INTRODUCTION: The aim of this prospective clinical study was to compare the incidence of difficult airway in patients undergoing septal deviation with the incidence of difficult airway in patients undergoing tympanoplasty and to determine the factors associated with the incidence of the difficult airway. Investigation of predisposing factors for difficult airway in patients undergoing septal deviation surgery was evaluated as a secondary outcome.


METHODS: A total of 255 participants, 130 patients undergoing septoplasty (study group-Group S) and 125 patients undergoing tympanoplasty (control group-Group T) were included in this study. Preoperative airway evaluation was performed using the LEMON protocol. For all patients, the STOP-BANG questionnaire was performed to identify the risk of Obstructive Sleep Apnea Syndrome (OSAS). Cormack-Lehane laryngeal view grades were noted during laryngoscopy. The definition of difficult intubation was identified according to the Cormack-Lehane scale (I–II=easy, III–IV=difficult). Additionally, the intubation method used, number of intubation attempts, use of stylet, cricoid pressure, and usage of airway were recorded.
RESULTS: There were no unintubated patients in this study population. Cormack-Lehane score and incidence of difficult airway were significantly higher in the Group S than the Group T (p<0.001). Micrognathia (p<0.001, OR: 9.38, 95% CI: 2.71–45.93) and OSAS (p<0.001, OR: 58.013, 95% CI: 14.025–239.98) were found to be risk factors for difficult airway in patients undergoing septoplasty.
DISCUSSION AND CONCLUSION: The airway should be evaluated for difficult intubation before surgery and risk factors for difficult airway should be determined even in minor surgery.

INTRODUCTION: The present study aims to evaluate the sociodemographic characteristics and clinical management of patients with uterine sarcoma.
METHODS: Retrospective analysis of 55 patients, who were diagnosed with uterine sarcomas between January 1, 2004–January 1, 2014, was performed. Sociodemographic characteristics, methods used in diagnosis and treatment processes were investigated by accessing the medical files of the patients. All patients were contacted by telephone to obtain information about disease progression and recurrence. Patients’ death reports were obtained from the national database of the Ministry of Health and the findings were analyzed statistically.

RESULTS: In this study, 55 cases of uterine sarcoma, of whom 31 carcinosarcomas (56.4%), 15 leiomyosarcomas (27.3%), six endometrial stromal sarcomas (10.9%) and three adenosarcomas (5.5%) were analyzed. The median age was 60.75±12.74 (min-max: 33–86). Forty-three (78.2%) patients were in postmenopausal period. Twenty-seven (47.3%) of these patients were diagnosed by endometrial sampling, 17 (30.9%) patients were diagnosed by frozen section, 11 (20%) patients were diagnosed by hysterectomy and one (1.81%) patient was diagnosed by myomectomy. Three patients had distant metastases at the time of diagnosis. According to FIGO (International Federation of Gynecology and Obstetrics) 2009, 65.5% of the patients were diagnosed at stage 1. 58.5% of the patients who underwent surgery were operated by gynecologist-oncologist. Total abdominal hysterectomy with bilateral salping-oopherectomy was performed in 52 patients (94.5%). Pelvic lymph node dissection was performed in 28 patients (51%). The mean survival time was 47 months in carcinosarcoma, 49.6 months in leiomyosarcoma, 84.8 months in endometrial stromal sarcoma and 68.7 months in adenosarcoma. Until the last date of collecting data, January 2019, 37 patients (67.3%) died.

DISCUSSION AND CONCLUSION: Uterine sarcomas are rare tumors with poor prognosis even in the early stages. Each histological type should be evaluated separately. Surgery is the main treatment method in uterine sarcoma. The role of adjuvant therapy is controversial.

INTRODUCTION: Postpartum bleeding is a life-threatening obstetric problem all over the world, which needs to be well managed to reduce maternal mortality. In this study, we aim to predict postpartum bleeding by menstrual cycles of the patients.
METHODS: A prospective, observational, cross-sectional study was conducted between November 2017 and July 2018. All the patients that gave labour in our clinic were evaluated and grouped. Group 1 (n=240) consisted of the patients with regular menstrual cycles, and they had no history of bleeding disorders, Group 2 (n=60) consisted of the patients with abnormal uterine bleeding as >80 mL bleeding in a period, having period before 24 days, >8 days of bleeding in a period or intermenstrual bleeding. However, they had no other history of bleeding disorder. All the patients were screened for bleeding diathesis.
RESULTS: The mean age was 28.77±5.88 years and the mean prepartum hemoglobin was 11.76±1.36 mg/dl. 118 (39.3%) of the patients had a vaginal delivery and 182 (60.7%) had a cesarean delivery. The mean postpartum hemoglobin was 10.71±1.49 mg/dl. Group 1 had higher prepartum and postpartum hemoglobin than Group 2 (p=0.001 and p=0.003, respectively). Abnormal uterine bleeding (AUB) was correlated with prepartum (r=0.222, p=0.000) and postpartum hemoglobin (r=0.171, p=0.030). AUB was not significantly related to postpartum bleeding. Regarding fetal outcome, only neonatal intensive care unit admission was significantly related to abnormal uterine bleeding history (p=0.03).
DISCUSSION AND CONCLUSION: Postpartum bleeding is not always a predictable status, and patients with abnormal uterine bleeding history should be expected to have lower hemoglobin levels prepartum and postpartum.

INTRODUCTION: In this study, we aimed to compare the results in patients undergoing the one-shot dilatation (OD) technique and the conventional serial dilatation (SD) technique with amplatz dilators in percutaneous nephrolithotomy (PNL) operations.
METHODS: We retrospectively evaluated the data of 213 patients who had undergone PNL between January 2016 and June 2018. The patients who had undergone SD were classified as Group 1 and the patients undergoing OD as Group 2. All of the patients had undergone contrast-free computed tomography (CT) before the operation. The PNL procedure was performed by experienced endo-urologists. Follow-up CT was performed in the 3rd postoperative month. The PNL procedure was considered unsuccessful in patients who had a stone larger than 4 mm on the CT scan. The patients were accepted as 'stone free' when there was no residual stone or there was a stone less than 4 mm in diameter on the CT scan. The groups were compared concerning demographic characteristics, operation duration, fluoroscopy duration, amount of hemoglobin change, complication rate (according to the modified Clavien classification), length of hospital stay and the operation success rate.
RESULTS: There was no statistically significant difference between the groups concerning operation data, rate of stone-free patients and complication rates. The mean length of hospital stay was shorter in the OD group (p<0.001).
DISCUSSION AND CONCLUSION: The conventional SD procedure is similar to the OD procedure with amplatz dilators concerning the total fluoroscopy time, complication rates and the surgical success rate.

INTRODUCTION: A preoperative checklists guide was issued in 2008 by the American Society of Anesthesiologists (ASA) to improve patient safety. We aimed to determine the applicability and effectiveness of video-based feedback for the transfer of knowledge into clinical practice by using this guide.
METHODS: Ten anesthesia residents were divided into two groups according to their seniority, under two years and over two years. Once the preparation, anesthesia induction and airway management steps were completed, video-based feedback was given according to the ASA checklist. The knowledge level and skills of the residents were evaluated. Two months after the video-based feedback, all steps were repeated in another patient. The results were compared with a checklist score. Each guideline item was analyzed.
RESULTS: The ages of participants varied between 27–34 years (28.9±2.28 years), five were female, and five were male. Results of the pre and post video-based feedback evaluations of the residents were statistically similar in the senior and junior groups. The post-feedback achievement score in both groups was significantly higher than the pre-feedback achievement score (p<0.05).
DISCUSSION AND CONCLUSION: It has been shown that the ASA Checklist Procedure before airway management during general anesthesia induction can be successfully put into clinical practice with video-based feedback. We concluded that patient safety could be increased by the integration of this method into the routine anesthesia resident training program.

INTRODUCTION: This study aims to evaluate the 90-day complication rate and 3-month mortality after open radical cystoprostatectomy using a standardized method to report complications.
METHODS: We retrospectively reviewed the data of 209 RC male patients operated by the same surgical team between March 2008 and December 2017 in our institution. Patients’ characteristics, clinical outcome, pathological parameters and reflectors of surgical difficulty were retrospectively collected from the hospital medical record. Postoperative complications were graded according to the Clavien-Dindo classification, whereas Martin criteria were used to report complications. SPSS version 22.0 was used for the statistical analyses.
RESULTS: A total of 239 complications developed in 143 of the 198 patients (72.2%). Thirtynine (19.7%) of these complications occurred after thirty days postoperatively. The mean operation time was 412.6± minutes (300–485). Mean EBL was 1107±617.3 ml (400–3600). Overall mean hospitalization time was 19.2±7.3 days (7–30). Perioperative transfusion was given in 78.8% of the patients (n=156). Major complications (Clavien 3-5) were observed in 41 (20.7%) patients. The most common complication categories were gastrointestinal (28.8%). Ileus was the most common complication, occurring in 21.2% of the patients.
DISCUSSION AND CONCLUSION: Our results support the consideration of a more extended follow-up period to define the morbidity of RC. The standardization of the reporting criteria for complications will allow direct comparisons between studies. The complication rates after utilizing a standard reporting methodology were higher compared to studies that do not employ such methodologies.

INTRODUCTION: This study aims to investigate the relationship between bacteremia and the level of acute phase reactants in cellulite cases and to evaluate the value of blood culture and tissue/wound/abscess cultures in determining causal microorganism.
METHODS: The adult patients were included in this study, who were hospitalized with a diagnosis of cellulitis between January 1, 2015, and December 31, 2016. Patients’ medical records revealed from computer based hospital system, retrospectively. Patients with diabetic foot
infections, decubitus infections, cellulite accompanying shingles and other concomitant system infections were excluded from this study. Before antibiotic treatment, patient’s body temperature, leukocyte count, c reactive protein level, erythrocyte sedimentation rate, culture
results, antibiotic treatment before hospitalization, empirical antibiotic treatment in hospital, treatment duration, comorbidities and clinical response data were collected.
RESULTS: There were 194 patients in this study. Blood cultures collected from 143 patients before antibiotic treatment. Nine of 143 (6.3%) patient’s blood cultures were positive. On the other hand, results of the tissue/wound cultures were positive in 17 of the 35 cases (48.6%). Mean white blood cell count at the first admission was 13.9x103/mm3 in non-bacteremic group and 15.2x103/mm3 in bacteremic group. Mean C-reactive protein level at the first admission was 148 mg/L in non-bacteremic group and 164 mg/L in bacteremic group. There was no statistical significance between these two acute phase marker and bacteremia in cellulitis cases. However, mean erythrocyte sedimentation rate was 92 vs 56.5 mm/h respectively in bacteremic and non-bacteremic patient (p=0.03).
DISCUSSION AND CONCLUSION: In the cases of cellulitis, blood culture did not provide sufficient clinical benefit for the etiology even the presence of fever. It was concluded that taking culture samples from infection site, such as abscess, wound and tissue culture, would be more useful for identification of the etiologic agent.

INTRODUCTION: In several studies, chronic heart failure has shown to be associated with cortisol levels as increasing morbidity and mortality. The present study aims to evaluate the relationship between serum cortisol levels measured at hospitalization and 48 hours after the first sample with the early and late mortality rate at follow up period in patients with chronic heart failure.
METHODS: Overall, 66 patients (36 female, 30 male) admitted with the diagnosis of heart failure were included in this study. First cortisol level measurement at the admission, and the second after 48 hours were made. Patients who died within the first sixty days were considered as early mortality and patients who died within 60–180 days as late mortality.
RESULTS: After six months of follow up, overall, 18 out of 66 patients died. First, cortisol levels were established to be higher in the mortality group than the patients survived (18.84±5.39 vs 15.47±4.95; p=0.028). The mortality rate was also found to be higher in the groups with NYHA class III-IV (p=0.033), in male sex (p=0.045), in the group with higher BMI (p=0.036), while it was found to be lower in the patients with hypertension group. In cox regression analysis with a model of gender, BMI, NYHA stage, Hypertension and cortisol levels, it was established that high NYHA stage 2.614 [1.017–6.717] (p=0.046), lack of HT 0.358 [0.139–0.921] (p=0.033) and high cortisol levels 5.091 [1.757–14.774] (p=0.003) were factors predicting mortality.
DISCUSSION AND CONCLUSION: In conclusion, a high level of serum cortisol is an independent predictor of early cause mortality risk in patients with chronic heart failure. Class III-IV NYHA and lack of HT were found to be other established factors influencing mortality rate of these patients.

INTRODUCTION: This study aims to investigate functional changes in the macula by multifocal electroretinography (mfERG) following intravitreal dexamethasone implant for the treatment of macular edema secondary to branch retinal vein occlusion (BRVO).
METHODS: Forty-two patients treated with intravitreal dexamethasone implant (Ozurdex®, Allergan, Irvine, CA) for macular edema secondary to branch retinal vein occlusion (17 male, 25 female, mean age: 58.4±10.3 years) were included this study. All patients had a detailed ophthalmological examination, including determination of best-corrected visual acuity, slitlamp examination, dilated fundus examination, optical coherence imaging of the macula and multifocal electroretinography. These examinations were performed in all cases before the intravitreal injection of dexamethasone implant, and the patients were followed with these modalities until six months after implantation.

RESULTS: The mfERG changes in rings and effected quadrants were not statistically significant (p>0.05). Implicit times in affected quadrants were 38.74±3.76 ms and 39.88±3.63 ms in preimplantation period and were measured as 38.08±2.66 ms, 38.57 ms in the post-implantation
period. Although p wave implicit times in all rings and effected quadrants were relatively shorter, the difference was not statistically significant (p>0.05).
DISCUSSION AND CONCLUSION: Previous reports with first and third month results showed no significant change in mfERG findings in patients with BRVO in the short term. In this study, although a significant increase in visual acuity and a significant decrease in central macular thickness were observed in six months after Ozurdex in BRVO patients, no significant functional change was observed in mfERG.

INTRODUCTION: To assess the effects of initial retinal volume (RV) on visual acuity (VA) after intravitreal bevacizumab treatment for diabetic macular edema (DME).
METHODS: The data of 28 eyes of 19 patients treated with bevacizumab for clinically significant diabetic macular edema were retrospectively evaluated in this study. The association of visual acuity and letter gain with initial retinal volüme (RV) and central retinal thickness (CRT) after one year of treatment were evaluated.
RESULTS: Baseline VA was 58.9±11.9 letters; CRT was 564.2±125.1 µm and baseline RV was 12.4±2.3 mm3. At 12 months; VA was 67.4±11.6 letter; CRT was 410.2±124.2 µm and RV was 10.6±2.2 mm3 (p=0.001, p<0.001 and p<0.001, respectively). Following 9.7±2.3 injections, the mean VA gain at month 12 was +8.5 letters. Visual acuity after one year of treatment was correlated with baseline RV and baseline VA (r=-0.542 p=0.003 and r=0.485 p=0.009, respectively). The letters gain was correlated only with the baseline VA (r=-0.528, p=0.004). A multiple regression analysis was performed to investigate the relationship between the baseline VA, RV, CRT, serous macular detachment, age, the number of the injections, and letter gain and final VA. The factors significantly affecting the letters gain and final VA were baseline VA and baseline RV (p<0.001).
DISCUSSION AND CONCLUSION: Baseline retinal volume seems to be an important factor predicting the response to anti-VEGF treatment in DME. Such objective and quantitative data would allow us to be more certain when discussing prognosis, treatment and monitoring strategies. Presumed prognostic factors as: macular ischemia, vitreoretinal interface abnormalities, cystoid degeneration and hard exudates should also be considered.

INTRODUCTION: In recent years, carbapenem-resistant Klebsiella pneumoniae infections have become an important health problem in our country and all over the world. In this study, we aimed to identify the risk factors of carbapenem-resistant K. pneumoniae bacteremia.
METHODS: Patients who suffered from Klebsiella pneumoniae bacteremia between December 2016 and May 2018 were included prospectively in this study. Patients were divided into groups according to carbapenem resistance and risk factors were analyzed under variable and multivariable logistic regression model.
RESULTS: Of the fifty-three patients were included in this study, 27 patients infected with carbapenem-resistant K. pneumoniae and 26 patients infected with carbapenem-suspectible K. pneumoniae. Risk factors for carbapenem-resistant K. pneumoniae bacteremia according to univariate analysis were listed prior hospitalization (p=0.043; OR=3.20; 95% CI: 1.04–9.85), admission to intensive care unit (p=0.001; OR=10.91; 955 CI: 2.61–45.6), use of beta-lactams/beta-lactamase inhibitor combination (p<0.001; OR=41.67; 95% CI: 7.57–229.2) and use of glycopeptides (p=0.001; OR=7.92; 95% CI: 2.31–27.1). Before hospitalization (p=0.016; OR=9.64; 95% CI: 1.54–60.46) and use of beta-lactams/beta-lactamase, inhibitor combination (p<0.001; OR=38.45; 95% CI: 6.04–244.85) were identified as independent risk factors for carbapenem resistance in multivariate analysis.
DISCUSSION AND CONCLUSION: According to our study, before hospitalization, the use of beta-lactams/beta-lactamase inhibitor combination was the major risk factor for carbapenem-resistant Klebsiella pneumoniae bacteremia.

INTRODUCTION: Polio survivors have common sequelae of lower extremity paralysis characterized by flaccid muscle tone, limited ambulation, asymmetric involvement, retarded growth, and disuse osteoporosis. Such patients at risk of disuse osteoporosis are also at risk of sustaining osteoporotic fractures. This study aims to evaluate the effectiveness of extramedullary internal fixation devices in achieving better results in osteoporotic polio-related femoral fractures.
METHODS: Retrospective evaluation was made of a total of 13 adult polio patients treated with extramedullary internal fixation devices for unilateral proximal and diaphyseal femoral fractures. The functional status of all patients was evaluated with the Vignos grade of disability.
RESULTS: All patients (mean age 62 years; range 47–88 years) were treated with extramedullary internal fixation devices (locked plate in eight diaphyseal fractures; dynamic condylar screw (DCS) and plate in three, and dynamic hip screw (DHS) and plate in two proximal femoral fractures). The mean follow-up period was 48.6 months (range 26–62 months). Bony union was confirmed at a mean of 3.7 months (range, 3–5 months) in all patients. Massive pulmonary embolism was seen in one patient. No cases of non-union, implant cutout or any other complications developed.
DISCUSSION AND CONCLUSION: Post-polio patients are at high risk of fractures. Extramedullary internal fixation devices provide effective stability for bony union and good functional results in polio-related femoral fractures.

INTRODUCTION: In the management of asthma disease, the aim is to keep the disease under control with treatment. Asthma control test (ACT) is the most widely used and important test that is easily figured out by the patients. This test is filled by the patient during the clinical practice. The present study aims to evaluate how the filling of ACT by the physician will affect the outcome and the concordance of results with clinical and functional parameters.
METHODS: Patients who applied to the Outpatient Clinic of Chest Diseases in our Hospital between dates of June–August 2016 and who had at least one year of asthma diagnosis were included in this study. The patients filled their own answers to the ACT before the outpatient clinic examination. The same test was given to the patients by the doctor during physical examination.
RESULTS: A total of 105 asthma patients were included in this study whose mean age was 38.8±13.6 (14–76) years, 58 (55%) of them were female and 47 (44.8%) of them were male. Mean ACT score of the cases was 14.5±5.8, while it was 13.9±4.4 in the tests filled by the doctor. 33.3% of the cases were college graduates, 23.8% of them were high school graduates, 38.1% of them were primary school graduates, and 4.8% of them were middle school graduates. A statistically significant difference was detected (p=0.02) between the results of asthma control tests filled by the doctor and that of those filled by the patients. It was detected that the status of education of the patient was the factor with the highest impact on the situation. It was found that ACT results filled by doctors were in higher concordance with clinical and functional parameters.
DISCUSSION AND CONCLUSION: Our study demonstrated that ACT being filled by the doctor in societies with lower levels of educational status would yield results that were in higher concordance with asthma control.

INTRODUCTION: Patient safety is a multi-factorial issue although the literature focused on the errors of health professionals. This study aims to disclose the safety problems that arise from patients’ attitudes and behaviors.
METHODS: To evaluate the patient attitudes and behaviors in patient safety practices, 300 patients or patient relatives were interviewed, and data were analyzed in this study.
RESULTS: Approximately 3/4 of the participants declared that they applied to a hospital in case of a health problem. More than half of the participants expressed that they were not informed about their treatment and care.
DISCUSSION AND CONCLUSION: An important component of coping with problems related to patient safety is to notice about patient attitudes and behaviors. Consequently, it is important for health care professionals to develop suggestions on patient-related safety concerns during treatment and care processes.

Chylothorax cases are associated with several etiologies. Non-Hodgkin lymphoma and intrathoracic surgical trauma are the most frequent reasons, but approximately 15% of the cases are idiopathic. Idiopathic chylothorax is thought to be related to minor trauma, and damage above the fifth thoracic vertebra is known to lead to left-sided effusion. In this report, we describe a left-sided chylothorax with an etiology that was finally identified by an in-depth interrogation of the patient’s past medical history. Several days previously, while he was weight training with his left arm, he experienced serious pain in his scalenus anterior muscle area. We thought that overstretching of the subclavious and anterior scalenus muscle might have led to the rupture of the left lymphatic duct. Traumatic chylothorax after weight lifting is a rare entity. Awareness and a high degree of suspicion are important in cases of unusual pleural effusion.

Myocardial infarctions (MI) has many complications and spinal infarction is one of them. Although spinal infarction is rare, we should keep in mind that spinal infarction is a possible complication after MI.

Ochronosis is an entity characterized by deposition of homogentisic acid and metabolites in connective tissues, such as joint cartilage, skin and sclera. Ochronosis is generally diagnosed by a clinical triad of degenerative arthritis, ochronotic pigmentation and urine color turning black upon alkalization. Since ochronotic arthropathy is one of the most important morbidity causes in ochronosis, in this study, we aimed to present two cases diagnosed. One of two cases we present had advanced degenerative alterations in both hip and knee, and the other case had advanced degenerative alterations in knee joints. Macroscopical examination of the resection materials revealed black pigmentation on joint surfaces. Histopathologically, cartilage lacunes filled with brown pigment and inflammatory infiltration, as well as brown pigmentation in soft tissue, were observed. Clinical history revealed that the patients had dark urine since childhood and they detected dark spotting at their underwear. As all findings evaluated together, these two rare cases, which are diagnosed as ochronotic arthropathy, reviewed in the light of the literature.

Ecthyma is a form of ulcerative impetigo which erodes through epidermidis and dermis. Mostly, the crusts are found on the lesions, and when the crust is removed, there is a purulent ulcer at the bottom. Herein, we report a patient who presented with ecthyma lesions on his legs to the outpatient clinic and had cutaneous anthrax reporting for differential diagnosis. A 10-year, 6-month old boy admitted to the hospital with five lesions with some of them are wet yellowish-colored, and some of them crusted in black color, surrounded with the hyperemic area on the leg which did not respond to topical treatment. In physical examination, he had no other pathological sign. The laboratory results showed a white blood cell (WBC) count of 9900/mm3, a hemoglobin level of 13.6 g/dL, platelet count of 478000/mm3 and C-reactive protein of 8.6 mg/L (0–3.5 mg/L. Biochemical values were normal. The patient was consulted the Department Dermatology and ecthyma was the primary diagnosis. However, cutaneous anthrax was in a differential diagnosis. Thus, we sent two swabs, one swab for PCR and one swab for culture. Because of penicillin allergy of the patient, clindamycin and ciprofloxacin were started. Streptococcus pyogenes yielded in culture and tests for anthrax were negative. Thus, we stopped ciprofloxacin and clindamycin therapy continued. On the day of 10th, the patient was discharged because of the crusted lesions with no hyperemic area. S. pyogenes is still susceptible to penicillin; however, it may cause severe complications. Thus, it should be treated promptly.