased incidence of alkaline reflux gastritis in the long term following cholecystectomy. Nevertheless, the preoperative status of the gastric mucosa and the presence of Helicobacter pylori (H. pylori) infection in these patients have not been sufficiently investigated. This study aims to evaluate preoperative upper gastrointestinal endoscopy (UGIE) findings in patients undergoing cholecystectomy to determine the prevalence of chronic gastritis and H. pylori infection. Additionally, we seek to analyze the association between preoperative findings and the persistence of postoperative symptoms, thereby contributing to clinical strategies for post-cholecystectomy patient management.

Methods: In this retrospective study, 465 patients who underwent cholecystectomy within the past year were reviewed. Among these, 50 patients (29 female, 21 male) who had undergone preoperative UGIE were included. Of the 465 patients reviewed, only those who had undergone preoperative UGIE and met the inclusion criteria (laparoscopic cholecystectomy, no gastrointestinal malignancy) were included, resulting in a final cohort of 50 patients. Demographic characteristics and endoscopic biopsy results were analyzed. Statistical evaluation was performed using SPSS software.

Results: The study cohort of 50 patients comprised 56% females and 44% males, with a mean age of 42.3 ± 12.1 years. Chronic gastritis was identified in 68% of patients, and H. pylori positivity was detected in 52%.

Conclusions: Preoperative evaluation of gastric mucosa and consideration of H. pylori eradication in patients undergoing cholecystectomy may hold clinical significance for managing postoperative symptoms. Routine preoperative endoscopy may be beneficial in identifying patients at risk for persistent postoperative symptoms.