Proton pump inhibitors (PPIs) are recommended for the prevention of gastrointestinal bleeding in acute coronary syndrome (ACS) patients who receive dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) but have been associated with an increased risk of major adverse cardiovascular events (MACE) in these patients. We aimed to investigate the relationship between serum asymmetric dimethylarginine (ADMA) and copeptin levels and MACE in those who started on imminent DAPT and PPI therapy after PCI. 90 patients with ACS were included in this prospective observational study and divided into three groups lansoprazole (n=30), rabeprazole (n=31), and pantoprazole (n=29). The serum ADMA and copeptin levels were examined at the time of diagnosis, at the end of 1st and 6th month. MACE was defined as mortality, recurrent AMI (acute myocardial infarction), and CST (coronary stent thrombosis) development after PCI. MACE developed in two patients in the first month and eight patients (8.9%) after six months of follow-up. At six months, CST was seen in only two patients (2.2%). At the first-month evaluation, while a significant increase was observed in serum ADMA levels at the time of admission (p<0.001), the copeptin levels decreased significantly in all patients (p<0.001). In the 6th month, the serum ADMA and copeptin levels significantly increased compared to the time of admission and 1st-month evaluation in all groups (p<0.001). PPIs might significantly influence serum ADMA and copeptin levels in patients undergoing coronary stenting due to ACS. Nevertheless, we did not notice clinical extrapolation of the potential effects.

Sleep-wake disorders are probably a part of Nonalcoholic Fatty Liver Disease (NAFLD) etiology. This study aimed to evaluate the relationship between NAFLD and the Pittsburgh Sleep Quality Index (PSQI) components. Sleep quality was assessed by the PSQI, which comprised seven components. Participants diagnosed with hepatic steatosis using ultrasonographic imaging and healthy volunteers were given the questionnaire. The percentage of subjects with poor sleep quality was noticeably higher in the NAFLD patients than in the non-NAFLD control group (OR: 4.58, 95% CI: 2.67-7.85) (p<0.001). Compared to the control group, the NAFLD group reported shorter sleep duration (p=0.044), a longer sleep onset delay (p<0.001), worse subjective sleep quality (p<0.001), a higher percentage of subjects with sleep disturbances (p<0.001), a higher percentage of subjects using hypnotic drugs (p=0.009), and a higher percentage of subjects with daytime dysfunction (p<0.001). When the subjects were split into two groups based on gender, global PSQI sleep quality and subjective sleep quality were significantly worse in both genders with NAFLD than in the non-NAFLD group (p<0.001). The sleep onset delay of the NAFLD group was substantially longer in males (p=0.002) and females (p<0.001) compared to controls. Sleep disturbances were significantly higher in both sexes with NAFLD compared to controls (p<0.001). The rate of those with daytime dysfunction in the NAFLD group was considerably higher in both genders compared to the non-NAFLD group (p=0.001). Only among the male patients in the NAFLD group the prevalence of hypnotic drug use was substantially greater (p=0.033) than in the non-NAFLD group. Poor sleep was associated with NAFLD in both genders.

Irritable bowel syndrome (IBS) is a functional digestive disorder that affects medical students at a higher rate than the general population. Intern doctors are the most affected class by IBS among medical students. Determining the prevalence of IBS and associated risk factors is essential for taking preventive measures. We aimed to investigate the prevalence and predictors of IBS among intern doctors in this study. This study was conducted using an online survey for intern doctors in the 2021-2022 academic year. Rome IV criteria were utilized for IBS diagnosis. Anxiety and depression scores were calculated according to the Hospital Anxiety and Depression Scale (HADS). The prevalence of IBS in the 249 participants was 31.7% included in this study. 32.1% of all participants had depression, 44.2% had anxiety, 65.1% had sleep disorders, 73.1% had MSE (medical specialty exam) anxiety, and 96% were concerned about carrying out the medical profession after graduating from university. Female gender (p<0.001), using regular medication (p=0.019), not exercising regularly (p=0.002), sleep disturbance (p<0.001), food hypersensitivity (p=0.001), having a history of severe acute gastroenteritis (AGE) before IBS symptoms started (p<0.001), IBS in first-degree relatives (p<0.001), be low income (p<0.001), having a divorced parent (p=0.008), not having siblings (p=0.002), severe emotional stress history in the last six months (p=0.004), having depression (p<0.001), having anxiety (p<0.001), and MSE anxiety (p<0.001) identified as risk factors associated with IBS. The multivariant analysis determined independent risk factors affecting the prevalence of IBS in intern doctors as female gender, depression, anxiety, and severe AGE history before IBS symptoms started. In this study, it was determined that approximately one-third of the interns were diagnosed with IBS. Stress management training can be considered to screen this group for IBS and psychological problems and to help them cope with these stressors.