GÝRÝÞ ve AMAÇ: Gebelikte yüksek olduðu düþünülen TSH deðerlerinin (≥2,5 ve <4 uIU/mL) fetomaternal etkilerini incelemek.


YÖNTEM ve GEREÇLER: 0cak 2017 ile Aralýk 2017 tarihleri arasýnda, Ýstanbul Kartal Eðitim ve Araþtýrma Hastanesi gebe polikliniðine baþvuran, gebeliðin ilk trimesterindeki TSH deðerleri >0,3 ve <4 uIU/mL olan ve gebelik boyunca kliniðimizde takip edilerek doðumu yine kliniðimizde gerçekleþen gebeler çalýþmaya dahil edildi. Hasta dosyalarý retrospektif olarak tarandý. Kriterlere uygun 518 hasta, gebelik baþlangýç TSH deðerlerine göre 2 gruba ayrýldý; Grup 1 TSH <2,5 uIU/mL (n: 410), Grup2 ise TSH ≥2,5 ve <4 uIU/mL olan hastalardan (n: 108) oluþturuldu. Hastalarýn demografik bulgularý ve kötü gebelik sonuçlarý karþýlaþtýrýldý.
BULGULAR: Hastalarýn gebelik baþlangýcý TSH deðerlerine göre oluþturulan 2 grubun demografik özellikleri birbiriyle karþýlaþtýrýldýðýnda gruplar arasýnda istatiksel olarak anlamlý fark izlenmedi (p<0,05). Gruplar kötü gebelik sonuçlarý (KGS) açýsýndan karþýlaþtýrýldýðýnda da istatiksel olarak anlamlý fark izlenmedi (p: 0,852; OR: 1,067; CI: 0.541-2.102).
TARTIÞMA ve SONUÇ: Gebelikte subklinik hipotroidi vakalarýnda, ilaç kullanýmýnýn olmamasý KGS’ye neden olmamaktadýr.

INTRODUCTION: To examine the fetomaternal effects of TSH values considered to be high (≥2.5 and <4 μIU/mL) during pregnancy.
METHODS: Pregnant women admitted to the obstetrical outpatient clinic of Istanbul Kartal Training and Research Hospital between January 2017 and December 2017 with TSH values >0.3 and <4 μIU/mL in the first trimester of their pregnancy who were followed up in our clinic until giving birth were included to the study. Patient files were reviewed retrospectively. The 518 patients meeting the criteria were divided into 2 groups according to their initial TSH values; Group 1 consisted of patients with TSH <2.5 μIU/mL (n=410), and Group 2 of patients with TSH ≥2.5 and <4 μIU/mL (n=108). Demographic characteristics and poor pregnancy outcomes (PPO) of the patients were compared.
RESULTS: Comparing the demographic characteristics of the two groups formed according to the patients’ TSH values at the onset of their pregnancy, no statistically significant differences were found (p<0.05). When the two groups were compared in terms of poor pregnancy outcomes (PPO), no statistically significant difference was found either (p=.852; OR: 1.067; CI: 0.541-2.102).
DISCUSSION AND CONCLUSION: In cases of subclinical hypothyroidism during pregnancy, refraining from medication does not cause PPO.

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GÝRÝÞ ve AMAÇ: Enuresis nokturna, çocuklarýn emosyonel durumu, sosyal geliþimi ve öz saygýsý üzerine olumsuz etkilerinin olmasý, çeþitli psikiyatrik durumlarla da birliktelik gösterebilen önemli bir saðlýk sorunudur. Obesite, kanser gibi kronik hastalýðý olan çocuklarýn yaþam kalitesinin düþtüðü bildirilmiþtir. Çocuklardaki olumsuz yaþam olaylarýnýn, olumsuz biliþsel yapýnýn geliþimine ve eriþkinlik dönemi ruhsal sorunlarýna yol açtýðý bildirilmiþtir.. Bu çalýþmada, primer enuresis nokturna tanýlý 8-17 yaþ grubu olgularýn sosyal ve ruhsal iyilik hallerinin, “Çocuklar için Yaþam Kalitesi Ölçeði”(ÇÝYKÖ) ile, geliþebilecek olumsuz biliþsel yapýlarýnýn ise “Çocukluktaki Olumsuz Düþünceleri Deðerlendirme Ölçeði”(ÇODDÖ) ile deðerlendirilmesi amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Çalýþmaya ailelerinden yazýlý onam alýnarak dahil edilen tüm çocuklara “Çocuklar için Yaþam Kalitesi Ölçeði” ve “Çocukluktaki Olumsuz Düþünceleri Deðerlendirme Ölçeði” anketleri uygulanmýþtýr. Ýstatistiksel analizler için NCSS(Number Cruncher Statistical System) 2007(Kaysville, Utah, USA) programý kullanýlmýþtýr
BULGULAR: Çalýþmaya, %39.3’ü (n=59) kýz, %60.7’si (n=91) erkek; 8-17 yaþ arasýnda ortalama 10.40±2.07 yýl yaþ olmak üzere 150 çocuk alýnmýþtýr. Enuretik olan çalýþma grubundaki çocuklarýn ÇÝYKÖ toplam puaný, saðlýklý çocuklardan anlamlý derecede daha düþük bulunmuþtur (p=0.001; p<0.01). Enuretik çocuklarýn ÇODDÖ toplam puanlarý, kontrol grubundan anlamlý derecede daha yüksektir (p=0.001; p<0.01).
TARTIÞMA ve SONUÇ: Bilgilerimize göre, bu çalýþmada ilk kez gösterildiði üzere; primer enuresis nokturnalý çocuklarda, olumsuz düþünceler geliþmekte; bunun yanýnda, saðlýklý akranlarýna kýyasla, yaþam kalitelerinin belirgin düþük olduðunu gözlemlenmiþtir.

INTRODUCTION: Enuresis nocturna is an important health problem having adverse effects on the child’s emotional state, social development and self-esteem and might be associated with various psychiatric conditions. Children with chronic diseases such as obesity and cancer have been reported to have decreased life quality. It has been reported that adverse life events in children lead to development of negative cognitive structure and mental problems in adulthood. It was aimed to evaluate the social and psychological well-being of 8-17 age group cases diagnosed with primary enuresis nocturna through “Pediatric Quality of Life Questionnaire (PedsQL)” and the probable negative cognitive structures for the same group through “Children’s Negative Cognitive Error Questionnaire (CNCEQ).”
METHODS: “Pediatric Quality of Life Questionnaire (PedsQL)” and “Children’s Negative Cognitive Error Questionnaire (CNCEQ)” were applied to all children included in the study with written consent from their families. The NCSS (Number Cruncher Statistical System) 2007(Kaysville, Utah, USA) program was used for statistical analysis.
RESULTS: In the study, 39.3% (n=59) girls and 60.7% (n=91) boys, 150 children between the ages of 8 and 17 with a mean age of 10.40±2.07 years were included. The total score of children in the enuretic study group had significantly lower PedsQL total score than healthy children (p=0.001; p<0.01). Total CNCEQ total scores of enuretic children were significantly higher than the control group (p=0.001; p<0.01).
DISCUSSION AND CONCLUSION: To our knowledge, we are the first to determine that children with primary nocturnal enuresis develop negative cognitive errors. Besides, it was observed that their quality of life was significantly lower compared to their healthy peers.

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GÝRÝÞ ve AMAÇ: Astým çocukluk çaðýnda en sýk rastlanan kronik hastalýklarýndan birisidir. Lökotrien antagonistleri uzun zamandýr astým tedavisinde kullanýlan ilaçlardýr. Astým tanýsý alan çocuklarda lökotrien reseptör antagonistlerinden zafirlukast ve montelukast tedavi etkinliðini karþýlaþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Çalýþmaya 6-14 yaþ grubunda kýsmi kontrollü astým tanýsý alan 61 hasta dâhil edildi. Hastalar randomize olarak iki gruba ayrýldý. Birinci gruba 5 mg montelukast gece yatmadan, ikinci gruba 10 mg zafirlukast 2 doza bölünerek verildi. Hastalar 6 ay süreyle takip edilerek aylýk vizitlerde gece semptomlarý, gündüz semptomlarý, astým ataðý geçirip geçirmemesi, kýsa etkili beta 2 agonist kullaným ihtiyacý, inhale steroid kullanýmý sorgulandý; üç aylýk sürelerle solunum fonksiyon testleri yapýldý.
BULGULAR: Tedavi sonrasýnda, tedavi öncesine göre her iki grupta: kýsa etkili beta 2agonist kullaným ihtiyacýnýn, gece ve gündüz semptom sýklýðýnýn ve geçirilen atak sayýsýnýn azaldýðý, FEV1 ortalamasýnýn arttýðý, inhalesteroid tedavi kullaným oranýnýn azaldýðý saptandý. Ancak, iki grup arasýnda tedavi etkinliði açýsýndan istatistiki fark saptanmadý.

TARTIÞMA ve SONUÇ: Astým tedavisinde monteluksat ve zafirlukastýnetkili olduðu ve etkileri arasýnda farkolmadýðý saptandý.

INTRODUCTION: Asthma is one of the most common respiratory disorders in clinical practice, affecting up to 13% of people worldwide. Leukotriene antagonists have long been used in the treatment of asthma. This study was conducted to compare the effectiveness of the montelukast and zafirlukast treatment in children diagnosed with asthma.
METHODS: Sixty-one patients diagnosed with asthma in the age group of 6-14 years were included in the study. Patients were consecutively divided into 2 groups, and the first group was given 5 mg of montelukast before sleep and the second group received 10 mg/day of zafirlukast in two doses. The patients were followed up monthly for 6 months. Short acting beta agonist and inhaled corticosteroid use, daytime symptoms, night awakenings, admission to the emergency department and FEV1 value were compared before and after the treatment and between two groups.
RESULTS: Significant improvement was observed in both groups during post-treatment period when compared to the pre-treatment period in terms of the short acting beta agonist and inhaled corticosteroid use, daytime symptoms, night awakenings, mean FEV I. However, no statistical difference was determined between two groups.
DISCUSSION AND CONCLUSION: It was found that monteluksat and zafirlukast were effective in asthma treatment and there was no difference between their effects.

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GÝRÝÞ ve AMAÇ: Gastrointestinal iþlemlerin taný ve tedavisinde endoskopi ve kolonoskopi altýn standartýr. Günübirlik gastrointestinal iþlemlerin baþarýsý, hastanýn deðerlendirilmesi, kooperasyonu, ilaç seçimi, anestezistin ve endoskopistin deneyimine baðlýdýr. Bu çalýþmanýn amacý endoskopi ünitelerinde ardarda uygulanan endoskopi ve kolonoskopide preoperatif anksiyetenin deðerlendirilmesi, önlem alýnmasý ve preemptif analjezide deksketoprofen ve parasetamol’ün karþýlaþtýrýlmasýdýr.
YÖNTEM ve GEREÇLER: Etik kurul onayý ve aydýnlatýlmýþ hasta onamý alýnan, endoskopi ve kolonoskopi uygulanan, 150 hasta (18-60 yaþ, ASAI-II) çalýþmaya alýndý. Demografik verileri (cinsiyet, yaþ, VKÝ), ASA skorlamasý (Amerikan anestezistler derneði), eðitim düzeyi kaydedildi. Hastalara‘Durumluluk-Sürekli Kaygý Ölçeði I-II (STAI I-II) uygulandý. Hastalar endoskopi ünitesinde Numerik Derecelendirme Ölçeði (NRS) ile bilgilendirildi. Gruplara prosedürden 1 saat önce pregabalin verildi. Hastalar 3 gruba ayrýldý, Grup P’ye parasetamol (n=20), Grup D’ye deksketoprofen (n=20), Grup C’ye de 150 cc salin (n=20) verildi. Ýþlemlerin sonunda Ramsey Sedasyon Skalasý 2’nin üzerinde olanlar derlenme ünitesine alýndý. Aðrý düzeyleri 5,30,60,120. dk’da NRS ile deðerlendirildi. Modifiye Derlenme Aldrete skorlamasý (MADS) 9’un üzerinde olma zamanlarý kaydedildi.

BULGULAR: Demografik veriler, ASA, eðitim durumu, anestezi süresi, iþlem süresi, endoskopist, hasta memnuniyeti, iþlem süresi ve NRS arasýnda fark yoktu. MADS 9 olma süresi, Grup D’de, Grup P ve Grup C’ye göre kýsaydý. Sedasyon süresince kullanýlan toplam propofol tüketimi, Grup D’de Grup P ve Grup C’ye göre azalmýþtý.
TARTIÞMA ve SONUÇ: Günübirlik anestezi uygulanan, gastrointestinal iþlemde hastalarýn anksiyetelerinin farkýna varýlmasý ve önlem alýnmasý gereklidir. Preemptif analjezi uygulanarak toplam anestezik ilaç dozu azaltýlýp, taburculuk süresi kýsaltýlabilinir.

INTRODUCTION: Endoscopy and colonoscopy are gold standards for the diagnosis and treatment of gastrointestinal diseases. The success of ambulatory gastrointestinal procedures rely on examination, the cooperation of the patient, drug selection, experience of anesthesiologists with endoscopists. This study aims to assess preoperative anxiety arising from endoscopy and colonoscopy applied successively in endoscopy units, to take precautions accordingly and to compare dexketoprofen and paracetamol for preemptive analgesia.
METHODS: In this study, 150 patients (ASA I-II,18-60 years) who were scheduled to go under endoscopy and colonoscopy were included. Demographic data (gender, age, BMI), American Society of Anesthesiologists(ASA) scores and education background were recorded. State-Trait Anxiety Inventory I-II(STAI I-II) testes were applied to the patients.
RESULTS: Patients were informed by the Numerical Rating Scale (NRS) in the endoscopy unit. Pregabalin was administered one hour before the procedure as per established procedures in all groups. Patients were divided into three groups, paracetamol in group P (n=20), dexketoprofen in group D (n=20), and saline in Group C (n=20) were administered. At the end of the procedure, patients above 2, according to the Ramsay Sedation Scale (RSS), were taken to the recovery room. Their pain levels were measured at minutes 5, 30, 60, and 120 following procedure using NRS. The times to reach above 9 of the modified Aldrete recovery score (MARS) were recorded. There was no difference concerning demographics, ASA, education, duration of anesthesia, endoscopist's and patient's satisfaction, duration of the procedure, and NRS levels. The time to reach MARS 9 was shorter in Group D than Group P, and C. Total propofol consumption throughout sedation was less in Group D compared to Group P and C.
DISCUSSION AND CONCLUSION: It is necessary to recognize the anxiety of the patients in the gastrointestinal procedure and to take precautions. By applying preemptive analgesia, the total anesthetic dose can be reduced, and discharge time can be shortened.

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GÝRÝÞ ve AMAÇ: Çalýþmada, dikkat, bellek, yürütücü iþlevler, dil, görsel-mekansal ve davranýþsal becerileri deðerlendiren kapsamlý bir nöropsikolojik bataryayla Hafif Kognitif Bozukluk (HKB) ve erken evre Alzheimer Hastalýðýnýn (AH) nöropsikolojik profilleri belirlenmiþtir.
YÖNTEM ve GEREÇLER: Çalýþmaya 60 denek alýnmýþtýr. 20 erken evre AH’li (12 kadýn, 8 erkek) ve bunlarla yaþ, cinsiyet ve eðitim açýsýndan eþlenmiþ 20 HKB’li (10 kadýn, 10 erkek) ve bir bozukluk tanýsý almayan 20 normal yaþlý (9 kadýn, 11 erkek) ile karþýlaþtýrýlmýþtýr.
BULGULAR: Bulgularýmýz göstermektedir ki HKB’nin genel kognitif profili epizodik bellek ve semantik bellek bozukluðu þeklinde kendini göstermektedir. Buna karþýlýk AH’li hastalarda aðýrlýklý olarak epizodik ve semantik bellek ve bunlara katýlan dil, görsel-mekansal beceriler, yürütücü iþlev testlerinden Ýkili Benzerlikler (soyutlama) ve Stroop’ta (enterferansa direnç) bozulma görülmektedir.
TARTIÞMA ve SONUÇ: Bulgular alanyazýn ýþýðýnda tartýþýlmýþtýr.

INTRODUCTION: In this study, neuropsychological profiles of Mild Cognitive Impairment (MCI) and early-stage Alzheimer's Disease (AD) were explored with a comprehensive neuropsychological battery that evaluates attention, memory, executive functions, language, visual-spatial, and behavioral skills.
METHODS: In this study, 60 people with minimum primary school degree were included. Twenty people of those with early-stage AD (12 women, 8 men), while 20 people were with MCI (10 women, 10 men). These groups were matched for age, sex and education with 20 normal elderly subjects (9 female, 11 male).
RESULTS: Our findings showed that the general cognitive profile of MCI is manifested as episodic memory and a semantic memory disorder. In contrast, in early-stage AD patients, language, visual-spatial skills, executive function, abstraction and interference resistance skills were found to be impaired and episodic and semantic memory problems were observed.
DISCUSSION AND CONCLUSION: The results of the present study suggesting a distinguished profile of MCI can be a promising factor in distinguishing the fine boundary between MCI and early-stage AD with an opportunity for early diagnosis and treatment of AD in the Turkish sample.

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GÝRÝÞ ve AMAÇ: Geniþlemiþ spektrumlu beta laktamaz (GSBL) beta laktam antibiyotikleri hidrolize ederek bu antibiyotiklerin kullaným alanlarýný sýnýrlayan önemli bir direnç kaynaðýdýr. GSBL üretiminin doðru bir þekilde saptanmasýnda, kullanýlacak yöntem son derece önemlidir. Antibiyotik duyarlýlýklarýnýn belirlenmesinde Clinical Laboratory Standards Institute (CLSI) ve European Committee on Antimicrobial Susceptibility Testing (EUCAST) en yaygýn olarak kullanýlan iki standarttýr. Bu çalýþmada bu iki standartýn GSBL tespitine yönelik duyarlýlýk ve özgüllüklerinin araþtýrýlmasý amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Çalýþmamýza Nisan 2014-Temmuz 2014 tarihleri arasýnda Haydarpaþa Numune Eðitim ve Araþtýrma Hastanesi Týbbi Mikrobiyoloji Laboratuvarýna gönderilen idrar örneklerinden GSBL ürettiði belirlenen 76 ve GSBL negatif 74 izolat dahil edilmiþtir. Tarama testleri için seftazidim (10µg ve 30µg), sefotaksim (5µg ve 30µg), seftriakson (30µg), sefpodoksim (10µg), sefepim (30µg) ve aztreonam (30µg) diskleri kullanýlmýþtýr. Doðrulama testleri için çift disk sinerji testi ve kombinasyon disk yöntemi uygulanmýþtýr. Moleküler doðrulama testi için CTX-M, TEM ve SHV gen bölgelerinin varlýðý polimeraz zincir reaksiyonu (PZR) ile saptanmýþtýr.
BULGULAR: Çalýþmamýzda GSBL üreten izolatlarýn %86.8’i CTX-M, %47.4’ü TEM ve %9.2’si SHV olarak bulunmuþtur. Bazý izolatlarda birden fazla direnç geni saptanmýþtýr. GSBL üreten izolatlarýn beta laktam duyarlýlýklarý CLSI ve EUCAST kriterleri kullanýlarak sýrasýyla seftazidim için %29.2 ve %19.7, sefepim için %14.5 ve %15.8, aztreonam için %2.6 ve %13.2 olarak bulunmuþtur. GSBL tarama testi için duyarlýlýk ve özgüllük dengesi en iyi disk EUCAST kriterlerine göre yorumlanan sefpodoksim diski olarak saptanmýþtýr. Bunu CLSI kriterleriyle yorumlanan sefpodoksim, ve her iki standardýn de benzer duyarlýlýk ve özgüllük gösterdiði sefotaksim ve seftriakson diskleri izlemiþtir.
TARTIÞMA ve SONUÇ: GSBL üretiminin tespitinde CLSI ve EUCAST kriterlerinin birbirine anlamlý bir üstünlüðü saptanmamýþtýr. EUCAST’in seftazidim ve sefotaksim için tarama ve doðrulama disk difüzyon testlerinde farklý içeriklerde diskler önermesinin özellikle seftazidimde duyarlýlýk artýþýný saðlamakla birlikte pratikte kullaným zorluðuna sebep olacaðýný düþünmekteyiz. Her iki standart için de tarama testlerinde sefpodoksim, sefotaksim veya seftriakson; doðrulama testlerinde ise sefotaksim ve sefotaksim-klavulonat disklerinin kullanýlmasý daha doðru sonuç verilmesini saðlayacaktýr.

INTRODUCTION: Expanded spectrum beta-lactamase is a critical source that is limiting the using areas of beta-lactam antibiotics by hydrolysing them. The method to be used for accurate detection of ESBL production is significant. CLSI and EUCAST are the two most commonly used standards for the determination of antibiotic susceptibility. This study aimed to investigate the sensitivity and specificity of these standards for ESBL detection.
METHODS: This study includes 76 ESBL producers and 74 ESBL negative strains, which were isolated from urine specimens that sent to the Medical Microbiology Laboratory of Haydarpasa Numune Training and Research Hospital from April to July 2014. For screening tests, ceftazidime (10µg and 30µg), cefotaxime (5µg and 30µg), ceftriaxone (30µg), cefpodoxime (10µg), cefepime (30µg) ve aztreonam (30µg) disks; for confirmation tests double-disk synergy and combination disk method were used. For molecular confirmation tests, CTX-M, TEM and SHV resistance genes were investigated by polymerase chain reaction.
RESULTS: ESBL producing isolates were found at 86.8% as CTX-M, 47.4% as TEM and 9.2% as SHV. More than one resistance gene was detected in some isolates. Beta-lactam susceptibilities of ESBL producers with CLSI and EUCAST breakpoints were 29.2% and 19.7% for ceftazidime, 14.5% and 15.8% for cefepime, 2.6% and 13.2% for aztreonam, respectively. Among the screening disks, cefpodoxime (interpreted by EUCAST criteria), showed the highest sensitivity and specificity. This was followed by cefpodoxime (CLSI), cefotaxime and ceftriaxone with similar sensitivity and specificity for both standards.
DISCUSSION AND CONCLUSION: There was no significant difference between CLSI and EUCAST in determining ESBL production. The suggestion of EUCAST that using different disks for screening and confirmation tests increases the sensitivity of detecting ESBL, especially in ceftazidime; however, it may cause practical difficulties. For both standards, the use of cefpodoxime, cefotaxime or ceftriaxone disks in screening and; cefotaxime and cefotaxime- clavulanate disks in confirmation tests will provide more accurate results.

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GÝRÝÞ ve AMAÇ: Akut astým ataðý için standart tedavi beta-2 agonistler, oksijen ve sistemik kortikosteroidleri içerir. Son yýllarda bu tedavi protokolünün yaygýn kullanýmý olmasýna raðmen, bazý çocuklarda yeterli yanýt alýnamamasý ilave tedavileri düþündürmektedir. Çocuklarda orta ve aðýr astým ataðýnda ipratropium bromidin (IB) etkinliðini belirlemek amacýyla bu çalýþmayý planladýk.
YÖNTEM ve GEREÇLER: Ýstanbul Üniversitesi Cerrahpaþa Týp Fakültesi, Çocuk Saðlýðý ve Hastalýklarý Ana Bilim Dalý Acil birimine akut astým alevlenmesi nedeniyle baþvuran orta ve aðýr astýmlý çocuklar çalýþmaya dahil edildiler. Randomize olarak iki gruba ayrýlan hastalarýn hepsine ortak olarak yirmi dakika arayla beta-2 agonist ve 2 mg/kg kortikosteroid tedavisi uygulanýrken; tedavi grubuna ayný þekilde yirmi dakika arayla ÝB, kontrol grubuna ise serum fizyolojik verildi. Çalýþmanýn baþýnda, her tedaviden önce ve tedavinin üçüncü gününde hastalar klinik astým skoru ve Peak Ekspiratuar Flow Rate (PEFR) düzeyleri ile deðerlendirildiler.
BULGULAR: Üç ila 18 yaþ arasýndaki hastalarý içeren iki grubun hastaneye yatma oranlarýnda anlamlý bir fark yoktu. Kombine tedavi uygulanan vakalar ile (beta-2 agonist + ÝB) tek baþýna beta-2 agonist kullanýlan olgular kýyaslandýðýnda; tedavi baþlandýktan sonraki kýrkýncý dakikada kombine tedav uygulanan grupta gerek klinik ve gerekse de klinik astým skorunda istatistiksel olarak anlamlý bir düzelme görülürken, PEFR deðerlerinde de anlamlý bir artýþ saðlandýðý gösterildi
TARTIÞMA ve SONUÇ: Çalýþmamýzýn sonucunda, orta ve aðýr astým ataðý geçiren çocuklarda beta-2 agonist tedaviye eklenen ipratropium bromidin etkili ve güvenli olduðu saptandý

INTRODUCTION: Standard therapy for acute asthma attack includes beta 2 agonists, O2 and systemic corticosteroids. Although there is a widespread usage of this therapy protocol in recent years, as some of the children still need hospitalization because of incomplete responses, adjunctive therapy measures should be considered. We planned this study protocol to assess the effects of ipratropium bromide (IB) for moderate and severe childhood asthma attacks.
METHODS: All of the consecutive 50 children admitted to the Pediatric Emergency Service of Ýstanbul University Cerrahpaþa Medicine Faculty were included in our study. All patients received short duration β2-adrenergic agonists and methylprednisolone consistent with current practice guidelines; then, they were randomized into two groups. While the first group received IB (250 µg/dosage) three times with 20 minutes of intervals, the second group received serum physiologic. Before each therapy regimen and at the 72nd hour, clinical asthma scores (CAS) and peak expiratory flow rates (PEF) of the patients were screened and their hospitalization status was recorded.
RESULTS: There was not any significant difference in the hospitalization status of the two groups, which included patients aged three to 18 years. Clinical asthma scores and PEFR of the first and second group of patients had a statistically significant difference beginning from the 40th minute.
DISCUSSION AND CONCLUSION: In our study, we reported that IB added to the standard therapy regimen of moderate and severe childhood asthma attacks was efficient and did not have any adverse effect.

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GÝRÝÞ ve AMAÇ: Streptcoccus pneumoniae (pnömokok) tüm dünyada çocuklarda pnömoniye baðlý ciddi hastalýðýn en önemli sebebidir.Biz bu çalýþmada, saðlýklý çocuklarda Streptcoccus pneumoniae’nin nazofarengeal taþýyýcýlýðýný, iliþkili risk faktörlerini ve nazofarengeal örneklerde pnömokok serotiplerini deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Bu çalýþma 6 ay-6 yaþ arasý kreþe giden 310 saðlýklý çocukta yapýldý. Çocuklarýn aile kalabalýklýðý, kardeþ sayýsý, aþýlanma durumu ve kreþe devam süreleri deðerlendirildi. Nazofarengeal örnekler toplandý, serotipler belirlendi.
BULGULAR: Ailede üye sayýsý, kardeþ sayýsý ve aþýlanma durumu nazofarengeal pnömokok taþýyýcýlýðýný etkileyen risk faktörleri deðildi. Ancak; çalýþmada kreþe 6 aydan kýsa süre devam eden çocuklarda nazofarengeal taþýyýcýlýk oraný, 6 aydan uzun süre devam eden çocuklara göre daha yüksek bulduk.
TARTIÞMA ve SONUÇ: Biz çalýþmamýzda kreþe devam süresinin nazofarengeal pnömokok taþýyýcýlýðýnda önemli rol oynadýðý sonucunu gösterdik.

INTRODUCTION: Streptococcus pneumoniae (pneumococcus) is a leading cause of severe illness among pneumoniae (pneumococcus children worldwide. In this study, we aimed to evaluate nasopharyngeal carriage of Streptococcus) in healthy children, related risk factors and pneumococcus serotypes isolate in nasopharyngeal swabs.
METHODS: This study was performed in 310 healthy children aged six months to six years who were attending day care centers. Family size, number of siblings, vaccination status and duration of attendance at day care centers were evaluated. Nasopharyngeal specimens were collected, and serotypes of the isolates were identified.
RESULTS: Family size, number of siblings, and vaccination status were not risk factors affecting the nasopharyngeal carriage of pneumococcus. However, we found significantly higher rates of nasopharyngeal pneumococcus carriage in children attending day care centers for less than six months compared to children attending for longer than six months.
DISCUSSION AND CONCLUSION: We demonstrated that the duration of attendance at day care centers played a significant role in the development of nasopharyngeal pneumococcus carriage.

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GÝRÝÞ ve AMAÇ: Kafatasý kemiklerinin tümöral lezyonlarý son derece nadir görülür, genellikle yavaþ geliþen fakat klinik olarak agresif seyir gösterebilen tümörlerdir. Tüm kemik tümörlerinin yaklaþýk %1 i dir. Genellikle benign olarak izlenmekle birlikte malign ve metastatik lezyonlar görülebilir. Primer tümörlerin kalvariuma metastaz insidansý yaklaþýk olarak %12 dir. Genellikle ele gelen aðrýlý ya da aðrýsýz kitle ile farkedilen lezyonlarda, taný yöntemleriyle planlanan cerrahi giriþim sonrasý kesin taný histopatolojik olarak konulabilir. Bu çalýþmada retrospektif olarak histopatolojik tanýnýn ve cerrahi eksizyon miktarýnýn tedavinin devamýnýn planlanmasýndaki önemini vurgulamak amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Bu çalýþmada 2010- 2020 yýllarý arasýnda kliniðimizce opere edilmiþ, histopatolojik taný almýþ 17 olgu üzerin-den olgularýn yaþ ve cinsiyet daðýlýmý, lezyonlarýn yerleþim yeri, cerrahi yöntem, histopatolojik tanýlar ve tercih edilen kranioplasti yöntemleri çalýþmaya dahil edilmiþtir. 17 olgunun 9u erkek (%52), 8i kadýn (%48) idi.Taný konulduðunda olgularda ortalama yaþ 24.3 (2yaþ-49 yaþ) iken olgularýn 7 tanesi çocuk (3 kýz, 4 erkek ) hasta idi. Çalýþmamýzda 17 yaþ altý çocukluk yaþ dönemi olarak deðerlendirmeye alýndý.
BULGULAR: Hastalarýn baþvuru semptomlarý ele gelen aðrýsýz kitle (n: 9),aðrýlý kitle (n: 4), lezyon yerleþimi ile ilgili görme alan defekti ve/veya görme kaybý (n: 1), 7. kranial sinir tutulumuna baðlý fokal nörolojik defisit (n: 1), ekzoftalmus (n: 1), 1 hastada da primer hastalýk için tetkik edilirken insidental taný (n: 1) idi. Lezyonlar frontal kemik (frontal kemik ve orbital tavaný) (n: 9), oksipital kemik (oksipital kemik ve klivus) (n: 5), sfenoid kemik (sfenoid kanat ve parasellar) (n: 1), multiple (n: 2) yerleþimliydi. Hastalarýn birinde baþvuru öncesi metastatik leiomyoma ve birinde de multiple mye-lom tanýsý mevcutken, diðer hastalarda bilinen kronik hastalýk yoktu.
TARTIÞMA ve SONUÇ: Kafa kemiklerinin lezyonlarý nadir rastlanan lezyonlardýr. Bunlar konjenital, inflamatuar, neoplastik lezyonlardýr. Kalvarial lezyonlar üç temel gruba ayrýlarak deðerlendirilebilir: 1-Benign lezyonlar 2-Tümör benzeri lezyonlar 3- Malign lezyonlar. Bu lezyonlar için ayrýntýlý klinik ve radyolojik deðerlendirmeyi takiben, lezyonun mümkün olduðu ölçüde total eksizyonu hastalýðýn prognozu için özellikle önemlidir.

INTRODUCTION: Tumor lesions of the skull bones are extremely rare; they are usually slow-growing but clinically aggressive. They constitute approximately 1% of all bone tumors. Although they are usually benign, malignant and metastatic lesions may also be seen. This retrospective study aimed to emphasize the importance of the histo-pathological diagnosis and surgical excision amount inplanning the treatment in advance.
METHODS: In this study, the age and gender distribution of the cases, the location of the lesions, the surgical method, histopathological diagnoses and the preferred cranioplasty methods were included over 17 cases that were operated by our clinic between 2010-2020. Nine cases were male (52%) and eight cases were female (48%). When the diagnosis was made, the mean age was 24.3 (2 years-49 years) in the cases, while seven of the cases were children (3 girls, 4 boys). In our study, children under 17 were considered as childhood.
RESULTS: The patients’ admission symptoms were palpable pain-free mass (n=9), painful mass (n=4), visual field defect and/or vision loss related to lesion location, focal neurological deficits due to 7th cranial nerve involvement. (n=1), exophthalmos (n=1), and one patient was an incidental diagnosis while examined for primary disease. Lesions exerted locations in the frontal bone (frontal bone and orbital roof) (n=9), occipital bone (occipital bone and clivus) (n=5), sphenoid bone (sphenoid wing and paracellar (n=1), and lesions were multiple in two cases (n=2). One patient had a diagnosis of metastatic leiomyoma before admission and one had multiple myeloma, while the other patients had no known chronic diseases.
DISCUSSION AND CONCLUSION: Lesions of the skull bones are rare in the clinic. Following the detailed clinical and radiological evaluation for these lesions, the total excision of the lesion to the extent possible is particularly important for the prognosis of the disease.

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GÝRÝÞ ve AMAÇ: Medial epikondilin proksimalinde, özellikle dirseðe yaslanarak çalýþmanýn neden olduðu ulnar sinir tuzak nöropatilerinin klinik ve elektrofizyolojik özelliklerini deðerlendirmek.
YÖNTEM ve GEREÇLER: Bu çalýþma retrospektif bir çalýþmadýr. Nöroloji Kliniði EMG Laboratuvarý'na dördüncü ve beþinci parmaklarda uyuþma ve ulnar güçsüzlük þikayetleri ile baþvuran ve elektrofizyolojik incelemelerinde ulnar tuzak nöropati saptanan 234 hastadan, medial epikondil proksimalinde ulnar tuzak nöropati saptanan 175 (% 74,78) hastanýn elektrofizyolojik ve klinik muayenelerinden elde edilen bulgular istatistiksel olarak incelendi.
BULGULAR: Hastalarýn % 96.57'sinde tuzak sol tarafta iken, % 3.43'ünde sað taraftaydý (p <0.001). Ulnar tuzak nöropati ile el baskýnlýðý arasýndaki iliþki istatistiksel olarak anlamlýydý. Ulnar sinir motor yanýtlarý dirsek üstü, dirsek altý ve bilek olmak üzere incelendi. Dirsek üstü latans, ileti süresi, amplitüd ve alan yanýtlarý sýrasýyla 8.69 ± 1.24 ms, 12.56 ± 2.73 ms, 3.64 ± 2.24 mV ve 11.62 ± 7.37 mV*ms olarak ölçüldü. Amplitüd ve alan yanýt ortalamalarý bilek ve dirsek altý ölçüm sonuçlarýna göre istatistiksel olarak anlamlý þekilde azalmýþ, latans ise anlamlý olarak uzamýþ olarak bulundu (sýrasýyla p<0.001, p<0.001, p<0.001). Ulnar sinir yanýt süresinde gruplar arasýnda istatistiksel fark saptanmadý (p>0.05). Dirsek üstü-dirsek altý ileti hýzý 33.98 ± 8.35m/s, dirsek altý-bilek ileti hýzý ise 61.99 ± 4.23m/s olarak ölçüldü. Dirsek üstü-dirsek altý ileti hýzý istatistiksel olarak anlamlý düzeyde yavaþ olarak saptandý (p<0.001). Hastalarýn lezyon tipine göre daðýlýmý incelendiðinde 146 (% 83.4) hastada demiyelinizan lezyonlar, 29 (% 16.6) hastada aksonal lezyonlar gözlendi.
TARTIÞMA ve SONUÇ: Tüm ulnar sinir tuzaklarýnda en sýk görülen durum, medial epikondil proksimalinde ulnar sinir tuzaklanmasý olarak saptandý. Bu akut tuzaklanma, el baskýnlýðý ile iliþkili ve en yaygýn olarak demiyelinizan karakterdeydi.

INTRODUCTION: To evaluate the clinical and electrophysiologic features of ulnar nerve entrapment neuropathies proximal to the medial epicondyle, especially those caused by working while leaning on the elbow.
METHODS: In this study, the data of 234 patients who were admitted to the EMG Laboratory of the neurology clinic with complaints of numbness in the fourth and fifth fingers, ulnar weakness, and in addition, ulnar entrapment neuropathy was detected in their electrophysiological examinations. In 175 (74.8%) of these patients, ulnar entrapment neuropathy was detected proximal to the medial epicondyle. The study was continued with these 175 patients. The findings obtained from the electrophysiological and clinical examinations of the patients were analyzed.
RESULTS: Entrapment was in the left side in 96.57% of the patients, whereas it was right-sided in 3.43% (p<0.001). Ulnar nerve motor responses Entrapment were investigated as above elbow, under elbow, and wrist. Above elbow latency, motor response duration, amplitude and field results were measured as 8.69±1.24 ms, 12.56±2.73 ms, 3.64±2.24 mV and 11.62±7.37 mV*ms, respectively. When compared the results of above elbow with wrist and under elbow, amplitude and field were decreased and latency were prolonged (p<0.001, p<0.001, p<0.001, respectively). There wasn’t statistical difference between the groups in the ulnar nerve motor response duration (p<0.001). Above elbow to under elbow nerve conduction velocity was 33.98±8.35 m/s, and under elbow to wrist nerve conduction velocity was measured as 61.99±4.23 m/s. Above elbow to under elbow conduction velocity was found to be slower (p<0.001). Demyelinating lesions were detected in 83.4% and axonal lesions in 16.6%.
DISCUSSION AND CONCLUSION: It was shown that ulnar nerve entrapment proximal to medial epicondyle was the most common type among all ulnar nerve entrapments. This acute entrapment was associated with hand dominance and was most commonly seen in demyelinating character.

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GÝRÝÞ ve AMAÇ: Benign tiroid hastalýðý nedeniyle opere ettiðimiz ve patolojisi insidental olarak papiller tiroid mikrokarsinomu (PTMK) gelen olgularla ilgili deneyimimizi paylaþmak
YÖNTEM ve GEREÇLER: Mayýs 2014-Kasým 2017 arasýnda tek cerrah tarafýndan benign tiroid hastalýðý nedeniyle opere edilen toplam 201 hastanýn dosyasý retrospektif incelendi. Tüm hastalarýn ince iðne aspirasyon biyopsisinde benign sitoloji mevcuttu ve tümüne total tiroidektomi uygulandý. Hastalarýn demografik verileri, patoloji bulgularý, tedavi ve sonuçlarý deðerlendirildi.
BULGULAR: Hastalarýn ortalama yaþý 46 (17-78 yaþ aralýðýnda) ve 159’ u (% 79.1) kadýndý. Ýnsidental olarak PTMK tanýsý alan 25 hasta (% 12.4) deðerlendirildi. PTMK nýn ortalama çapý 4.7+2.4 mm idi. Altý hastada (6/25, % 24) tümör multifokal idi ve bunlarýn yarýsýnda tümör odaðý her iki lobdaydý. Bir hastada tümör tiroid kapsülüne infiltre idi. Tüm hastalar supresyon tedavisi aldý ve muhtemel radioiyot tedavisi için nükleer týp bölümüne yönlendirildi. Kapsüle infiltre bir olgu ile multifokal tümörü olan 3 hastanýn radyoiyot tedavisine alýndýðý tespit edildi (% 16). Ortalama takip süresi 2.6 yýl (range, 4-44 ay) idi. Hastalarýn hepsi salimdi ve hastalýklarý nüks etmedi.
TARTIÞMA ve SONUÇ: PTMK un benign tiroid hastalýðý nedeniyle opere edilen olgularda az rastlanan insidental bir antite olduðu söylenemez. Selim tiroid hastalýðý tedavisinde insidental PTMK olasýlýðý akýlda tutulmalý ve total tiroidektominin en azýndan seçilmiþ hasta gruplarýndaki avantajý göz önünde bulundurulmalýdýr.

INTRODUCTION: To present our experience with incidental papillary thyroid microcarcioma (PTMC) in patients operated for presumably benign thyroid disease.
METHODS: he files of 201 patients operated by the same surgeon for benign thyroid diseases from May 2014 to November 2017 were reviewed retrospectively. All had benign fine needle aspiration cytology and underwent total thyroidectomy. Data regarding demographics, pathology findings, management and outcomes were retrieved.
RESULTS: The mean age of the patients was 46 years (range: 17-78) and 159 (79.1%) of them were female. Twenty-five patients (12.4%) with incidental PTMC were evaluated. Mean diameter of PTMC was 4.7±2.4 mm. In 6 patients (6/25, 24%), the tumor was multifocal and in half of these, tumor foci were found in both lobes. In one patient, tumor infiltrated the capsule. All patients received suppressive therapy and referred to the nuclear medicine department for possible radioiodine therapy. One case with capsule infiltration and 3 patients with multifocal tumor (16%) received radioiodine. Mean follow-up was 2.6 years (range, 4-44 months). All patients were alive and disease-free.
DISCUSSION AND CONCLUSION: PTMC is not an uncommon incidental finding after surgery for presumably benign thyroid disease. The possibility of an underlying PTMC should be taken into account in the management and total thyroidectomy should be considered at least in selected patients.

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GÝRÝÞ ve AMAÇ: Kaliforniya Sözel Öðrenme Testi (CVLT), Delis ve arkadaþlarý tarafýndan sözel öðrenme ve hafýzanýn kapsamlý bir deðerlendirmesine duyulan ihtiyacý karþýlamak için geliþtirilmiþtir. CVLT'yi Türkiye'de önleyici amaçlar doðrultusunda yapýlan deðerlendirmelerde kullanmak için, testin normatif verileri çok önemlidir. Bu nedenle, bu çalýþmanýn amacý, Türkiye'deki saðlýklý yetiþkinler için normatif deðerleri cinsiyet, yaþ ve eðitim düzeyi temelinde tanýmlamaktýr.
YÖNTEM ve GEREÇLER: Çalýþmada CVLT kullanýlmýþtýr. 90 kadýn 90 erkek olmak üzere 180 katýlýmcý ile çalýþýlmýþtýr.
BULGULAR: Normatif veri elde edilmiþtir.
TARTIÞMA ve SONUÇ: Çalýþma sonucu elde edilen verilerle CVLT'nin klinik uygulamasýnýn mümkün olmasý daha sonraki çalýþmalarýn önünü açabilir.

INTRODUCTION: California Verbal Learning Test (CVLT) was developed by Delis et al. for the need for a comprehensive evaluation of verbal learning and memory. To employ CVLT in assessments carried out in Turkey for preventive purposes, the test’s normative data were crucial. Therefore, this study aimed to identify the normative values as gender, age and education level of CVLT for the healthy adults in Turkey.
METHODS: 180 healthy individuals (Gender: 90 female and 90 male; Age groups: 17-64 (n=90) and 65-88 (n=90)) participated in the present study.
RESULTS: Normative data from all different subgruops (depending on age and gender) are generated.
DISCUSSION AND CONCLUSION: The clinical application and scientific researches using CVLT in Turkey can be better interpreted with the help of acquired normative data.

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GÝRÝÞ ve AMAÇ: Mide kanseri dünya çapýnda en yaygýn ve ölümcül kanserlerden biridir ve Türkiye'de de gitgide daha yaygýn bir malignite haline gelmektedir. Mide kanseri hastalarýnda prognozun iyileþtirilmesinde erken taný ve tedavi çok önemli bir role sahiptir. Mac-2 baðlayýcý protein (Mac-2BP), birçok doku tipinde eksprese edilir ve son çalýþmalar, çeþitli kanserli dokularda up-regülasyonunu göstermiþtir. Bu çalýþmada gastrik kanser hastalarýnda Mac-2BP ekspresyonunun yaný sýra klinik ve patolojik deðiþkenlerle iliþkisini araþtýrdýk.

YÖNTEM ve GEREÇLER: 90 mide kanseri hastasý ve 40 saðlýklý kontrol olmak üzere toplam 130 hasta çalýþmaya dahil edildi. Serum Mac-2BP düzeyleri her iki grupta da ölçüldü. Gastrik kanser grubunda tümör boyutu, histolojik derece, primer tümör evresi, lenf nodu metastazý, lenfatik invazyon, vasküler invazyon ve nöral invazyon gibi klinik ve patolojik deðiþkenler deðerlendirildi.
BULGULAR: Mide kanseri olan hastalarda dolaþýmdaki Mac-2BP düzeyleri kontrol grubuna göre daha yüksekti. Serum Mac-2BP düzeyleri özellikle daha büyük tümör boyutu, zayýf histolojik derece, ileri primer tümör evresi, lenf nodu metastazý, lenfatik invazyon, vasküler invazyon ve nöral invazyonu olan hastalarda yükselmiþtir.
TARTIÞMA ve SONUÇ: Bu sonuçlar serum Mac-2BP düzeylerinin hem mide tümörü teþhisinde hem de prognozda prediktif rolü olabileceðini düþündürmektedir.

INTRODUCTION: Gastric cancer is one of the most common and deadly cancers worldwide. Currently, it is becoming an over-prevalent malignancy in Turkey. Early diagnosis and treatment have a pivotal role in ameliorating the prognosis in patients with gastric cancer. Mac-2 binding protein (Mac-2BP) is expressed in many types of tissues, and recent studies have demonstrated that it is upregulated in various cancerous tissues. We investigated the expression of Mac-2BP in patients with gastric cancer, as well as its association with clinical and pathological variables.
METHODS: In this study, 130 patients, 90 patients with gastric cancer and 40 healthy controls were included. Serum Mac-2BP levels were measured in both groups. Clinical and pathological variables, including tumor size, histologic grade, primary tumor stage, lymph node metastasis, lymphatic invasion, vascular invasion, and neural invasion, were evaluated in the gastric cancer group.
RESULTS: Circulating Mac-2BP levels were higher in patients with gastric cancer than the control group. Serum Mac-2BP levels especially elevated in patients with larger tumor size, poor histologic grade, advanced primary tumor stage, lymph node metastasis, lymphatic invasion, vascular invasion, and neural invasion.
DISCUSSION AND CONCLUSION: The findings obtained in this study suggest that serum Mac-2BP levels may have a predictive role in both gastric tumor diagnosis and prognosis.

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GÝRÝÞ ve AMAÇ: Dünya Saðlýk Örgütü’nün (DSÖ) karayolu trafik kazalarýnýn önlenmesi ile ilgili raporuna göre, trafik kazalarý her yýl yaklaþýk 1.25 milyon insanýn ölümüne ve her yýl 20 ila 50 milyon insanýn yaralanmasýna veya sakatlanmasýna neden olmaktadýr. Bu çalýþmada motorlu araç kazalarýnda emniyet kemeri ve hava yastýðý kullanýmýnýn travma þiddeti üzerindeki etkisini araþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Motorlu taþýt kazalarýna yolcu olarak karýþmýþ 274 hasta incelendi. Týbbi kayýtlarýn detaylý anamnez bölümünde, kaza sýrasýnda hastanýn emniyet kemeri takýp takmadýðý, hava yastýðýnýn açýlýp açýlmadýðý ve aracýn yaklaþýk hýzý gibi yaralanmanýn ciddiyetini tahmin etmekiçin kullanýlan rutin sorulara verilen cevaplar incelendi.
BULGULAR: Emniyet kemeri kullanan ve hava yastýðý açýlan hastalarda yaralanma þiddetinin ve hastanede yatýþ oranýnýn daha düþük olduðu tespit edildi. Emniyet kemeri takýlmadan sadece hava yastýðýnýn açýldýðý kazalarda ise yaralanma þiddetinde düþüþ saptanmadý.
TARTIÞMA ve SONUÇ: Emniyet kemeri kullanýmý ile birlikte hava yastýðýnýn açýlmasý travma þiddetini ve hastanede kalýþ süresini sadece hava yastýðý açýlmasýna göre daha fazla azaltmaktadýr. Emniyet kemeri takýlmasýnýn yaygýnlaþtýrýlmasý kazalarda travma þiddetini azaltmaktadýr ve hava yastýðýnýn etkin hale gelmesini saðlamaktadýr.

INTRODUCTION: According to the report of the World Health Organization on the prevention of road traffic injuries, road traffic accidents result in the death of approximately 1.25 million people and injury or disability of 20 to 50 million people every year. In this study, we aimed to investigate the effects of seat belt and airbag use on the severity of the injury in motor vehicle accidents.
METHODS: In this study, 274 patients involved in motor vehicle accidents were examined. The medical records of the patients were screened for responses to routine questions that aimed to predict the severity of the injury, such as whether the patient was wearing a seat belt if the airbag deployed and the approximate speed of the vehicle at the time of the accident.
RESULTS: It was determined that the severity of the injury and the hospitalization rate were lower in the restrained and airbag-deployed patient group. In unrestrained patients, airbag deployment alone did not reduce the severity of the injury.
DISCUSSION AND CONCLUSION: Seat belt use and the airbag deployment reduce the severity of the injury and the hospitalization rate more than airbag deployment alone. Encouraging the wearing of seat belts is significant to decrease the severity of the injury and ensure that the airbag is activated during accidents.

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GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý, deri altý yað dokusunun soyulma yaralanmasý olarak tanýmlanan Morel-Lavellée lezyonunun (MLL) manyetik rezonans görüntüleme (MRG) bulgularýný retrospektif olarak incelemekti.
YÖNTEM ve GEREÇLER: MLL tanýlý on beþ hastanýn MRG bulgularý analiz edildi.
BULGULAR: Tüm lezyonlar alt ekstremitelerde yerleþmiþ olup, bunlarýn % 86.6'sý (n = 13) diz seviyesinin üzerinde idi. Tüm lezyonlarýn derin fasya ile anatomik iliþkisi vardý. Lezyonlarýn çoðunluðu fusiform veya kresentik formda idi. Ýyi sýnýrlý düzgün kontur özelliði % 60 (n=9) oranýnda saptandý. Psödokapsül 9 (% 60) hastada gözlendi. Lezyonlarýn % 46.6'sý (n = 7) homojen sinyal özelliðinde idi. Lezyonlarýn % 26.6'sýnda (n = 4) intra-lezyonel hemorajik sinyal ve % 46.6'sýnda (n = 7) intra-lezyonel yað sinyali izlendi. Bir hastada sývý-sývý seviyesi tespit edildi. Ýki hastada beraberinde adele yaralanmasý izlenirken, hiçbir hastada postravmatik kemik lezyonu saptanmadý.
TARTIÞMA ve SONUÇ: Geçmiþte travma öyküsün varlýðýnda; derin fasya ile iliþkili iyi sýnýrlý, kresent veya fusiform subkütan kitle lezyonun olmasý MLL'yi akla getirmelidir.

INTRODUCTION: This study aims to evaluate the magnetic resonance imaging (MRI) findings of the Morel-Lavellée lesion (MLL), which described as degloving injury of the subcutaneous fatty tissue.
METHODS: MRI features of fifteen patients in whom the diagnosis of MLL was established by clinically or surgery retrospectively analyzed.
RESULTS: All the lesions were located in the lower extremities, and 86.6% (n=13) were located at the knee level or above. All lesions had an anatomic relationship with deep fascia. The majority of the lesions were in either fusiform or crescentic form. 60% (n=9) of the lesions showed a well-defined smooth contour. Pseudocapsules were observed in nine patients (60%). 46.6% (n=7) of the lesions had a homogeneous signal property. The intralesional hemorrhagic signal was observed in 26.6% (n=4) of the lesions and intra-lesional fat signal in 46.6% (n=7). One patient had fluid-fluid leveling. In two cases, muscle injury were accompanied by the MLL. In all cases, no associated bone lesion was noted.
DISCUSSION AND CONCLUSION: MLL should be considered if a well-circumscribed, crescentic or fusiform subcutaneous mass lesion in association with the deep fascia is present, especially in the presence of a history of previous trauma.

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GÝRÝÞ ve AMAÇ: Kafa travmalarý; çocuk yaþ grubunda önemli bir morbidite ve mortalite nedenidir. Bu çalýþmada amacýmýz; çocukluk çaðý kafa travmasý olgularýnýn yönetimi ile ilgili tecrübelerimizi paylaþmaktýr.
YÖNTEM ve GEREÇLER: 2017 ve 2019 yýllarý arasýnda kliniðimizce takip edilen kafa travmasý geçiren çocuk olgularýmýzýn klinik, radyolojik ve demografik özelliklerine dair veriler retrospektif olarak incelendi
BULGULAR: Çocuklarýn %77.6’sýnda yüksekten düþme, %10.2’sinde taþýt kazasý ve %12.2’sinde izole kafa travmasý görülmüþtür. Çocuklarýn %56.1’i 0-2 yaþ, %19.4’ü 3-7 yaþ ve %24.5’i 8-17 yaþ grubu arasýndadýr. 0-2 yaþ grubu çocuklarda yüksekten düþme görülme oraný (%96.4); 3-7 yaþ (%57.9) ve 8-17 yaþ (%50) grubu çocuklardan anlamlý þekilde yüksektir. Giriþ GKS’ leri 4 ile 15 arasýnda deðiþmekte olup, ortalamasý 14.63±1.58, medyaný 15’tir. %92.9 olgu hafif kafa travmasý iken, %5.1 olgu orta kafa travmasý, %2 olgu ise aðýr kafa travmasýdýr. BT bulgularýna bakýldýðýnda; %49’unda lineer fraktür, %42.9’unda epidural hematom, %21.4’ünde kontüzyon, %19.4’ünde subdural hematom, %14.3’ünde SAK ve %10.2’sinde çökme fraktürü tespit edilmiþtir. Çocuklarýn %77.6’sýna cerrahi uygulanmazken, %15.3’üne hematom cerrahisi, %3.1’ine dekompresif cerrahi, %4.1’ine ise hematom ve dekompresif cerrahi birlikte uygulanmýþtýr. Giriþ GKS puaný ile kan þekeri arasýnda ters yönlü, %50.5 düzeyinde ve istatistiksel olarak anlamlý bir korelasyon bulunmaktadýr.
TARTIÞMA ve SONUÇ: Önlenebilir bir morbidite ve mortalite sebebi olan kafa travmalarýnýn pediatrik beyin cerrahisi hasta takibinde yeri önemlidir. Bu hastalarda erken taný ve tedavi sakatlýklardan ölüme kadar pek çok ciddi sonucu azaltmaktadýr.

INTRODUCTION: Head injury is an important cause of morbidity and mortality in the pediatric age group. In this study, we aim to share our experience in the management of childhood head trauma cases.
METHODS: Data on the clinical, radiological and demographic characteristics of our children patient group who had head trauma followed by our clinic between the years of 2017 and 2019 were analyzed retrospectively in this study.
RESULTS: 77.6% of the children fell from a height, 10.2% of them were vehicle accidents and 12.2% of them were isolated head trauma. 56.1% of children are between 0-2 years old, 19.4% between 3-7 years old and 24.5% between 8-17 years old. The rate of falling from height in children aged 0-2 years (96.4%), 3-7 age (57.9%) and 8-17 age (50%) groups were significantly higher than children. GKS scores ranged from 4 to 15, with an average of 14.63±1.58 and a median of 15. While 92.9% of the cases were mild head trauma, 5.1% of the cases were middle head trauma, and 2% were severe head trauma. Considering the findings of IT, Linear fracture was found in 49%, epidural hematoma in 42.9%, contusion in 21.4%, subdural hematoma in 19.4%, SAK in 14.3% and collapse fracture in 10.2%. While 77.6% of the children did not have surgery, hematoma surgery was performed in 15.3%, decompressive surgery in 3.1%, hematoma and decompressive surgery in 4.1%. There was an inverse, 50.5% and statistically significant correlation between the initial GCS score and blood sugar.
DISCUSSION AND CONCLUSION: Head trauma, which is a preventable cause of morbidity and mortality, is important in pediatric neurosurgery patient follow-up. Early diagnosis and treatment in these patients reduce many severe consequences from disabilities to death.

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GÝRÝÞ ve AMAÇ: Toplum kökenli pnömoni (TKP), geliþmiþ ülkelerde, özellikle yaþlýlarda, yetiþkinlerde morbidite ve mortalitenin en önemli nedenlerinden biridir. Hayatta kalan hastalarda TKP ile kýsa ve uzun dönem mortalite arasýndaki iliþkiyi belirlemek önemlidir. TKP nedenli mortalite iliþkili faktörlerin daha iyi anlaþýlmasý hasta bakýmý için çýkarýmlarda bulunmamýzý saðlayabilir.
Bu çalýþmada, TKP için hastaneye yatýrýldýktan sonra kýsa süreli (1 ay) mortalite oranýný saptamayý ve bu çalýþmada mortalite ile iliþkili risk faktörlerini bulmayý amaçladýk.
YÖNTEM ve GEREÇLER: Hastaneye yatýrýlan TKP hastalarý iki gruba ayrýldý: hastaneden taburcu olduktan sonra 1 ay içinde ölenler ve ayný dönemde hayatta kalanlar. Tüm hastalarýn verileri bilgisayar destekli bir protokole kaydedildi. Demografik özellikler, komorbiditeler, etken organizmalar, laboratuvar bulgularý ve saðkalým durumlarý ile ilgili veriler toplandý.
BULGULAR: 489 baðýþýklýk sistemi baskýlanmayan TKP'li yetiþkin hastaneye kaldýrýldý. % 11.4 hastala hastaneye yatýþtan 1 ay sonra ex oldu. Erkek cinsiyet ve mevcut / eski sigara içenlerin sýklýðý gruplar arasýnda benzerdi. Ancak hastaneden taburcu olduktan 1 ay sonra ex olan hastalar daha yaþlýydý (p> 0.05). Komorbiditeler ile ilgili olarak, hastaneden taburcu olduktan sonra 1 ay içinde ex olan hastalarda kronik böbrek hastalýðý daha sýktý, diðer komorbiditeler canlý hastalarda daha fazla görüldü. Hastaneden taburcu olduktan sonra 1 ay içinde ölen hastalar daha sýk WBC, Nötrofil, Prokalsitonin, BUN, AST, PaCO2 deðeri ve daha düþük lenfosit, Hct, Hb, protein, albümin deðerine hayatta kalanlardan daha yüksekti. Hayatta kalan hastalarda hastanede kalýþ süresi ölmüþ hastalara göre daha uzundu. Bir aylýk mortalite ile baðýmsýz olarak iliþkili risk faktörleri saptanmadý.
TARTIÞMA ve SONUÇ: Bu çalýþma, TKP'li hastalarýn mortalitesinin oldukça yüksek olduðunu göstermektedir. Mortalite için anlamlý bir baðýmsýz risk faktörü gösteremesek de, bazý laboratuvar parametrelerinin ve bazý komorbid durumlarýn mortalite oranýný etkileyebileceðini söyleyebiliriz. Bulgularýmýz, KTP ve mortalite arasýndaki iliþkiyi anlamaya ve taburcu olduktan sonra bu popülasyondaki komorbiditelerin optimal yönetimini tasarlamaya yardýmcý olabilir.

INTRODUCTION: Community-acquired pneumonia (CAP) is one of the most important causes of morbidity and mortality in developed countries, especially in the elderly and adults. Thus, the relationship between CAP and short and long-term mortality in patients is critical. A better understanding of CAP related mortality factors can enable us to make inferences for patient care. In this study, we aimed to determine the short-term (1 month) mortality rate for CAP after hospitalization and to find the risk factors associated with mortality.
METHODS: Hospitalized patients with CAP were classified into two groups as follows: patients who died within 1-month after hospital discharge and patients who survived in the same period. All patients’ data recorded in a computer-assisted protocol. Data were collected on demographic characteristics, comorbidities, causative organisms, laboratory findings, and survival situations.
RESULTS: The findings showed that 489 non-immunosuppressed adults with CAP were hospitalized. 11.4% patients died 1-month after the hospitalization. The frequency of male sex and current smokers were similar between the groups. However, patients who died in 1-month after hospital discharge were older. Regarding comorbidities, patients who died within 1-month after hospital discharge more often had chronic renal disease; other comorbidities were more seen in alive patients. Patients who died within 1-month after hospital discharge more often had higher WBC, Neutrophil, Procalcitonin, BUN, AST, PaCO2 value, and lower lymphocyte, Hct, Hb, protein, albumin value than who survived. Length of hospital stay was longer in survived patients than died patients.
DISCUSSION AND CONCLUSION: The findings obtained in this study suggest that mortality of in-patients with CAP is remarkably high. Although we could not show any significant independent risk factor for mortality, we can say that some laboratory parameters and some comorbid conditions may affect the mortality rate. Our findings may help to understand the relationship between CAP and mortality, and designing optimal management of comorbidities in this population after discharge.

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GÝRÝÞ ve AMAÇ: Çalýþmamýzýn amacý transrektal ultrason eþliðinde prostat biyopsisi sonrasý idrar yolu enfeksiyonu geliþen hastalarý deðerlendirmek ve ayrýca prostat biyopsisi sonrasý idrar kültürlerinde antibiyotik direnç profilini deðerlendirmektir.
YÖNTEM ve GEREÇLER: 2015 ve 2019 yýllarý arasýnda þüpheli parmak rektal muayenesi ve/ veya PSA seviyesinde artma nedeniyle transrektal ultrason eþliðinde prostat biyopsisi yapýlan 892 hasta retrospektif olarak incelendi.Biyopsi öncesi tüm hastalarýn idrar kültürleri sterildi. Tüm hastalara prostat biyopsisinden 3 gün önce baþlayan oral siprofloksasin profilaksisi yapýldý.Tüm hastalara standart 12 kor prostat biyopsisi yapýldý.Çalýþmaya ateþ, dizüri veya sepsis nedeniyle tekrar hastaneye baþvuran 40 hasta dahil edildi.Bu hastalarda, mikroorganizmalar ve direnç durumu araþtýrýldý.


BULGULAR: Kýrk hastada dizüri þikayeti, 17 hastada ateþ ve titreme ve 1 hastada sepsis vardý.Ultrasonda hiçbir hastada prostat apsesi saptanmadý. Siprofloksasin profilaksisi sonrasý idrar yolu enfeksiyonu oraný% 5.04 ve% 1.90 idi. Bu hastalarýn biyopsi sonrasý yapýlan idrar kültürlerinin% 77,7'sinde üreme tespit edildi.En sýk izole edilen mikroorganizmalar Escherichia koli (% 71.4), Klebsiella pneumoniae (% 20) ve Stafilokokus (% 8.5) idi. Kan kültürü hastalarýn% 37.7'sinden elde edildi ve üreme oraný% 64.7 idi. E. coli kan kültüründe en sýk izole edilen ajandý. Ýdrar kültüründe stafilokoklarda metisilin direnci% 66.6 idi. E. coli'de geniþletilmiþ spektrum beta Laktamaz (ESBL) oraný% 56, siprofloksasin direnci% 91,4, trimetoprim-sülfometaksazol direnci% 54,2 ve gentamisin direnci% 25,7 idi


TARTIÞMA ve SONUÇ: Prostat biyopsisinden sonra idrar yolu enfeksiyonu geliþen hastalarýn hemen hepsinin idrar kültüründe siprofloksasine dirençli mikroorganizm saptandý. Hedefe yönelik antibiyotik kullanýmý prostat biyopsisi sonrasý enfeksiyonu azaltmak için kullanýlabilir. Ayrýca alternatif profilaktik ajanlar kullanýlabilir.

INTRODUCTION: This study aims to evaluate the patients who developed urinary tract infection after transrectal ultrasound-guided prostate biopsy and to determine antibiotic resistance profiles in urinary cultures after prostate biopsy.
METHODS: Between 2015 and 2019, 892 patients who underwent transrectal ultrasound-guided prostate biopsy because of suspected rectal examination and/or increased PSA level were retrospectively reviewed. Urine cultures of all patients before biopsy were sterile. All patients received oral ciprofloxacin prophylaxis, starting three days before prostate biopsy. Standard 12 quadrant prostate biopsies were performed to all patients. Forty-five patients who were admitted to the hospital again due to fever, dysuria or sepsis were included in this study. In these cases, microorganisms and resistance status were investigated.
RESULTS: Forty patients had complaints of dysuria, 17 patients had fever with tremors, and one patient had sepsis. No prostate abscess was detected on ultrasound. The rate of urinary tract infection after ciprofloxacin prophylaxis was 5.04% and 1.90% of the patients had fever after prostate biopsy. Reproduction was detected in 77,7% of urine cultures performed after the biopsy. The most commonly isolated microorganisms were Escherichia coli (71.4%), Klebsiella pneumoniae (20%), and Staphylococcus spp (8.5%), respectively. Blood culture was obtained from 37.7% of the patients, and the reproduction rate was 64.7%. E. coli was the most frequently isolated agent in blood culture. In urine culture, methicillin resistance in staphylococci was 66.6%, Extended Spectrum Beta-Lactamase (ESBL) rate in E. coli was 56%, ciprofloxacin resistance was 91,4%, trimethoprim- sulfamethoxazole resistance was 54.2% and gentamicin resistance was 25.7%.
DISCUSSION AND CONCLUSION: Nearly all patients who developed urinary tract infection after prostate biopsy had ciprofloxacin- resistant microorganisms in urine cultures. Targeted antibiotic use can be considered to reduce post- biopsy infection. Also, alternative agents as prophylaxis can be used.

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GÝRÝÞ ve AMAÇ: Çok düþük doðum aðýrlýklý preterm yenidoðanlarda intrakranial kanama (ÝKK) sýklýðý ve risk faktörlerinin araþtýrýlmasý,
YÖNTEM ve GEREÇLER: Dört yýllýk sürede (2011-2014) ünitemizde takip edilen doðum aðýrlýðý (DA) <1500 g [24 - 32 gebelik haftasý (GH)] 816 preterm yenidoðanýn verileri, ÝKK ve risk faktörleri açýsýndan retrospektif olarak incelendi. ÝKK olan ve olmayan yenidoðanlarýn verileri Student T ve Ki kare testleri ile karþýlaþtýrýldý. ÝKK’ye etkili baðýmsýz risk faktörleri lojistik regresyon analiziyle saptandý.
BULGULAR: Ýntrakranial kanamasý olan 232 hastanýn ortalama GH 27.6 ± 2.2 ve DA 945 ± 241 g, ÝKK’si olmayan 584 hastanýn ise 28.9 ± 2 hafta ve 1106 ± 263 g bulundu. ÝKK oraný %28.4 saptandý (Evre I, II, III ve IV ÝKK oranlarý sýrasýyla %12.4, %6.6, %6 ve %3.4). Tekli oran karþýlaþtýrýlmalarýnda GH (p<0.001), DA (p<0.001), vajinal doðum (p= 0.014), canlandýrma (p <0.001), respiratuar distres sendromu (RDS) (p<0.001), mekanik ventilasyon (MV) (p<0.001), yüksek frekanslý osilatuar ventilasyon (HFOV) (p<0.001), nazal intermitan pozitif pressure (NÝPPV) (p<0.001), patent duktus arteriosus (PDA) (p<0.001), sepsis (p<0.001), eritrosit transfüzyonu (p<0.001), pnömotoraks (p= 0.017) ve inotrop kullanýmý (p<0.001) anlamlý fark bulundu. Lojistik regresyon analizinde ise canlandýrma [relative risk (RR): 1.85, confidence interval (CÝ): 1.13 - 3.04], PDA (RR: 1.74, CÝ: 1.19 - 2.53), eritrosit transfüzyonu (RR: 1.87, CÝ: 1.24 - 2.82), MV (RR: 2.19, CÝ: 1.24 - 3.88), HFOV (RR: 1.61, CÝ: 1 - 2.59) ve NÝPPV (RR: 1.61, CÝ: 1.13 - 2.32) baðýmsýz risk faktörleri olarak saptandý.
TARTIÞMA ve SONUÇ: Geliþen teknolojiye raðmen, immatür yenidoðanlarýn sað kalýmýnýn artmasý nedeniyle ÝKK sýklýðýnda istenen azalma saðlanamamýþtýr. Belirtilen risk faktörlerinin azaltýlmasýna çalýþýlmalýdýr.

INTRODUCTION: To investigate Intracranial Hemorrhage Incidence (ICH) and Risk Factors in Very Low Birth Weight Preterm Newborns.
METHODS: Data of 816 preterm newborns with birth weight (BW) <1500 g [24-32 weeks of gestation (GW)] followed in our unit over a four-year period (2011-2014) were retrospectively analyzed in terms of ICH and risk factors. The data of the newborns with and without ICH were compared with Student T and Chi-square tests. Independent risk factors that are effective on ICH were determined by logistic regression analysis.
RESULTS: Average gestational week and birth weight of 232 patients with ICH were 27.6±2.2 weeks and 945±241 g, respectively and the incidence of ICH was found 28.4% (grade I, II, III and IV ICH rates; 12.4%, 6.6%, 6% and 3.4%, respectively). In single variable comparison, GW (p<0.001), BW (p<0.001), vaginal birth (p=0.014), resuscitation (p<0.001), respiratory distress syndrome (RDS) (p<0.001), mechanical ventilation (MV) (p<0.001), high frequency oscillatory ventilation (HFOV) (p<0.001), nasal intermittent positive pressure (NIPPV) (p<0.001), patent ductus arteriosus (PDA) (p<0.001), sepsis (p<0.001), erythrocyte transfusion (p<0.001), pneumothorax (p= 0.017) and inotrope use (p<0.001) were found statistically significant. In logistic regression analysis, resuscitation [relative risk (RR): 1.85, confidence interval (CÝ): 1.13-3.04], PDA (RR: 1.74, CÝ: 1.19-2.53), erythrocyte transfusion (RR: 1.87, CÝ: 1.24-2.82), MV (RR: 2.19, CÝ: 1.24-3.88), HFOV (RR: 1.61, CÝ: 1-2.59) and NIPPV (RR: 1.61, CÝ: 1.13-2.32) were detected as significant independent risk factors.
DISCUSSION AND CONCLUSION: Despite the advancing technology, the desired reduction in the ICH frequency could not be achieved due to the increase in the survival numbers of immature newborns. Efforts should be made to reduce the risk factors mentioned.

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GÝRÝÞ ve AMAÇ: Çalýþmamýzýn amacý tek seviye travmatik torakolomber bileþke kýrýklarýnýn incelenmesidir.
YÖNTEM ve GEREÇLER: Tek seviye travmatik torakolomber bileþke kýrýðý nedeniyle 2012-2018 yýllarý arasýnda ameliyat edilmiþ hastalar retrospektif olarak incelenmiþtir.
BULGULAR: Toplam 32 hasta incelendi. Hastalarýn yaþ ortalamasý 51.7±13.1 olarak hesaplandý. Hastalarýn 14’ ü kadýn(%43.8) ve 18’i erkektir(%56.3). Yirmiiki hastada L1 kýrýðý (%68.8), 6 hastada T11 kýrýðý (%18.8), ve 4 hastada T12 kýrýðý (%12.5) görülmüþtür. En çok yapýlan ameliyatýn 16 hasta ile T11-12-L1-2 posterior füzyon(PF) (%50) olduðu görüldü. T11-12-L2-3 PF ve T9-10-11-12-L1 PF ameliyatlarýndan dörder tane(%12.5) yapýlmýþ. Cinsiyetler arasýndaki yaþ daðýlýmý benzerlik göstermektedir. Yný þekilde kýrýk yeri ve yapýlan ameliyatlar da benzer olarak bulunmuþtur.
TARTIÞMA ve SONUÇ: Torakolober bileþke kýrýklarýnda cinsiyetler arasýnda kýrýk yeri ve ameliyatlarda fark saptanmamýþtýr. Hastalara yaklaþýmda stabil kýrýklarda ortez vermekle hareketsiz býrakmanýn arasýnda fark yoktur. Cerrahi tedavide ise posterior yaklaþým diðer yaklaþýmlara göre daha az komplikasyon riski olmasý ve perkütan tekniklerin de geliþmesi ile çoklu travma hastalarýnda iyi bir seçenektir.

INTRODUCTION: This study aims to investigate the one level thoracolumbar junction traumatic fracture operations.
METHODS: Thirty-two patients who were diagnosed and operated for one level traumatic thoracolumbar junction fractures were investigated between 2012-2018 retrospectively in this study.
RESULTS: In this study, 32 patients were included. Mean age of the patients was 51.7±13.1 years. Fourteen patients (43.8%) were females and 18 were males (56.3%). Twenty-two patients had an L1 fracture (68.8%), six patients had T11 fracture (18.8%), and four patients had T12 fracture (12.5%). The most frequent operations applied to patients were T11-12-L1-2 posterior fusion (PF) to 16 patients (50%) and T11-12-L2-3 PF and T9-10-11-12-L1 PF to four patients for each (12.5%). The age distribution between genders was statistically similar (p=0.12). Likewise, the distributions of disease localization (p=0.92) and operation types (p=0.91) were also similar between female and male patients.
DISCUSSION AND CONCLUSION: Thoracolumbar junction fractures are similar between genders in localization and surgery type. In stable fractures treated conservatively, the use of orthoses has not shown a benefit greater than the use of no immobilization at all. If surgery is chosen, posterior approaches are related to fewer complications than anterior or combined approaches, and percutaneous techniques have shown good results, especially in polytrauma patients.

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GÝRÝÞ ve AMAÇ: Bu çalýþmada, çocuk yoðun bakým ünitesine zehirlenme nedeni ile kabul edilen pediatrik olgularýn demografik, epidemiyolojik ve klinik özelliklerinin araþtýrýlmasý amaçlandý.
YÖNTEM ve GEREÇLER: Mayýs 2015 ile Mayýs 2020 arasýnda çocuk yoðun bakým ünitesinde tedavi edilen zehirlenme olgularý retrospektif olarak incelendi.

BULGULAR: Çalýþmaya toplam 86 olgu alýndý. Ortalama yaþ 10.8 ± 6.4 yýl idi. Olgularýn 53.5'i 13-18 yaþ arasýnda idi. Olgularýn %48.8'i erkekti. Zehirlenmelerin yarýya yakýný (% 53.5) intihar amaçlý,% 39.6'sý kaza,% 4.6'sý madde kötüye kullanýmý ve% 2.3'ü doz hatalarýnda kaynaklandý. Farmasötik ajanlarla zehirlenme daha sýk (%71.9) olup, zehirlenmeye neden olan en sýk farmasötik ajanlar %41.8 ile santral sinir sistemi (SSS) ilaçlarý idi. Farmasötik olmayan ajanlarla zehirlenmenin en sýk nedeni %8.1 ile karbonmonoksit zehirlenmesi idi. Zehirlenmeye yol açan ajanlarýn en sýk alýnma yolu %91.8 ile aðýz yolu idi. Zehirlenmeden hastaneye baþvuruya kadar geçen ortalama süre 239.0 ± 423.9 dakikaydý. Hastalarýn %41.9'una mide yýkama, %44.1'ine aktif kömür uygulandý. Hastalarýn %32.6'sýna mekanik ventilasyon desteði verildi. En sýk bulgu %54.6 ile SSS ile iliþkili semptomlardý. Ortalama çocuk yoðun bakýmda yatýþ süresi 4.3 ± 6.7 gün, ortalama hastanede yatýþ süresi 5.8 ± 7.1 gün idi. Mortalite oraný %1.2 idi.
TARTIÞMA ve SONUÇ: Zehirlenmelerin epidemiyolojisinin bilinmesi, hýzlý ve doðru tedavi için önem taþýmaktadýr. Mortalite ile iliþkili risk faktörlerini ortaya koymak için çok merkezli geniþ kapsamlý çalýþmalara ihtiyaç vardýr.

INTRODUCTION: This study was designed to investigate the demographic, epidemiologic and clinical characteristics of cases admitted to the pediatric intensive care unit (PICU) with a diagnosis of intoxication.
METHODS: Inpatient intoxication cases who were treated in the PICU between May 2015 and May 2020 were analyzed retrospectively.
RESULTS: A total of 86 patients were included in the study. The average age was 10.8 ± 6.4 years and 53.5% of the cases were aged between 13-18 years. In terms of gender, 48.8% of the cases were male. Almost half of the (53.5%) intoxications occurred due to attempted suicide, 39.6% were accidental, 4.6% were due to substance abuse and 2.3% were due to incorrect drug dosage. Pharmaceutical agents were responsible for intoxication in the majority (79.1%) of patients, and among these, central nervous system (CNS) drugs were the most common (41.8%). Carbon monoxide poisoning was the most common nonpharmaceutical agent cause (8.1%). The agents that caused the intoxication were taken orally in 91.8% of cases. The average time from consumption to admission was 239±423.9 minutes. Gastric lavage was applied to 41.9% of the cases and activated charcoal was applied to 44.1%. Mechanical ventilation support was given to 32.6% of the patients. The most common findings were CNS symptoms (in 54.6% of patients). The mean length of stay (LOS) in PICU was 4.3±6.7 days and LOS in the hospital was 5.8±7.1 days. Mortality rate was 1.2%.
DISCUSSION AND CONCLUSION: Knowing the epidemiology of intoxication is of great importance for rapid and correct treatment. Multicenter comprehensive studies are needed to reveal risk factors related to mortality.

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Daptomisin Streptomyces roseospours fermantasyon yan ürünü olarak elde edilen, siklik yapýda aerop ve anaerop gram pozitif bakterilere etki edebilen geniþ spektrumlu bir antibiyotiktir. Metisiline dirençli Staphylococcus aureus (MRSA), glikopeptid antibiyotiklere azalmýþ duyarlýlýk gösteren (intermediate) staphylococcus aureus, koagülaz negatif stafilokok türleri, penisiline dirençli Streptococcus pneumoniae, enterokoklar, Pediococus, Leuconostoc ve Lactobacillus gibi vankomisine dirençli bakterilere, Clostridium difficile dahil gram pozitif anaerob bakterilere, Corynebacterium ve Bacilluscinsi bakterilere, peptostreptokoklara karþý etkin olduðu bildirilmiþtir. Daptomisin kullanýmýna baðlý geliþen primer toksisite myopatidir. Nadir görülür. Myopatiye baðlý kas aðrýsý, kas güçsüzlüðü ve kreatin kinaz (CPK) enziminde (MM izoenzimi) artýþ saptanýr. Parestezi ve geri dönüþümlü olarak paralizi seyrek de olsa görülebilir. Bu yazýda daptomisin iliþkili kreatin fosfokinaz (CK) yüksekliði geliþen bir olgu sunulmuþtur. Ýlacýn kesilmesi ve destek tedavi ile klinik kontrol altýna alýnmýþ ve takiplerde CK normale gelmiþtir. Daptomisin kullanýmý esnasýnda ani geliþen kas aðrýsý ve CK yüksekliði durumunda miyopati yan etkisi akýlda tutulmalýdýr.

Daptomycin is a fermentation product produced by Streptomyces roseosporus, which can act on aerobic and anaerobic gram-positive bacteria in its cyclic form. Daptomycin has activity against methicillin-resistant Staphylococcus aureus (MRSA), glycopeptide-intermediate Staphylococcus aureus, coagulase-negative staphylococcus species, penicillin-resistant Streptococcus pneumoniae, enterococci, vancomycin-resistant bacteria such as Pediococcus, Leuconostoc and Lactobacillus, gram positive anaerobic bacteria including Clostridium difficile, Corynebacterium and Bacillus bacteria and peptostreptococci. The primary toxicity associated with daptomycin is myopathy, which is rare. Muscle pain, muscle weakness and increased creatine kinase (CK) levels (MM isoenzyme) are detected due to myopathy. Paresthesia and reversible paralysis can be observed infrequently. In this article, a case of daptomycin-associated creatine phosphokinase elevation is presented. Clinical signs and symptoms improved with normal CK levels after discontinuation of daptomycin. Myopathy should be kept in mind in case of sudden muscle pain and high CK levels during the treatment with daptomycin.

Abstract | Full Text PDF