INTRODUCTION: The aim of the present study was to determine the etiological profile, clinical course, and outcome of patients hospitalized with severe influenza during the 2015-2016 influenza season.
METHODS: Patients with severe influenza who were admitted to the emergency department of the hospital between December 1, 2015 and March 15, 2016 and who required admission were included. The presence of dyspnea, tachypnea, tachycardia, hypotension, hypoxia, mental status changes, severe dehydration, or chest X-ray compatible with bronchopneumonia/pneumonia were considered “severe influenza.” Nasopharyngeal aspirate specimens from all patients were tested for respiratory viruses using the reverse transcriptase-polymerase chain reaction technique.
RESULTS: Of a total of 95 hospitalized patients, 65 patients (68.4%; 38 adults and 27 children) were virus-positive. The etiological virus was 42 (64.6%) cases of influenza A (H1N1), 9 (13.8%) of influenza A (H3N2), and 5 (7.7%) of coronavirus. Six patients (9.2%) were pregnant. Only 1 pregnant patient died, due to H1N1 influenza. Fifteen (23%; 14 adults and 1 child) required follow-up in the intensive care unit (ICU). Nine adult patients died [7 due to influenza A (6 H1N1, 1 H3N2), 1 due to human metapneumovirus, 1 due to coronavirus], but all of the children survived. The case-fatality rate of H1N1 infection was 14.3%.
DISCUSSION AND CONCLUSION: Two-thirds of the admitted patients had an influenza A H1N1 infection. Seven (16.7%) of them required ICU follow-up. The H1N1 case-fatality rate was 14.3%. Patients with risk factors who have severe influenza should be hospitalized.

INTRODUCTION: The aim of this study was to investigate the sociodemographic, clinical, radiological, histopathological, and survival characteristics of lung cancer patients ≤55 years of age.
METHODS: The files of patients diagnosed in the clinic as lung cancer between January 2014 and December 2016 were retrospectively evaluated. These cases were divided into 2 groups: patients who were ≤55 years of age and patients >55 years of age. The clinical, radiological, and demographic findings; histopathological type and stage of cancer; treatment modalities used; and survival data were analyzed and compared.
RESULTS: A total of 323 cases, 85 (26.3%) of them aged ≤55 years and 238 (73.7%) aged >55 years, were included in the study. The stage and histopathological type of lung cancer, smoking history, gender, oncological and surgical treatment modalities used, and survival characteristics were similar in both groups (p>0.05).
DISCUSSION AND CONCLUSION: Since the 2 groups of lung cancer patients formed on the basis of the age limit of 55 years were similar in many respects, and because the number of cancer cases increases in 5-year subgroups under the age of 55 years, screening for lung cancer may be recommended for those under 55 years, especially in cases with risk factors.

INTRODUCTION: Cervical cytology samples were analyzed to determine the prevalence of human papilloma virus infection (HPV) and the most frequently observed types. Methods used to assess the presence of HPV were also evaluated.
METHODS: A total of 837 female patients who presented at the hospital between June 2016 and March 2017 were retrospectively included in the study. Real-time polymerase chain reaction (RT-PCR) analysis was used to detect the presence and identify the type of HPV, and a liquid-based cytology technique was also used to evaluate cervical cytology in concurrently obtained samples taken during a gynecological examination.
RESULTS: Of 837 cervical cytology samples, squamous cell atypia (SCA) was seen in 208 (24.9%) samples, and was not present in the remaining 629 (75.1%). Analysis of the samples with SCA revealed the presence of SCA of undetermined significance in 142 (17.0%), low-grade squamous intraepithelial lesion in 53 (6.3%), and high-grade squamous intraepithelial lesion in 13 (1.6%) samples. HPV-positivity was detected in 344 of the 837 patients (41.1%). The most frequently seen types were HPV 16, 18, 31, and 51. HPV prevalence was greatest in women younger than 30 years of age and those over 50. HPV 16 and multiple strains were most often seen in women under 30. HPV 16 was the most frequently seen single HPV strain, followed by HPV types 51, 31, and 18, respectively. HPV 16 was also most common among samples with multiple strains, followed by types 31, 51, and 18, respectively. HPV-positivity was detected in 132 (63.5%) patients with SCA. Of the 629 who had an SCA-negative result, HPV positivity was determined in 212 (33.7%) cases.
DISCUSSION AND CONCLUSION: The most frequently detected strain of HPV in this study was type 16. HPV prevalence demonstrated a bimodal age distribution. HPV was correlated with SCA; however, HPV-positivity was also observed using RT-PCR in cases without SCA. This indicates the importance of the combination of RT-PCR and cytological examination in the determination of HPV types and prevalence, and in the treatment and follow-up of HPV-positive patients.

INTRODUCTION: Pectoralis minor syndrome (PMS) is a neurovascular disorder affecting the upper extremity. In the present study, the demographic and clinical features of patients diagnosed as PMS were examined, as well as cases of concomitant subacromial impingement syndrome (SIS).
METHODS: A retrospective trial was conducted with 12 patients with the diagnosis of PMS according to a pectoralis minor muscle (PMM) block test. The PMM block was performed under the guidance of ultrasonography.
RESULTS: Of the 12 PMS patients evaluated, 83% had a complaint of pain, 58.3% had paresthesia, and 16.6% had swelling of the hand. A physical examination revealed that 58.3% of the patients had tenderness at the biceps tendon, 16.6% had subacromial tenderness, and 16.6% had tenderness at the acromioclavicular joint. In 66.6% patients, subacromial impingement tests were positive, and 33.3% of them had a positive subacromial injection test (SIT).
DISCUSSION AND CONCLUSION: PMS can be overlooked and may also be confused with other disorders, such as SIS. Furthermore, SIS may also accompany PMS. Therefore, in such painful pathologies, injection tests such as SIT and PMM block should be used as the reference test for the diagnosis and it should be kept in mind that these 2 clinical disorders can be observed together.

INTRODUCTION: The aim of the present study was to investigate changes in short-term visual acuity and foveal thickness after single-dose intravitreal bevacizumab treatments for macular edema secondary to central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO).
METHODS: The patients were separated into 2 groups: 18 eyes of 18 patients with BRVO, and 10 eyes of 10 patients with CRVO. Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity scores, changes in foveal thickness measured with optical coherence tomography, and complications of treatment were evaluated.
RESULTS: In each monthly measurement, in the BRVO group, foveal thickness decreased from baseline statistically significantly from baseline (p<0.05) and ETDRS score of visual acuity increase also was statistically significant (p<0.05) at each interval. In the CVRO group, although 1 month after injection, foveal thickness decreased significantly (p<0.05), and second and third months, the reduction in foveal thickness was not statistically significant (p>0.05) and compared with preinjection values, increase ETDRS score at all months was not statistically significant (p>0.05).
DISCUSSION AND CONCLUSION: Treatment of macular edema secondary to BRVO with intravitreal injection of bevacizumab in the early stages was effective and reliable.

INTRODUCTION: This study was conducted to investigate traditional beliefs and practices of women regarding care of the mother and the infant during pregnancy, in childbirth, and in the postpartum period.
METHODS: This was a descriptive, cross-sectional study conducted at a public hospital in Istanbul. The data collected consisted of socio-demographic and obstetric characteristics, and responses to questions about some traditional customs regarding pregnancy, delivery, and the postpartum period.
RESULTS: In our research, some non-harmful cultural practices were found, such as the belief that to have a clever and beautiful baby the mother should eat fruit; that to have a healthy and peaceful pregnancy, the mother should not look upon ugly things; the mother should indulge her food cravings; and to have an easy birth, the mother should walk and focus on prayers. On the other hand, we also found beliefs that could be harmful, such as wiping the mouth of a baby with a date before breastfeeding, and practices believed to be protective that could cause harm, such as putting a knife under the baby’s bed, fastening a safety pin to the baby’s clothes, and for the mother and child to remain at home for 40 days.
DISCUSSION AND CONCLUSION: While non-harmful and beneficial practices related to maternal and infant health should be accepted and supported as a part of our cultural richness, practices that could be harmful should be prevented in pregnancy classes or with training upon hospital discharge.

INTRODUCTION: As the frequency of skin cancers continues to increase, the aim of this study was to determine the incidence of precancerous and cancerous skin lesions diagnosed and treated during 2016 at the dermatology outpatient clinics of 3 private hospitals in 3 cities in Turkey.
METHODS: All of the patients who presented at 3 outpatient clinics located in the Marmara and Anatolian regions of Turkey in 2016 were retrospectively evaluated. Patients with precancerous and cancerous skin lesions were identified via the relevant International Classification of Diseases code, and sociodemographic and clinical features were obtained from their medical records.
RESULTS: Among the 21,085 patients who presented at the 3 study centers, there were 81 cases of precancerous or cancerous skin lesions. The annual combined incidence of precancerous and cancerous skin lesions was 0.38%. The incidence of precancerous lesions (n=58) was 0.27%, while it was 0.11% (n=23) for cancerous lesions.
DISCUSSION AND CONCLUSION: The prevalence of precancerous and cancerous skin lesions is increasing worldwide. The results of this study were consistent with the findings previously detected in this country and worldwide. This study included patients from only 2 regions of Turkey, but the findings could be used as a reference for dermatology outpatient clinics located in second level healthcare facilities.

INTRODUCTION: The aim of this study was to investigate the frequency of use of the Central Physician Appointment System (CPAS) in a Konya hospital and the factors affecting use.
METHODS: A total of 7187 people who were admitted to the outpatient clinics of the hospital and had completed an examination between January 20 and February 28, 2017 were included in the study. Face-to-face interviews were performed with the patients.
RESULTS: Of all the patients, 49.9% made their appointment via CPAS, and 47.4% made an appointment from a kiosk. CPAS usage was higher among white-collar workers than tradesmen, laborers, housewives, or retirees (p<0.001). As education level and monthly income level increased, the use of CPAS also increased (p<0.001). CPAS was also used more by those who lived in the center of Konya than by those who lived in surrounding rural areas (p<0.001). The patient satisfaction rate was 89.4%.
DISCUSSION AND CONCLUSION: In order to increase the use of CPAS, new strategies should be developed targeting residents of rural areas and those of lower socioeconomic status. Existing public service announcements and promotional leaflets should also be disseminated.

INTRODUCTION: The aim of this study was to evaluate depression, anxiety, loneliness, and the effects of social support in infertile women in Turkey.
METHODS: A total of 140 patients who presented at the infertility clinic between June 2012 and December 2012 were included in the study. All of the participants completed the Hamilton Anxiety Rating Scale, the Beck Depression Inventory, the University of California Los Angeles Loneliness Scale, and the Multidimensional Scale of Perceived Social Support.
RESULTS: The depression score of the infertile women was lower than that of the general population, and the anxiety score was found to be similar to that of the general population. The loneliness scale score decreased with additional years of marriage and greater monthly income (p<0.05; p<0.05). The social support score also increased with the length of marriage (p<0.05). Two patients were referred to the psychiatry clinic based on the results of the depression scale, and 4 participants were referred based on their anxiety scale scores.
DISCUSSION AND CONCLUSION: Financial circumstances, duration of marriage, and social support influence depression, anxiety, and loneliness in infertile patients. Since there was no significant difference in the level of depression or anxiety in this group of patients, it was concluded that professional support and treatment are only necessary when appropriate.

INTRODUCTION: The rehabilitation of stroke patients is work that requires a multi-faceted team, which includes the patients, physicians, nurses, psychologists, and caregivers. In this study, the purpose was to determine the level of anxiety, depression, and burnout in caregivers of stroke inpatients.
METHODS: In all, 72 caregivers who each care for 1 stroke patient were included in the study. The Beck Anxiety Inventory, the Beck Depression Inventory, and the Maslach Burnout Inventory were used to assess the level of anxiety, depression, and burnout in the study group.
RESULTS: The caregivers of stroke patients were found to have scores reflecting mild depression and mild anxiety. The burnout level evaluated in subdimensions of emotional exhaustion, desensitization, and personal accomplishment was at a normal level.
DISCUSSION AND CONCLUSION: The psychiatric component of stroke therapy and rehabilitation should not only be patient-oriented. Patient relatives, and particularly their caregivers, may need training and psychiatric support. A rehabilitation program that includes education and interactive group therapies could be very useful.

INTRODUCTION: Retrorectal tumors (presacral, precoccyxgeal) are rare, and remain a significant diagnostic and therapeutic challenge. The aim of this study was to describe the surgical experience of 1 hospital with retrorectal tumors.
METHODS: Twelve patients admitted to the Dr. Lutfi Kirdar Training and Research Hospital/Istanbul Department of General Surgery between January 2012 and December 2016 were included in our study. Medical records, radiology results, pathology reports, and surgical techniques were analyzed retrospectively.
RESULTS: Of the 12 patients evaluated, 10 were female and 2 were male. The mean age was 45 years (range: 31-65 years). Eight patients had masses of a congenital origin, 3 patients had masses of neurogenic origin, and 1 had an angiomyxomatous tumor. Both an anterior and posterior surgical approach were used.
DISCUSSION AND CONCLUSION: Complete removal of the tumor and preservation of neurological function remain major aspects of successful treatment. To achieve the best results, a multidisciplinary approach and correct planning are important.

Objective: Defects of the nasal, perinasal, and infraorbital areas usually develop after trauma or tumoral excision. The key points of reconstruction of these areas are achieving a good color match and tissue compatibility, avoiding or minimizing functional deficits, and preventing disfigurement in the surrounding tissue. This study is a review of midfacial defects reconstructed with a facial artery perforator flap.
Methods: Nineteen patients were operated on for midfacial tumoral masses between 2008-2017. After excision of the lesion with the appropriate surgical margins, the resulting defects were reconstructed with facial artery perforator flaps. Recovering the anatomical and functional structure of the area or avoiding deterioration was the goal. In order to avoid ectropion, flaps were anchored to the periosteum when the lower eyelid was involved. All flap donor sites were primarily repaired.
Results: In 1 patient, venous insufficiency was observed, and in another, hematoma and ecchymosis developed, but flap failure did not occur. A trap door deformity was observed in 2 flaps. The patients were satisfied with the aesthetic and functional outcomes.
Conclusion: The facial artery perforator flap is a good option for reconstruction of midface defects because it is elevated in a single stage, it provides freedom to design and transfer, and the donor site can be primarily closed.

The presence of more than 1 distinct lung cancer in the same patient, or multiple primary lung cancer (MPLC) is a rarely seen condition. Multiple lung cancers are classified as synchronous when more than 1 type of lung cancer is detected at the same time, and as metachronous tumors if the second tumor is detected some months after the first lesion. Synchronous tumors are more rare and the treatment and prognosis differs from that observed in metastatic lung cancers. In recent years, thanks to the development of radiological modalities, such as multislice computed tomography and positron emission tomography-computed tomography, as well as invasive diagnostic methods, such as endobronchial ultrasound, transthoracic needle aspiration biopsy, and transbronchial needle aspiration biopsy, the detection rate of synchronous tumors has increased.

Clinically isolated syndrome (CIS) and multiple sclerosis are autoimmune diseases of the central nervous system that are characterized by inflammation, demyelination, and axonal damage. Clinical symptoms can be aggravated by fever or concomitant infection. Malaria can also demonstrate neurological symptoms and develop into cerebral malaria, which can lead to severe neurological disability. The present patient had a diagnosis of Plasmodium vivax infection and displayed neurological symptoms and fever. After exclusion of cerebral malaria and other infectious diseases, the patient had a final diagnosis of CIS and the appropriate treatment was initiated. This report is a description of this rare presentation.

Traumatic diaphragmatic hernia (TDH) is a serious, frequently overlooked complication observed secondary to a thoracoabdominal trauma. The treatment of TDH is surgical and diaphragmatic repair, usually performed with a thoracotomy approach. During a thoracotomy, the lung on the operation side is collapsed and single-lung ventilation is employed. This procedure facilitates the work of the surgeon; however, it makes the administration of anesthesia more difficult. Obstructive sleep apnea (OSA) is a disorder characterized by attacks of apnea and hypopnea due to partial or complete obstruction of the upper respiratory tract during sleep. Administration of anesthesia to patients with OSA involves several difficulties with respect to ventilation and intubation, as well as potential respiratory complications during the postoperative period. In this case report, critical issues faced during the administration of anesthesia to a 46-year-old male patient with OSA who was diagnosed with TDH 1 year after a trauma were discussed in the context of the literature.

Spontaneous subluxation of the atlantoaxial joint secondary to inflammatory head and neck conditions is defined as Grisel syndrome, and is usually seen in children. The primary treatment is conservative. Delayed diagnosis and treatment can result in a painful and persistent cervical deformity, and may require surgical treatment. In this report, the case of a 14-year-old patient who presented with spontaneous atlantoaxial rotatory subluxation after adenotonsillectomy is described. When no reduction was obtained with conservative treatment, surgical intervention was performed.