GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý; Tümefaktif demiyelizan lezyonu(TDL) olan onbir hastanýn ayýrýcý tanýdaki zorluklarýný takip verilerinin eþliðinde sunulmasý ve olasý prognostik faktörlerin özelliklerini ortaya koymaktýr.
YÖNTEM ve GEREÇLER: Çalýþmamýz SBÜ Haydarpaþa Numune Eðitim Araþtýrma Hastanesi’nde; 2000-2020 yýllarý arasýnda en az bir serebral demiyelinizan lezyon (> 2cm) ile baþvuran TDL olan 11 hastanýn prospektif takibi ile klinik, laboratuvar ve radyolojik bilgileri toplanarak retrospektif bir analiz gerçekleþtirildi.
BULGULAR: Hastalarýmýzýn %72,7’si kadýn (n=8), %27,2’si erkek (n=3) idi. Kadýn üstünlüðü (K/E= 2,66) görülmekle birlikte ortalama baþlangýç yaþý 33,45 yýl (min: 18 max: 68) idi. 11 hastanýn 9’unda (%81,8) TDL ilk nörolojik olay ile prezente olurken, 2’sinde (%18,1) MS teþhisi konulduktan sonra TDL geliþti.
Ýlk nörolojik olayý tümefaktif lezyon olan 9 hastanýn 3’ünde Nöromiyelitis Optika(NMO), 2’si Multipl Skleroz(MS), 2’si Akut Dissemine Ensefalomiyelit(ADEM) tanýsý konularak izlendi. Ýki hasta ise monofazik seyirli TDL olarak takibe alýndý. Ortalama takip süresi: 62,16 ay (min: 1 ay, max: 180 ay) idi.
TARTIÞMA ve SONUÇ: TDL klinik ve radyolojik bulgular ile beyin tümörü dahil diðer lezyonlardan ayýrt edilerek taný konulmasý zordur. Ayrýntýlý anamnez, fizik muayene ve MR görüntüleme, hastalarýn beyin biyopsisine olan ihtiyacýný ortadan kaldýrabilir. Erken teþhis ve agresif immünomodülatör tedaviler, ikinci bir demiyelinizan olayý veya klinik olarak kesin MS'e ilerlemeyi geciktirebilir.

INTRODUCTION: The aim of this study was to present the follow-up data of eleven patients with tumefactive demyelinating lesions (TDL) with pointing the challenges of differential diagnosis and indicate the possible prognostic features.

METHODS: In our study, a retrospective analysis was performed by collecting clinical, laboratory and radiological findings with the prospective follow-up of 11 patients with TDL who presented with at least one cerebral demyelinating lesion (> 2cm) and admitted to Haydarpasa Numune Training and Research Hospital between 2000-2020.
RESULTS: 72.7% of the patients were female (n = 8) and 27.2% were male (n = 3). There was a female predominance (F / M = 2.66) and the mean age of onset was 33.45 years (18-68 years). While TDL was the first neurological event in 9 (81.8%) of 11 patients, 2 patients (18.1%) had developed TDL after the diagnosis of multiple sclerosis (MS). Among 9 patients whose first neurological event was a tumefactive lesion, three of them were diagnosed with Neuromyelitis Optica (NMO), two patients with MS, and two patients with acute demyelinating encephalomyelitis (ADEM). Two patients were followed up as TDL with a monophasic course. The average follow-up period was 62.16 months (1-180 months).
DISCUSSION AND CONCLUSION: It is difficult to diagnose TDL by distinguishing it from other lesions, including brain tumors, with clinical and radiological findings. Detailed anamnesis, physical examination and magnetic resonance imaging (MRI) can eliminate the need for brain biopsy in patients for the diagnosis. Early diagnosis of TDL and aggressive immunomodulatory treatments may delay the progression to a second demyelinating event or clinically definite MS.

Makale Özeti | Tam Metin PDF

GÝRÝÞ ve AMAÇ: Çalýþmamýzda üst gastrointestinal sistem endoskopik deðerlendirmesinde helikobakter pilori enfeksiyonu saptanan ve saptanmayan hastalarda D3 vitamini düzeylerini retrospektif olarak karþýlaþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Çalýþma 01.07.2019-31.03.2021 tarihleri arasýnda üçüncü basamak bir merkezin Çocuk Gastroenteroloji polikliniðinde takip edilen tedaviye dirençli dispeptik yakýnmalarý olan çocuk hastalara yapýlan üst gastrointestinal sistem endoskopisi verileri geriye dönük incelenerek yapýlmýþtýr. Endoskopik biyopsi örneklerinde histopatolojik olarak helikobakter pilori varlýðýna göre iki gruba ayrýlan hastalarýn yaþ, boy,kilo, vücut kitle indeksi deðerleri ile serum vitamin D3 düzeyleri incelendi
BULGULAR: Çalýþmaya üst gastrointestinal sistem endoskopisi yapýlan, 86 çocuk hasta alýndý. Çocuklarýn 58’i (%67,44) kýz iken 28’i (%32,55) erkekti. Üst gastrointestinal sistem endoskopisi yapýlan 43 hastanýn antrum ve korpustan alýnan biyopsi materyallerinin histopatolojik deðerlendirilmesinde 43 hastada (%50.00) helikobakter pilori pozitifliði saptandý. Kýrk üç hastada (%50.00) ise helikobakter pilori saptanmadý. Vücut kitle indeksi deðerleri ortalama; helikobakter pilori pozitif grup için 18,81± 3,86, helikobakter pilori negatif grup için 17,82 ± 3,18 olarak saptandý (t-test p = 0,195). Vitamin D3 düzeyi helikobakter pilori pozitif grupta ortanca olarak 10,00 ng/ml (Çeyrekler-arasý aralýk = 6,00) negatif grupta ortanca 14,00 ng/ml (Çeyrekler-arasý aralýk = 9,30) olarak bulundu. Vitamin D3 düzeylerinde helikobakter pilori pozitif ve helikobakter pilori negatif hasta gruplarý arasýnda istatiksel olarak anlamlý fark bulundu (p = 0.033)
TARTIÞMA ve SONUÇ: Çalýþmamýz, helikobakter pilori pozitif olan grupta helikobakter pilori negatif olan gruba göre vitamin D3 düzeyleri anlamlý düþük saptandý (p = 0,033). Bu bulgu mukozal hasarýn vitamin D3 emilimini etkileyebileceðini desteklemektedir. Çalýþmamýzda dispeptik yakýnmalarý olan hastalarýn boy standart deviasyon skor ve kilo standart deviasyon skor ortanca deðerleri helikobakter pilori enfeksiyonu olan grupta daha yüksek olduðunu gördük. Bu sonuç boy kýsalýðýnýn geliþiminde birçok deðiþkenin etkili olmasýndan kaynaklanmýþ olabilir. Helikobakter pylori enfeksiyonunda erken teþhis ve tedavi, kronik enfeksiyonun uzun vadeli sonuçlarýný önlemek için önemlidir.

INTRODUCTION: We aimed to compare serum levels of vitamin D3 in patients with and without helicobacter pylori infection detected with the upper gastrointestinal endoscopic examination. We hypothesized that patients diagnosed with helicobacter pylori pathologically had low serum vitamin D3 levels.
METHODS: The study was held between 01.07.2019-31.03.2021, tertiary referee hospital. The upper gastrointestinal system endoscopic data of pediatric patients with treatment-resistant dyspeptic complaints who were followed up in the Pediatric Gastroenterology outpatient clinic of hospital between 01.07.2019 and 31.03.2021 were retrospectively evaluated. The age, height, height standard deviation score, weight, weight standard deviation score, body mass index, body mass index standard deviation score, and serum vitamin D3 levels of the patients who were divided into two groups according to the presence of helicobacter pylori histopathologically in the endoscopic biopsy samples were examined.
RESULTS: Eighty-six patients were evaluated, while 58 (67.44%) were girls, 28 (32.55%) were boys. The median age was 14.43 (Interquartile range = 4.99) years. Histopathological evaluation of biopsy materials taken from the antrum and corpus of 43 patients who underwent upper gastrointestinal endoscopy revealed helicobacter pylori positivity in 43 patients (50.00%). Helicobacter pylori was not detected in 43 patients (50.00%).
The median vitamin D3 level was 10.00 ng/ml in the helicobacter pylori positive group (Interquartile range = 6.00), and the median was 14.00 ng/ml (Interquartile range = 9.30) in the negative group. This study found a significant difference between helicobacter pylori positive and helicobacter pylori negative patient groups in vitamin D3 serum levels (p = 0.033).
DISCUSSION AND CONCLUSION: Vitamin D3 serum levels were found to be significantly lower in the helicobacter pylori positive group than that of controls (p = 0.033). This finding supports that mucosal damage may affect vitamin D3 absorption. Early diagnosis and treatment maintain their importance to prevent long-term consequences of chronic infection.

Makale Özeti | Tam Metin PDF

GÝRÝÞ ve AMAÇ: Lökosit fonksiyonu iliþkili antijen 1 (LFA-1), lökosit yüzeylerinde eksprese edilir ve hücrelerarasý adezyon molekülleri (ICAM) ile etkileþime girer. LFA-1'in tümörün hayatta kalmasýnda ve büyümesinde rolleri olabileceðinden, rs2230433 varyasyonunun kolorektal kanser üzerindeki etkilerini araþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Çalýþmamýza kontrol grubu olarak kanser öyküsü olmayan 67 saðlýklý kiþi ve hasta grubu olarak kolorektal kanser tanýsý konmuþ 100 kiþi dâhil edildi. DNA, kan örneklerinden izole edildi ve polimeraz zincir reaksiyonu (PCR)-restriksiyon fragman uzunluk polimorfizmi (RFLP) yöntemleriyle varyasyon analizi yapýldý. Ýstatistiksel analiz SPSS 22.0 kullanýlarak yapýldý ve p˂0.05 istatistiksel olarak anlamlý kabul edildi.
BULGULAR: LFA-1 rs2230433 genotipleri ve aleller hasta ve kontrol gruplarý arasýnda benzer bulundu. Genotip ile hastalýk riski deðerlendirmesi için allel karþýlaþtýrmalarý arasýnda anlamlý bir fark bulunmadý (p˃0.05).
TARTIÞMA ve SONUÇ: Sonuçlarýmýz LFA-1'in rs2230433'ün kolorektal kanser ile iliþkili olmadýðýný göstermektedir.

INTRODUCTION: Leukocyte function‐associated antigen 1 (LFA-1) is expressed on leukocyte surfaces and interacts with the intercellular adhesion molecules (ICAM). Since LFA-1 may have roles in tumor survival and growth, so we aimed to investigate the effects of rs2230433 variation on colorectal cancer.
METHODS: 67 healthy subjects without any cancer history as control group and 100 subjects diagnosed with colorectal cancer as patient group were included in our study. DNA isolated from the blood samples and polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) methods were performed. Statistical analysis was performed using SPSS software for Windows, version 22.0 and p˂0.05 was considered as statistically significant.
RESULTS: LFA-1 rs2230433 genotypes and alleles were found similar between patient and control groups. No significant difference was observed between genotype and allele comparisons for disease risk assessment (p˃0.05).
DISCUSSION AND CONCLUSION: Our results showed that LFA-1 rs2230433 is not associated with colorectal cancer.

Makale Özeti | Tam Metin PDF

GÝRÝÞ ve AMAÇ: Kliniðimizde takip edilen prematüre bebeklerde üç yýl içindeki prematüre retinopatisi görülme sýklýðý, retinopati geliþiminde rol oynayan risk faktörlerinin belirlenmesi, vitre içi ranibizumab tedavisi ve sonuçlarýnýn irdelenmesi amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Doðum haftasý ≤32 hafta ve/veya doðum aðýrlýðý ≤1500 gram olan bebekler ile klinisyen tarafýndan risk taþýdýðý belirlenen bebekler retinopati geliþimi açýsýndan muayene edildi. Doðum haftasý, doðum aðýrlýðý, doðum þekli, cinsiyet, APGAR skorlarý, mekanik ventilasyon ihtiyacý, ≥% 40 oksijen tedavisi, oksijen tedavi süresi, sürfaktan tedavisi, asidoz, hipoksi, sepsis, eritrosit transfüzyonu, intraventriküler kanama, apne ve anemiyi içeren risk faktörleri, prematüre retinopatisi geliþen ve geliþmeyen olgularda karþýlaþtýrýldý.
BULGULAR: Bebeklerin doðum haftalarý ortalamasý 30,1±0,24 hafta (23-36 hafta), doðum aðýrlýklarý ortalamasý ise 1362,3 ± 378,6 gram (450-2020 gram) idi. 130 hastanýn 21’inde (%16,2) deðiþik evrelerde prematüre retinopatisi saptandý. Prematüre retinopatisi için taranan tüm hastalarýn sekizi (%6,1) tedaviye ihtiyaç duydu. Evre III retinopati saptanan yedi hastaya (%5,3) vitre içi ranibizumab, Evre IV retinopati saptanan bir hastaya ise hem ranibizumab hem de lazer tedavisi uygulandý. Doðum haftasý ve doðum aðýrlýðý düþüklüðünün (p<0.001), oksijen tedavi süresinin (p<0.001), sürfaktan tedavisi almýþ olmanýn (p=0.002), sepsisin (p<0.001), kan transfüzyonunun (p<0.001),intraventriküler kanama (p=0.019), apne (p<0.001), anemi (p<0.001), hipoksi (p<0.001), asidoz (p<0.001) varlýðýnýn ve APGAR skor düþüklüðünün (p<0.001), prematüre retinopatisi geliþme riskini istatistiksel olarak anlamlý derecede artýrdýðý saptandý.
TARTIÞMA ve SONUÇ: Düþük doðum haftasý ve aðýrlýðý, yüksek konsantrasyonda ve uzun süreli oksijen kullanýmý gibi prematüre retinopatisini artýran risk faktörlerinin uygun yönetimi ile retinopati geliþimi azaltýlabilir. Prematüre retinopatisi tedavisinde net bir öneri olmamasýna karþýn seçilmiþ olgularda intravitreal ranibizumab tedavisinin iyi bir seçenek olabileceði düþünülmektedir.

INTRODUCTION: The aim of our study was to determine the prevalence of retinopathy of prematurity and the risk factors that play a role in the development of retinopathy, to evaluate the intravitreal ranibizumab treatment and its results in premature babies
METHODS: Babies with a gestational age of ≤32 weeks and / or a birth weight of 1500 grams and babies found to be at risk by the clinician were examined for the development of retinopathy. Risk factors including gestational week, birth weight, mode of delivery, gender, APGAR scores, need for mechanical ventilation, 40% oxygen therapy, oxygen therapy duration, surfactant treatment, acidosis, hypoxia, sepsis, erythrocyte transfusion, intraventricular bleeding, apnea and anemia, were compared in cases with and without retinopathy of prematurity.
RESULTS: The mean gestational weeks of babies were 30.1 ± 0.24 (23-36 weeks), the mean birth weight was 1362.3 ± 378.6 grams (450-2020 grams). Any stage of retinopathy of prematurity was detected in 21 (16.2%) of 130 evaluated patients. Intravitreal ranibizumab was applied to seven patients (5.3%) with stage III retinopathy, and both ranibizumab and laser therapy were applied to one patient with stage IV retinopathy. Low gestational week and birth weight (p <0.001), duration of oxygen treatment (p <0.001), surfactant treatment (p = 0.002), sepsis (p <0.001), blood transfusion (p <0.001), intraventricular hemorrhage (p = 0.019), apnea (p <0.001), anemia (p <0.001), hypoxia (p <0.001), acidosis (p <0.001) and decreased APGAR score (p <0.001) were found to statistically significantly increase the risk of retinopathy of prematurity
DISCUSSION AND CONCLUSION: Retinopathy development can be reduced by appropriate management of risk factors that increase retinopathy of prematurity, such as low gestational age and weight, high concentration and long-term use of oxygen. Although there is no definite recommendation for the treatment of retinopathy of prematurity, intravitreal ranibizumab treatment is thought to be a good option in selected cases.

Makale Özeti | Tam Metin PDF

GÝRÝÞ ve AMAÇ: Menopoz yaşýnýn sabit kaldýğý göz önüne alýnacak olursa, kadýnlarýn yaşamlarýnýn büyük bir bölümünü postmenopozal dönemde geçirdikleri açýktýr. Bu dönem östrojen üretiminin de azalmasý ile birlikte birçok metabolik sorunu beraberinde getirir.
Bizim bu çalýþmadaki amacýmýz Ýnsülin direnci olan ve olmayan gruplarda ki BMD’nin FRAX üzerindeki etkinliðini deðerlendirmek. Yeni risk faktörlerinin FRAX tanýmlamadaki yerini araþtýrmak. Böylelikle kýrýk riski olan kadýnlarýnýn erken önlem, teþhis ve tedavisinin saðlanmasýdýr.

YÖNTEM ve GEREÇLER: Postmenopozal dönemdeki ve öncesinde bozulmuþ glukoz toleransý tanýsý mevcut 68 hasta çalýþmaya dahil edildi. Hastalar rutin biyokimyasal parametreler, kemik mineral yoðunluklarý, kýrýk risk skorlarý ve insülin dirençleri açýsýndan deðerlendirildi.
BULGULAR: Ýnsülin direnci olan grupta (HOMA ≥2.5) HDL kolesterol deðeri diðer gruba göre düþük (p= 0.014), TG düzeyi ise direnç olan grupta yüksek olup anlamlý bulunmuþtur (p<0,0001). Gruplar arasý 25(OH) Vit-D3 deðerleri incelendiðinde istatistiksel olarak anlamlý fark gözlendi (p=0,026), insülin direnci mevcut olan hasta grubundaki D vitamini deðerlerinin düþük olduðu izlendi. Gruplar arasý femur T skor BMD ve lumbar T skor BMD deðerleri incelendiði zaman inslün direnci olan gruptaki hastalarýn kemik yoðunluklarý diðer gruba göre anlamlý olarak yüksek izlendi ( p<0.0001, p=0.039).
TARTIÞMA ve SONUÇ: Hastalarýn risk faktörlerinin dýþlanmasý, erken menopozal evrede olmasý sebebiyle, gruplar arasýnda kýrýk riski FRAX skorlamasýna göre düþük çýksa da, kemik kalitesi uzun dönemde düþmesi ile bu riskin artacaðý öngörülmektedir. Düþük kemik kalitesine, uzun dönem bozulmuþ glukoza baðlý olarak yavaþlayan kemik döngüsünün ve menapoza baðlý uzun dönem östrojen hormon yetersizliðinin sebep olduðunu düþünmekteyiz. Bu da bize kemik fraktürlerini belirlemede, BMD deðerinin yeterince spesifik ölçüm olmayabileceðini düþündürmektedir. Sonuç olarak; DM veya bozulmuþ glukoz toleransý ile osteoporoz arasýndaki iliþkiyi daha doðru temellere oturtmak, yeni risk faktörlerinin FRAX tanýmlamadaki yerini araþtýrmak, böylelikle kýrýk riski olan kadýnlarýnýn erken önlem, teþhis ve tedavisinin saðlanmak için farklý taný ve takip parametrelerinin de kullanýldýðý, prospektif, geniþ çaplý çalýþmalar yapmak gerekmektedir.

INTRODUCTION: Women spend most of their life in the postmenopausal period. This period brings along many metabolic problems with the decrease in estrogen production. Our purpose was to evaluate the effectiveness of bone mineral density(BMD) on fracture risk assessment tool(FRAX) between groups with and without insulin resistance, investigate the importance of new risk factors in FRAX identification, and facilitate early prevention, diagnosis, and treatment of women with fractures risk.
METHODS: 68 patients admitted to our clinic with diagnosis of impaired glucose tolerance during postmenopausal period were included in this study retrospectively. Those who had their routine biochemical parameters, insulin, and BMD measured were included in the study. Fracture risk analyses were performed with the FRAX score. BMIs and homeostasis model assessment-insulin resistance(HOMA-IR) of the patients were calculated.
RESULTS: In the group with insulin resistance, high-density lipoprotein cholesterol(HDL-C) value was low (p=0.014), and triglyceride(TG) level was high (p<0,0001). When 25(OH)Vit-D3 values were examined between the groups, the mean values were 22.8±13.6 and 15.7±11.8 ng/ml, respectively(p=0.026). When the femoral and lumbar T score BMD values between the groups were examined, the bone density of the patients with insulin resistance was significantly higher than the other group (p=0.039).
DISCUSSION AND CONCLUSION: To summarize, we believe that low bone quality is caused by a slowing bone cycle owing to long-term impaired glucose levels and long-term estrogen hormone deficiency caused by menopause. This suggests that the BMD value is not specific enough for determining bone fractures. The conclusion to be drawn here is to accurately establish the relation between DM or impaired glucose tolerance and osteoporosis; to constitute a guide for further prospective and large-scale studies that use different diagnostic and follow-up parameters; and to investigate the significance of new risk factors in FRAX identification for early prevention, diagnosis, and treatment of women who are at a risk of fractures.

Makale Özeti | Tam Metin PDF

COVID 19 enfeksiyonu, 11 Mart 2020’de Dünya Saðlýk Örgütü tarafýndan “pandemi” ilan edilmesinin ardýndan, dünya saðlýk sisteminin hizmet sunum kapasitesi, COVID 19 un daha çok solunum yolu semptomlarýný içeren hastalar sayesinde aþýldý. Ancak ülkemiz devlet hastanelerinin oluþan bu duruma hýzla adapte olmasý gerekti. Zaten normal þartlarda da, birçok hastane yataklý servisleri, yoðun bakým üniteleri ve palyatif servislerde yatmakta olan yatak basý yaralarý mevcut hastalarýn tedavileri çok zor ve maliyetliydi. Uyum aþamasýnda evde tedavi altýnda olan basý yaralarýnýn, hastaneye mümkün olduðunca az getirilmesi, mümkünse evde tedavilerinin yapýlmasý, hastanede yatan hastalarýn ise yaralarýnýn hýzla kapatýlýp, erken dönemde taburcu edilmesi ve yeni basý yaralarýnýn açýlmasýnýn engellenmesi amaçlandý. Bu konuda, devlet hastaneleri eðitim birimleri tarafýndan, yara bakýmý personelleri, evde bakým servisi personelleri ve evlerde bakýmý üstlenen aile bireylerine eðitimler verildi. Bu zorlu süreçte, enfeksiyona bu denli açýk bu hasta grubu, bu þekilde korunmaya çalýþýldý.

It was declared a "pandemic" of COVID 19 infection by the World Health Organization on March 11, 2020. After this date, the service delivery capacity of the world health system has been exceeded, mostly due to patients with COVID 19 respiratory symptoms. However, the state hospitals in our country had to adapt quickly to this situation. In normal circumstances, it was already very difficult and costly to treat existing bed pressure wound patients being treated in many inpatient services, intensive care units and palliative services. In the integration phase, it was aimed at bringing the patients who are treated at home to the hospital as little as possible, if possible treating them at home, quickly closing hospitalized patients' wounds and discharging in the early period and preventing the opening of new pressure wounds. In this regard, training was given by the public hospital training units to wound care personnel, home care service personnel and family members undertaking care in homes.With this form of organization, opening new wounds of patients was prevented at home and hospitals, existing wounds were closed.During this difficult period, this group of patients who are so open to infection were tried to be protected in this way.

Makale Özeti | Tam Metin PDF

GÝRÝÞ ve AMAÇ: Sitotoksisite testleri, hücre kültürü ve ilaç geliþtirme çalýþmalarýnda sýklýkla kullanýlmaktadýr. Bu testlerin bazýlarý, testlerde kullanýlan kimyasallardan kaynaklanan etkileþimler nedeniyle yanlýþ sonuçlar verebilmektedir. Bu çalýþmada, HCT-116 ve DLD-1 kolorektal kanser hücre hatlarýnda Karadeniz propolisi özü (BSPE) ve kafeik asit fenetil ester (CAPE) kullanýlarak, MTT ve WST-1 testlerinden elde edilen sonuçlarý karþýlaþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: HCT-116 ve DLD-1 hücreleri, farklý dozlarda CAPE ve BSPE ile muamele edildi. Hücre canlýlýðý, MTT ve WST-1 sitotoksisite testleri ile karþýlaþtýrmalý olarak analiz edildi. Bunu takiben hücre ölümü, akridin oranj/etidyum bromür boyama (AO/EB) ile morfolojik olarak ve Annexin V/7AAD apoptoz saptama yöntemi ile kantitatif olarak incelendi.
BULGULAR: MTT ve WST-1 analizleri, ayný BSPE dozlarýnda her iki hücre hattýnda da farklý canlýlýk deðerleri gösterdi. Bununla birlikte, ayný dozlardaki CAPE muamelesinde iki testin sonuçlarý arasýnda anlamlý bir fark görülmedi. AO/EB boyamasý, BSPE ve CAPE muamelesini takiben gerçekleþen hücre ölümünü doðruladý. Annexin V/7AAD testinden elde edilen tüm sonuçlar, özellikle BSPE muamelesi için WST-1 testinin sonuçlarýyla tutarlýydý.
TARTIÞMA ve SONUÇ: BSPE'nin sitotoksik etkilerinin belirlenmesinde, WST-1 testi MTT testine göre daha kesin sonuçlar vermiþtir. Bununla birlikte, CAPE'nin sitotoksik etkilerinin belirlenmesinde her iki test de benzer sonuçlar göstermiþtir. Sonuç olarak, BSPE gibi doðal bir ürünün sitotoksisite analizinde, WST-1 testinin MTT testine göre daha güvenilir olduðu ortaya konulmuþtur.

INTRODUCTION: Cytotoxicity assays are frequently used in cell culture and drug development studies. Some of these cytotoxicity assays may give incorrect results due to interactions of chemicals used in the assays. This study aimed to compare the results between the MTT and WST-1 assays, by using Black Sea propolis extract (BSPE) and caffeic acid phenethyl ester (CAPE) on HCT-116 and DLD-1 colorectal cancer cell lines.
METHODS: HCT-116 and DLD-1 cells were treated with different doses of CAPE and BSPE. The cell viability was analyzed by MTT and WST-1 cytotoxicity assays comparatively. Afterward, cell death was examined morphologically by acridine orange/ethidium bromide staining (AO/EB) and quantitatively by Annexin V/7AAD apoptosis detection method.
RESULTS: MTT and WST-1 assays showed different viability results on two cell lines with the same doses of BSPE. However, there was no significant difference between the results of two assays upon CAPE treatment with the same doses. AO/EB staining confirmed cell death following BSPE and CAPE treatment. All results from Annexin V/7AAD assay were consistent with the results of the WST-1 assay, particularly for BSPE treatment.
DISCUSSION AND CONCLUSION: In the determination of the cytotoxic effects of BSPE, WST-1 assay reflected more precise results than MTT assay. However, two assays showed similar results when the cytotoxic effects of CAPE were determined. Consequently, WST-1 assay is found to be more reliable than MTT assay in the cytotoxicity analysis of a natural product such as BSPE.

Makale Özeti | Tam Metin PDF

GÝRÝÞ ve AMAÇ: Romatizmal hastalýklarda etkilenen sistemlerden biri de solunum sistemidir. Bu çalýþma romatizmal hastalýklarda görülen akciðer tutulum bulgularý ve solunum fonksiyon testlerini araþtýrmak amacýyla yapýldý.
YÖNTEM ve GEREÇLER: Çalýþmaya 2015-2017 tarihleri arasýnda göðüs hastalýklarý bölümünden konsültasyon istenen romatizmal hastalar alýndý. 64 romatoid artrit, 43 ankilozan spondilit, 2 psöriatik artrit, 1 Behçet olmak üzere toplam 110 hasta alýndý. Akciðer grafisi ve yüksek rezolüsyonlu bilgisayarlý tomografideki (HRCT) akciðer tutulum bulgularý, solunum muayene bulgularý ve solunum fonksiyon testleri (SFT) incelendi.
BULGULAR: HRCT bulgularýnda %33,64 normal, %66,36 anormal bulgular izlendi.RA'li hastalarýn %70'inde (n: 45), AS'li hastalarýn %58'inde (n: 25) anormal HRCT bulgularý saptandý. SFT’leri incelendiðinde %50,0 normal, %32,7 restriktif tip solunum bozukluðu, %15,5 miks tip solunum bozukluðu, %1,8 obstruktif solunum bozukluðu görüldü.
TARTIÞMA ve SONUÇ: Romatizmal hastalýklarla akciðer tutulumu farklý þekillerde görülebilir. HRCT ve SFT pulmoner hastalýðýn yaygýnlýðý ve derecesi hakkýnda bilgi verir. Doðru taný ve tedavide yol gösterir.

INTRODUCTION: One of the affected systems in rheumatic diseases is the respiratory system. This study was carried out to investigate the pulmonary involvement findings and the respiratory function tests in rheumatic diseases.
METHODS: Rheumatic patients, who were requested consultation by the Baðcýlar Training and Research Hospital Department of Chest Diseases between 2015 and 2017, have been included in the study. A total of 110 patients; 64 rheumatoid arthritis, 43 ankylosing spondylitis, 2 psoriatic arthritis and 1 Behcet were included. Pulmonary involvement findings, respiratory examination findings and pulmonary function tests (RFT) in chest X - ray and high resolution computed tomography (HRCT) were examined.
RESULTS: 33.64% normal and 66.36% abnormal findings were observed in HRCT findings. Abnormal HRCT findings were found in 70% of RA patients (n: 45) and in 58% of patients with AS (n: 25). When RFTs were examined, 50.0% normal, 32.7% restrictive type respiratory disorder, 15.5% mixed type respiratory disorder and 1.8% obstructive respiratory disorder were observed.
DISCUSSION AND CONCLUSION: Pulmonary involvement with rheumatic diseases can be seen in different ways. HRCT and RFT provide information on the prevalence and grade of pulmonary disease. It leads to correct diagnosis and treatment.

Makale Özeti | Tam Metin PDF

GÝRÝÞ ve AMAÇ: Önerilmiþ olan kýsýtlý tip Dikkat Eksikliði Hiperaktivite Bozukluðunun (DEHB-S) klinik özellikleri ergenlerde yeterli düzeyde belirlenmemiþtir. DEHB-K’nin Dikkat Eksikliðinin önde geldiði DEHB’den (DEHB-DE) ayrý bir klinik durum olup olmadýðý hala tartýþýlan bir konudur. Bu çalýþmada ergenlerde DEHB-S’nin klinik özelliklerinin tanýmlanmasý ve DEHB-K’nin diðer alt tiplerle karþýlaþtýrýlmasý hedeflenmiþtir.
YÖNTEM ve GEREÇLER: Total olarak DSM-V DEHB tanýsý olan 87 ergen (yaþ ortalamasý: 143 ay, %73.5’i erkek) çalýþmaya alýndý. Aralarýnda DEHB-S’nin de bulunduðu DEHB alt tipleri klinik görüþme, ebeveyn bildirileri ve öðretmen bildirilerine dayanarak belirlendi. Çalýþma ölçümleri Turgay DSM-IV’e dayalý Çocuk ve Ergen Davranýþ Bozukluklarý Tarama ve Derecelendirme Ölçeði (T-DSM-IV-S), Conners Ebeveyn Derecelendirme Ölçeði (CEDÖ) ve Conners Öðretmen Derecelendirme Ölçeði (CÖDÖ-R) oluþturuldu.
BULGULAR: 39 ergende (%44.8) DEHB kombine tip (DEHB/K), 33 (%37.9)’ünde DEHB/DE and 15 (%17.2) had DEHB/S alt tipi olduðu bulundu. Cinsiyet açýsýndan, DEHB/S ve DEHB/DE gruplarý arasýnda fark yoktu. Ebeveyn-derecelendirme ölçeði sonuçlarýna göre; T-DSM-IV-S’nin total, hiperaktivite, davraným problemleri ve karþýt olma skorlarý ve CEDÖ’nün total, hiperaktivite, öðrenim problemleri skorlarý DEHB/DE’de DEHB-S’ya göre daha yüksekti (p<0.05). Öðretmen derecelendirme ölçeklerinde T-DSM-IV-S dikkat eksikliði skorlarý dýþýnda iki grup arasýnda fark yoktu. Çalýþma ölçeklerinden, aralarýnda total ve hiperaktivite skorlarýnýn da bulunduðu, çok sayýda alt skor DEHB-K grubunda DEHB-S grubuna göre daha yüksek olarak bulundu.
TARTIÞMA ve SONUÇ: DEHB-S grubu ile karþýlaþtýrýldýðýnda, DEHB-DE’li ergenler pek çok ebeveyn derecelendirme ölçeði eksternalize davranýþ problemi açýsýndan göre daha yüksek skorlar aldý. Bulgularýmýz DEHB-S ve DEHB-DE’ alt tipleri arasýnda farklarýn büyük oranda DSM belirti kümesi varlýðý ve þiddeti olduðunu düþündürmektedir. Ergenlerde DEHB-S’nýn klinik özelliklerinin belirlenmesi için gelecek çalýþmalara ihtiyaç vardýr.

INTRODUCTION: Clinical correlates of the proposed restrictive type Attention Deficit Hyperactivity Disorder (ADHD/R) is not well established in adolescents. There is still contraversy on the validity of ADHD/R as a distinct entity from ADHD predominantly inattentive (ADHD/I). This study aims to define the clinical symptoms of of ADHD/R and compare of ADHD/R with other subtypes of ADHD in adolescents.
METHODS: A total of 87 adolescents (mean: 143 months, 73.5% male) with a DSM-V ADHD diagnosis were included. ADHD subtypes, including the proposed restrictive subtype, were diagnosed based on clinical interview, parental reports and teacher reports. Study measures, included the Turgay DSM-IV based ADHD rating Scale (T-DSM-IV-S) parent and teacher forms, Conners' Parent Rating Scale (CPRS) and Conners' Teacher Rating Scale (CTRS-R).
RESULTS: 39 adolescents (44.8%) had ADHD combined (ADHD/C), 33 (37.9%) had ADHD/I and 15 (17.2%) had ADHD/R subtype. Regarding gender, no significant difference was found between ADHD/I and ADHD/R. Regarding the parent-rated scales; the total, hyperactivity, conduct problems and oppositional scores of T-DSM-IV-S; and the total, hyperactivity and learning problems scores of CPRS were found to be higher in adolescents with ADHD/I when compared to those with ADHD/R (p<0.05). Among the teacher-rated scores; no significant difference was found between ADHD/I and ADHD/R, except for the T-DSM-IV-S inattentivess score. Several scores of the study scales, including the total and hyperactivity scores, were found to be higher in adolescents with ADHD/C when compared to ADHD/R (p<0.05).
DISCUSSION AND CONCLUSION: When compared to those with ADHD/R, adolescents with ADHD/I had higher scores on most of the parent-rated externalized behavioral problem scores. Our findings suggest that the differences between ADHD/R and ADHD/I are mainly based on the presence and severity DSM symptom dimensions. Future studies are needed to clarify the correlates of ADHD/R in adolescents with ADHD.

Makale Özeti | Tam Metin PDF

GÝRÝÞ ve AMAÇ: Lentikülostriat arterler (LSA), orta serebral arter (MCA) ana trunkusundan ayrýlan sayýlarý 6 ile 12 arasýnda deðiþen n.lentiformis, n.kaudatus'un dýþ bölümü, kapsula interna ön bacaðý ile dorsal parçalarýný ve globus pallidus’un bir bölümünü sulayan damarlardýr. LSA enfarktlarý tüm inmlerin yaklaþýk %1-2'sini oluþturur.Biz bu çalýþmada kliniðimizde 2013-2018 tarihleri arasýnda yatarak tedavi görmüþ ve yapýlan tetkikler sonucunda LSA enfarktý tanýsý almýþ 143 hastanýn (68 E, 75 K) demografik verilerini ve tespit edilebilen etyolojik risk faktörlerini paylaþmak istedik.

YÖNTEM ve GEREÇLER: Ýskemik inme etyolojik sýnýflamasý Trial of Org 10172 in Acute Stroke Treatment (TOAST) sýnýflandýrmasýna göre yapýldý.Internal karotid arterde (ICA) enfarkt alaný ile ilgili olan %50'nin üzerindeki darlýklar anlamlý kabul edildi. Enfarkt lokalizasyonlarý manyetik rezonans görüntüleme (MRI) ile yapýldý. Ýnme aðýrlýðý National Institude of Health Stroke Scale (NIHSS) kullanýlarak sýnýflandýrýldý (hafif: <8, orta: 8-14, aðýr: >14). Prognoz tayini modifiye Rankin Skalasý kullanýlarak yapýldý (iyi prognoz: mRS: 0-2, kötü prognoz: mRS: 3-6).

BULGULAR: Ýnme etyolojisi ile prognoz arasýnda anlamlý farklýlýk tespit edilmedi (p: 0.206). Sigara içme ve kötü erken dönem prognoz arasýnda istatistiki açýdan anlamlý iliþki vardý (p<0.001, rho: 0.458). Tek deðiþkenli analizde kötü erken dönem prognoz ile cinsiyet, yaþ, hipertansiyon, diyabetes mellitus, coroner arter hastalýðý ve hiperkolesterolemi arasýnda anlamlý farklýlýk tespit edilmedi. Kötü erken dönem prognoz gösteren hastalar, baþlangýç NIH ve mRS skorlarý yüksek ve sigara kullanýmý olan hastalardý.
TARTIÞMA ve SONUÇ: LSA enfarktlarý izole formunda diðer damar alaný tutulumlarýna göre nispeten daha az görülen, etyolojisinde aterotromboz ve/veya embolinin sorumlu tutulduðu klinik tablolardýr. Bu çalýþmada demografik verilerini deðerlendirdiðimiz hastalarýn risk faktörlerinin, oransal daðýlým açýsýndan literatürle benzer þekilde oranlar gösterdiðini tespit ettik.

INTRODUCTION: Lenticulostriate arteries (LSA) are main truncal branches of middle cerebral artery. Their number changes between 6 to 12 and they supply n.lentiformis, external part of n.caudatus, anterior and dorsal parts of internal capsule and limited parts of globus pallidus. LSA infarcts constitute 1-2% of all cerebral ischemic accidents. In this study we investigated the demographic datas and etiologic risk factors of 143 patients (68 males, 75 females) who were treated in our inpatient clinic between the years 2013-2018 with the diagnosis of LSA infarction.
METHODS: The mechanism of stroke was determined based on the Trial of Org 10172 in the Acute Stroke Treatment (TOAST) classification. Significant stenosis of internal carotid artery (ICA) was defined as stenosis >50% or occlusion of the artery relevant to the infarction. Infarct locations were determined by using MRI scan. Stroke severity of patients were classified according to National Institute of Health Stroke Scale (NIHSS) as mild (<8), moderate (8-14) and severe (>14). Prognosis of patients was classified according to modified Rankin Scale (mRS) as good prgnosis (mRS: 0-2) and bad prognosis (mRS: 3-6).
RESULTS: There was no difference between etiology of stroke and prognosis (p: 0.206). A correlation was found between smoking and early-term prognosis (p<0.001 rho: 0.458). Univariate analysis showed that there was no difference between the patients with poor functional outcome and age, sex, hypertension, diabetes mellitus, coronary artery disease or hypercholesterolemia. The patients with poor functional outcome had more commonly current smoking history, higher initial NIHSS score and higher mRS scores.
DISCUSSION AND CONCLUSION: LSA infarcts have been seen relatively less common compared to other vascular territory infarcts and etiologically related to atherotrombosis and cardioembolism. In this study we showed a similar distribution of risk factors with the literature reports by evaluating the demographic data of LSA infarct patients.

Makale Özeti | Tam Metin PDF

GÝRÝÞ ve AMAÇ: Ýnsizyonel herni cerrahi tedavisinde greftin yerleþim yerine göre farklý yaklaþýmlar uygulanmaktadýr. Bu yöntemlerin yara yeri komplikasyonlarý ve rekürrens açýsýndan tartýþmalý sonuçlarý bulunmaktadýr. Bu çalýþmada, “onlay” ve “sublay” olarak yerleþtirilen greft kullanýlarak yapýlan açýk insizyonel herni onarýmlarýnýn komplikasyon ve rekürrens açýsýndan karþýlaþtýrýlmasý hedeflenmiþtir.
YÖNTEM ve GEREÇLER: Hastanemizde 2 yýllýk retrospektif deðerlendirmede açýk greftli insizyonel herni cerrahisi yapýlan hastalar incelendi. Hastalar polipropilen greftin “onlay” (Grup O, n=27) ve “sublay” (Grup S, n=25) yerleþtirilmesine göre iki gruba ayrýldý. Hastalara ait demografik ve klinik veriler kaydedildi. Postoperatif erken (seroma, hematom, yara enfeksiyonu) ve geç dönem (kronik aðrý, rekürrens) komplikasyonlar gruplar arasýnda karþýlaþtýrýldý.
BULGULAR: Çalýþmada yaþ ortalamasý 60.4 ± 12 yýl olan toplam 52 hasta vardý. Gruplar arasýnda demografik ve klinik özellikler açýsýndan bir fark yoktu (p>0,05). Grup S’deki hastalarýn ortalama ameliyat süresi, Grup O’daki hastalarýn ameliyat süresinden anlamlý olarak daha uzundu (p=0,02). Hastane yatýþ süresi Grup S’de daha uzun olmakla birlikte, iki grup arasýnda hastane yatýþ süresi açýsýndan anlamlý bir fark yoktu (p=0,067). Erken ve geç dönem yara komplikasyonlarý açýsýndan gruplar arasýnda anlamlý bir fark yoktu (p>0,05).

TARTIÞMA ve SONUÇ: “Onlay” ve “sublay” yöntemleri ile yapýlan greftli insizyonel herni onarýmlarý sonrasý erken ve geç dönem yara komplikasyonlarý arasýnda anlamlý bir farklýlýk bulunmamaktadýr. Her iki yöntem de benzer etkinlik ve güvenlik ranlarý dahilinde uygulanabilir.

INTRODUCTION: Different approaches are used depending on placement of mesh in the surgical treatment of incisional hernia. These methods have controversial results in terms of wound complications and recurrence. In this study, it was aimed to compare open mesh repair of incisional hernia using the approaches of "onlay" and "sublay" mesh placement in terms of complications and recurrence.
METHODS: Patients who underwent mesh repair of incisional hernia in our hospital for a 2-year retrospective study were evaluated. The patients were divided into two groups according to the placement of the polypropylene mesh: "onlay" (Group O, n = 27) and "sublay" (Group S, n = 25). Demographic and clinical data of the patients were recorded. Postoperative early (seroma, hematoma, wound infection) and late (chronic pain, recurrence) complications were compared between groups.
RESULTS: There were 52 patients in the study with a mean age of 60.4 ± 12 years. There was no difference between the groups in terms of demographic and clinical characteristics (p> 0.05). The mean duration of the surgery in Group S was significantly longer than Group O (p = 0.02). Although the length of hospital stay was longer in Group S, there was no significant difference between the two groups in terms of the length of hospital stay (p = 0.067). There was no significant difference between the groups in terms of early and late wound complications (p> 0.05).
DISCUSSION AND CONCLUSION: There is no significant difference between early and late wound complications after mesh repair of incisional hernia with "onlay" and "sublay" methods. Both methods can be applied with similar efficacy and safety.

Makale Özeti | Tam Metin PDF

GÝRÝÞ ve AMAÇ: Dermal sinüs traktlarý, cilt ve derin dokular arasýnda yer alan orta hat lezyonlarýdýr. Ciddi komplikasyonlara yol açmadan taný konulmasý önemlidir. Bu çalýşmada, geç taný almýş ve/veya hastaneye geç yatýş nedeniyle intradural / intramedüller abse oluşumuna yol açan 5 spinal dermal sinüs traktý vakasý bildirilmiştir.
YÖNTEM ve GEREÇLER: Ocak 2010 ile Eylül 2019 arasýnda ameliyat edilen spinal dermal sinüs traktý vakalarý týbbi kayýtlardan incelenmiştir.
BULGULAR: Spinal dermal sinüs traktýna bağlý intradural / intramedüller abse tanýsý alan 5 hasta bulundu. Tüm vakalarýn taný konmamýş ve/veya geç tedavi edilmiş dermal sinüs traktýna sahip hastalar olduğu saptandý.
TARTIÞMA ve SONUÇ: Dermal sinüs traktý, pediatristlerin ve nöroşirurjenlerin dikkat etmesi gereken önemli patolojilerden biridir. Taný konulamamasý ya da geç konulmasý geri dönüşü olmayan ciddi sorunlara yol açabilir.

INTRODUCTION: Dermal sinus tract is a midline lesion between skin and deep tissues. They are crucial to be early diagnosed before leading to severe complications. In this paper, we report 5 spinal dermal sinus tract cases that were lead to intradural/intramedullary abscess formations because of late diagnose or late admission to hospital.
METHODS: The patients with spinal dermal sinus tract who were operated in the authors’ department between January 2010 to September 2019 were investigated from medical records.
RESULTS: Five patients diagnosed with intradural/intramedullary abscess due to spinal dermal sinus tract were found. It is understood that all abscess formations were complications of undiagnosed and missed spinal dermal sinus tracts.
DISCUSSION AND CONCLUSION: Dermal sinus tract is one of the important pathologies that pediatricians and neurosurgeons should pay attention to. Missing or delay in diagnosis can lead to irreversible deficits.

Makale Özeti | Tam Metin PDF

GÝRÝÞ ve AMAÇ: COVID-19 için henüz spesifik bir tedavi mevcut olmadýðýndan enfekte vakalarýn hýzlý tespiti ve izolasyonu, enfeksiyonun yayýlým sürecine etki edebilecek en önemli basamaktýr. Çalýþmamýzda hedefimiz, acil serviste deðerlendirdiðimiz olasý/kesin COVID-19 vakalarýna ait öykü, klinik bulgular, initial toraks bilgisayarlý tomografi (BT) bulgularý ve real-time polymerase chain reaBTion (RT-PCR) sonuçlarýný inceleyip bu verilerin kendi içindeki tutarlýlýklarýný deðerlendirmektir.
YÖNTEM ve GEREÇLER: Bu çalýþma çok merkezli, retrospektif olarak dizayn edilmiþ olup COVID-19 01.04.2020 ile 01.05.2020 tarihleri arasýnda acil serviste deðerlendirilmiþ 18 yaþ ve üstü hastalardan, Türkiye Cumhuriyeti saðlýk bakanlýðý algoritmasýnda belirtilmiþ olan olasý ve kesin COVID-19 vakalarý dahil edilmiþtir. Hastalara ait yaþ, cinsiyet, komorbidite, baþvuru ve temas bilgileri; baþvuru þikayetleri, vital bulgularý, laboratuvar parametreleri, BT bulgularý, servis/yoðun bakým yatýþ durumu, hastanede kalýþ süresi ve vaka ölüm oraný (VÖO) geriye dönük olarak incelendi.
BULGULAR: 687 hastanýn %62,4'ü erkekti, ortalama yaþ 49,7’ydi. Hastalarýn% 49.9'unda en az bir komorbidite vardý. En sýk görülen semptomlar ateþ (%61,6), öksürük (%56,5), nefes darlýðýydý (% 33,2). Hastalarýn% 33.9'unda RT-PCR pozitifliði,% 69.9'unda BT pozitifliði ve% 72.5'inde hem RT-PCR hem de BT pozitifliði vardý. BT'nin duyarlýlýðý 72,5, özgüllüðü%31,5 ve doðruluðu%45,5 idi. En yaygýn BT paterni saf GGO idi (%47,9). VÖO %6 idi ve hem RT-PCR hem de CT pozitif hastalarda anlamlý olarak yüksekti (p = 0.01). Lojistik regresyon analizine göre, erkek cinsiyet (p = 0.037; OR: 0.385; % 95 CI, 0.157–0.943), daha yüksek yaþ (p = 0.000; OR: 1.068;% 95 CI, 1.031–1.106) ve komorbidite varlýðý (p = 0.008; OR: 5.374;% 95 CI, 1.539–7.618) mortalite ile iliþkili bulunmuþtur.
TARTIÞMA ve SONUÇ: RT-PCR ve BT’nin birlikte kullanýmý ve hastalara ait klinik veriler ile desteklenmesinin tanýda temel yol gösterici olduðunu tespit ettik. Hem RT-PCR hem de BT pozitif olan hastalarýmýzda hospitalizasyon süresi, yoðun bakým takip oraný ve VÖO anlamlý derecede artmýþtý. Ayrýca ileri yaþ, erkek cinsiyet ve komorbidite varlýðý durumlarýnýn hasta mortalitesi üzerinde etkili olduðunu tespit ettik.

INTRODUCTION: The aim of this study is to examine the story, clinical findings, initial computed tomography (CT) findings and reverse transcription–polymerase chain reaction (RT-PCR) results and evaluate the consistency of this data.
METHODS: This is a multi-center retrospective study and out of patients aged 18 and over who were evaluated for COVID-19 in the emergency department between 01.04.2020 and 01.05.2020. Data regarding the patients such as age, gender, comorbidity, COVID-19 contact, symptoms, vital findings, laboratory parameters, CT findings, hospitalization status and case fatality rate (CFR) were examined.
RESULTS: 62.4% of 687 patients were male, the mean age was 49.7. 49.9% of patients had at least one comorbidity. The most common symptoms were fever (61.6%), cough (56.5%), dyspnea (33.2%). 33.9% of patients had RT-PCR positivity, 69.9% had CT positivity, and 72.5% had both RT-PCR and CT positivity. Sensitivity of CT was 72.5, its specificity was 31.5% and its accuracy was 45.5%. Most common CT pattern was pure GGO (47.9%). CFR was 6% and it was significantly higher in both RT-PCR and CT positive patients (p=0.01). According to logistic regression analysis, male gender (p=0.037; OR: 0.385; 95% CI, 0.157–0.943), higher age (p=0.000; OR: 1.068; 95% CI, 1.031–1.106) and comorbidity presence (p=0.008; OR: 5.374; 95% CI, 1.539–7.618) were found to be associated with mortality.
DISCUSSION AND CONCLUSION: In our study, we found that using RT-PCR and CT together and supporting them with clinical data was the strongest approach in the diagnosis of COVID-19 cases.

Makale Özeti | Tam Metin PDF

GÝRÝÞ ve AMAÇ: Mekanik ventilasyon tedavisi genellikle 3.düzey yoðun bakýmlarda sýk uygulanmaktadýr. Hastalarýn bir kýsmý pozitif sývý dengesi, elektrolit dengesizlikleri, uzamýþ mekanik ventilasyon süresi, protein-enerji dengesizlikleri veya yaþ nedeniyle reentübasyona ihtiyaç duyabilirler. Reentübasyon ise yoðun bakýmda morbidite ve mortalitenin artmasýna neden olmaktadýr. Bu nedenle kliniðimizde reentübasyon oranlarýný ve nedenlerini araþtýrdýk.
YÖNTEM ve GEREÇLER: 01.06.2018 tarihinden 01.01.2019 tarihine kadar olan 18 aylýk dönemde yoðun bakýma yatan hastalarýn dosyalarýný retrospektif olarak inceledik. Extübasyonu baþarýlý olan hastalarý ve reentübe edilen hastalarý kaydettik.
BULGULAR: Çalýþmaya kriterleri karþýlayan 84 hasta dahil edildi. Hastalarýn 43’ü (%51.2) reentübasyon ve 41’i (%48.8) baþarýlý extübasyon olmak üzere 2 grup altýnda incelenmiþtir. Reentübasyon grubunun yaþ ortalamalarý, apache II deðerleri ve komorbidite oranlarý baþarýlý extübasyon grubundan istatistiksel olarak anlamlý düzeyde daha yüksektir. Reentübasyon grubunda inotrop tedavisi görülme oraný (%48.8), baþarýlý extübasyon grubundan (%14.6) istatistiksel olarak anlamlý düzeyde yüksek bulunmuþtur. Reentübasyon ve baþarýlý extübasyon gruplarý arasýnda aldýðý enerji ve protein miktarý açýsýndan istatistiksel olarak anlamlý bir farklýlýk bulunmamýþtýr.
TARTIÞMA ve SONUÇ: Yoðun bakýmda uygulanan mekanik ventilasyon tedavisi genellikle sorunsuz bir þekilde sonlandýrýlmaktadýr. Ancak hastalarýn bir kýsmýnda tekrardan mekanik ventilasyon tedavisine baþlamak gerekebiliyor. Reentübasyon, mekanik ventilasyonun beklenmeyen bir sonucu olarak karþýmýza çýkabilmekte ve yoðun bakýmda mortaliteyi artýrabilmektedir. Reentübasyon-mortalite iliþkisi birçok çalýþmada gösterilmiþtir. Yaptýðýmýz çalýþmada reentübe olan hastalarda mortalite oranýnýn yaklaþýk 2 kat daha fazla olduðunu tespit ettik. Bu nedenle hastalarýn extübasyonu planlanýrken solunum desteðine neden olan esas problem düzeltildikten sonra reentübasyona neden olabilecek diðer risk faktörlerinin gözden geçirilmesi olasý bir reentübasyon riskini azaltacaktýr.

INTRODUCTION: Mechanical ventilation is frequently applied in 3rd level intensive care units. Some patients may require re-intubation due to positive fluid balance, electrolyte imbalances, prolonged mechanical ventilation, protein-energy imbalances or age. Re-intubation causes increases in morbidity and mortality in intensive care. Hence we investigated the rates and causes of re-intubation in our clinic.
METHODS: We retrospectively analyzed the files of patients hospitalized in intensive care during the 18-month period from 01.06.2018 to 01.01.2019.We recorded patients with successful intubation and patients who were reintubated.
RESULTS: 84 patients who met the criteria were included in the study. The patients were studied under two groups, namely 43 re-intubed patients (51.2%) and 41 successfully extubated patients (48.8%). Mean age, apache II values and comorbidity rates of the re-intubation group were statistically significantly higher than of the successful extubation group. The rate of inotrope treatment (48.8%) in the re-intubation group was statistically significantly higher than in the successful extubation group (14.6%). No statistically significant difference was found between re-intubation and successful extubation groups in terms of energy and protein intake.
DISCUSSION AND CONCLUSION: Mechanical ventilation treatment in intensive care can usually be finished without any problems. However, some patients may need mechanical ventilation treatment again. Reintubation can occur as an unexpected result of mechanical ventilation and increase mortality in intensive care. Reintubation-mortality relationship has been shown in many studies. Our study reports that mortality rate is approximately twofold in re-intubed patients. Therefore, before planning the extubation of patients, correcting the main problem causing respiratory support and reviewing other risk factors that may cause reintubation, will reduce the risk of reintubation.

Makale Özeti | Tam Metin PDF

GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý araç içi fayton kazalarýnýn travmatik sonuçlarýnýn deðerlendirilmesidir.
YÖNTEM ve GEREÇLER: Çalýþma retrospektif, gözlemsel bir araþtýrmadýr. Üçüncü basamak bir üniversite hastanesinde, 2011-2019 yýllarý arasýnda 8 yýllýk dönemde, acil servise fayton kazalarý nedeniyle baþvuran hastalar çalýþmaya dahil edilmiþtir. Veriler hastane otomasyon sisteminden iki defa taranmýþtýr. Dahil edilme kriterlerini karþýlayan, dýþlanma kriterlerini karþýlamayan hastalar çalýþmaya alýnmýþtýr. Hastalarýn demografik verileri ve yaralanma bölgeleri çalýþmada incelenmiþtir. Ýstatistiksel anlamlýlýk p<0.05 olarak kabul edildi.
BULGULAR: Çalýþma 52 kadýn cinsiyetinde, 72 erkek cinsiyetinde, 124 hasta ile çalýþma yürütüldü. Mortalite 35(%28.2) hastada görüldü. Ex olgularda nazal, subdural, epidural, intraparankimal, kafa kemik kýrýðý, barsak perforasyonu, batýn içi serbest mai, pelvis, femur, pnömotoraks, hemotoraks, kot fraktürü ve yumuþak doku yaralanmasý yüzdelerinin sað olgulardan daha yüksek olduðu saptandý. (p<0.05).
TARTIÞMA ve SONUÇ: Fayton kazalarý ölümcül sonuçlara sebep olabilen ciddi yaralanmaladýr. Araç içine entegre güvenlik önlemlerinin arttýrýlmasý ile bu kazalardaki mortalite oranlarý düþürülebilinir.

INTRODUCTION: The aim of this study is to evaluate the traumatic consequences of in-vehicle phaeton accidents.
METHODS: The study is a retrospective and observational study. Patients who admitted to the emergency department (ED) due to phaeton accidents, in a period of 8 years between 2011 and 2019, in a tertiary university hospital, were included in the study. The data were scanned twice from the hospital automation system. Patients who met the inclusion criteria and did not met the exclusion criteria were included in the study. Demographic data and injury regions of the patients were examined in the study. Statistical significance was accepted as p <0.05.
RESULTS: There were 124 patients included in this study, which 52 were women and 72 were men. Mortality was seen in 35 (28.2%) patients. In Ex cases, the percentage of nasal, subdural, epidural, intraparenchymal, skull fractures, intestinal perforation, intraabdominal free mai, pelvis, femur, pneumothorax, hemothorax, rib fracture and soft tissue injury were found to be higher than the survivor cases (p <0.05 ).
DISCUSSION AND CONCLUSION: Phaeton accidents are serious injuries that can cause fatal consequences. Mortality rates in these accidents can be reduced through increasing the safety measures integrated into the vehicle.

Makale Özeti | Tam Metin PDF

GÝRÝÞ ve AMAÇ: D vitamini; yaðda eriyen vitaminler arasýnda yer almakta olup ayný zamanda endojen olarak sentezlendikleri için hormon olan bir grup steroldür. Kalsiyum, fosfor metabolizmasý ve kemik mineralizasyonu üzerine etkisi vardýr ve ayný zamanda genel saðlýk ve iyilik hali için de çok önemlidir. D vitamini düzeyini deðerlendirmek için 25-Hidroksi vitamin D (25-OH D) düzeyine bakýlmalýdýr. Çalýþmanýn amacý hastanemize baþvuran yaygýn vücut aðrýlarý olan hastalarda D vitamini eksikliði olup olmadýðýný belirlemek ve yaþ ile cinsiyete göre 25-OH D düzeyleri arasýndaki farký tespit etmekti.
YÖNTEM ve GEREÇLER: 01.04.2018–30.11.2018 tarihleri arasýnda hastanemiz uzman aile hekimliði polikliniðine baþvuran hastalardan 25-OH D vitamini düzeyi çalýþýlanlar retrospektif olarak incelendi. Araþtýrmaya katýlan yaygýn vücut aðrýsý olan hastalar (n=473) yaþ gruplarýna ve cinsiyete göre sýnýflandýrýldý. Ýstatistiksel analizler için Number Cruncher Statistical System 2007 (Kaysville, Utah) programý kullanýldý.
BULGULAR: Olgularýn %13,5’inde (n=64) ciddi vitamin D eksikliði, %51,6’sýnda (n=244) vitamin D eksikliði, %26,9’unda (n=127) vitamin D yetersizliði görülmüþtür. Cinsiyete göre D vitamini ölçümleri arasýnda istatistiksel olarak anlamlý farklýlýk saptanmýþ ve kadýnlarýn ölçümleri erkeklerden düþük bulunmuþtur (p=0,001; p<0,01). Yaþ açýsýndan gruplar arasý anlamlý farklýlýk saptanmadý (r: 0,051; p=0,271; p>0,05).
TARTIÞMA ve SONUÇ: Yaygýn vücut aðrýsý þikayeti olan 473 hastanýn ortalama 25-OH D düzeyleri 30 ng/ml’in altýnda bulundu. Bu durumun güneþ ýþýðýndan yeterli düzeyde faydalanmama ve diyetsel faktörlerle iliþkili olacaðý düþünülerek, kiþilere D vitamini takviyesi yapýlmasý uygundur.

INTRODUCTION: Vitamin D is a fat soluble vitamin and as it can be acquired endogenously, it is also a group of sterol that can function as hormones. Vitamin D has effects on calcium, phosphor metabolism and bone mineralization and plays a vital role in general health and well-being. 25 Hydroxyvitamin D (25-OH D) level should be checked to determine vitamin D levels. The objective of the study was to determine whether patients presenting to our hospital with widespread body pain had vitamin D deficiency and determine the difference in 25-OH D levels based on age and gender.
METHODS: 25-OH vitamin D levels in patients who presented to the family practice clinic in Hospital between the dates 01.04 / 30.11/2018 were examined retrospectively. Patients with widespread body pain included in the study (n=473) were classified based on age and gender. Number Cruncher Statistical System 2007 (Kaysville, Utah) program was used for statistical analysis.
RESULTS: 13.5% (n=64) of the subjects had severe vitamin D deficiency, 51.6% (n=244) had vitamin D deficiency and 26.9% (n=127) had vitamin D insufficiency. A statistically significant difference found in vitamin D results between the two genders and vitamin D levels in women were lower than vitamin D levels in men (p=0.001; p<0.01). No significant difference was found between age groups (r: 0.051; p=0.271; p>0.05).
DISCUSSION AND CONCLUSION: The mean 25-OH D level of 473 patients with widespread body pain was less than 30 ng/ml. This was thought to be caused by insufficient exposure to sunlight and dietary factors and vitamin D supplements can be recommended to these people.

Makale Özeti | Tam Metin PDF

GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý Guillain-Barré Sendromu (GBS) tanýsýnda tedavi öncesi nötrofil lenfosit oraný (NLR) ve trombosit lenfosit oraný (PLR) ve monosit lenfosit oraný (MLR) 'nýn prognostik deðerini belirlemekti.
YÖNTEM ve GEREÇLER: Bu retrospektif çalýþmada toplam 98 GBS hastasý ve 101 saðlýklý kontrol (HC) vardý.
BULGULAR: Çalýþmamýz GBS hastalarýnda HC ile karþýlaþtýrýldýðýnda daha yüksek düzeyde NLR, PLR ve MLR olduðunu gösterdi (sýrasýyla p <0.001, p <0.001, p <0.001). Alýcý iþletim karakteristiði analizini (ROC) kullanarak NLR, PLR ve MLR'nin GBS hastalýðý tahminindeki etkinliðini araþtýrdýk. NLR eðri altýndaki en yüksek alana (AUC) sahipti (0.912,% 95 CI, 0.870 ila 0.954), ardýndan MLR ve PLR (sýrasýyla AUC = 0.811, 0.753) gelmekteydi.
TARTIÞMA ve SONUÇ: NLR, PLR ve MLR, GBS hastalarý için potansiyel bir inflamatuar biyobelirteç olarak düþünülebilir.

INTRODUCTION: The purpose of this study was to determine the prognostic value of the pretreatment neutrophil lymphocyte ratio (NLR), and platelet lymphocyte ratio (PLR) and monocyte lymphocyte ratio (MLR) in the diagnosis of Guillain-Barré Syndrome (GBS).
METHODS: This retrospective study enrolled a total of 98 GBS patients and 101 healthy control (HC).
RESULTS: Our study showed that GBS patients had higher level of NLR,PLR and MLR compared with HC (p < 0.001, p < 0.001, p < 0.001, respectively). We investigated the effectiveness of NLR, PLR and MLR in prediction of GBS using receiver operating characteristic (ROC) analysis. NLR had the highest area under curve (AUC) (0.912, 95% CI, 0.870 to 0.954), followed by MLR and PLR (AUC = 0.811, 0.753, respectively).
DISCUSSION AND CONCLUSION: NLR, PLR and MLR can be considered as a potential inflammatory biomarker for GBS patients

Makale Özeti | Tam Metin PDF

GÝRÝÞ ve AMAÇ: Diyabet kýlavuzlarý özellikle çocukluk çaðý baþlangýçlý Tip 1 diyabette (T1D) otoimmün tiroid hastalýðý (OÝT) ve çölyak hastalýðý taramasý önermektedir. Bu konudaki kanýtlar zayýf (uzman düzeyinde) olmakla birlikle eriþkin baþlangýçlý T1D'te veriler daha kýsýtlýdýr. Bu çalýþmanýn amacý, çocukluk çaðý ve eriþkin baþlangýçlý T1D'li hastalarda eþlik eden OH'lerin prevalansýný belirlemek, OH'lerin daðýlýmýný T2D olan hastalarla karþýlaþtýrmaktýr.
YÖNTEM ve GEREÇLER: Tek bir merkezde takip edilen ardýþýk 1594 yetiþkin diyabet hastasýnýn %22'sinde (n=351) T1D mevcuttu. T1D'li hastalar otoimmün tiroid hastalýðý, pernisiyöz anemi, vitiligo, çölyak, Addison ve diðer organa özgü/sistemik otoimmün/inflamatuar hastalýklar için tarandý.
T1D olan bireylerdeki OH'lerin daðýlýmýný karþýlaþtýrmak için otoimmünitesi olduðu bilinen 50 T2D hastasý çalýþmaya dahil edildi. Ayrýca glisemik kontrol düzeyi ve komplikasyonlarýn daðýlýmý deðerlendirildi.
BULGULAR: Otoimmün hastalýk prevalansý T1D'de %26.2 idi ve kadýnlar erkeklerden daha fazla etkileniyordu. Otoimmün tiroid hastalýðý en yaygýn görülen OH olup, bunu pernisiyöz anemi, vitiligo, çölyak ve erken gonadal yetmezlik izledi. Hastalarýn %60'ýnýn üzerinde tek OH mevcutken (çoðunlukla otoimmün tiroid hastalýðý; T1D %83,6, T2D %68,6), %20'den fazla hastada iki adet eþlik eden OH vardý. T1D olan hastalarýn %8.2'sinde üç adet eþlik eden OH mmevcuttu. Otoimmün tiroid hastalarýnýn çoðunda Hashimoto tiroiditi ve/veya hipotiroidi mevcutken, sadece %12'sinde Graves hastalýðý vardý (T1D %10.9 ve T2D %14). T1D kadýnlarda pernisiyöz anemi (%22.8), vitiligo (%9.8) ve çölyak (%8.7) otoimmün tiroid hastalýðýna eþlik eden en sýk komorbiditelerdi. Otoimmün hastalýk, hastalýk baþlangýç zaman glisemik kontrol, ve komplikasyon oranlarý arasýnda anlamlý bir fark saptanmamýþtýr.
TARTIÞMA ve SONUÇ: Otoimmün tiroid hastalýðý taramasý, çocukluk çaðý baþlangýçlý T1D önerildiði gibi eriþkin baþlangýçlý T1D'nin rutin programýnda da düþünülmelidir. Ayrýca, T1D'li kadýnlar eþlik edebilecek pernisiyöz anemi, vitiligo ve çölyak hastalýðý için deðerlendirilmelidir.

INTRODUCTION: Diabetes guidelines recommend routine screening for autoimmune thyroid disease (ATD) and celiac disease, especially in cases of childhood-onset type 1 diabetes (T1D). However, level of evidence is weak (expert opinion), and for adult-onset T1D even less clear. The aim of this study is to evaluate the prevalence of comorbid autoimmune diseases (ADs) in childhood-onset and adult-onset T1D patients, and to compare distribution of individual ADs with those with T2D.
METHODS: Among a total of 1594 adult diabetes patients who were consecutively followed by a single Diabetes Center, 22%(n=351) had T1D. Patients with T1D were screened for ATD, pernicious anemia, vitiligo, celiac, and when clinically relevant for Addison’s, and other organ-specific/systemic autoimmune/autoinflammatory diseases. To compare distribution of ADs we included a group of 50 T2D patients with at least one known autoimmunity. Additionally, relationship between ADs, level of glycemic control, presence of micro-and macrovascular complications were investigated.
RESULTS: The prevalence of AD was 26.2% in T1D with females being more affected than males. ATD was the most prevalent, followed by pernicious anemia, vitiligo, celiac, and premature gonadal failure. Over 60% had single (mostly ATD; T1D 83.6%, T2D 68.6%), and over 20% had double AD with no significant difference between T1D and T2D. Of T1D patients, 8.2% had triple AD. The majority of ATDs was Hashimoto’s thyroiditis and/or hypothyroidism, only 12% had Graves’ disease (T1D 10.9%, and T2D 14%). In T1D women, pernicious anemia (22.8%), vitiligo (9.8%), and celiac (8.7%) were the most common comorbidities of ATD. There was no significant relationship between the frequency of ADs and individual ADs and glycemic control, age-at-onset of diabetes, and micro-and macrovascular complications.
DISCUSSION AND CONCLUSION: Screening for ATD should be included in routine management protocol of adult-onset T1D as recommended in those with childhood-onset. Furthermore, we suggest investigation for pernicious anemia, vitiligo, and celiac disease in women with T1D.

Makale Özeti | Tam Metin PDF

GÝRÝÞ ve AMAÇ: Korpus kallosum agenezisi çeþitli faktörler dolayýsýyla komissural liflerin orta hattý geçemediði, arkaya doðru ilerleyen kör bir bandýn meydana geldiði doðumsal bir olgudur. Bu olgu sonucunda bireylerde farklý etkilenimler söz konusu olmakta ve deðiþken performanslar sergilenmektedir. Bu çalýþmanýn amacý dil ve konuþma alanýnda sýklýkla karþýlaþýlmayan bir korpus kallozum agenezisi vakasý hakkýnda deðerlendirmeye ve süregelen bir müdahale sürecine yönelik bilgi sunmaktýr.
YÖNTEM ve GEREÇLER: Çalýþmada 42 aylýk bir katýlýmcýnýn TEDÝL ve TÝGE dil ve konuþma deðerlendirmesi yapýlmýþ, ardýndan 18 haftalýk dil ve konuþma terapisi sonrasýnda sonuçlar tekrar incelenmiþtir.
BULGULAR: Vakanýn terapi sürecinin baþlarýnda en fazla 5-6 sözcük üretimi gerçekleþtirebiliyorken, 18-seanslýk terapi sonrasýnda sözcük sayýsýnýn 20-25 civarýna yükseldiði görülmüþtür. Ayrýca, vakanýn istediði nesneyi jest kullanarak belirtmeye, sözel ve motor taklitleri yavaþ yavaþ gerçekleþtirmeye baþladýðý ifade edilmiþ, bazý durumlarda ikili sözcük kombinasyonlarýný ürettiði ve aðlama, vurma gibi davranýþ problemlerinin azaldýðý gözlenmiþtir.
TARTIÞMA ve SONUÇ: Çalýþmada alanyazýnda yer alan çalýþmalara benzer sonuçlara eriþilmiþ; vakanýn yaþýtlarýna göre geliþimsel geriliðinin olduðu, kronolojik yaþýna uygun bir dil geliþimi sergilemediði görülmüþtür.KKA olgularýnda dil ve konuþma terapisinin etkinliðine yönelik çok fazla çalýþma bulunmamasýna raðmen, gerekli ve zamanýnda interdisipliner bir müdahale ile taný almýþ olan bireyin söz konusu defisitlerini kompanse edecek becerilerin öðretilebileceði savunulmaktadýr.

INTRODUCTION: Corpus callosum agenesis is a rare congenital condition result from a fiberal malformation. Individuals with corpus callosum agenesis may have different symptoms. This study aims to introduce a rare condition and inform about ongoing assessment and treatment processes.
METHODS: 1 participant diagnosed with corpus callosum agenesis who is 42 months was assessed with TEDÝL and TÝGE assessment tests and had speech and language therapy for 18 months. While therapy was continuing, the second evaluation was carried out.
RESULTS: The participant was found to produce only 5-6 single words in the beginning of intervention besides exhibiting many of behavioral problems. With 18 month sessions, the participant was able to not only use more words, word combination and pragmatic gestures but also have eye contact, imitation skills and less behavioral problems.
DISCUSSION AND CONCLUSION: The results were similar to the ones in related studies which focus on corpus callosum agenesis which shows that the participant has had developmental delay and speech & language disorder. It is stated that intervention and assessment process is better conducted with multidisciplinary team

Makale Özeti | Tam Metin PDF

Yenidoðanda Batýn içi Kitle: Konjenital Mezoblastik Nefroma

Intra-Abdominal Mass in Newborns: Congenital Mesoblastic Nephroma

Makale Özeti | Tam Metin PDF

Ýnvaziv fungal enfeksiyonlar (ÝFE), özellikle hematolojik maligniteli ve immün yetmezliði bulunan hastalarda önemli bir morbidite ve mortalite nedenidir. Bu hasta grubunda ÝFE etkeni olarak en sýk Aspergillus cinsi küf mantarlarý saptanmakla birlikte, son yýllarda nadir rastlanan küflerin de etken olabileceði çeþitli yayýnlarda bildirilmiþtir. Bu raporda akut miyeloid lösemi (AML) tanýsý ile remisyon indüksiyon kemoterapisi alan 80 yaþýnda erkek hastada posakonazol (POS) profilaksisini takiben Liposomal Amfoterisin B (LAmB) ile tedavi sýrasýnda, Spiromastix cinsi küf mantarýna baðlý geliþen ve vorikonazol (VOR) ile baþarýlý bir þekilde tedavi edilen invaziv pulmoner fungal enfeksiyon olgusu sunulmaktadýr. Günümüze kadar literatürde Spiromastix cinsi küf mantarýnýn etken olarak izole edildiði iki olgu bildirilmiþ olup, bizim olgumuzda Türkiye’den bildirilen ilk olgu olma özelliðini taþýmaktadýr.

Invasive fungal infections (IFEs) are significant causes of morbidity and mortality, particularly in patients with hematological malignancies and immune deficiency. The fungus Aspergillus is the most commonly detected cause of IFEs in this patient group, although recent studies have reported rare fungi as the causative agent. We present here the case of an 80-year-old male patient who was undergoing remission induction chemotherapy due to acute myeloid leukemia (AML). The patient developed an invasive pulmonary fungal infection caused by the fungus Spiromastix during therapy with liposomal amphotericin B (LAmB) following posaconazole prophylaxis (POS), and was treated successfully with voriconazole (VOR). There have been two studies to date in literature detailing the isolation of the fungus Spiromastix, although this is the first case report from Turkey.

Makale Özeti | Tam Metin PDF