GÝRÝÞ ve AMAÇ: Kuduz, enfekte hayvanýn temasýyla bulaþabilen ve büyük oranda ölümle sonuçlanan bir zoonozdur. Ýnsan ölümlerinin en sýk nedeni köpek ýsýrýklarýdýr. Bu çalýþmada Ýstanbul’da bir eðitim araþtýrma hastanesinin acil servisine son bir yýlda kuduz riskli temas nedeniyle baþvuran olgular irdelenmiþtir. Amacýmýz riskli temas sonrasý profilaksi ihtiyacýnýn azaltýlmasýna yönelik öneriler sunmaktýr.
YÖNTEM ve GEREÇLER: Eylül 2017 ve Aðustos 2018 tarihleri arasýnda kuduz riskli temas nedeni ile acil servise baþvuran olgular çalýþmaya dahil edildi. Hastanenin kuduz aþý birimince tutulan kayýtlarý incelenerek veriler elde edildi. Riskli temasa neden olan kedi ve köpek sayýlarý, benzer çalýþmalarla kýyaslandý. Ýstatistiksel anlamlýlýk için p<0,01 kabul edildi.
BULGULAR: Yukarýda belirtilen zaman aralýðýnda toplam 10.974 olgu riskli temas nedeni ile baþvurmuþtur. Olgular %50,1 (n= 5493) erkek, %49,9 (n=5481) kadýn þeklindedir. Riskli temaslara en fazla kedi (%64,1) ve köpekler (%35,2) neden olurken, temaslar yaz mevsiminde en fazla, kýþ mevsiminde en az olmuþtur. Acil servise baþvuran olgularýn %87,2’sine sadece kuduz aþýsý yapýlmýþ, %9,1 olguya da aþý ve immünglobulin yapýlmýþtýr. Bu kuduz riskli temaslar sonucunda herhangi bir ölüm ve uzuv kopmasý saptanmazken, 6 olguya sütürasyon yapýlmýþtýr.
TARTIÞMA ve SONUÇ: Kuduz riskli temaslarda kedilerin köpeklere oranýnýn geçmiþ yýllara göre arttýðý görülmektedir. Kuduza neden olabilen hayvanlarýn aþýlanmasý, kýsýrlaþtýrýlmasý, kayýt altýna alýnmasý, aþýlý hayvanlarýn da aþýlý olduklarýný açýkça gösteren uygun iþaretlemeler yapýlmasý ve halkýn bu konuda bilinçlendirilmesi temas sonrasý aþýlama ihtiyacýný azaltabilir.

INTRODUCTION: Rabies is a zoonosis that can be transmitted by contact with an infected animal and results in death. Dog bites are the most common cause of human deaths. In this study, cases who applied to the emergency service of a training and research hospital in Istanbul due to suspected rabies exposure in the past year were examined. Our aim is to provide recommendations for reducing the need for prophylaxis after suspected exposure.
METHODS: Patients who presented to the emergency department due to suspected rabies exposure between September 2017 and August 2018 were included in the study. Data were obtained by examining the emergency service files of the patients and the records kept by the hospital’s rabies treatment unit. The number of cats and dogs causing suspected exposure were compared with similar studies. p<0.01 was accepted for statistical significance.
RESULTS: A total of 10,974 cases applied due to suspected exposure within the time period stated above. About 50.1% (n=5493) of the cases were male and 49.9% (n=5481) were female. While the most suspected contacts were caused by cats (64.1%) and dogs (35.2%), the exposure was highest in summer and least in winter. Only rabies vaccine was administered to 87.2% of the cases admitted to the emergency service, and vaccine and immunoglobulin were administered to 9.1% of the cases. As a result of these suspected rabies exposures, no death and limb amputation were detected, while six cases had saturation.
DISCUSSION AND CONCLUSION: It is seen that the ratio of cats to dogs in suspected rabies exposure has increased, compared to previous years. Vaccination, sterilization, and registration of animals that can cause rabies, making appropriate markings that clearly show that the animals have been vaccinated, and raising the public awareness on this issue can reduce the need for post-exposure vaccination.

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GÝRÝÞ ve AMAÇ: Ýdeal kardiyovasküler saðlýk 2020 yýlýna kadar kardiyovasküler hastalýklarý azaltmak ve saðlýðý geliþtirmek amacýyla tanýmlandý. Kardiyoloji Polikliniðine Baþvuran Hastalarda Cinsiyete Göre Ýdeal Kardiyovasküler Saðlýk Ve Miyokardiyal Enfarktüs Rekürrensinin deðerlendirilmesi amaçlandý.
YÖNTEM ve GEREÇLER: Anket form araþtýrmacýlar tarafýndan yüzyüze görüþme metoduyla dolduruldu. Kardiyovasküler risk faktörlerinin ve ideal kardiyovasküler saðlýðýn deðerlendirilmesinde Amerikan Kalp Birliði’nin tanýmlarý kullanýldý. Her bir risk faktörüne sahip olmak 1 puan olarak tanýmlandý. Buna göre hesaplanan toplam kardiyovasküler saðlýk skoru 0-7 arasýnda deðiþmekte idi. Ýstatistiksel anlamlýlýk deðeri p ≤ 0.05 kabul edildi.
BULGULAR: Çalýþmaya katýlan 261 kiþinin yaþlarý 18-83 arasýnda deðiþmekte olup; yaþ ortalamasý± standard sapma tüm çalýþma grubunda 50.68 ± 15.39, erkeklerde 51.03 ± 15.17, kadýnlarda 50.44 ± 15.58 yýl idi( p>0.05). Katýlýmcýlar arasýnda ideal kardiyovasküler saðlýk sýklýðý %4.6 idi. Çalýþmada iki cinsiyettte de toplam kardiyovasküler saðlýk skoru ile geçirilen miyokardiyal enfarktüs sayýsý arasýnda orta derecede pozitif yönde bir iliþki saptandý.
TARTIÞMA ve SONUÇ: Her iki cinsiyette de ideal kardiyovasküler saðlýk sýklýðýnýn çok düþük olduðu görüldü. Toplam kardiyovasküler saðlýk skorunun her iki cinsiyette de miyokardiyal enfarktüs rekürrensi ile iliþkili olduðu saptandý.

INTRODUCTION: Ideal cardiovascular health (ICH) has defined to reduce cardiovascular disease and to improve health by 2020. The aim was to evaluate ICH and recurrence of myocardial infarctions by gender in cardiology outpatients.
METHODS: The questionnaire form was applied by face-to-face interviews method by researchers. It was used American Heart Association definitions to determine the cardiovascular risk factors and ICH. Having each risk factor was defined as 1 point. According to this, the total cardiovascular health score calculated ranged from 0 to 7. It is considered statistically significant if p≤0.05.
RESULTS: The ages of 261 participants of the study group ranged between 18 and 83, the mean age ± standard deviation (SD) was 50.68±15.39 years in the entire study group, 51.03±15.17 years in men and 50.44±15.58 years in women (p>0.05). The ICH status among the participants was found to be 4.6%. In the study, in both sexes there was a moderate positive correlation between the total cardiovascular health score and the number of experienced myocardial infarctions.
DISCUSSION AND CONCLUSION: ICH frequency was found to be very low in both sexes. Furthermore, ICH score was associated with myocardial infarction recurrences in both sexes.

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GÝRÝÞ ve AMAÇ: Disfaji ve yutma bozuklarýnýn benign nedenleri saptamaya yönelik çalýþmalar teknolojik geliþmelerin katkýsýyla, günümüzde yeme bozukluklarýnýn etiyolojisi konusunda ciddi geliþmeler saðlamýþtýr. Etyolojide sýk görülen nedenlerden biri hiatal herniler olup, günümüzde hem patofizyolojisinin anlaþýlmasýnda ve hem tedavisinde ciddi geliþmeler olmuþtur. Bu çalýþmada hiatal herni nedeniyle laparoskopik onarým yapýlan 51 olgunun sonuçlarýný literatur eþiliðinde deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: SBÜ Ümraniye Eðitim ve Araþtýrma Hastanesi Genel Cerrahi Kliniði’nde Eylül 2011 ile Ekim 2014 tarihleri arasýnda gastro-özofageal reflü ve hiatal herni nedeniyle laparoskopik olarak tek genel cerrahi uzmaný tarafýndan Nissen fundoplikasyon ve Toupet fundoplikasyon operasyonu yapýlan hastalar çalýþmaya retrospektif olarak dahil edildi. Her olgunun demografik özellikleri, þikayetleri, ek hastalýklarý, hiatal herninin tipi, geçirilmiþ operasyon, cerrahi sonrasý erken ve geç dönem komplikasyon parametreleri deðerlendirildi. Elde edilen sonuçlar, Windows için SPSS v21 programýnda yüzdelik analizler açýsýndan deðerlendirilerek sonuçlar tablolar ve grafikler eþliðinde sunuldu.
BULGULAR: Nissen fundoplikasyon ve Toupet Fundoplikasyon operasyonu yapýlan 51 olgu çalýþmaya dahil edildi. Olgularýn yaþ ve cinsiyet açýsýndan deðerlendirilmesinde, tüm hastalarýn yaþ ortalamasý 50.61 ± 1.62 yýl olup, 23 erkek hastanýn yaþ ortalamasý 48.30 ± 2.69 yýlken, 28 Kadýn hastanýn yaþ ortalamasý 52.5 ± 1.93 yýldý. Olgularýn biri hariç hepsine Nissen fundoplikasyon uygulandý. Hastalarýn tanýdan ameliyata kadar geçen süresi 440,50 ± 128,30, ameliyat sonrasý yatýþ süresi 2.24 ± 0.28 gündü. Hastalarýn 4’ünde intraoperatif komplikasyon (2 hastada plevra defekti, 1 hastada karaciðer yaralanmasý, 1 hastada cilt altý amfizem), 1’inde erken dönem atelektazi geliþirken 1 hastada postoperatif kardiak nedenle 2. günde mortatilite geliþti. 6.ayda yapýlan kontrol endoskopilerinde bir hastada nüks saptanýrken diðer hastalarda herhangi bir patolojiye rastlanmadý.
TARTIÞMA ve SONUÇ: Hiatal herni, hayat kalitesini düþüren ve sýk karþýlaþýlan bir benign patolojidir. Laparoskopik cerrahi onarýmýn yeterli deneyim sonrasý güvenle uygulanabilecek efektif bir yöntem olduðunu düþünmekteyiz.

INTRODUCTION: Studies on the detection of benign causes of dysphagia and swallowing disorders have been blended with the current technology, and thus, serious advances have been made in determination of etiology of eating disorders. The most common of these are hiatal hernias, and there have been significant improvements in both understanding the pathophysiology of the disease and its treatment. In this study, we aimed to evaluate the results of 51 cases who underwent laparoscopic repair due to hiatal hernia in light of the literature.
METHODS: Between September 2011 and October 2014, laparoscopic Nissen and Toupet fundoplication operations performed by a single general surgeon for gastroesophageal reflux and hiatal hernia in SBU Ümraniye Training and Research Hospital, Department of General Surgery, were included retrospectively in this study. Demographic characteristics, complaints, comorbidities, type of hiatal hernia, previous operation, and early and late post-operative complication parameters of each case were evaluated. The results were evaluated in percentage analyses with SPSS v21 for Windows and presented with tables and graphs.
RESULTS: Fifty-one patients who underwent Nissen and Toupet fundoplication operations were included in the study. The mean age of all patients was 50.61±1.62 years. The mean ages of 23 male and 28 female patients were 48.30±2.69 years and 52.5±1.93 years, respectively. All but one patient underwent Nissen fundoplication. The time from diagnosis to surgery was 440.50±128.30 days. Post-operative hospital stay was 2.24±0.28 days. Four patients developed intraoperative (pleural defect in two patients, one liver injury, and one subcutaneous emphysema), and one patient developed early post-operative complications (postoperative atelectasis). In the 6th month control endoscopy, one patient had recurrence and the other patients had no pathology.
DISCUSSION AND CONCLUSION: Hiatal hernia is a common benign pathology that decreases quality of life. We believe that laparoscopic surgical repair is an effective method that can be safely applied after enough experience.

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GÝRÝÞ ve AMAÇ: Atelektazi akciðerlerde geliþen hacim kaybýdýr. Çocuklarda havayolunun dar ve kollapsa eðilimli olmasý, altta yatan kronik hastalýklar atelektazi geliþimini kolaylaþtýrmaktadýr. Atelektazi, çocuklarda önemli bir morbidite ve mortalite nedeni olduðundan erken taný ve tedavisi büyük önem taþýmaktadýr.

YÖNTEM ve GEREÇLER: 1 Aralýk 2018-1 Haziran 2019 tarihleri arasýnda kliniðimiz pediatri servisi ve pediatri yoðun bakým ünitesinde izlenen ve radyolojik olarak atelektazi saptanan 36 hasta retrospektif olarak deðerlendirildi.

BULGULAR: Median yaþ 1,85 yýl (1,0-7,37) idi. En sýk yatýþ nedeni pnömoni (n=30,%83) idi. Ýki hasta dýþýnda hastalarýn tamamýnda atelektazi riskini arttýran altta yatan hastalýk mevcuttu. Altta yatan hastalýklar içinde en sýk nörolojik hastalýklar saptandý (n=12, %36). Tedavide 4 (%11,1) hastaya göðüs fizyoterapisi, 19 (%52,7) hastaya nebül ilaç uygulamasý ile birlikte göðüs fizyoterapisi, 13 (%36,1) hastaya ise bu tedavilere ek olarak pozitif ekspiryum sonu basýncý desteði verildi. Nörolojik hastalýðý olan çocuklarda birden fazla lokalizasyonda atelektazi görülme sýklýðý diðer hastalara göre daha fazla idi (n=7 (%54)’e karþý n=3 (%13); p=0,018).
Birden fazla lokalizasyonda atelektazisi olan hastalarda yatýþ süresi daha uzun bulundu (medyan 12,5 gün (9,5-16,75)’ e karþý 19 gün (13-22,75; p=0,034).

TARTIÞMA ve SONUÇ: Sonuç
Hastanede yatýrýlarak izlenen, altta yatan hastalýðý olan çocuklarda atelektazi sýk görülmektedir. Patolojik solunumsal semptom ve bulgular varlýðýnda atelektazi akýlda tutulmalý ve erken dönemde tedavi baþlanmalýdýr.

INTRODUCTION: Atelectasis is the loss of lung volume secondary to collapse. Narrow and collapsible airways and underlying chronic diseases facilitate the development of atelectasis in children. Since atelectasis is an important cause of morbidity and mortality in children, early diagnosis and treatment are of great importance.
METHODS: Thirty-six patients who were followed up in the pediatric service and pediatric intensive care unit of our clinic between December 1, 2018, and June 1, 2019, and were diagnosed radiologically with atelectasis were evaluated retrospectively.
RESULTS: The median age was 1.85 years (1.0–7.37). The most common cause for hospitalization was pneumonia (n=30, 83%). Except for two patients, all patients had an underlying disease that increased the risk of atelectasis. Neurological diseases were the most common diseases among the underlying diseases (n=12, 36%). For the treatment, 4 (11.1%) patients received chest physiotherapy, 19 (52.7%) patients received nebulized medications, and chest physiotherapy, and 13 (36.1%) patients received positive end-expiratory pressure support in addition to these treatments. The frequency of atelectasis in more than one localization was higher in children with the neurological disease than in other patients (n=7, [54%] vs. n=3, [13%]; p=0.018). In patients with atelectasis in more than one localization, the duration of hospitalization was longer (median 12.5 days [9.5–16.75] vs. 19 days [13–22.75]; p=0.034).
DISCUSSION AND CONCLUSION: Atelectasis is common in hospitalized children with an underlying disease. In the presence of pathological respiratory symptoms and signs, atelectasis should be kept in mind, and treatment should be started early.

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GÝRÝÞ ve AMAÇ: Akut iskemik inmede, doku hasarýnýn geliþmesinde lökositlerin rolü olduðu bilinmektedir. Akut iskemik inmede nötrofil lenfosit oraný (NLO) ile etyolojik alt tiplerin iliþkisinin araþtýrýldýðý çalýþmalar bulunmaktadýr. Biz, bu çalýþmada, akut iskemik inmede etyolojik alt tiplerle NLO iliþkisini araþtýrmayý amaçladýk.

YÖNTEM ve GEREÇLER: Erenköy Ruh ve Sinir EAH Nöroloji servisine iskemik inme ile ilk 24 saat içinde baþvurmuþ ve nötrofil lenfosit oraný için hemogram alýnmýþ olan hastalar çalýþmaya dahil edildi. Hastalar TOAST klasifikasyonuna göre sýnýflandýrýldý. Ýlk baþvuruda enfeksiyon, akut koroner sendrom, pulmoner embolisi olan hastalar çalýþmaya alýnmadý.
BULGULAR: Çalýþmaya 467 iskemik inme, 162 kontrol hastasý dahil edildi. Hastalarýn 239’u kadýn (%51), 228’i erkek (%49) idi. Kontrol grubu 77 kadýn (% 47) ve 85 erkekten (% 53) oluþuyordu. Hasta ve kontrol grubunun yaþ ortalamasý sýrasýyla 69.41 ± 14.4 ve 67,35 ± 19,41 idi. N/L oraný kontrol grubunda ortalama 2,12±1,11 inme grubunda 3,38±3,43 olup istatistiksel açýdan anlamlý bulundu (p 0,001). Aterotrombotik grupta N/L oraný 3.26 ±2,35, kardiyoembolik grupta 4,46±5,6 olup arasýndaki fark istatistiksel olarak anlamlý bulunmuþtur (p 0.03).
TARTIÞMA ve SONUÇ: Nötrofil lenfosit oraný iskemik inmeli olgularda kardiyoemboli ile iliþkilidir. Ýlk baþvuruda N/L oranýnýn yüksek olduðu olgularda etiyolojik nedenler arasýnda kardiyoembolik nedenlerin daha detaylý araþtýrýlmasý gerektiði düþünülmektedir.

INTRODUCTION: The role of leukocytes in tissue damage in acute ischaemic stroke is well-known. There are some studies examining the relationship between etiologic subtypes of acute ischaemic stroke and neutrophil/lymphocyte ratio (NLR). In this study, we planned to investigate the relationship between NLR and etiologic subtypes of acute ischaemic stroke.
METHODS: In this study, acute ischaemic stroke patients who were admitted to our hospital in the first 24 hours were included. Etiologic classification of patients was done by TOAST classification system. Patients who had history of acute coronary syndrome and pulmonary emboli were excluded.
RESULTS: We included 467 acute ischemic stroke patients and 162 control patients. Of the patients, 239 were females (51%) and 228 were males (49%). Of the control group, 77 (47%) were females and 85 (53%) were males. Mean ages in patient and control groups were 69.41±14.4 and 67.35±19.41, respectively. NLR’s in acute stroke and control groups were 3.38±3.43 and 2.12±1.11, respectively, and this difference was found to be statistically significant (p=0.001). NLR’S in atherothrombotic and cardioembolic groups were 3.26±2.35 and 4.46±5.6, respectively, and this was found to be statistically significant (p=0.03).
DISCUSSION AND CONCLUSION: High NLR was found to be related with cardioembolic etiology in acute ischaemic stroke. We think that more detailed investigation for cardioembolic sources may be necessary in patients with high NLR at first admission.

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GÝRÝÞ ve AMAÇ: Çocukluk döneminde idrar yolu enfeksiyonlarý (ÝYE) sýktýr. Uzun dönem sonuçlarý açýsýndan önemli olan ÝYE’da uygun tedavi ile bulgularýn giderilmesi, ürosepsisin önlenmesi ve böbreklerde hasar olasýlýðýnýn en aza indirgenmesi amaçlanmaktadýr. Çalýþmamýzda üç yýllýk süreçte ÝYE tanýsýyla hastaneye yatýrýlan olgularýn klinik, laboratuvar, görüntüleme bulgularýný incelemeyi amaçladýk.
YÖNTEM ve GEREÇLER: Olgularýn dosyalarý geriye dönük incelendi. Demografik özellikleri, öz- ve soygeçmiþleri, klinik ve laboratuvar bulgularý, kültür için idrar alýnma yöntemi, idrar kültüründen izole edilen mikroorganizma, uygulanan tedavi süresi, ÝYE nedeniyle tekrarlayan yatýþ öyküsü ile ilgili bilgiler toplandý. Üriner sistem görüntüleme (USG, DMSA sintigrafisi ve VSUG) bulgularý kaydedildi.
BULGULAR: Çalýþmaya, yaþlarý 1 ay-18 yaþ arasýnda(ortanca yaþ: 10 ay) olan, yatarak tedavi edilen 201 hasta alýndý. Olgularýn %45.8’inde üriner sistem anomalisi vardý. Sýk idrar yolu enfeksiyonu geçirme oraný %26,4; doðuþtan anomali ve vesikoüreteral reflü (VUR) oraný her biri % 8,5 olarak belirlendi. En sýk baþvuru þikayeti ateþ (% 54,2), kusma (% 22,9) ve dizüri (% 12,4) idi. %45,3 oranýnda (n=91) üst üriner sistem etkilenmiþti. Üst üriner sistem enfeksiyonu olanlarda ateþ (p=0,0001), alt üriner sistem enfeksiyonu olanlarda ise, sarýlýk (p=0,004) ve huzursuzluk (p=0,039) anlamlý yüksek oranda saptandý. Ýdrar kültüründe en sýk (%74,6) E.coli izole edildi. Üriner USG bulgularý %26,9 hastada (n=54) patolojikti. Hastalarýn %53,7’sine DMSA, %55,2’sine VSUG çekildi. DMSA sintigrafisi çekilen hastalarýn %28,7’sinde (n=31) ve VSUG yapýlan hastalarýn %28,8’inde (n=32) sonuç patolojik bulundu. Tedavi süresi ortalama 8,48±1,94 gündü.

TARTIÞMA ve SONUÇ: Süt çocukluðu döneminde ateþ ve kusma yakýnmasýnda ÝYE tanýsý mutlaka akla getirilmelidir. Enfeksiyonun uygun antibiyotik ve destek tedavisi, görüntüleme yöntemlerinin uygulanmasý, gerekli durumlarda multidisipliner takip ve tedavi ÝYE yönetiminin önemli basamaklarýdýr. Altta yatan üriner sistem patolojisi olan hastalarýn daha dirençli mikroorganizmalar ile enfekte olabileceði düþünülerek tedavi planlanmalý, öncesinde mutlaka uygun yöntemle idrar kültürü alýnmalýdýr. Böbrek parenkim hasar ve skarý olan olgularýn uzun dönem komplikasyonlar açýsýndan izlemlerinin yapýlmasý gerekmektedir.

INTRODUCTION: Urinary tract infections (UTIs) are common and important because of their long-term consequences in childhood. The treatment of UTI consists mainly of antimicrobial agents to eliminate the symptoms, to prevent urosepsis, and to reduce the likelihood of renal damage. Here, we aimed to evaluate the clinical, laboratory findings of children hospitalized for UTI, in a 3-year period.
METHODS: Hospital records of the patients were investigated retrospectively. Data about demographic features, past and family history, clinical and laboratory findings, urine sampling methods, microorganisms isolated from urine culture, treatment duration, and recurrent hospitalization data were collected. Urinary system imaging (USG), dimercaptosuccinic acid scintigraphy, and voiding cystourethrography findings were obtained.
RESULTS: We enrolled 201 children aged between 1 month and 18 years (median age: 10 months) to our study. About 45.8% of children had urinary tract anomalies. The presence of recurrent UTI, congenital anomaly, and vesicoureteral reflux was 26.4%, 8.5%, and 8.5%, respectively. The most common symptoms were fever (54.2%), vomiting (22.9%), and dysuria (12.4%). Upper urinary tract involvement rate was 45.3%. Fever was observed in children with upper UTI significantly (p=0.0001) more than in children with lower UTI, while jaundice (p=0.004) and restlessness (p=0.039) were observed more in lower UTI than in upper UTI. Escherichia coli was the most isolated agent from urine cultures (74.6%). About 26.9% of cases (n=54) had pathologic urinary sonography (USG) findings. About 53.7% and 55.2% of cases had 99m Tc-DMSA scintigraphy and VCUG, respectively. Thirty-one cases with DMSA and 32 cases with VCUG had pathologic findings. Mean duration of treatment was 8.48±1.94 days.
DISCUSSION AND CONCLUSION: Urinary tract infections should be in differential diagnosis of infants with fever and vomiting. Appropriate antimicrobial and supportive treatment, urinary tract imaging studies, in relevant cases, multidisciplinary treatment, and follow-up are the main steps of UTI management. Treatment should be aimed according to resistant microorganisms in cases with urinary tract anomalies. Before initialization of treatment, urine culture should be done. Cases with renal scarring should be followed up for long-term complications.

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GÝRÝÞ ve AMAÇ: Mekanik bel aðrýsý olan hastalarda aðrý þiddeti ve aðrýyý felaketleþtirme ile Lasegue Belirtisi arasýndaki iliþkiyi araþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Bel aðrýsý þikayeti olan 345 kiþi Lasegue iþaretine göre pozitif ve negatif olmak üzere iki gruba ayrýldý. Katýlýmcýlara Sayýsal Aðrý Derecelendirme Ölçeði (SADÖ) ve Aðrý Felaketleþtirme Ölçeði (AFÖ) uygulanarak Lasegue iþaretini yordama güçleri araþtýrýldý.
BULGULAR: Heri iki ölçeðin puanlarý Lasegue pozitif olan grupta negatif olan gruba göre istatiksel olarak anlamlý derecede yüksek bulundu. Basit Lojistik Regresyon analizinde SADÖ ve AFÖ’nün Lasegue testi pozitifliðini istatiksel olarak anlamlý þekilde yordayabildiði saptandý.
TARTIÞMA ve SONUÇ: SADÖ ve AFÖ’nün lomber radikülopati varlýðýný ortaya çýkarmak için kullanýlabilecek araçlar olduðu saptanmýþtýr. Çalýþmamýzýn sonuçlarý aðrýnýn algýlanmasýnda felaketleþtirme gibi psikolojik etkenlerin de önemli olduðunu, klinisyenlerin tedavi sürecini yönetirken bu durumu dikkate almalarýnýn yararlý olacaðýný ortaya koymuþtur.

INTRODUCTION: We wanted to investigate the relationship between the severity of pain and pain catastrophizing and Lasegue sign in patients with mechanical low back pain.
METHODS: Three hundred and forty-five people with low back pain were divided into two groups as positive and negative according to the Lasegue sign. Numerical rating scale for pain (NRS-P) and pain catastrophizing scale (PCS) were administered to the participants and the predictive power of these tests for the Lasegue sign was investigated.
RESULTS: The scores of both scales were found to be statistically significantly higher in the Lasegue positive group compared to the negative group. In the simple logistic regression analysis, it was determined that NRS-P and PCS could significantly predict Lasegue test positivity.
DISCUSSION AND CONCLUSION: It has been determined that NRS-P and PCS are tools that can be used for the presence of lumbar radiculopathy. The results of our study revealed that psychological factors such as catastrophizing are also important in the perception of pain, and it would be beneficial for clinicians to consider this situation while managing the treatment process.

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GÝRÝÞ ve AMAÇ: Femtosaniye laser in situ keratomileusis (FS-LASÝK) ve Wavefront rehberliðinde yapýlan femtosaniye laser in situ keratomileusis (WFG FS-LASÝK) prosedürlerinin yüksek sýralý aberasyonlar (YSA) açýsýndan deðerlendirilmesi.
YÖNTEM ve GEREÇLER: Miyopi ve/veya miyopik astigmatý olan ve FS-LASÝK prosedürü uygulanan 64 hastanýn 128 gözü 1.Grubu oluþturmaktaydý. Ortalama yaþlarý 27.87 ± 5.49 (19-41) idi. Otuz ikisi erkek (%50), 32’si de kadýndý (%50). Miyopi ve/veya miyopik astigmatý olan ve WFG FS-LASÝK prosedürü uygulanan 64 hastanýn 128 gözü de 2.Grubu oluþturmaktaydý. Ortalama yaþlarý 28.56 ±6.01 (19-42) idi. Otuz ikisi erkek (%50), 32’si de kadýndý (%50). Ýki grup YSA açýsýndan birbiriyle kýyaslandý.
BULGULAR: Yaþ ve cinsiyet açýsýndan iki grup arasýnda anlamlý bir farklýlýk yoktu (p deðerleri 0.050’den büyük). Preoperatif ve postoperatif sferik, silindirik, sferik eþdeðer, düzeltilmemiþ ve düzeltilmiþ görme keskinlikleri açýsýndan da iki grup arasýnda anlamlý bir farklýlýk yoktu (p deðerleri 0.050’den büyük). FS-LASÝK uygulanan gözlerde postoperatif koma, trefoil ve sferik aberasyon oraný WFG FS-LASÝK uygulanan gözlere göre anlamlý olarak daha fazlaydý (p=0.000).
TARTIÞMA ve SONUÇ: Miyopi ve miyopik astigmatizmanýn düzeltilmesinde uygulanan hem FS-LASÝK hem de WFG FS-LASÝK prosedürleri etkin ve güvenilir metodlardýr. FS-LASÝK prosedürü daha fazla postoperatif koma, trefoil ve sferik aberasyona neden olmaktadýr, yani daha fazla yüksek sýralý aberasyona neden olmaktadýr.

INTRODUCTION: To compare the results of femtosecond-assisted laser in situ keratomileusis (FS-LASIK) and wavefront-guided FS-LASIK (WFG FS-LASIK) procedures in terms of high-order aberrations (HOAs).
METHODS: One hundred and twenty-eight eyes of 64 patients with myopia and/or myopic astigmatism who had undergone FS-LASIK procedure comprised Group I. Their mean age was 27.87±5.49 (19–41) years. Thirty-two of them were male (50%) and 32 (50%) were female. One hundred and twenty-eight eyes of 64 patients with myopia and/or myopic astigmatism who had undergone WFG FS-LASIK procedure comprised Group II. Their mean age was 28.56±6.01 (19–42) years. Thirty-two of them were male (50%) and 32 (50%) were female. Two groups are compared with each other in terms of HOAs.
RESULTS: In respect to age and sex, there was no significant difference between FS-LASIK and WFG FS-LASIK groups (p>0.050). Regarding pre-operative and post-operative spherical, cylindrical, and spherical equivalent values, uncorrected distance visual acuity, and corrected distance visual acuity, there was no significant difference between two groups (p>0.050). FS-LASIK induced more spherical aberration, coma, and trefoil than WFG FS-LASIK (p=0.000).
DISCUSSION AND CONCLUSION: In conclusion, both FS-LASIK and WFG FS-LASIK are effective and safe procedures in the treatment of myopia and myopic astigmatism. FS-LASIK induces more spherical aberration, coma, and trefoil than WFG FS-LASIK procedure, meaning it causes more HOAs.

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GÝRÝÞ ve AMAÇ: Migren patofizyolojisinde inflamasyonun rolü tartýþmalýdýr. Migren hastalarýnda kýrmýzý kan hücresi daðýlým geniþliði (RDW) ve plateletkrit gibi yeni inflamatuar belirteçleri araþtýrmayý amaçladýk
YÖNTEM ve GEREÇLER: Bu çalýþmaya 100 migren hastasý ve benzer demografik özelliklere sahip 67 saðlýklý kontrol dahil edildi. Nötrofil, lenfosit ve trombosit sayýsý, RDW, plateletkrit, eritrosit sedimantasyon hýzý (ESR), C-reaktif protein (CRP), açlýk kan þekeri, serum kreatinin, nötrofil-lenfosit oraný (NLR) dahil olmak üzere tam kan sayýmý (CBC) bu iki grup arasýnda karþýlaþtýrýldý. Ýstatistiksel analiz için SPSS kullanýldý.
BULGULAR: RDW ile migren grubu, CRP, plateletkrit, trombosit ve nötrofil sayýlarý arasýnda pozitif korelasyon vardý. Migren grubunda ESR, trombosit sayýsý ve RDW sonuçlarý kontrol grubuna göre anlamlý olarak yüksekti (sýrasýyla p = 0,044, p = 0,024, p = 0,002). CRP, NLR ve platelekrit, migren grubunda anlamlý olmaksýzýn daha yüksekti. Çok deðiþkenli analizde, RDW, diðer risk faktörlerine göre ayarlandýktan sonra migrenin anlamlý baðýmsýz öngörücüsü olarak bulundu (p=0,048). Receiver Operating Characteristics (ROC) eðrisi analizinde, %13.25'lik bir RDW deðeri migren için etkili bir kesme noktasý olarak tanýmlanmýþtýr (eðri altýndaki alan = 0.620, % 95 CI: 0.53-0.71, p=0,009). % 13.25'in üzerindeki bir RDW deðeri, %58'lik bir duyarlýlýk ve %54'lük bir özgüllük saðlamýþtýr.
TARTIÞMA ve SONUÇ: Çalýþmamýzda, migrenli hastalarda RDW'nin diðer deðiþkenlerden baðýmsýz olarak kontrol grubuna göre daha yüksek olduðunu bulduk. RDW, basit ve ucuz bir tam kan sayýmý incelemesi olarak migren için enflamatuar bir belirteç olarak kullanýlabilir.

INTRODUCTION: The role of inflammation in the pathophysiology of migraine is controversial. We aimed to investigate new inflammatory markers such as red blood cell distribution width (RDW) and plateletcrit in patients with migraine.
METHODS: In this study, 100 patients suffering from migraine and 67 healthy controls with similar demographic characteristics were included in the study. Complete blood count (CBC) including number of neutrophils, lymphocytes and platelets, RDW, plateletcrit, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), fasting blood glucose, serum creatinine, and neutrophil-to-lymphocyte ratio (NLR) was compared between these two groups. SPSS was used for statistical analysis.
RESULTS: There was positive correlation between RDW and migraine group, CRP, plateletcrit, platelet, and neutrophil counts. The results of ESR, platelet count and RDW in migraine group were higher than control group significantly (p=0.044, p=0.024, and p=0.002, respectively). CRP, NLR, and plateletcrit were higher in migraine group without significance. In multivariate analysis, RDW was found as a significant independent predictor of migraine after adjusting for other risk factors (p=0.048). In a receiver operating characteristic curve analysis, an RDW value of 13.25% was identified as an effective cutoff point for migraine (area under curve = 0.620, 95% confidence interval: 0.53–0.71, p=0.009). An RDW value of more than 13.25% yielded a sensitivity of 58% and a specificity of 54%.
DISCUSSION AND CONCLUSION: In our study, we found that RDW was higher in patients with migraine than control group, independent of other variables. RDW can be used as an inflammatory marker for migraine with a simple and inexpensive CB examination.

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GÝRÝÞ ve AMAÇ: Bu çalýþmada amacýmýz hipotroidi hastalarýnda fibromiyalji varlýðýnýn kemik mineral yoðunluðunu olumsuz yönde etkileyip etkilemediðini araþtýrmaktýr.
YÖNTEM ve GEREÇLER: Hipotroidizm ve FMS'li 30 hasta, hipotroidizmli 30 hasta ve 27 saðlýklý gönüllü olmak üzere çalýþmamýz 3 gruptan oluþturuldu. Gruplarýn Lomber vertebra ve sol proksimal femur kemik mineral yoðunluðu (KMY) ölçümleri Dual-enerji X-ýþýný absorpsiyometrisi (DXA) ile yapýldý. Gruplar kemik mineral yoðunluðu açýsýndan karþýlaþtýrýldý.
BULGULAR: Saðlýklý gönüllülerden oluþan grup diðer iki grup ile karþýlaþtýrýldýðýnda, lomber spinal total T skoru ile lomber spinal total KMY deðerleri arasýnda anlamlý bir fark bulundu. Ancak gruplar arasýnda yaþ, cinsiyet, BKÝ, sigara içme ve alkol kullaným alýþkanlýklarý, ESR, CRP, TSH, fT3, fT4, 25OH-D açýsýndan anlamlý bir fark bulunmadý.
TARTIÞMA ve SONUÇ: Sonuç olarak, hipotroidili hastalar ve hem fibromiyalji hem hipotroidili olan hastalarda kemik mineral yoðunluðu saðlýklý bireylerden düþüktü. Bununla birlikte, hem fibromiyalji hem hipotroidili hastalar ve sadece hipotroidisi olan hastalar arasýnda kemik mineral yoðunluðu açýsýndan fark yoktu.

INTRODUCTION: The aim of this study was to investigate whether the presence of fibromyalgia affects the bone mineral density (BMD) in hypothyroid patients.
METHODS: Our study consisted of three groups, including 30 patients with hypothyroidism and FMS, 30 patients with hypothyroidism, and 27 healthy volunteers. Lumbar vertebrae and left proximal femur BMD measurements of groups were performed by dual-energy X-ray absorptiometry. Groups were compared in terms of BMD.
RESULTS: Lumbar spinal total T score and lumbar spinal total BMD were significantly different between healthy volunteers and the other two groups. However, no significant difference was found between the groups in terms of age, gender, body mass index, smoking and alcohol use habits, erythrocyte sedimentation rate, C-reactive protein, thyroid-stimulating hormone, fT3, fT4, and 25-OH Vitamin D.
DISCUSSION AND CONCLUSION: BMD was lower in patients with hypothyroidism and in patients with both fibromyalgia and hypothyroidism compared with healthy individuals. However, there was no difference in BMD between patients with both fibromyalgia and hypothyroidism and only with hypothyroidism.

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GÝRÝÞ ve AMAÇ: COVID-19 hastanýn teþhisi, morbidite ve mortalitesi ile MPV iliþkisi üzerine yürütülmüþ çalýþmalar olmasýna raðmen, sonuçlar çeliþkilidir. Bu çalýþmada belirgin sayýda hasta ile MPV'nin hastanede yatýþ süresi ve mortalite üzerindeki etkilerini araþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Bu çok merkezli çalýþma, 9.487 hasta üzerinde retrospektif olarak gerçekleþtirildi. Hastalarýn demografik bilgileri ve laboratuvar parametreleri hastanedeki týbbi kayýtlarýndan elde edildi. Analizler, Windows (SPSS) 22.0 sürümü kullanýlarak yapýldý.
BULGULAR: Çalýþmaya, 8.681 yoðun bakým ünitesi (YBÜ) dýþýnda takip edilen hastaya ek olarak 806 yoðun bakým hastasý dâhil edildi. YBÜ'de takip edilen hastalarýn yaþ ortalamasý (YBÜ) dýþýnda takip edilen hastalara göre anlamlý derecede yüksekti (71,25 ± 13,42'ye karþý 56,17 ± 16,59; p <0,001). Baþvuru anýndaki ortalama trombosit hacmi (Mean Platelet Volume: MPV) deðerleri ve yatýþ süresindeki maksimum MPV deðerleri yoðun bakým ünitesinde takip edilen hastalarda anlamlý olarak yüksekti (p <0.05). Hayatýný kaybeden grupta MPVilk, MPVson, ΔMPVson-ilk ve ΔMPV% deðerleri sað kalan hastalara göre anlamlý olarak daha yüksekti. ROC analizi sonucunda MPVson ≥ 10.05 fl olan kiþilerde ölüm riskinin 5.15 kat daha fazla olduðu belirlendi (ODDS oraný: 5.15 %95 CI: 4.374-6.067). Hastanýn, hastaneye ilk geliþ MPV deðerinde %2.18'in üzerindeki artýþlarda ölüm riskinin 4.62 kat arttýðý görüldü (ODDS oraný: 4.62,%95 CI: 3.455-6.203).
TARTIÞMA ve SONUÇ: Sonuç olarak, hastanede yatýþ sýrasýndaki MPV ve MPV deðiþikliklerinin COVID-19 hastalarýnda mortalitenin güçlü bir belirleyicisi olabileceði düþünüldü.

INTRODUCTION: Although several studies have been conducted on the association of mean platelet volume (MPV) with the diagnosis, morbidity, and mortality of coronavirus disease 19 (COVID-19) patients, the results were contradictory. We aimed to investigate the effects of MPV on hospitalization and mortality with a significant number of patients.
METHODS: This multicenter study was carried out retrospectively on 9.487 patients. The demographic information and laboratory parameters of the patients were obtained from their medical records in the hospital. Analyses were performed using Statistical Package for the Social Sciences (SPSS) version 22.0 for Windows.
RESULTS: In total, there were 806 intensive care unit (ICU) patients, in addition to 8.681 non-ICU patients. The mean age of patients in ICU was significantly higher than non-ICU (71.25±13.42 vs. 56.17±16.59; p<0.001). MPV values at admission and max MPV values during the period of hospitalization were significantly higher in patients followed in the ICU (p<0.05). MPVfirst, MPVlast, ΔMPVlast-first, and ΔMPV% values were significantly higher in non-survivor group than the survived patients. As a result of receiver-operating characteristic analysis, the risk of mortality was determined to be 5.15 fold greater in people with MPVlast ≥10.05 fl. (ODDS ratio: 5.15 95% CI: 4.374–6.067). The patient has a 4.62 fold risk of death after a 2.18% increase of arrival MPV value (ODDS ratio: 4.62, 95% CI: 3.455-6.203).
DISCUSSION AND CONCLUSION: We thought that MPV and MPV changes during hospitalization may be a powerful predictor of mortality in patients with COVID-19.

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GÝRÝÞ ve AMAÇ: Ýbuprofen, prematüre bebeklerde patent duktus arteriozusun (PDA) farmakolojik tedavisinde kullanýlan etkili bir ajandýr. Bu çalýþmada PDA tanýsý konulan ve farmakolojik kapatma tedavisi için intravenöz bolus tedavisi (ÝVBT) ve sürekli intravenöz infüzyon tedavisi (SÝVÝT) þeklinde ibuprofen verilen hastalarda iki farklý tedavi yönteminin etkinlik ve komplikasyonlarý karþýlaþtýrýlmýþtýr.
YÖNTEM ve GEREÇLER: Bu çalýþma hastanemiz Yenidoðan Yoðun Bakým Ünitesinde, 2015-2018 yýllarý arasýnda yatmýþ olan 34. gestasyon haftasýndan önce doðmuþ 64 preterm bebekle gerçekleþtirildi. Hastalarýn demografik özellikleri, klinik bulgularý, tedaviye baðlý komplikasyonlar ve tedaviye yanýtlarý deðerlendirildi.
BULGULAR: Olgularýn % 48,4’ine (n=31) ÝVBT, %51,6’sýna (n=33) SÝVÝT yöntemleriyle standart dozda (10/5/5 mg/kg) ibuprofen tedavisi verildi. Tedavi öncesi ve sonrasý PDA kapanmasý üzerine etki ve ilacýn yan etkileri karþýlaþtýrýldý. SÝVÝT verilen 6 hastada (%18.2) beslenme intoleransý geliþmiþ olup hiçbirinde evre 3 nekrotizan enterokolit (NEK) olmadý. ÝVBT verilen grupta is 15 hastada (%48.4) beslenme intoleransý, 3 hastada (%9.7) evre 3 NEK geliþti. ÝVBT alan hastalarýn 3’ünde (%9.7) cerrahi ligasyon ihtiyacý oldu. SÝVÝT alan hiçbir hastada cerrahi ligasyon ihtiyacý olmadý. Ýki grup arasýnda oligüri, renal yetmezlik, hiponatremi, kanama diyatezi gibi yan etkiler ile mortalite, hastanede kalýþ süresi ve periventriküler kanama açýsýndan anlamlý fark saptanmadý.
TARTIÞMA ve SONUÇ: nmelidir.PDA’nýn kapatýlmasýnda farmakolojik tedavi olarak kullanýlan ibuprofenin SÝVÝT þeklinde uygulandýðýnda ÝVBT’ne göre beslenme intoleransý ve NEK geliþme riskininin daha az olduðunu tespit ettik. Bu bulgular daha büyük olgu gruplarý ile tekrar incelenmelidir.

INTRODUCTION: Ibuprofen (IBU) is an effective agent for the pharmacological treatment of patent ductus arteriosus (PDA) in premature infants. In this study, we compared the efficacy and complications of intravenous bolus therapy (IVBT) and continuous intravenous infusion therapy (CIVIT) for the treatment of PDA.
METHODS: The study was conducted with 64 preterm infants in neonatal intensive care unit with gestational age <34 weeks between 2015 and 2018. Demographic characteristics, clinical findings, complications, and response to treatment were evaluated.
RESULTS: IBU treatment with a standard dose (10/5/5 mg/kg) was given as IVBT in 48.4% (n=31) of the patients and as CIVIT 51.6% (n=33) of the patients. The efficacy and the side effects of the treatment modalities were compared. In CIVIT group, feeding intolerance was found in 6 patients (18.2%) and none of them had Stage 3 necrotizing enterocolitis (NEC). In the IVBT group, 15 patients (48.4%) had feeding intolerance and 3 patients (9.7%) had Stage 3 NEC. Surgical ligation was needed in 3 (9.7%) patients who received IVBT. There was no need for surgical ligation in patients who received CIVIT. No significant difference was found between two groups in terms of mortality, hospital stay, periventricular hemorrhage, and side effects such as oliguria, renal insufficiency, hyponatremia, and bleeding diathesis.
DISCUSSION AND CONCLUSION: When IBU is used as CIVIT for the pharmacological treatment of PDA, we found that the risk of developing feeding intolerance and NEC is less than IVBT. These results should be studied with larger sample sizes.

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GÝRÝÞ ve AMAÇ: NCCN kriterleri kullanarak pankreas adenokarsinomunun rezektabilitesini belirlemede BT'nin tanýsal doðruluðunu deðerlendirdik.
YÖNTEM ve GEREÇLER: Ýki radyolog, 2018-20120 yýllarý arasýnda ameliyat edilen metastatik olmayan pankreas adenokarsinomlu 36 hastanýn abdominal BT görüntülerini retrospektif olarak inceledi. BT bulgularýna göre NCCN rezektabilite kriterleri kullanýlarak 6 hasta rezektabl, 7 hasta sýnýrda rezektabl ve 23 hasta rezeke edilebilir olarak rapor edildi. Negatif rezeksiyon marjý (R0) için pozitif prediktif deðerler, postoperatif histopatolojik raporlar referans standartlar olarak kullanýlarak BT ile deðerlendirildi.
BULGULAR: Cerrahiye giden 36 hastada R0 rezeksiyon oranlarý rezektabl, borderline rezektabl ve rezeke edilemeyen hastalýk için sýrasýyla% 83 (5/6),% 71 (5/7) ve% 60 (14/23) idi (P <.001).
TARTIÞMA ve SONUÇ: BT, R0 rezeksiyon olasýlýðý ile cerrahiden fayda görebilecek pankreas kanserli hastalarý tanýmlamak için kullanýlabilir. Çalýþma sonuçlarýmýz, NCCN kýlavuzlarýnýn kullanýlmasýyla CT'nin R0 rezeksiyonunu tahmin etmek için tanýsal doðruluðunun geliþtirilebileceðini gösterdi.

INTRODUCTION: We evaluated the diagnostic accuracy of computed tomography (CT) in determining resectability of pancreatic adenocarcinoma using National Comprehensive Cancer Network (NCCN) Criteria.
METHODS: Two radiologists retrospectively reviewed abdominal CT images from 36 patients with non-metastatic pancreatic adenocarcinoma who were operated on between 2018 and 20120. Based on CT findings six patients were reported as resectable, seven patients as borderline resectable, and 23 patients as unresectable using NCCN criteria for resectability. Positive predictive values for negative resection margin (R0) were assessed for CT using post-operative histopathological reports as reference standards.
RESULTS: In 36 patients who preceded to surgery R0 resection rates were 83% (5 of 6), 71% (5 of 7), and 60% (14 of 23) for resectable, borderline resectable, and unresectable disease, respectively (p<0.001).
DISCUSSION AND CONCLUSION: CT can be used to identify patients with pancreatic cancer who can benefit from surgery with the possibility of R0 resection. Our study results showed that using NCCN guidelines the diagnostic accuracy of CT to predict R0 resection can be improved.

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GÝRÝÞ ve AMAÇ: GÝRÝÞ ve AMAÇ: Ýrritabl baðýrsak sendromu (ÝBS), altýnda organik patoloji olmadan karýn aðrýsý, gaz ve baðýrsak alýþkanlýklarýnda deðiþiklikle karakterize fonksiyonel bir gastrointestinal hastalýktýr. Kabýzlýk baskýn, ishal baskýn ve karýþýk olmak üzere üç türe ayrýlýr. Rifaximin, baðýrsaktaki florayý etkileyerek ÝBS semptomlarýný iyileþtirebileceði düþünülen bir antibiyotiktir. Bu çalýþmada amaç Rifaximin tedavisinin diare ve konstipasyon aðýrlýklý ÝBS hastalarýnda Trimebutin Maleat tedavisine üstün olup olmadýðýný göstermektir.
YÖNTEM ve GEREÇLER: Bu retrospektif çalýþmada hastalar konstipasyon ve diare aðýrlýklý ÝBS olarak iki grupta incelendi. Ayrýca her bir grup Trimebutin Maleat ve rifaximin tedavisi olarak alt gruplara ayrýldý. Rifaximin grubuna ilaç 200 mg, 3x2, 15 gün süreyle verildi. Trimebutin Maleat grubunda yaþam tarzý deðiþiklikleri ve Trimebutin Maleat 200 mg 3x1 verildi. Tedavi bitiminde ve 20 gün sonra hastalar tekrar deðerlendirildi.
BULGULAR: Toplam 179 hasta incelendi. ÝBS semptomlarý; þiþkinlik, karýn aðrýsý, dýþký þekli; açýsýndan bakýldýðýnda tedavi süresünce her iki tedavinin etkin olduðu ancak tedavi bitiminden 20 gün sonra Rifaximin tedavisinin Trimebutin Maleat tedavisine kýyasla daha etkin olduðu görüldü.
TARTIÞMA ve SONUÇ: Rifaximin kullanýmý hem diare hem de konstipasyon aðýrlýklý ÝBS hastalarýnda Trimebutin Maleat tedavisine göre uzun dönemde anlamlý düzelme saðlamaktadýr.

INTRODUCTION: Irritable bowel syndrome (IBS) is a functional gastrointestinal disease with changes in bowel habits, abdominal pain, and gas without any organic pathology. IBS is divided into three types as constipation – IBS (IBS-C), diarrhea – IBS (IBS-D), and mixed. Rifaximin is an antibiotic that improves IBS symptoms by improving the flora in the intestine. The aim of the study was to determine whether the treatment of rifaximin is superior to treatment.
METHODS: This study performed retrospectively and patients were divided into two groups as IBS-C and IBS-D. Each group was divided into two groups as rifaximin and Trimebutin Maleate treatment. Rifaximin at a dose of 200 mg, 3×2 daily for 15 days. Trimebutin Maleate group includes lifestyle modification and Trimebutin Maleate 200 mg 3×1. At the end of the treatment and after 20 days, the patients were re-evaluated.
RESULTS: A total of 179 subjects had examined. In terms of IBS symptoms; bloating, abdominal pain, and stool consistency, both treatments are effective as long as patients continue treatment; however, 20 days after the end of the treatment, rifaximin treatment was found to be more effective than trimebutin maleate treatment.
DISCUSSION AND CONCLUSION: The use of rifaximin provides significant long-term improvement in both diarrhea and constipation IBS patients compared to Trimebutin Maleate treatment.

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GÝRÝÞ ve AMAÇ: Lokal ileri kolorektal kanserlerde komþu organ invazyonu durumunda multivisseral organ rezeksiyonlarý önerilmektedir. Bu çalýþmadaki amacýmýz multivisseral organ rezeksiyonlarý yapýlan kolorektal kanser hastalarýnýn kýsa dönemdeki sonuçlarýný deðerlendirmek, morbidite ve mortalite üzerine olan etkilerini deðerlendirmektir.
YÖNTEM ve GEREÇLER: Çalýþmaya küratif amaçla ameliyat edilen kolorektal kanserli hastalar alýnmýþtýr. Hastalar multivisseral rezeksiyon grubu (MRG) ve standart rezeksiyon grubu (SRG) olarak ikiye ayrýldý. Bu iki grup; hastalarýn demografik özellikleri, tümör lokalizasyonlarý, ameliyat süreleri ve kanama miktarý, hastanede kalýþ süresi, postoperatif morbidite ve mortalite açýsýndan karþýlaþtýrýldý. Ýstatistiksel deðerlendirmeler Mann-Whitney U ve Chi-Square testleri ile yapýldý.
BULGULAR: Çalýþmaya alýnan 316 hastanýn 32’si (%10.1)MRG’da 284’ü (%89.9) SRG’da yer aldý. Erkek/kadýn oraný, komorbid hastalýk varlýðý, tümör lokalizasyonlarý her iki grupda benzerdi. Ayrýca hastanede kalýþ süreleri açýsýndan fark yoktu (MRG: 8.4 ± 4.2 gün, SRG: 8.2 ± 6.2 gün). Operasyon süreleri MRG’da daha uzun (MRG: 221 ± 62.3 dk. SRG: 181 ± 70.1 dk.), kanama miktarý [(MRG: 180 (50-410) cc, SRG: 150 (40-390) cc] daha fazla ve istatistiksel olarak anlamlýydý (sýrasýyla p<0.001 ve p<0.001). Her iki grup arasýnda morbidite (MRG: %21.8, SRG: %20.8) ve mortalite (MRG: %3.1, SRG: %3.5) açýsýndan fark yoktu. MRG’da histopatolojik olarak gerçek organ invazyonu (T4) saptanan hasta sayýsý 17 (%53.1) idi.
TARTIÞMA ve SONUÇ: Kolorektal kanserlerde multivisseral organ rezeksiyonlarý deneyimli merkezlerde kabul edilebilir morbidite ve mortalite ile uygulanabilir.

INTRODUCTION: Multivisceral organ resection is recommended in patients with locally advanced colorectal cancer. The aim of this study was to determine the influence of additional organ resection on morbidity and mortality on short term.
METHODS: Patients who underwent curative resection for colorectal cancer were included in the study. They were divided into two groups as multivisceral resection groups (MRGs) and standard resection groups (SRGs). The patients were compared in terms of demographics, tumor localization, operation time, blood loss, length of hospital stay, and post-operative morbidity and mortality. In statistical analysis, Mann–Whitney U and chi-square tests were used.
RESULTS: Thirty-two (10.1%) of 316 patients were in the MRG and 284 (89.9%) in the SRG. Male/female ratio, presence of comorbid diseases, and tumor localization were similar in the groups. Hospital stay (8.4±4.2 vs. 8.2±6.2 days) was also similar. Operation time (221±62.3 vs. 181±70.1 min) was longer and blood loss (180 [50–410] cc vs. 150 [40–390] cc) was significantly higher in the MRG (p<0.001 and p<0.001, respectively). There was no statistically significant difference with regard to morbidity (21.8% vs. 20.8%) and mortality (3.1% vs. 3.5%). In the MRG, histopathologically confirmed tumoral invasion (T4) was detected in 17 (53.1%) patients for whom multiorgan resection was performed.
DISCUSSION AND CONCLUSION: Multiorgan resections can be performed with acceptable morbidity and mortality in specialized centers.

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GÝRÝÞ ve AMAÇ: Türkiye'nin Doðu bölgesi, coðrafi yapýsý ve saðlýk insan gücü istihdamýnýn sürekli kýlýnmasýndaki güçlükler nedeniyle saðlýk hizmet sunumunda zorluklarla karþý karþýyadýr. Bu çalýþmada Aile hekimliði (AH) uygulamasýnýn, Kuzeydoðu Anadolu Bölgesi’ ndeki birinci basamak saðlýk hizmet (BBSH) parametreleri üzerine etkileri ve dönemsel deðiþimler incelenerek bölgenin saðlýk düzeyine katkýsýnýn ölçülmesi amaçlanmaktadýr.
YÖNTEM ve GEREÇLER: Kesitsel tanýmlayýcý retrospektif çalýþmada Ýstatistiki Bölge Birimleri Sýnýflandýrmasý (ÝBBS) kapsamýnda KAB ’nin illerinin açýk kaynaklardan elde edilen 2008-2016 yýllarý arasýndaki temel saðlýk verileri karþýlaþtýrýlmaktadýr. Hesaplamalarda Microsoft Excel 2016 programý kullanýlmýþtýr.
BULGULAR: Bölgede BBSH’ ne eriþim kolaylaþmýþ, 2018 yýlýnda 2008 yýlýna göre; hekim sayýsýnda %26,3 ve hemþire-ebe sayýsýnda %24,6, birinci basamaða baþvuru sayýsýnda ise %42 oranýnda artýþ olmuþtur. Aktif çalýþan aile hekimi baþýna düþen nüfus Türkiye’de 3.405 iken Kuzeydoðu Anadolu Bölgesi 3.252 kiþi olmuþtur. Ýzlemlerde yüksek artýþlar gerçekleþmiþ, gebe izleminde %45, lohusa izleminde %166, bebek baþýna ortalama izlemde %57, çocuk baþýna ortalama izlemde %29 oranýnda artýþ olmuþtur. Anne ölüm oraný 2008 yýlýnda Türkiye’de yüz bin canlý doðumda 19,4 iken KAB’ da 22,9; 2018 yýlýnda ise bu oran Türkiye’de 13,6, bölgede ise 24 olarak saptanmýþtýr. Ülke ortalamasýna göre anne ölüm oranlarýnýn 2008 öncesine göre önemli azalma göstermesine ve yaklaþýk olarak ayný oran korunmasýna raðmen ülke ortalamasýna göre hala yüksek olmasý dikkat çekmektedir. Bölgede bebek ölüm hýzý 2008 yýlýnda binde 17,8 iken %40 azalmayla 10,6 ya inmiþtir. Beþli Karma Aþý (DaBT+IPA+Hib) oraný 2002 yýlýnda %74; 2008 yýlýnda %96 olarak saptanmýþ ve AH uygulamasýnýn yaygýnlaþtýðý 2010 yýlýnda %100 oranýyla Türkiye ortalamasýnýn üzerine çýkýlmýþ, 2018 yýlýndaysa bu oran %93’e olarak gerçekleþmiþ, Kýzamýk, Kýzamýkçýk ve Kabakulak (KKK) aþýlama hýzý da %6 azalmýþtýr. Saðlýða eriþim ve parametrelerdeki genel iyileþmenin aksine aþýlama oranlarýndaki gerilemede coðrafi zorluklar, saðlýk çalýþaný ve yönetici devir hýzýnýn yüksek olmasý ve aile hekimliði öncesinde kesin kayda dayanmayan tahmini hedef nüfus belirlenmesi rol oynamýþ olabilir.
TARTIÞMA ve SONUÇ: Saðlýkta yapýlan iyileþtirmeler ve sonrasýnda baþlatýlan AH uygulamasýyla hizmet entegrasyonunun saðlanmasý, saðlýk personelinin dengeli istihdamý sonucunda saðlýk hizmetlerine eriþim ve temel saðlýk göstergelerinin yükseltilmesi açýsýndan genel olarak olumlu sonuçlar alýndýðý görülmektedir. Bölgede anne ölümleri ve baðýþýklama konusunda daha dikkatli olunmalýdýr. BBSH bakým kalitesinin sürdürülebilirliði açýsýndan AH baþýna düþen nüfus azaltýlmalý, uzmanlaþmaya aðýrlýk verilmeli; kronik hastalýklarýn erken teþhisi ve yönetimine imkân veren bir yapýda, birinci basamakta farklý disiplinleri bir araya getiren bütünleþik saðlýk bakým modelleriyle aile hekimliði desteklenmelidir. Yaklaþýk 15 yýldýr ülkemizde uygulanan Aile hekimliði uygulamasý sürekli iyileþtirmelerle ihtiyaçlara göre güncellendiði taktirde ülkemiz saðlýðý ile ilgili olarak geleceðe dair umut vermektedir.

INTRODUCTION: Eastern region of Turkey faces challenges in the provision of health-care services due to insufficient human resources and geographical difficulties. In our study, periodic changes and effects of family medicine (FM) practice on the parameters of first step health-care of Northeast Anatolia Region (NAR) are examined.
METHODS: In the descriptive and cross-sectional retrospective study, basic health data of NAR obtained from open sources between 2008 and 2018 were compared within the scope of Nomenclature of Territorial Units for Statistics. Microsoft Excel 2016 was used for calculations.
RESULTS: In the region, access to Primary Health-Care (PHC) got easier, the number of doctors and nurses-midwives rose by 24.6% and the number of applications for PHC increased by 42% in 2018 compared to 2008. In Turkey, while the average per capita population of 3405 family physicians, the NAR’s population has been in the family physician per 3252 people as top average. The monitoring numbers recorded even higher increases with a 45% increase in pregnancy monitoring, 166% rises in post-puerperal monitoring, 57% growth in average monitoring per baby, and an average increase of 29% in monitoring per child were recorded. Whereas maternal death rate was 22.9 in the region for every one hundred thousand births versus a countrywide average of 19.4 in 2008, these rates were recorded as 24.9 and 13.6, respectively, in 2018. It could be argued that maternal rates fell by one third compared to 2006 and the approximately same rate was maintained between 2008 and 2018 but it was higher than the average of Turkey. Compared to 2008, the infant mortality rate in the region was 17.8 per thousand live births, but decreased by 40% and fell to 10.6. While the rate of Quinary Composit Vaccination (DaBT+IPA+Hib) was 74% in 2002, it was observed as 96% in 2008 and exceeded the Turkey average with 100% in 2010 when FM practice became widespread, this rate fell back down to 93% in 2018. The pace of Measles, Rubella, and Parotitis vaccination pace slowed by 6% as well. Fall in vaccination rates contrary to the general improvement in parameters could be attributed to vaccination reluctances, administrative changes, geographical difficulties, the high turnover rate among the health professionals, and difficulty to detect the target population before FM Practice.
DISCUSSION AND CONCLUSION: With improvements in health-care followed by FM practice, generally positive results were recorded in terms of service integration, access to protective health-care thanks to the balanced distribution of health personnel, and raising the basic health level indicators. More attention should be paid to maternal mortality and immunization in the region. To the sustainability of quality of care in PHC, population per FM should be reduced, specialization should be prioritized, and FM should be supported with integrated health-care models that unite various disciplines at the first step enabling early diagnosis and management of chronic diseases and disease management. If the FM system which is implemented for almost 15 years in our country is continuously updated according to needs, promising signs for the health of our nation could be expected for the future.

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GÝRÝÞ ve AMAÇ: Karaciðer kitlelerinin tanýsýnda önemli olan sitolojik özellikleri belirlemektir.
YÖNTEM ve GEREÇLER: Bu çalýþma beþ yýllýk dönemde XXX Hastanesinde ince iðne aspirasyon biyopsisi ile taný verilen 137 vaka ile retrospektif olarak yapýldý. Vakalarýn tüm preperatlarý tekrar incelendi. Sonuçlar Step Wise Logistic Regression Analysis yöntemi ile deðerlendirildi.
BULGULAR: Hepatosellüler karsinom ile metastaz ayýrýcý tanýsýnda; monoton atipi, atipik hepatositik çýplak nükleuslar, nüklus sitoplazma oraný artýþý ve hepatositik morfolojinin belirleyici önemde olduðu görüldü. Hepatosellüler karsinom ile benign hepatik lezyonlarýn ayýrýcý tanýsýnda nükleus sitoplazma oraný artýþý ve safra duktus epitel hücresi olmayýþý belirleyici önemdeydi.
TARTIÞMA ve SONUÇ: Sitomorfolojik özelliklerin yeterli olduðu vakalarda karaciðer lezyonlarýnýn sitolojik tanýsý zor deðildir. Karaciðer sitolojisinde benign kitleler ile hepatosellüler karsinom ayrýcý tanýsýnda sitolojinin etkinliði sýnýrlý olmakla birlikte hücre bloðuna immunhistokimya uygulanmasý ile bu ayrým yapýlabilir. Sitopatolojik taný radyolojik ve biyokimyasal sonuçlar ile konfirme edilmelidir.

INTRODUCTION: The objective of the study was to determine the critical diagnostic cytological features of the liver masses.
METHODS: This retrospective study was conducted with 137 fine needle aspiration biopsies diagnosed in a 5-year period in Haydarpaþa Numune Hospital. All the glass slides of the cases were re-evaluated and 11 cytomorphologic features were investigated in each case. The results were evaluated by Stepwise Logistic Regression Analysis method.
RESULTS: Monotonous atypia, atypical hepatocytic naked nuclei, increased nucleus/cytoplasm (N/C) ratio, and hepatocytic morphology were critical for differential diagnosis of hepatocellular carcinoma (HCC) and metastasis. Increase N/C ratio and the absence of bile duct epithelial cells were critically important for differential diagnosis of HCC from benign liver mass.
DISCUSSION AND CONCLUSION: Cytological diagnosis of liver mass is not difficult in cases where cytomorphological features are sufficient. The efficacy of cytology in the differentiation of benign liver masses from HCC is limited. This can be achieved by performing immunohistochemistry to the cell block. Cytopathologic diagnosis should be confirmed with radiological and biochemical results.

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GÝRÝÞ ve AMAÇ: Ýntihar, gebelikte ve postpartum dönemde kadýn ölümlerinin en önemli nedenlerinden biridir. Bu çalýþmanýn amacý, gebelikte intihar giriþimi nedeniyle acil servise baþvuran hastalarýn sosyo demografik ve klinik özelliklerini incelemektir.
YÖNTEM ve GEREÇLER: Bu çalýþma retrospektif bir çalýþmadýr. Çalýþmaya Ocak 2009-Aralýk 2019 tarihleri arasýnda intihar giriþimi nedeniyle acil servise baþvuran 18-50 yaþ arasý gebe hastalar (n = 46) dahil edildi.
BULGULAR: Gebelerin ortalama yaþý 27.74 (SS = 5.99) saptandý. En sýk intihar giriþimleri gebeliðin 15. haftasýnda idi. Gebeler en çok ilk trimesterde (% 52,2) intihar giriþiminde bulunmuþtur. Ýntihar için en sýk kullanýlan yöntem aþýrý doz ilaç alýmý (% 80.4), bunu toksik maddelere maruz kalma (% 10.9), yüksekten atlama (% 4.3) ve kendine zarar verme (% 4.3) izlemiþtir. Gebelerin %15,2'sinin geçmiþte intihar giriþiminde bulunduklarý tespit edildi.
TARTIÞMA ve SONUÇ: Ýntihar, önlenebilir bir psikiyatrik durumdur. Ýntihar giriþimi gebeliðin rutin takiplerinde mevcut ruh saðlýðý ve geçmiþ psikiyatrik öyküsü sorgulanarak önlenebilir.

INTRODUCTION: Suicide is one of the most important causes of female deaths during pregnancy and postpartum period. The aim of this study is to examine the sociodemographic and clinical characteristics of patients who applied to the emergency department for suicide attempts during pregnancy.
METHODS: This is a retrospective study. Pregnant patients (n=46), between the ages of 18 and 50, admitted to the emergency department for suicide attempt between January 2009 and December 2019 were included in the study.
RESULTS: The mean age of the pregnant was 27.74 (SD=5.99). The most common suicide attempts were in the 15th week of gestation. Pregnant mostly attempted suicide in the 1st trimester (52.2%). The most commonly used method for suicide was overdose medication (80.4%). This was followed by exposure to toxic substances (10.9%), jumping from high (4.3%), and self-injury (4.3%). About 37% of the pregnant had a psychiatric history and used psychiatric drugs. About 15.2% of the pregnant had a past suicide attempt.
DISCUSSION AND CONCLUSION: Suicide is a preventable psychiatric situation. It can be prevented in pregnant by asking for their current mental health and psychiatric history during early pregnancy assessments.

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GÝRÝÞ ve AMAÇ: Miyokard infarktüsünde tromboliz (TIMI) risk indeksi koroner arter hastalýðý olan hastalarda prognozu öngörmek için geliþtirilmiþtir. Bu çalýþmada, TIMI risk indeksinin ST segment yükselmeli miyokard infarktüslü (STEMI) hastalarda acil serviste hesaplanarak giriþimsel bir merkeze yönlendirilmesinin prognostik deðerini deðerlendirdik.
YÖNTEM ve GEREÇLER: Bu çalýþmada TIMI risk indeksinin hastane içi mortalite tahmininde etkinliðini primer perkütan koroner giriþim (PPCI) ile tedavi edilen STEMI'li 944 hasta üzerinde retrospektif olarak deðerlendirdik. Çalýþmamýzda hastalar hastane içi mortalite varlýðýna göre iki gruba ayrýlarak temel özellikler bu gruplar arasýnda karþýlaþtýrýlmýþtýr.
BULGULAR: Çalýþmamýzda Hastane içi mortaliteyi öngörmede çok deðiþkenli regresyon analizi sonuçlarýna göre, TIMI risk indeksi (OR: 5,75;% 95 güven aralýðý CI: 2,09–15,8; p = 0,0007) baðýmsýz bir belirleyici olarak tespit edilmiþtir. Hastane içi mortaliteyi tahmin etmek için TIMI risk endeksinin en iyi kesme deðerinin 29,3% olduðunu; 80,7% duyarlýlýk ve 79,1% özgüllük ile ROC analizi göstermiþtir.
TARTIÞMA ve SONUÇ: Çalýþmamýz acil serviste hesaplanan TIMI risk endeksi deðerinin, STEMI hastalarýnda hastane içi mortalite için baðýmsýz bir prognostik faktör olduðunu göstermiþtir.

INTRODUCTION: Thrombolysis in myocardial infarction (TIMI) risk index has been developed to predict the prognosis in patients with coronary artery disease. In this study, we evaluated the prognostic value of TIMI risk index in patients with ST-segment elevation myocardial infarction (STEMI) when TIMI risk index was calculated in the emergency department (ED) and patients were referred to an interventional center.
METHODS: In this retrospective analysis, we evaluated the in-hospital mortality prognostic impact of TIMI risk index on 944 patients with STEMI treated with primary percutaneous coronary intervention. Patients were divided into two groups according to the presence of in-hospital mortality and the baseline features were compared between these groups. Multivariate analysis was implemented to detect independent predictors of in-hospital mortality.
RESULTS: TIMI risk index was an independent predictor (OR: 5.75; 95% confidence interval: 2.09–15.8; p=0.0007) of in-hospital mortality besides Killip stage, chronic kidney disease, and total ischemic time according to the results of the multivariate regression analysis. ROC analysis showed that the best cutoff value of the TIMI risk index to predict in-hospital mortality was 29.3 with 79.1% sensitivity and 80.7% specificity.
DISCUSSION AND CONCLUSION: Our study indicated that TIMI risk index calculated in the ED is an independent prognostic factor for in-hospital mortality in patients with STEMI.

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Belirli mesleksel ortamlarda toz, zararlý maddeler ya da dumanýn solunmasý, maruz kalan çalýþanlarda akciðer hasarýna neden olabilir. Pnömokonyozlarýn tanýnmasý, hastalýk durumunun hem tedavisi hem de önlenmesi açýsýndan önemlidir. Pnömokonyozlar akciðer grafisi ile tespit edilebilmesine raðmen, Yüksek Çözünürlüklü Bilgisayarlý Tomografi’nin (YÇBT) maruziyet hikayesi ve klinik özelliklerle birlikte kullanýmý, akciðer parankimal yapýyý daha iyi gösterebilmesi sayesinde spesifik bir tanýya ulaþmayý ya da en azýndan ayýrýcý tanýyý daraltmayý saðlar. Bu araþtýrmada mesleksel akciðer hastalýklarýnýn ortak YÇBT görünümleri derlenmiþtir.

Inhalation of dust, noxious agents, or fume in certain occupational environments may cause pulmonary damage in exposed workers. Recognition of these pneumoconiosis is important both for treatment and prevention of the disease condition. Although may pneumoconiosis may be detected by chest X-ray, the use of high-resolution computed tomography (HRCT) combined with exposure history and clinical features allows to reach to a specific diagnosis or at least to narrow the differential diagnosis thanks to its ability to demonstrate lung parenchymal architecture in a superior way. In this article, we review the common HRCT appearances of a spectrum of occupational lung diseases.

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Tüberküloz hem geliþmekte hem de geliþmiþ ülkelerde halen önemli bir halk saðlýðý sorunudur. Ekstrapulmoner tüberküloz, çocuk hastalarda ayýrýcý tanýda akýlda tutulmalý, maligniteler dahil birçok tabloyu taklit edebileceði unutulmamalýdýr. Akciðer dýþý tüberküloz enfeksiyonlarýnýn en öldürücü formu tüberküloz menenjiti’dir. Tüberküloz Menenjitin’de erken taný ve tedaviyle mortalite ve morbidite oranlarý azalmaktadýr.

Tuberculosis (TB) is still a major public health problem in developing and developed countries. Extrapulmonary TB (EPTB) may mimic malignancies and many other diseases, and it should be kept in mind in the differential diagnosis. Tuberculous meningitis (TM) has high mortality and morbidity rates among EPTB forms. Mortality and morbidity rates are reduced by early diagnosis and treatment in TM.

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