GÝRÝÞ ve AMAÇ: Eriþkinlerde Coronavirus Hastalýðý 2019 (COVID-19) hakkýnda artan verilere raðmen, pediatrik hastalardaki veriler hala sýnýrlýdýr. Çalýþmamýzýn amacý, doðrulanmýþ pediatrik COVID-19 olgularýmýzýn klinik özelliklerini ve laboratuvar bulgularýný deðerlendirmektir.
YÖNTEM ve GEREÇLER: Bu geriye dönük çalýþma, Türkiye’deki en büyük COVID-19 tedavi merkezlerinden birinde yapýldý. Çalýþmaya ters transkriptaz polimeraz zincir reaksiyonu (RT-PCR) kullanýlarak doðrulanan 456 olgu dahil edildi.Yüz hasta yatarak, 356 hasta ayakta tedavi edildi. Hastalar hastalýk þiddetine göre asemptomatik, hafif, orta ve þiddetli olarak sýnýflandýrýldý.
BULGULAR: Asemptomatik, hafif, orta ve aðýr vaka sayýsý sýrasýyla 199 (%43.6), 194 (%42.5), 33 (%7.2) ve 30 (%6.6) idi. Hastanede yatan beþ yaþ altý hastalarýn çoðu hafif (%67.7) iken, 15 yaþ üstü hastalarýn çoðu aðýr hastalýða (%54.2) sahipti. Baþvuru anýnda lenfopeni ve yüksek ferritin düzeyleri aðýr olgularda daha yaygýndý (p<0.05). Ayrýca çoklu regresyon analizi, yüksek ferritin ve D-dimer düzeylerinin hastanede yatýþ süresini artýrdýðýný ortaya koydu (p=0.000; R2=0.404).
TARTIÞMA ve SONUÇ: Çocuklarda COVID-19 enfeksiyonu için hastalýk þiddetini tahmin etmek için yaþ, lenfosit sayýsý, ferritin ve D-dimer seviyeleri kullanýlabilir.

INTRODUCTION: Despite increasing data on Coronavirus Disease 2019 (COVID-19) in adults, the data in pediatric patients are still limited. The aim of our study is to evaluate the clinical features and laboratory findings of our confirmed pediatric COVID-19 cases.
METHODS: This retrospective descriptive study was conducted in one of the largest COVID-19 treatment centers in Ýstanbul, Turkey. Four hundred and fifty-six cases confirmed using reverse transcriptase-polymerase chain reaction (RT-PCR) were included in the study. One hundred inpatients and 356 outpatients were treated. Patients were classified according to the disease severity as asymptomatic, mild, moderate and severe.
RESULTS: The number of asymptomatic, mild, moderate or severe cases were 199 (43.6%), 194 (42.5%), 33 (7.2%) and 30 (6.6%) respectively. Most of the hospitalized patients younger than 5 years old had the mild disease (67.7%), whereas most of the patients over 15 years of age had severe disease (54.2%). Lymphopenia and high ferritin levels at admission were more common in severe cases (p<0.05). Also, multiple regression analysis revealed that high ferritin and D-dimer levels were found to prolong hospital stay (p=0.000; R2=0.404).
DISCUSSION AND CONCLUSION: Age, lymphocyte count, ferritin and D-dimer levels can be used to estimate the disease severity for COVID-19 infection in children.

GÝRÝÞ ve AMAÇ: COVID-19 pandemi sürecinde ön saflarda görev yapan saðlýk çalýþanlarýnýn inaktif COVID-19 aþýsý sonrasýndaki depresyon, anksiyete ve insomnia düzeylerindeki deðiþimleri incelemek.
YÖNTEM ve GEREÇLER: Bu kesitsel çalýþma, 1 Ocak–30 Haziran 2021 tarihleri arasýnda Türkiye’de ön saflarda yer alan saðlýk profesyonellerini deðerlendirmek için çevrimiçi bir anket kullanýlarak yürütülmüþtür. Katýlýmcýlarýn mental saðlýðýný deðerlendirmek için Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7) ölçekleri kullanýldý. Uyku problemlerini deðerlendirmek için Insomnia Severity Index-7 (ISI-7) kullanýldý. Çalýþmada aþýlama öncesi (AÖ) ve sonrasý (AS) olmak üzere iki ayrý döneme dair veriler incelendi.
BULGULAR: Çalýþmaya 416 saðlýk çalýþaný dahil edildi. AÖ dönemde depresyon, anksiyete ve insomnia sýklýðý sýrasýyla; %27.9, %31.5 ve %41.1 þeklindeydi. Bu oranlarda AS dönemde azalma olup; %22.8, %21.9 ve %34.1 þeklinde olduðu görüldü. Dönemler arasýndaki bu farklar PHQ-9 (p=0.000), GAD-7 (p=0.002) ve ISI-7 (p=0.038) için istatistiksel olarak da anlamlýydý. Çalýþmamýzda yüksek haftalýk çalýþma saatleri, kadýn cinsiyet, tek baþýna yaþam ve psikiyatrik hastalýk varlýðý faktörlerinin depresyon ve anksiyete geliþiminde etkili olduðunu tespit ettik.
TARTIÞMA ve SONUÇ: Ön saflardaki saðlýk çalýþanlarýnda depresyon, anksiyete ve insomnia semptomlarý ve bu kinik tablolara taný konma sýklýðýnýn COVID-19 pandemisine baðlý olarak arttýðý görülmektedir. Ancak baðýþýklama süreci baþladýktan sonra bu mental bozukluklarýn sýklýðý ve saðlýk çalýþanlarýnýn endiþe düzeyleri belirgin bir þekilde azalma göstermiþtir.

INTRODUCTION: The aim of this study was to examine changes in the levels of depression, anxiety, and insomnia after inactive COVID-19 vaccination among healthcare professionals working actively during the COVID-19 pandemic.
METHODS: This cross-sectional study was conducted from January 1, 2021, to June 30, 2021, using an online survey across frontline healthcare professionals in Turkey. The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scale were used to evaluate the mental health of the participants, and the Insomnia Severity Index-7 (ISI-7) was used to evaluate their sleep problems. The data obtained from two different periods, pre-vaccination and post-vaccination, were examined.
RESULTS: The study included 416 healthcare professionals. The frequency of depression, anxiety, and insomnia was 27.9%, 31.5%, and 41.1%, respectively, in the pre-vaccination period, and there was a decrease in these rates (22.8%, 21.9%, and 34.1%, respectively) in the post-vaccination period. The differences between the two periods were also statistically significant for the PHQ-9 (p=0.000), GAD-7 (p=0.002), and ISI-7 (p=0.038) scores. We determined that the presence of long weekly working hours, being female, living alone, and presence of psychiatric disease were effective in the development of depression and anxiety.
DISCUSSION AND CONCLUSION: Among frontline healthcare professionals, depression, anxiety, and insomnia symptoms and the frequency of the diagnosis of these clinical conditions increased due to the COVID-19 pandemic. However, after the start of the immunization process, the frequency of these mental disorders and the anxiety levels of the healthcare professionals significantly decreased.

GÝRÝÞ ve AMAÇ: Yoðun bakým hastalarý gibi kritik durumdaki hastalar, basýnç ülserlerine karþý oldukça savunmasýzdýr. COVID-19 pandemisinin getirmiþ olduðu artmýþ iþ gücü nedeniyle yoðun bakým ünitelerinde takip edilen hasta sayýsýnda ve takip kalitesinde deðiþiklikler olmuþtur. Çalýþmamýzýn birincil amacý, pandeminin ilk yýlýnda artan saðlýk ihtiyaçlarýnýn, COVID dýþý yoðun bakým ünitelerinde (YBÜ) yatan hastalara yönelik basýnç ülseri takip ve tedavi stratejileri üzerindeki etkilerini incelemek, ikincil amacý ise beslenme desteðinin basýnç ülserleri üzerine olan etkisini ve bu süreçteki seyrini incelemektir.
YÖNTEM ve GEREÇLER: Ocak–Mart 2021 (Grup 1) ve Ocak–Mart 2020 (Grup 2) tarihlerinde en az iki hafta COVID dýþý YBÜ’de izlenen ve basýnç ülseri ile takip edilen 120 hastanýn verileri geriye dönük olarak incelendi. Hastalarýn demografik verileri ve komorbiditelerinin yaný sýra bakým evinden kabul edilmiþ olmasý, kabuldeki basýnç ülserlerinin evreleri, evrelerdeki deðiþiklikler, ve beslenme parametreleri kaydedildi. Profesyonel yara bakým ekibi tarafýndan yara evreleri ve deðiþimleri kayýt edildi.
BULGULAR: Grup 1’de 24 hastada basý yarasý evresinde artýþ saptanýrken, Grup 2’de yara evresinde artýþ izlenmedi (32.0’a 0, p=0.000). Hastanede yatýþ sýrasýnda ölçülen transferrin deðeri Grup 1’de daha düþük bulundu (1.23’e karþý 1.43, p=0.008). Grup 1’de yatýþa göre 15. günde prealbümin deðeri azaldý (0.9’a 0.2; p=0.008), CRP deðeri arttý. Grup 2’de albumin deðeri yatýþ gününe göre 15. günde (2.5’e 2.3; p=0.047) daha düþük bulundu.
TARTIÞMA ve SONUÇ: Pandeminin ilk yýlýnda, COVID dýþý nedenlerle yoðun bakým ünitesinde yatan hastalarda mevcut basýnç ülseri evresinde artýþ ve beslenme durumunda azalma oldu. Bunun, COVID pandemisi nedeniyle artan hasta bakým ihtiyaçlarý ve saðlýk personelinin tükenmiþliðinden kaynaklanabileceðini düþünüyoruz.

INTRODUCTION: Critically ill patients, such as intensive care patients, are highly vulnerable to pressure ulcers (PUs). Due to the increased workforce brought by the COVID-19 pandemic, there have been changes in the number of patients and the quality of follow-up. The primary aim of our study is to examine the effects of the first year of the pandemic on pressure ulcer follow-up and treatment strategies for patients hospitalized in non-COVID intensive care units (ICU). The secondary aim is to examine the effect of nutritional support.
METHODS: The data of 120 patients who were followed up in the non-COVID ICU for at least 2 weeks between January–March 2021(Group 1) and January–March 2020 (Group 2) and followed up with PUs were retrospectively analyzed. In addition to the demographic data and comorbidities of the patients, admission from the nursing home, stages of PUs at admission, changes in stages, and nutritional parameters were recorded.
RESULTS: While an increase in the PU stage was detected in 24 patients in Group 1, no increase in the stage of the wound was observed in Group 2 (32.0 vs 0, p=0.000). The transferrin value measured during hospitalization was found to be lower in Group 1 (1.23 vs 1.43, p=0.008). In Group 1, the prealbumin value decreased (0.9 vs 0.2, p=0.008) on day 15 compared with the hospitalization and C-reactive protein value increased. In Group 2, the albumin value was found to be lower (2.5 vs 2.3, p=0.047) on day 15 compared with the day of hospitalization.
DISCUSSION AND CONCLUSION: In the first year of the pandemic, there was an increase in the existing pressure ulcer stage and a decrease in the nutritional status in patients hospitalized in the ICU for non-COVID reasons. We believe that this might be due to the increased patient care needs and the burnout of healthcare staff due to the COVID pandemic.

GÝRÝÞ ve AMAÇ: Burada, fraksinin, etanol kaynaklý mide ülseri üzerindeki antioksidan özellikleri ile gastroprotektif bir aktivite gösterip göstermediðinin deðerlendirilmesi planlanmýþtýr.
YÖNTEM ve GEREÇLER: Wistar Albino erkek sýçanlar, her grupta altý hayvan bulunan dört gruba ayrýldý. Gruplar kontrol (grup I), etanol (grup II), etanol+omeprazol (grup III) ve etanol+fraksin (grup IV) gruplarý olarak düzenlenmiþtir. Tüm denekler, %70, 10 mg/kg etanol uygulamasýndan üç saat sonra sakrifiye edildi. Grup III ve IV’te, sýçanlara etanol indüksiyonundan 30 dakika önce oral gavaj ile sýrasýyla 30 mg/kg omeprazol ve 50 mg/kg fraksin verildi. Deneyin sonunda, mide dokularý çýkarýldý, yýkandý ve ülser bölgeleri makroskopik olarak deðerlendirildi. Daha sonra biyokimyasal analiz için uygun koþullar altýnda saklandý.
BULGULAR: Grup II grup I ile kýyaslandýðýnda süperoksit dismutaz (SOD) ve glutatyon (GSH) deðerleri azaldý, malondialdehit (MDA) seviyesi arttý (p<0.05). Ancak bu deðerler grup III ve grup IV anlamlý olarak deðiþti (p<0.05). Grup III’teki gastrik ülser alanlarý grup II’ye kýyasla anlamlý derecede daha azdý (p<0.05). Grup IV’teki gastrik ülser alanlarý grup II’ye kýyasla anlamý derecede azdý (p<0.05).
TARTIÞMA ve SONUÇ: Biyokimyasal ve makroskopik bulgularýn ýþýðýnda, fraksin etanol ile indüklenen mide ülserine karþý antioksidan etkinliði ile gastroprotektif etki gösterdi.

INTRODUCTION: Here, we planned to evaluate whether fraxin performed a gastroprotective activity or not with its antioxidant properties on the ethanol induced gastric ulcer.
METHODS: Wistar Albino male rats were assigned to 4 groups with 6 animals in each group. The groups were arranged as control (group I), ethanol (group II), ethanol+omeprazole (group III), and ethanol+fraxin (group IV) groups. All subjects were sacrificed 3 hours after administration of 70%, 10 mg/kg of ethanol. In groups III and IV, rats were given omeprazole 30 mg/kg and fraxin 50 mg/kg, respectively, by oral gavage 30 minutes before the ethanol induction. At the end of the experiment, the gastric tissues were removed, washed and the ulcer areas were macroscopically evaluated. Later, the samples were stored under appropriate conditions for biochemical analysis.
RESULTS: Superoxide dismutase (SOD) and glutathione (GSH) levels decreased, and malondialdehyde (MDA) value increased in group II compared to group I (p<0.05). However, these results changed significantly in groups III and IV (p<0.05). In group III, a significant reduction was noticed in gastric ulcer areas compared to group II (p<0.05). In group IV, the size of the gastric ulcer areas decreased considerably compared to group II (p<0.05).
DISCUSSION AND CONCLUSION: In the light of biochemical and macroscopic findings, fraxin showed a gastroprotective effect with its antioxidant activity against ethanol induced gastric ulcers.

GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý nefropatili diyabetik hastalarda uygun endikasyonla yapýlan böbrek biyopsisinin taný ve tedaviye katkýsýný tek merkez deneyimi ile deðerlendirmektir.
YÖNTEM ve GEREÇLER: Çalýþmamýza 2012–2019 yýllarý arasýnda hastanemizde böbrek biyopsisi yapýlan 32 tip 2 diyabet hastasý dahil edildi. Böbrek biyopsisi endikasyonlarý diyabetik retinopatisi olmayan diyabetli ve proteinürisi 1 g/gün’ün üzerinde olan hastalar olarak belirlendi.
BULGULAR: Diyabetik ve diyabetik olmayan nefropati tanýsý böbrek biyopsisi ile konuldu. Histopatolojik deðerlendirmede 32 hastanýn 14’ünde NDN rapor edildi. Bu hastalarýn dördünde membranöz nefropati, diðer dört hastada fokal segmental glomerüloskleroz (FSGS), iki hastada hafif zincir hastalýðý, iki hastada IgA nefropatisi, diðer hastada minimal deðiþiklik nefropatisi ve son olarak bir hastada AA amiloid saptandý. DN üzerine bindirilmiþ görülen NDRD (DN + interstisyel nefrit ve DN + FSGS) iki hastada gözlendi. On altý diyabetik hastada böbrek biyopsisi ile diyabetik nefropati tespit edildi.
TARTIÞMA ve SONUÇ: Diyabetik hastalarda diyabetik olmayan böbrek hastalýðýný diyabetik böbrek nefropatisinden ayýrt etmenin, uygun tedavi yöntemlerini seçmenin ve böbrek prognozunu belirlemenin önemli olabileceðine inanýyoruz.

INTRODUCTION: The aim of this study is to evaluate the contribution of kidney biopsy performed with an appropriate indication to diagnosis and treatment in diabetic patients with nephropathy with a single-center experience.
METHODS: In our study, 32 patients with type 2 diabetes who underwent kidney biopsy in our hospital between 2012 and 2019 were included. Kidney biopsy indications were determined as patients with diabetes without diabetic retinopathy and with proteinuria above 1 g/day.
RESULTS: Diabetic nephropathy (DN) and nondiabetic nephropathy (NDN)were diagnosed with renal biopsy. In 14 of 32 patients, NDN was reported in histopathological evaluation. Membranous nephropathy was detected in 4 of these patients, focal segmental glomerulosclerosis (FSGS) in other 4 patients, light chain disease in 2 patients, IgA nephropathy in 2 patients, minimal change nephropathy in 1 patient, and finally AA amyloid in 1 patient. Nondiabetic renal disease superimposed on DN (DN + interstitial nephritis and DN + FSGS) was observed in two patients. In 16 diabetic patients, DN was detected by renal biopsy.
DISCUSSION AND CONCLUSION: We believe that for diabetic patients, it may be important to distinguish nondiabetic kidney disease from diabetic kidney nephropathy, to choose proper treatment methods and determine kidney prognosis.

GÝRÝÞ ve AMAÇ: Böbrek nakli sonrasý geliþen hiperkalseminin nedenlerini incelemek ve greft fonksiyonlarý üzerine etkilerini araþtýrmak.
YÖNTEM ve GEREÇLER: Toplam 104 hastanýn sonucu geriye dönük olarak incelendi. Hastalar nakil sonrasý 12. ayda kalsiyum düzeylerine göre hiperkalsemi grubu (Ca2+ >10.2 mg/dl) ve normokalsemi (Ca2+ ≤10.2 mg/dl) grubu olarak belirlendi. Glomerüler filtrasyon hýzlarý, her takip dönemi için Chronic Kidney Disease Epidemiology Collaboration formülü ile hesaplandý.
BULGULAR: Çalýþmamýza 30’u (%29) kadýn, 74’ü (%71) erkek olmak üzere toplam 104 hasta dahil edildi. Hastalar 12 aylýk takip sonuçlarýna göre hiperkalsemik (n=30, %29) ve normokalsemik (n=74, %71) olarak iki gruba ayrýldý. Transplantasyon sýrasýnda alkalin fosfataz düzeylerinde (p=0.720) anlamlý bir farklýlýk yokken, 12. ay ölçümlerinde alkalen fosfataz düzeylerinde anlamlý farklýlýk bulundu (p<0.001). Hem transplantasyon anýndaki parathormon düzeyleri (p=0.006) hem de 12. ay takip sonuçlarý (<0.001) hiperkalsemi grubunda anlamlý olarak yüksekti. Hastalarýn greft iþlevlerini deðerlendirdiðimizde 1., 3. ve 12. aylarda e-GFR düzeyleri arasýnda anlamlý bir fark bulunmadý.
TARTIÞMA ve SONUÇ: Böbrek nakli hastalarýnda nakil sonrasý hiperkalsemi ile greft fonksiyonundaki deðiþiklikler arasýnda bir iliþki yoktur.

INTRODUCTION: To examine the causes of hypercalcemia developing after kidney transplantation and investigate its effects on graft functions.
METHODS: The results of 104 patients were explored retrospectively. Patients assigned according to calcium levels at 12th month after transplantation as hypercalcemia group (Ca2+ >10.2) and normocalcemia (Ca2+ ≤10.2) group. Glomerular filtration rates were calculated using the Chronic Kidney Disease Epidemiology Collaboration equation for each follow-up period.
RESULTS: A total of 104 patients, 30 (29%) females and 74 (71%) males, were included in our study. Patients were divided into two groups as hypercalcemic (Ca2+ >10.2) (n=30, 29%) and normocalcemic (Ca2+ ≤10.2) (n=74, 71%) according to their 12-month follow-up results. While there was no significant difference in alkaline phosphatase levels (ALP) (p=0.720) at the time of transplantation, a significant difference was found in ALP in the 12th-month measurements (p<0.001). Both parathormone levels at the transplantation time (p=0.006) and 12th-month follow-up results (p<0.001) were significantly higher in the hypercalcemia group. When we evaluated the graft functions of the patients, no significant difference was found between e-GFR levels in the 1st, 3rd, and 12th months.
DISCUSSION AND CONCLUSION: There is no association between posttransplant hypercalcemia and changes in graft function in kidney transplantation patients.

GÝRÝÞ ve AMAÇ: Pilonidal sinüs hastalýðý, genellikle sakrokoksigeal bölgede kronik enflamatuvar ve granülomatöz epitel traktý oluþumu ile karakterizedir. Nadiren vücudun diðer bölgelerinde görülür. Bu çalýþmada intermammarian pilonidal sinüs (IMPS) olan hastalarýmýzý ve bu hastalara uyguladýðýmýz flep operasyonu tekniðini sunmayý amaçladýk.
YÖNTEM ve GEREÇLER: Genel cerrahi kliniðine 2010–2019 yýllarý arasýnda IMPS tedavisi için baþvuran toplam dokuz hasta geriye dönük olarak deðerlendirildi. Hastalarýn demgrafik özellikleri, þikayetlerin baþlama zamaný, sinüs yolunun uzunluðu, tedavisi ve varsa nüks olup olmadýðý hastane kayýtlarý incelenip telefonla aranarak toplandý. Apse ile baþvuran hastalara drenaj yapýldý ve hastalara antibiyotik tedavisi verildi. Cerrahiye alýnan hastalara standart sinüs eksizyonu ve ardýndan bilateral subkutan flep ile kapatma uygulandý.
BULGULAR: Çalýþmada toplam dokuz kadýn hasta vardý. Tüm hastalar 15–28 yaþlarý arasýnda, yaþ ortalamasý 19.2±3.4 yýl olan kadýndý. Tüm hastalarýn baþvuru þikayeti intermammarian alanda aralýklý akýntý, sinüs aðzý oluþumu ve bazen aðrý idi. Sinüsün ortalama uzunluðu 4.1±0.7 cm idi. Hastalarda ameliyat sonrasý dönemde herhangi bir komplikasyon ve þikayet görülmedi.
TARTIÞMA ve SONUÇ: Ýntermammarian pilonidal sinüs, genç kadýnlarýn hastalýðýdýr ve ameliyatla tedavi edilebilir. Flep yöntemi ile hastalar baþarýlý ve güvenli bir þekilde tedavi edilmektedir.

INTRODUCTION: Pilonidal sinus disease is characterized by chronic inflammatory and granulomatous epithelial tract, usually in the sacrococcygeal area. It is rarely seen in other regions of the body. In this study, we aimed to report our patients with intermammary pilonidal sinus (IMPS) and to present the flap operation technique applied to these patients
METHODS: A total of nine patients who applied to the general surgery clinic between the years 2010 and 2019 for the treatment of IMPS were evaluated retrospectively. Demographic characteristics of patients, time of onset of the complaints, the length of the sinus tract, the treatment, and the presence of any recurrences were collected by reviewing the hospital records and calling the patients by phone. In the patients presenting with abscesses, drainage was performed and antibiotic treatment was given to the patients. A standard sinus excision was followed by the closure with a bilateral subcutaneous flap.
RESULTS: A total of nine female patients were included in the study. All patients were females between ages 15 and 28 years with a mean age of 19.2±3.4 years. The presenting complaints of all patients were intermittent drainage in the intermammary area, the formation of openings, and sometimes pain. The mean length of the sinus was 4.1±0.7 cm. No complications and complaints were seen in the patients in the postoperative period.
DISCUSSION AND CONCLUSION: IMPS is a disease of young women and is curable with surgery. The patients are successfully and safely treated with the flap method.

GÝRÝÞ ve AMAÇ: Günümüzde hastane kaynaklý dirençli bakterilerin neden olduðu enfeksiyonlarýn tedavisi çok zor hale gelmiþtir. Uygun sterilizasyondezenfeksiyon yöntemlerinin kullanýlmasýyla hastane enfeksiyonlarýnýn sýnýrlandýrýlabileceði ve minimumda tutulabileceði bilinmektedir. Çalýþmamýzda düþük maliyetli ve toksik olmayan, kimyasal kalýntý ve atýk býrakmayan ozon gazýnýn nozokomiyal enfeksiyonlara neden olan dirençli mikroorganizmalar üzerindeki inhibisyon etkisini araþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Çalýþmamýza 80 adet çeþitli direnç paternine sahip, hastane enfeksiyonu etkeni olan bakteri kökeni dahil edildi. Her bir bakteriden onar adet olmak üzere; MRSA, VRE, MDR P. aeruginosa, ESBL (+) K. pneumoniae, karbapenemaz(+) K. pneumoniae, kolistin dirençli K. pneumoniae, kolistin dirençli A. baumannii complex ve kolistin hassas A. baumannii complex kullanýldý. Bir litre steril distile su (DS) bir saat boyunca ozon ile doyuruldu. 9.9 mL ozonlanmýþ DS üstüne 0.1 mL bakteri süspansiyonu eklendi (son bakteri konsantrasyonu 106 KOB/ml). Oda sýcaklýðýnda bekletilen süspansiyonlardan 10. ve 30. dakikalarda 10 μL’lik kalibre öze ile koyun kanlý agara sayým plaðý þeklinde ekim yapýldý. Yirmi dört saatlik inkübasyon sonrasýnda petriler deðerlendirilerek üreyen koloni sayýsý hesaplandý.
BULGULAR: Ozonlanmýþ su ile 10. ve 30. dakikada elde edilen bakteri inhibisyon oranlarý sýrasýyla Gram pozitif nozokomiyal dirençli patojenler için %97.29 ve %100; Gram negatif nozokomiyal dirençli patojenler için ise %94.76 ve %99.99 olarak saptandý.
TARTIÞMA ve SONUÇ: Çalýþmamýzda kullandýðýmýz ozonlanmýþ suyun in vitro olarak çok düþük bir maliyetle çok yüksek antibakteriyel etki saðlayabildiði tespit edilmiþtir. Diðer çalýþmalarda, SARS-CoV-2 dahil ozonun antiviral aktivitesi de gösterilmiþtir. Elde ettiðimiz veriler, ozonun hastanelerde çeþitli dezenfeksiyon-sterilizasyon iþlemlerinde kullanýlabileceðini göstermektedir. Bu tür çalýþmalarýn klinik araþtýrmalarla desteklenerek uygun maliyetli/etkin bir çözüm üretilebileceðine inanýyoruz.

INTRODUCTION: Nowadays, the treatment of infections caused by hospital-acquired resistant bacteria has become very difficult. It is known that hospital infections can be limited and kept to a minimum with the use of appropriate sterilization–disinfection methods. In our study, we aimed to investigate the inhibition effect of ozone—which is low cost, has a nontoxic effect on humans, and does not leave chemical residues and wastes—on resistant microorganisms that cause nosocomial infections.
METHODS: In this study, 80 strains of bacteria with various resistance patterns and isolated as a causative agent of nosocomial infection were included. Ten strains of each bacterium—MRSA, VRE, MDR Pseudomonas aeruginosa, ESBL (+) Klebsiella pneumoniae, carbapenemase (+) K. pneumoniae, colistin-resistant K. pneumoniae, colistin-resistant Acinetobacter baumannii complex, and colistin sensitive A. baumannii complex—were used. One liter of sterile distilled water (DW) was saturated with ozone for 1 h. A quantity of 0.1 mL of bacterial suspension was added onto 9.9 mL ozonated DW (final bacterial concentration 106 cfu/mL). From the suspensions kept at room temperature, samples were inoculated as a count plate on sheep blood agar with a 10 μL calibrated loop at 10 and 30 min. After 24 h of incubation, the number of growing colonies was calculated by evaluating the Petri dishes.
RESULTS: The bacterial inhibition rates of ozonated water at 10 and 30 min exposure times were detected as 97.29–100% for Gram-positive nosocomial-resistant pathogens and 94.76–99.99% for Gram-negative nosocomial-resistant pathogens, respectively.
DISCUSSION AND CONCLUSION: It has been determined that ozonated water can provide a very high antibacterial effect in vitro at a very low cost. In other studies, the antiviral activity of ozone, including SARS-CoV-2, has also been shown. The data we obtained suggest that ozone can be used in various disinfection–sterilization processes in hospitals. We believe that a cost-effective solution can be produced by supporting such studies with clinical research.

GÝRÝÞ ve AMAÇ: Bronkoskopi, boðulma hissi ve öksürük oluþturan invaziv bir iþlem olduðundan kiþilerde korku, rahatsýzlýk hissi ve kaygýya yol açabilmektedir. Bu araþtýrmanýn amacý, bronkoskopi uygulanan hastalarda iþlem öncesi korkuyu ve nedenlerini belirlemektir.
YÖNTEM ve GEREÇLER: Tanýmlayýcý tipteki bu araþtýrma Nisan 2019–Eylül 2019 tarihleri arasýnda bir üniversite hastanesinde çeþitli endikasyonlarla elektif bronkoskopi uygulanan 138 hastanýn katýlýmýyla gerçekleþtirildi. Veri toplamada “Hasta Tanýtým Formu” ve “Bronkoskopi Korku Anketi” kullanýldý. Veriler SPSS 22.0 programýnda Ki-kare testi kullanýlarak analiz edildi. P<0.05 istatistiksel olarak anlamlý kabul edildi.
BULGULAR: Hastalarýn yaþ ortalamasýnýn 62.4±11.5 (24–88) yýl, %79.7’sinin (n=110) erkek, %78.3’ünün (n=108) ilköðretim mezunu olduðu belirlendi. Hastalarýn %57.2’sinin (n=79) genel olarak bronkoskopi sürecinden korktuðu belirlendi. Hastalarýn %93.5’inin (n=129) iþlemi gerektiðinde ayný þartlarda tekrar yaptýrmayý kabul ettiði saptandý. Hastalarýn bronkoskopi sürecinden korkma durumlarýnýn yaþ ve cinsiyete göre istatistiksel açýdan anlamlý derecede farklýlýk gösterdiði belirlendi (p<0.05).
TARTIÞMA ve SONUÇ: Araþtýrmada bronkoskopi uygulanan hastalarýn genel olarak sürece iliþkin korku yaþadýklarý belirlendi. Endoskopi ünitelerinde çalýþan hekim ve hemþirelerin, bronkoskopi uygulanan hastalarýn korku düzeylerini ve korku nedenlerini belirlemeleri ve hastalara uygun bakým sunarak ve bilgilendirme yaparak korkularýnýn azaltýlmasýna yardýmcý olmalarý önerilir.

INTRODUCTION: Bronchoscopy is an invasive procedure that can cause a feeling of suffocation and cough. It may cause fear, discomfort, and anxiety in individuals. The aim of this research is to determine the fear and its causes before the procedure in patients undergoing bronchoscopy.
METHODS: This descriptive research was conducted between April 2019 and September 2019 with the participation of 138 patients who underwent elective bronchoscopy with various indications in the endoscopy unit of a university hospital. “Patient Information Form” and “Bronchoscopy Fear Questionnaire” were used for data collection. The data were analyzed using Chi-squared test in IBM SPSS 22.0 program. The level of significance in statistical analysis was accepted as p<0.05.
RESULTS: It was found that the average age of the patients was 62.4±11.5 (24–88) years. Of these patients, 79.7% (n=110) of them were males and 78.3% (n=108) were primary school graduates. It was found that 57.2% of the patients (n=79) felt fear of the bronchoscopy process in general. However, 93.5% of the patients agreed to undergo the procedure under the same conditions when necessary. It was determined that the patients’ fear of the bronchoscopy procedure differed statistically significantly according to age and gender (p<0.05).
DISCUSSION AND CONCLUSION: These research results reveal that patients who undergo bronchoscopy experience fear of the process in general and that male patients or patients over the age of 61 are more prone to procedural fear. To optimize patient comfort and satisfaction, it is recommended that physicians and nurses working in endoscopy units question the presence of procedural fear before the procedure and help patients reduce their fears.

GÝRÝÞ ve AMAÇ: Bu çalýþmanýn ilk amacý, endometrial karsinomlu (EK) hastalarda adenomyozis (AM) varlýðýnýn patolojik prognostik özellikler ve saðkalým süresi üzerine etkisinin olup olmadýðýný araþtýrmaktýr. Ýkinci amaç, düþük dereceli endometrioid karsinom, yüksek dereceli endometrioid karsinom ve yüksek dereceli endometrioid olmayan karsinom olarak her bir alt tip gruplandýrmasý için AM iliþkisini deðerlendirmekti.


YÖNTEM ve GEREÇLER: Mevcut retrospektif gözlemsel kohort çalýþmasý, Saðlýk Bilimleri Üniversitesi, Ýstanbul Kartal Dr. Lütfi Kýrdar Þehir Hastanesi'nde evreleme ameliyatý geçiren EK’lý hastalardan kurumun veri tabaný kullanýlarak yapýlmýþtýr. Kohort, AM varlýðýna veya yokluðuna göre iki gruba ayrýldý. Ek olarak, EK alt tipleri düþük dereceli endometrioid, yüksek dereceli endometrioid ve yüksek dereceli endometrioid olmayan tümörler olarak gruplandýrýldý ve ayrýca AM'nin varlýðýna veya yokluðuna göre ayrýldý. Saðkalým sonuçlarý ve patolojik prognostik özellikler her grup arasýnda karþýlaþtýrýldý.


BULGULAR: Toplam 518 endometriyal kanser hastasý analiz edildi. AM olan ve olmayan hastalar arasýnda genel saðkalým (OS) benzerdi (Cox regresyon Wald=0.654, p=0.419). Çok deðiþkenli Cox regresyon analizinde AM varlýðý saðkalým süresi ile iliþkili deðildi (p=0,378). Ancak histolojik tip ve grade, lenfovasküler invazyon ve metastaz saðkalým süresini öngören önemli faktörlerdi. (Endometrioid düþük dereceli ve endometrioid yüksek dereceli, p1= 0,075, Endometrioid düþük dereceli ve endometrioid olmayan yüksek dereceli, p2= 0,020; p= 0,001 ve p=0,001). AM olan ve olmayan farklý grade ve histolojik tiplere sahip EK hastalarýnýn sað kalým süresi ortalamalarý her alt grup için benzerdi. (her grup için p>0,005).


TARTIÞMA ve SONUÇ: Bulgularýmýz, Ek ile AM varlýðýnýn OS için baðýmsýz bir prognostik faktör olmadýðýný gösterdi.

INTRODUCTION: The first aim of the present study was to investigate whether the presence of adenomyosis (AM) had an effect on pathologic prognostic characteristics and survival time in patients with endometrial carcinoma (EC). The second aim was to evaluate the association of AM for each subtype grouping as low-grade endometrioid carcinoma, high-grade endometrioid carcinoma, and high-grade non-endometrioid carcinoma.
METHODS: The present retrospective observational cohort study was conducted using the institution’s database of patients with EC who underwent staging surgery. The cohort was divided into two groups according to the presence or absence of AM. Additionally, EC subtypes were grouped into low-grade endometrioid, high-grade endometrioid, and high-grade non-endometrioid tumors according to the presence or absence of AM as well. The survival outcomes and pathologic prognostic characteristics were compared between the groups.
RESULTS: A total of 518 endometrial cancer patients were analyzed. Overall survival (OS) was similar between patients with and without AM (Cox regression Wald=0.654, p=0.419). In multivariate Cox regression analysis, the presence of AM was not associated with survival time (p=0.378). However, histologic type with grade, lymph vascular space invasion, and metastasis were significant factors predicting the survival time (endometrioid low grade vs endometrioid high grade, p1=0.075 and endometrioid low grade vs non-endometrioid high grade, p2=0.020; p=0.001 and p=0.001, respectively). Survival means for survival time in patients with and without AM in different histologic types with grade was similar for each subgroup (p>0.005 for each group).
DISCUSSION AND CONCLUSION: Our findings indicated that the presence of AM with EC is not an independent prognostic factor for OS.

GÝRÝÞ ve AMAÇ: Laparoskopik histerektomi ameliyat sonrasý aðrý açýsýndan hasta konforunu arttýrýr. Ancak birçok hasta laparoskopik operasyonlardan sonra ameliyat sonrasý aðrý ile mücadele etmektedir. Bu çalýþmada, laparoskopik histerektomi operasyonlarýnda oblik subkostal transversus abdominis plan (OSTAP) bloðunun ameliyat sonrasý analjezik etkinliðinin deðerlendirilmesi amaçlandý.
YÖNTEM ve GEREÇLER: ASA fiziksel durumu I ila II olan, yaþlarý 18 ila 65 arasýnda olan 58 kadýn hasta bu randomize kontrollü çalýþmaya dahil edildi. OSTAP grubunda %0.25 bupivakain ile blok uygulandý. Tüm hastalara ameliyat sonrasý analjezi için 1 gr parasetamol ve 100 mg tramadol intravenöz (IV) uygulandý. Kontrol grubuna ek bir iþlem uygulanmadý. Hastalarýn ameliyat sonrasý analjezik tüketim miktarý, ilk analjezik ihtiyacýna kadar geçen süre ve vizüel analog skala (VAS) skorlarý deðerlendirildi.
BULGULAR: Hastalarýn 24 saatlik ortalama tramadol tüketimi grup OSTAP’da 58.62±48.22 mg iken, grup grup K’da 165.52±93.640 mg idi (p<0.001). Ýlk analjezik gereksinim zamaný grup OSTAP’da 396.43±202.508 dk iken grup K’da 119.79±71.361 dk idi (p<0.001). Bakýlan 0, 1, 2, 6, 12 ve 24. saatteki VAS deðerleri ve tramadol ihtiyacý olan hasta sayýlarý OSTAP grubunda anlamlý olarak daha düþük bulundu (p<0.05).
TARTIÞMA ve SONUÇ: Çalýþmamýzda 24 saatlik toplam tramadol tüketimi ve VAS skorlarýnda azalma görülmesi, ilk analjezik gereksinim zamanýnýn ise uzamýþ olmasý nedeniyle, OSTAP blok uygulamasýnýn laparoskopik histerektomide etkili bir analjezi yöntemi olduðu sonucuna varýlmýþtýr.

INTRODUCTION: Laparoscopic hysterectomy increases patient comfort in terms of postoperative pain. However, many patients struggle with postoperative pain after laparoscopic operations. This study aims to evaluate the postoperative analgesic efficacy of oblique subcostal transversus abdominis plane (OSTAP) block in laparoscopic hysterectomy operations.
METHODS: 58 female patients aged between 18 and 65, with the American Society of Anesthesiologists (ASA) physical status I-II, were recruited in this randomized controlled study. In the OSTAP group, a block was applied with 0.25% bupivacaine. For postoperative analgesia, 1gr paracetamol and 100mg tramadol were administered intravenously (IV) to all patients. No additional procedure was applied to the control group (Group C). The amount of postoperative analgesic consumption, time to first analgesic requirement and visual analog scale (VAS) scores of the patients were evaluated.
RESULTS: The mean 24-hour tramadol consumption of the patients was 58.62±48.22 mg in the OSTAP group, while it was 165.52±93.640 mg in Group C (p<0.001). While the time to the first analgesic requirement was 396.43±202.508 minutes in the OSTAP group, it was 119.79±71.361 minutes in Group C (p<0.001). VAS values at 0, 1, 2, 6, 12 and 24th hours and the number of patients in need of tramadol were found to be significantly lower in the OSTAP group (p<0.05).
DISCUSSION AND CONCLUSION: In our study, it was concluded that OSTAP block application is an effective analgesic method in laparoscopic hysterectomy because of the reduction in 24-hour total tramadol consumption and VAS scores, and the prolongation of the time until the first analgesic requirement was prolonged.

GÝRÝÞ ve AMAÇ: Akut immün trombositopenik purpura (ÝTP) sýk görülen edinsel bir kanama bozukluðudur. ÝTP’li çocuk hastalarda intravenöz immünglobulin (ÝVÝG) baþlangýç tedavisi olarak sýklýkla kullanýlýr. ÝVÝG’ye yanýtý öngörebilecek faktörler kesin olarak belirlenememiþtir. Burada ÝTP’li çocuk hastalarýn tanýdaki klinik ve laboratuvar bulgularýnýn ÝVÝG tedavisine olan yanýtlarý ile kronik ÝTP geliþmesi arasýndaki iliþki incelenmiþtir.
YÖNTEM ve GEREÇLER: Haziran 2016–Aralýk 2019 tarihleri arasýnda baþlangýç tedavisi olarak ÝVÝG uygulanan 45 akut ÝTP tanýlý hasta deðerlendirilmiþtir. Kýsa dönem ÝVÝG cevabý; ÝVÝG verildikten iki hafta sonra bakýlan trombosit sayýsý, uzun dönem yanýt ise trombositopenisiz geçen süre (TFS) olarak belirlenmiþtir. TFS, baþlangýç tedavisi olarak uygulanan ÝVÝG sonrasý relaps, ek tedavi gereksinimi veya kronik ÝTP’ye progresyon izlenmeden elde edilen saðkalým olarak tanýmlanmýþtýr.
BULGULAR: Tek deðiþkenli analizlerde; hasta yaþýnýn ≥25 ay, (p=0.002) trombosit sayýsýnýn ≤6.9x109/L olmasý (p=0.034) ile hemoglobin (Hb) deðerinin >12.4 g/dL olmasýnýn (p=0.001) kýsa dönem cevap için olumsuz faktörler olduðu belirlendi. Uzun dönem yanýtta ise yapýlan tek deðiþkenli analizlerde hasta yaþýnýn ≥25 ay, (p=0.002) trombosit sayýsýnýn ≤6.9x109/L olmasý (p=0.034) ile hemoglobin (Hb) deðerinin >12.4 g/dL olmasýnýn (p=0.001) ÝVÝG’ye yanýtta olumsuz faktörler olduðu belirlendi.
TARTIÞMA ve SONUÇ: Çalýþmadan elde edilen veriler doðrultusunda yeni taný almýþ ÝTP’li hastalarda yaþý ≥25 ay olanlar ile trombosit sayýsý <6.9x109/L olan hastalarýn ÝVÝG’ye yanýtlarý göz önünde bulundurulduðunda, bu hastalarýn baþlangýç tedavilerinde kortikosteroidler gibi ÝVÝG dýþýndaki tedavi seçeneklerinin tek baþýna ya da ÝVÝG ile kombine edilerek kullanýlmasý önerilmektedir.

INTRODUCTION: Acute immune thrombocytopenic purpura (ITP) is a common acquired bleeding disorder. Intravenous immunoglobulin (IVIG) therapy is commonly given as initial treatment to pediatric patients with ITP. Factors that can predict the response to IVIG have not been fully determined. We retrospectively evaluated whether the clinical and laboratory findings of pediatric patients with ITP at the time of diagnosis could predict the response to IVIG and progression to chronic ITP.
METHODS: A total of 45 patients with newly diagnosed ITP who were initially treated with IVIG were evaluated between January 2016 and December 2019. Short-term response was estimated by platelet counts 2 weeks after IVIG, and long- term response was assessed by thrombocytopenia-free survival (TFS). TFS was defined as the probability of survival without treatment failure after initial IVIG, such as relapse, requiring additional therapeutic interventions, or progression to chronic ITP.
RESULTS: In univariate analysis, age ≥25 months (p=0.002), platelet count ≤6.9x109/L (p=0.034), and hemoglobin (Hb) level >12.4 g/dl (p=0.001) were considered to be unfavourable factors for short-term response. Univariate analysis of unfavourable factors for longterm response showed that age ≥25 months (p=0.002), platelet count ≤6.9x109/L (p=0.034), and Hb level >12.4 g/dl (p=0.001) were significant factors.
DISCUSSION AND CONCLUSION: These results suggest that in newly diagnosed ITP patients older than 25 months and/or with platelet count <6.9x109/L, other therapeutic options such as corticosteroids alone or in combination with IVIG may be considered as initial therapy.

GÝRÝÞ ve AMAÇ: Helicobacter pylori (HP) enfeksiyonunun, lenfoid agregatlarýnýn ve mide baðýrsak metaplazisinin tespitinde endoskopik mide biyopsi bölgesini ve yeterli biyopsi sayýsýný standartlaþtýrmanýn etkinliðini ortaya koymaktýr.
YÖNTEM ve GEREÇLER: Ocak 2018–Aralýk 2020 tarihleri arasýnda hastanemiz genel cerrahi kliniðinde dispeptik þikayetler nedeniyle gastroskopi yapýlan 146 hasta çalýþmaya dahil edildi. Çalýþmanýn verileri geriye dönük olarak toplandý. Çalýþmaya korpus ve antrum olmak üzere iki mide bölgesinden biyopsi alýnan hastalar dahil edildi.
BULGULAR: Antrumdan alýnan biyopsilerde HP enfeksiyonu saptanan 58 (%39.7) hasta vardý. Korpustan alýnan biyopsilerde HP saptanan 57 (%39) hasta vardý. Toplamda HP pozitif saptanan 74 (%50.7) hasta vardý. Antral biyopsi için duyarlýlýk ve özgüllük sýrasýyla %78 ve %100 bulundu. Korpus için sýrasýyla %77 ve %100 idi. Lenfoid agregalý hastalarýn biyopsi sonuçlarý bir bölgede ve her iki bölgede de karþýlaþtýrýldýðýnda, p deðeri <0.05. Tek ve her iki bölgedeki intestinal metaplazili hastalarýn biyopsi sonuçlarý karþýlaþtýrýldýðýnda p deðeri <0.05.
TARTIÞMA ve SONUÇ: HP enfeksiyonunu doðru tanýmlamak ve ayrýca lenfoid agregatlarýný, mide baðýrsak metaplazisini tespit etmek için endoskopik mide biyopsilerinin sayýsý ve yeri önemlidir. Çünkü yalnýzca antrum ya da yalnýzca korpustan alýnan biyopsi örnekleri yanlýþ negatiflik oranýný artýrmaktadýr. Baþarý oranýný arttýrmanýn yolu hem antrum hemde korpusun büyük ve küçük kurvaturundan alýnan biyopsilerden elde edilebileceði akýlda tutulmalýdýr.

INTRODUCTION: To demonstrate the effectiveness of standardizing the endoscopic gastric biopsy site and sufficient quantity of biopsies in the detection of Helicobacter pylori (HP) infection, lymphoid aggregates, and gastrointestinal metaplasia.
METHODS: Having undergone gastroscopy due to dyspeptic complaints, 146 patients were included in the study. The data of the study were collected retrospectively. The patients whose biopsies were taken from two stomach regions, namely the corpus and antrum, were included in the study.
RESULTS: There were 58 (39.7%) patients with HP infection detected in the biopsies taken from the antrum and 57 (39%) patients with HP infection detected in the biopsies taken from the corpus. In total, there were 74 (50.7%) patients with HP positive. Sensitivity and specificity for antral biopsy were 78% and 100%, respectively. As for the corpus, the values were 77% and 100%, respectively. When the biopsy results of patients with lymphoid aggregate and intestinal metaplasia in one and both regions were compared, the p-values were found to be <0.001 and <0.001,respectively.
DISCUSSION AND CONCLUSION: The quantity and location of endoscopic gastric biopsies are of importance to correctly identify HP infection and also to detect lymphoid aggregates and gastrointestinal metaplasia because biopsy specimens taken only from the antrum or only from the corpus increase the rate of false negativity.

GÝRÝÞ ve AMAÇ: Omurganýn dekompresif prosedürleri (laminektomi, fasetektomi) disk hernisi, enfeksiyon, tümör ve travma dahil olmak üzere birçok patoloji için gerçekleþtirilir. Fizyolojik yükleme altýndaki instabilite düzeyini bilmek, cerrahýn ek spinal füzyonun gerekli olup olmadýðýna karar vermesine yardýmcý olabilir. Bu nedenle bu çalýþmada unilateral ve tek segment laminektomi ve fasetektominin lomber omurga stabilitesine biyomekanik etkileri araþtýrýldý ve bu prosedürler lomber omurga instabilitesine neden olur mu sorusuna cevap vermeyi amaçladýk.
YÖNTEM ve GEREÇLER: Bu çalýþma için Merinos cinsi 3–4 yaþýnda diþi koyun lomber omurgalarýndan L1-L7 vertebralarý içerecek þekilde 72 adet elde edildi. Kontrol grubu, unilateral tek segment laminektomi grubu ve unilateral tek segment laminektomi+fasetektomi þeklinde gruplandýrýlan vertebralar kompresyon, fleksiyon, ekstansiyon ve eksenel rotasyon açýsýndan biyomekanik teste tabi tutuldu. Ýstatistiksel analizler IBM SPSS 21.0 (IBM Corp. Released 2012. Armonk) programý ile yapýldý. Ýstatistiksel anlamlýlýk düzeyi p<0.05 olarak kabul edildi.
BULGULAR: Rotasyon maksimum tork dýþýnda diðer ölçümlerde gruplar arasýnda istatistiksel olarak anlamlý düzeyde fark yoktur (p>0.05) Rotasyon maksimum tork deðerleri en az bir grupta diðer gruplarýn en az birinden farklýdýr (p=0.031). Yapýlan ikili karþýlaþtýrmalar sonucunda; yalnýzca kontrol ile fasetektomi grubu arasýnda Rotasyon maksimum tork deðerleri açýsýndan anlamlý düzeyde fark belirlenmiþtir (p=0.048).
TARTIÞMA ve SONUÇ: Tek taraflý ve tek segment laminektomiye fasetektomi eklenmesiyle eksenel rotasyon kuvvetlerine karþý lomber vertebrada bir instabilite oluþabilmektedir.

INTRODUCTION: Decompressive spinal procedures (laminectomy, facetectomy) are performed to treat many pathologies including disk hernia, infection, tumor, and trauma. Knowing the level of instability under physiological loading can help the surgeon decide whether additional spinal fusion is required. Therefore, in this study, the biomechanical effects of unilateral and single-segment laminectomy and facetectomy on lumbar spine stability were investigated and we aimed to answer the question of whether these procedures cause lumbar spine instability.
METHODS: For this study, 72 lumbar spines containing L1-L7 vertebrae were obtained from 3-4 years old female Merino sheep. The spines were classified as the control group, the unilateral single segment laminectomy group, and the unilateral single segment laminectomy + facetectomy group, and followed by biomechanical testing for compression, flexion, extension, and axial rotation. The statistical analyses were performed using IBM SPSS 21.0 (IBM Corp. Released 2012. Armonk) program. The statistical significance level was considered as p<0.05.
RESULTS: There was no statistically significant difference in the measurement values except for the maximum torque of rotation between the groups (p>0.05). The rotation maximum torque values were different in at least one group from at least one of the other groups (p=0.031). The paired comparisons showed a significant difference in rotation maximum torque values only between the control group and the facetectomy group (p=0.048).
DISCUSSION AND CONCLUSION: When the unilateral single segment laminectomy is combined with facetectomy, instability may occur in the lumbar vertebra against axial rotational forces.

GÝRÝÞ ve AMAÇ: Diyabetes mellitus tüm dünyada görülme sýklýðý artan yaygýn bir saðlýk sorunudur. Diyabetik ayak ülseri morbidite artýþýna, yaþam kalitesinde azalmaya, uzun hastane kalýþ sürelerine ve yüksek oranda alt ekstremite amputasyonuna yol açmaktadýr. Bizim bu çalýþmada amacýmýz diyabetik ayak tanýsý ile hastaneye baþvuran hastalarý deðerlendirmektir.
YÖNTEM ve GEREÇLER: Hastanemizde 2016–2017 yýllarý arasýnda kronik yara konseyinde 147 diyabetik ayak hastasý geriye dönük olarak deðerlendirildi. Olgularýn yara sýnýflamasýnda Wagner, enfeksiyon sýnýflamasýnda IDSA kullanýldý.
BULGULAR: Olgular Wagner sýnýflamasý ile deðerlendirildiðinde bir hasta evre 1, 19 evre 2, 58 hasta evre 3, 58 hasta evre 4, 11 hasta evre 5 idi. Evre 3 ve üzeri olan hastalar olgularýn %86.4’ünü oluþturmaktaydý. Altmýþ altý hastaya (%45) minör, 18’ine (%21) diz altý, ikisine (%1) diz üstü amputasyon uygulandý. Kýrkdört hasta debritman ve yara bakýmý ile iyileþme saðlandý.
TARTIÞMA ve SONUÇ: Diyabetik hastalarda alt ekstremite ülser ve enfeksiyonlarý hastaneye yatýþ ve travmatik olmayan amputasyonlarýn en sýk sebeplerinden biridir. Çalýþmamýzda amputasyon oraný %58.5 bulunmuþ ve benzer çalýþmlara göre daha yüksektir. Bunun sebebi olarak da hastalarýn geç evrede baþvurmasý, Wagner yara evrelerinin yüksek oluþu, osteomyelit varlýðý, vasküler problemlerin olmasý ve amputasyon kararý için bu hastalarýn merkezimize yönlendirildiðini düþünmekteyiz.

INTRODUCTION: Diabetes mellitus is a common health issue with an increasingly rampant incidence all over the world. Diabetic foot ulcers raise morbidity, reduce the quality of life, prolong hospital stay, and cause a high rate of lower extremity amputation. Our aim in this study is to evaluate the patients presented to the hospital with the diabetic foot diagnosis.
METHODS: 147 diabetic foot patients were evaluated retrospectively in the chronic wound council between 2016–2017 at our hospital. Wagner was used for wound classification, whereas Infectious Diseases Society of America (IDSA) was for infection classification.
RESULTS: Evaluating the cases according to the Wagner classification, 1 patient was observed to be on stage 1, 19 were on stage 2, 58 were on stage 3, 58 were on stage 4, 11 were on stage 5. Patients on stage 3 and above accounted for 86.4% of all cases. 66 patients (45%) underwent minor amputation, whereas 18 (21%) were below-knee amputation and 2 (1%) were above-knee amputation. 44 patients recovered with debridement and wound care.
DISCUSSION AND CONCLUSION: Lower extremity ulcers and infections in diabetic patients are one of the most common causes of hospitalization and non-traumatic amputation in diabetic patients. The amputation rate, which was determined as 58.5% in our study, is higher compared to similar studies. We consider that this is due to patients who presented late, who had higher grades of Wagner wound stages, who had osteomyelitis, who had vascular problems and were referred to our center for decision of amputation.

GÝRÝÞ ve AMAÇ: Baþarýlý böbrek naklinden sonra bile, ilerleyici kemik kaybý, kýrýklar, tubulointerstisyel kalsifikasyonlar, vasküler kalsifikasyon ve greft disfonksiyonu geliþimi için bir risk faktörü olarak kabul edilen hiperkalsemi ile kalýcý hiperparatiroidizm (HPT) yaygýndýr. Subtotal paratiroidektomi (PTX) standart tedavidir, ancak þu anda bunun yerini kalsimimetik sinakalset almýþtýr. Bu tek merkezli, geriye dönük çalýþmanýn amacý, böbrek transplantasyonu hastalarýnda PTX ve sinakalset’in kalsiyum, fosfor ve paratiroid hormon (PTH) düzeyleri ve greft fonksiyonu üzerindeki uzun vadeli etkilerini karþýlaþtýrmaktýr.
YÖNTEM ve GEREÇLER: Çalýþma popülasyonu, Ocak 2004 ile Aralýk 2020 arasýnda takip edilen, 13’ü PTX uygulanan ve 12’si sinakalset tedavisi alan 24 hastadan oluþuyordu. Cerrahi grup ve medikal tedavi grubu karþýlaþtýrýldý. Yaþ, cinsiyet, nakil zamaný ve böbrek vericisi açýsýndan benzer özelliklere sahip kontrol grubu oluþturulmuþ ve sonuçlar yine bu grupla karþýlaþtýrýlmýþtýr. Ortalama PTH, kalsiyum, fosfor, kreatinin düzeyleri ve eGFR deðerleri PTX ve sinakalset tedavisi öncesi/sonrasý kaydedildi.
BULGULAR: Hem paratiroidektomi hem de sinakalset gruplarýnýn uzun dönem ve kýsa dönem allogreft fonksiyonlarý üzerinde kontrol gruplarýna göre negatif etkisi yoktu. Allogreft fonksiyonlarý paratiroidektomi ve sinakalset gruplarý arasýnda benzerdi.
TARTIÞMA ve SONUÇ: Sonuç olarak, hiperparatiroidizm nedeniyle hiperkalsemisi olan renal allogreft alýcýlarýnda hem sinakalset tedavisinin hem de paratiroidektominin intakt PTH’yi azaltmada ve serum kalsiyumunu normalleþtirmede benzer þekilde etkili ve güvenli olduðu bulundu.

INTRODUCTION: Even after successful kidney transplantation, persistent hyperparathyroidism (HPT) with hypercalcemia is common, which is considered to be a risk factor for progressive bone loss, fractures, tubulointerstitial calcifications, vascular calcification, and development of graft dysfunction. The subtotal parathyroidectomy (PTX) is the standard treatment, but currently, it has been replaced by the calcimimetic cinacalcet. The aim of this single-center, retrospective study was to compare the long-term effects of PTX and cinacalcet on calcium, phosphorus, and parathyroid hormone (PTH) levels, as well as graft function in renal transplantation patients.
METHODS: The study population consisted of 24 patients followed between January 2004 and December 2020, 13 of whom underwent PTX and 12 of whom take cinacalcet therapy. The surgical group and the medical treatment group were compared. A control group with similar characteristics in terms of age, gender, transplant time, and kidney donor was formed, and the results were also compared with this group. The median PTH, calcium, phosphorus, creatinine levels, and eGFR values were recorded before/after PTX and cinacalcet therapy.
RESULTS: There was nonnegative effect of both PTX and cinacalcet groups on long-term and short-term allograft functions compared with control groups. Allograft functions were similar in comparison between PTX and cinacalcet groups.
DISCUSSION AND CONCLUSION: In conclusion, both cinacalcet treatment and PTX were found to be similarly effective and safe in reducing intact PTH and normalizing serum calcium in renal allograft recipients with hypercalcemia due to persistent HPT.

2020 yýlýnda, Dünya Saðlýk Örgütü (DSÖ) tarafýndan pandemi olarak kabul edilen yeni tip koronavirüs hastalýðý (COVID-19) tüm dünyada milyonlarca insaný etkilemiþ ve ölümlere neden olmuþtur. Radyolojik lezyonlarýn patofizyolojisini incelemek, yüksek bulaþýcýlýðý nedeniyle erken teþhisin çok önemli olduðu bu uçsuz bucaksýz hastalýðý anlamak için belki de anahtar rol oynamaktadýr. Hafif ve hatta asemptomatik COVID-19’lu bireylerin toplumdaki bulaþmayý önemli ölçüde artýrabileceði düþünüldüðünde, pandemiyle mücadelede erken taný konulabilmesi oldukça önemlidir. Tanýda ilk tercih edilen yöntem RT-PCR olmasýna raðmen, çalýþmalar gözden geçirildiðinde RT-PCR ve akciðer görüntülemesinin birbirlerine karþý net bir avantajý olmamakla birlikte teþhise yardýmcý olmaktadýrlar. Özellikle klinik olarak aðýr vakalarda tanýda daha hýzlý sonuç veren görüntüleme yöntemleri ön plana çýkmaktadýr. Bu noktada, görüntülemede tespit edilen bu patolojik oluþumlarýn patogenezini anlamak, belki de uçsuz bucaksýz bu hastalýkta kilit rol oynayacaktýr. Bu yazýda biz klinisyenler için önemli olan radyolojik görüntülemenin arka planýndaki patofizyolojisi güncel literatür incelemesi ýþýðýnda tartýþýlmýþtýr.

The novel coronavirus disease (COVID-19), which was accepted as a pandemic by the World Health Organization (WHO) in 2020, has affected millions of people all over the world and caused deaths. Examining the pathophysiology of radiological lesions is perhaps the key in understanding this endless disease for which early diagnosis is crucial due to its high contagiousness. Considering that individuals with mild or even asymptomatic COVID-19 can significantly increase the transmission in the society, early diagnosis is crucial in the fight against the pandemic. Although RT-PCR is the first method of choice for diagnosis, when the studies are reviewed, imaging methods that provide faster results in diagnosis come to the fore, especially in clinically severe cases, since RT-PCR and lung imaging do not have a clear advantage over each other and even they help in diagnosis. At this point, understanding the pathogenesis of these pathological formations detected on imaging may play a key role in this broad disease. In this article, the background pathophysiology of radiological imaging, which is important to us, clinicians, has been discussed in the light of the current Iiterature review.

Yabancý cisim aspirasyonu çocukluk çaðýnda sýk görülen bir durumdur ve ciddi komplikasyonlara neden olabilir. Günümüzde trakeobronþiyal yabancý cismi çýkarmak için geliþmiþ teknikler kullanýlsa da, Amerika Birleþik Devletleri’nde hala her yýl farklý sekeller býrakan 3000’den fazla ölüm ve komplikasyon vardýr. Hava yollarýndaki yabancý cisimlerin aspire edilmesi, çoðunlukla ç yaþýn altýndaki çocuklara sýklýkla erken teþhis konulamadýðýndan çeþitli komplikasyonlara yol açabilir. Çocuklar özellikle bu dönemde çok aktif olduklarý için akut aspirasyon sýrasýnda ebeveynlerinin gözetiminden kolaylýkla kaçabilirler. Çocuklarda pozitif öykünün olmamasý ve spesifik olmayan semptomlar tanýda gecikmenin en olasý nedenleridir. Bu olguda geç teþhis edilen, çok nadir görülen ve vücutta göç ederek ilerleyen organik bir yabancý cisim olan yabani arpanýn (Hordeum murinum) aspirasyonu hakkýnda farkýndalýk yaratmayý amaçladýk.

Foreign body aspiration is a common condition in childhood and can cause serious complications. Although advanced techniques are used today to remove the tracheobronchial foreign body, there are still more than 3000 deaths and complications that leave different sequelae per year in the United States. Aspirating foreign bodies in the airways can lead to various complications because children mainly under the age of 3 years are not often diagnosed early. As children are especially very active during this period, they can easily escape the supervision of their parents during acute aspiration. The absence of positive history in children and nonspecific symptoms are the most likely causes of delay in diagnosis. In this case report, we aimed to raise awareness about the aspiration of wild barley (Hordeum murinum), which is an organic foreign body that is diagnosed late, is very rare, and progresses by migrating in the body.