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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.