GÝRÝÞ ve AMAÇ: Çalýþmamýzda elektif, non-kardiyak cerrahi planlanan dahili görüþ gerektiren hastalarýn ameliyat öncesi deðerlendirilmesi ve demografik verileri, kronik hastalýklarý, operasyon nedeni, obezite sýklýðý, laboratuvar verileri ile saðkalým, yoðun bakým ünitesine gidiþ ve mortalite oranlarý üzerine etkisini belirlemeyi amaçladýk.
YÖNTEM ve GEREÇLER: Kartal Dr. Lütfi Kýrdar Þehir Hastanesinde 01 Haziran–01 Ekim 2020 tarihleri aralýðýnda elektif, kardiyak olmayan operasyon planlanan 1345 hasta ileriye yönelik olarak deðerlendirilerek altý aylýk takipleri yapýldý. Hastalarýn ameliyat öncesi American Society of Anesthesiologists skorlarý (ASA), demografik bilgileri, operasyon nedeni ve yöntemi, kronik hastalýklarý, boy, kilo, bel çevresi, vücut kitle indeksi, ameliyat sonrasý yoðun bakým gerekliliði ve incelemeleri kaydedildi.
BULGULAR: Bu çalýþmaya toplam 1230 hasta dahil edildi. Ortalama yaþ 60.2±12.7 olup, hastalarýn %50.7’si (n=624) erkekti. Ameliyat öncesi ASA skorlarý, ASA-1, ASA-2, ASA-3 ve ASA-4 sýrasýyla %16.3 (n=200), %49 (n=603), %32.9 (n=405) ve %1.8 (n=22) idi. Malignite nedeniyle ameliyat edilecek hastalarýn oraný %22.4 (n=276) idi. Göz ameliyatlarý en çok deðerlendirilen hasta grubuydu (n=438) ve hipertansiyon, diabetes mellitus, koroner arter hastalýðý en sýk görülen hastalýklardý. Yoðun bakýmda yatýþ oraný %5.2 (n=70), ölüm oraný %1.3 (n=18) idi. Bu grup içinde en yüksek mortalite oraný malignite tanýsý olan (%18.5), yoðun bakým ünitesine kabul edilen (%10.9) ve vücut kitle indeksi deðeri <18.5 kg/m2 ve ≥40 kg/m2 olan hastalarda görülmüþtür.
TARTIÞMA ve SONUÇ: Çalýþmamýzda ameliyat öncesi dahili deðerlendirmede en sýk rastlanan hastalýklar olarak sýrasýyla hipertansiyon, diabetes mellitus ve koroner arter hastalýðý ilk üç sýrada saptanmýþtýr. Maligniteye sahip ve vücut kitle indeksi çok düþük veya çok yüksek olan hastalar ameliyat sonrasý dönemde anlamlý olarak daha fazla yoðun bakým gereksinimi ve mortalite geliþimi ile iliþkili bulunmuþtur. Bu hasta gruplarýnýn perioperatif ve ameliyat sonrasý dönemde çok daha yakýn takip edilmesinin saðkalým açýsýndan önemli olduðunu düþünmekteyiz.

INTRODUCTION: We aimed to determine the effects of preoperative evaluation, demographic data including the presence of chronic diseases, surgery indication, obesity frequency, and laboratory data on survival, admission to intensive care unit (ICU), and mortality rate of patients requiring internal examination scheduled for elective, noncardiac surgery.
METHODS: A total of 1230 patients, for whom an elective, noncardiac surgery was planned between June 1, 2020, and October 1, 2020, in our hospital, were prospectively evaluated and their follow-up assessment was conducted at 6 months. Preoperative American Society of Anesthesiologists scores, demographic information, indication for surgery and surgical method, chronic diseases, height, weight, waist circumference, body mass index (BMI), requirement for postoperative intensive care, and laboratory results were recorded.
RESULTS: A total of 1230 patients were included in this study. The mean age was 60.2±12.7 years, and 51.0% (n=624) of the patients were men. Preoperative ASA scores were 16.3% (n=200), 49% (n=603), 32.9% (n=405), and 1.8% (n=22) for ASA-1, ASA-2, ASA-3, and ASA-4, respectively. Patients who would be operated on for malignancy constituted 22.4% (n=276). Ophthalmic surgeries were the most evaluated patient group (n=438) and hypertension (HT), diabetes mellitus (DM), and coronary artery disease (CAD) are the most common diseases. The hospitalization rate in the ICU was 5.7% (n=70) and the mortality rate was 1.5% (n=18). The highest rate of mortality among this group was seen in patients with malignancy diagnosis (18.5%), admission to ICU (10.9%), and BMI value <18.5 kg/m2 and ≥40 kg/m2.
DISCUSSION AND CONCLUSION: The three most common diseases during internal medicine preoperative evaluation were HT, DM, and CAD. Patients with malignancy and very high or very low BMI were found to be significantly related to more requirements for ICU and mortality in the postoperative period. We think that close monitoring of these patient groups in the perioperative and postoperative periods is important for survival.

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GÝRÝÞ ve AMAÇ: Larinkste fibrinoid madde birikimi ve zamanla subepitelyal kollajenöz bað dokusunun artmasý aþýrý büyüme ile sonuçlanýr. Mukozal epitel, fibrinoid birikimini sýnýrlamak ve ortadan kaldýrmak için subepitelyal alana doðru çoðalabilir. Bu çoðalma, invaziv kanser benzeri bir görüntüye neden olabilir. Bu çalýþmada fibrinoid madde birikiminin patogenezi ve iliþkili skuamöz epitel proliferasyonunun geliþim mekanizmalarý üzerinde durulmuþtur.
YÖNTEM ve GEREÇLER: Beþ yüz yetmiþ beþ laringeal nodül yeniden incelendi ve deðiþen derecelerde düzensiz skuamöz epitel proliferasyonu gösteren 111 tanesi çalýþmaya dahil edildi. Ýmmünhistokimyasal olarak CK5/6, CK17, CK14, kollajen tip I, kollajen tip III, kollajen tip IV ve fibrinojen için immünohistokimyasal boyama yapýldý. Kollajenin histokimyasal boyamasýnda modifiye Masson trikrom yöntemi kullanýldý.
BULGULAR: Akut lezyonlarýn %18’inde ödem ve %42’sinde fibrin birikimi mevcuttu. Nispeten matür lezyonlar çoðunlukla yoðun kollajen lifleri içeriyordu. Kollajen tip III’ün yoðunluðu, fibrin birikimi miktarý ile ters orantýlýydý. Kollajen tip IV epitelyal ve vasküler bazal membranlarda bulundu. Fibrin boyanma yoðunluðundaki azalma ve tip I ve tip III kolajen varlýðý, fibrinin kolajen ile yer deðiþtirdiðini gösteriyordu. Bazal tip keratinler, epitelin rejenerasyon alanlarýnda daha belirgin boyama gösteriyordu. Laringeal subepitelyal fibrinoid madde birikimi kollajen ile yer deðiþtirdiði için lezyonun gerilemesi zorlaþmaktaydý.
TARTIÞMA ve SONUÇ: Düzensiz skuamöz epitel proliferasyonu lezyonun evresinden baðýmsýz olarak mevcuttur. Etiyolojisi farklý olmakla birlikte, oluþan lezyonlar histolojik olarak lignöz mukoza hastalýðýnda görülenlere benzerdir

INTRODUCTION: Fibrinoid accumulation in the larynx and increase in the subepithelial collagenous connective tissue result in overgrowth. Mucosal epithelium may proliferate downward to organize and remove the fibrinoid accumulation. This downward proliferation may cause an invasive cancer-like image. This study focused on the pathogenesis of the accumulation of fibrinoid substance and the development mechanism of the associated squamous epithelium proliferation.
METHODS: Five hundred and seventy-five laryngeal nodules were reexamined and 111 of them with varying degrees of irregular downward squamous epithelial proliferation were included in the study. Immunohistochemical staining of CK5/6, CK17, CK14, collagen type I, collagen type III, collagen type IV, and fibrinogen was performed. A modified Masson’s trichrome method was used for the histochemical staining of collagen.
RESULTS: Edema was present in 18% of the acute lesions and fibrin deposition in 42%. Rela-tively mature lesions mostly contain dense collagen fibers. The intensity of collagen type III was inversely proportional to the amount of fibrin accumulation. Collagen type IV was found in the epithelial and vascular basement membranes. A decrease in fibrin staining intensity and the presence of collagen type I and type III indicated the replacement of fibrin with collagen. Basal-type keratins showed more pronounced staining in the regenerated areas of the epithelium. As the laryngeal subepithelial fibrinoid accumulation was replaced with collagen, regression of the lesion became difficult.
DISCUSSION AND CONCLUSION: Irregular squamous epithelial proliferation occurs independent of the stage of the lesion. Although the etiology is different, the resulting lesions are histologically similar to those seen in the ligneous mucosal disease.

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GÝRÝÞ ve AMAÇ: Akut pankreatit; pankreas bezinin kendi enzimlerinin aktivasyonu ile interstisyel alana serbestlenmesi ve kendi dokusunu sindirmesi sonucunda oluþan nonbakteriyel enflamasyondur. Akut pankreatitin en sýk sebebi safra taþlarýdýr. Akut biliyer pankreatit (ABP) tedavisinde, komplikasyonlarý ve nüksleri önlemek için kolesistektomi altýn standartdýr. Kolesistektominin zamanlamasý hala tartýþmalýdýr. Bu çalýþma da hafif ve orta derecede ABP tanýsý ile kliniðimizde yatýrýlarak laparoskopik kolesistektomi (LK) yapýlan hastalarýn erken ve geç dönem sonuçlarýný karþýlaþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: ABP tanýsý ile yatan ve LK uygulanan 45 hastanýn dosyalarý geriye dönük olarak incelendi. Hastalardan 35'i kadýn (%77.8) ve 10'u erkek (%22.2) hastaydý. ABP tedavisi tamamlandýktan sonra LK yapýlan 22 hasta Grup 1, ABP tedavisinden sonra iki aylýk interval verilen ve daha sonra LK yapýlan hastalar Grup 2 olarak adlandýrýldý.
BULGULAR: Grup1; 22, Grup2 ise 23 olmak üzere toplam 45 hastadan oluþmaktaydý. Olgularýn ortalama yaþý 56 (26–93) yýl olup, hastalarýn yatýþ süreleri; Grup 1’de ortalama 13.18, Grup 2’de 8.3 gün idi. Grup 1 hastalarýnda LK süresi ortalama 57.8 dakika, Grup 2’de 45.7 dakika olup anlamlý fark bulundu (p<0.01). Grup 1’de 3 (%13.6), Grup 2'de iki (%8.7) hastada açýða geçildi. Ameliyat sonrasý komplikasyon Grup 1’de dört (%18.1), Grup 2’de dört (%17.4) hastada görüldü. Grup 1'de bir (%4.5) hastada; Grup 2'de iki (%8.7) hastada yeniden akut pankreatit görüldü.
TARTIÞMA ve SONUÇ: ABP tedavisinde; erken dönemde yapýlan LC'nin süresi uzamýþ olmasýna raðmen, ameliyat sonrasý hastanede kalýþ süresi ve komplikasyonlarda fark saptanmadý. ABP ataklarýndan sonra geliþebilecek nüksleri ve komplikasyonlarý önlemek için erken LK yapýlmasý gerektiði kanaatindeyiz.

INTRODUCTION: Acute pancreatitis is a nonbacterial inflammation that occurs as a result of the pancreatic gland being released into the interstitial area with the activation of its own enzymes and digesting its own tissue. Gallstones are the most common cause of acute pancreatitis. Cholecystectomy is the gold standard in the treatment of acute biliary pancreatitis (ABP) to prevent complications and recurrences. The timing of cholecystectomy is still controversial. In this study, we aimed to compare the early and late results of patients who were hospitalized in our clinic with the diagnosis of mild and moderate ABP and underwent laparoscopic cholecystectomy (LC).
METHODS: The files of 45 patients who were hospitalized with the diagnosis of ABP and underwent LC were reviewed retrospectively. Of the patients, 35 (77.8%) were females and 10 (22.2%) were males. Twenty-two patients who underwent LC after completion of ABP treatment were named Group 1, and patients who were given a 2-month interval after ABP treatment and underwent LC afterward were named Group 2.
RESULTS: There were 22 patients in Group 1 and 23 patients in Group 2, It consisted of a total of 45 patients. The average age of the patients was 56 (26–93) years. The average hospital length of stay was 13.18 days in Group 1 and 8.3 days in Group 2. The mean duration of LC was 57.8 min in Group 1 patients, 45.7 min in Group 2, and a significant difference was found (p<0.01). Postoperative complications were seen in 4 (18.2%) patients in Group 1 and 4 (17.4%) patients in Group 2. Acute pancreatitis was seen again in 1 (4.5%) patient in Group 1 and 2 (8.7%) patients in Group 2.
DISCUSSION AND CONCLUSION: In the treatment of ABP, although the duration of LC performed in the early period was prolonged, there was no difference in postoperative hospital stay and complications. We believe that early LC should be performed to prevent recurrences and complications that may develop after ABP attacks.

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GÝRÝÞ ve AMAÇ: Mesane divertikülü uzun zamandýr bilinen ve tedavi edilen bir hastalýk olmasýna raðmen, literatürde mesane divertiküllü hastalarda yapýlmýþ ürodinamik çalýþmalar yeteri kadar mevcut deðildir. Çalýþmamýzda mesane divertikülü olan hastalarda alt üriner sistemin depolama ve boþaltým fazýnda var olan ürodinamik bozukluklarýn tanýmlamasý amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Þubat 2010 ile Aðustos 2020 tarihleri arasýnda üroloji polikliniðine alt üriner sistem semptomlarý (AÜSS) ile baþvurmuþ ve incelemeleri sonrasýnda mesane divertikülü tespit edilmiþ olan hastalar geriye dönük olarak deðerlendirildi. Çalýþma ölçütlerine uyan 50 hasta çalýþmaya alýndý. Tüm hastalarýn öyküsü, fizik muayenesi, laboratuvar tetkikleri, görüntüleme sonuçlarý, ürodinamik inceleme sonuçlarý ve ameliyat olan hastalarda ameliyat notlarý deðerlendirildi.
BULGULAR: Çalýþmaya alýnan hastalarýn %18’i kadýn, %82’si erkekti. Hastalarýn %54’ü boþaltým semptomlarý ile polikliniðe baþvurdu. Mesane divertikülü olan %4 hastanýn ise asemptomatik olduðu tespit edildi. Ürolojik operasyon öyküsü olan erkek hastalarýn %60’ýnda infravezikal obstrüksiyon nedenli iþlem uygulandýðý saptandý. Çalýþmaya dahil edilen hastalarýn %22’si cerrahi tedavi uygulanmadan takip edilmiþtir. Çalýþmaya dahil edilen hastalarýn %50’sine ürodinami yapýlmýþ olup en fazla tespit edilen ürodinamik bulgu detrüsör aþýrý aktivitesi (DAA) olarak saptanmýþtýr, bunu çýkým obstrüksiyonu izlemektedir.
TARTIÞMA ve SONUÇ: Edinsel mesane divertikülü saptanmýþ olan hastalarýn çoðu asemptomatik olduðu için tüm hastalarda divertikülektomi endikasyonu yoktur. Öncelikle hastalar divertikül oluþumuna neden olan patolojiye yönelik araþtýrýlmalý ve ona yönelik takip ya da tedavi seçenekleri dü-þünülmelidir. Bizim görüþümüze göre ürodinamik inceleme tedavi kararýný ve seçimini etkilemekte ve tedavinin sonuçlarýnýn tahmininde yol gösterici olabilmektedir. Bu nedenle mesane divertikülü olan her hastanýn ürodinamik olarak deðerlendirilmesi gereklidir. Bu konunun tam olarak aydýnlatýlmasý için ileri araþtýrmalara gerek vardýr.

INTRODUCTION: Although bladder diverticulum is a disease that has been known and treated for a long time, there are not enough urodynamic studies about patients with bladder diverticulum in the literature. In this study, it was aimed to describe the urodynamic findings in the storage and voiding phases of the lower urinary tract in patients.
METHODS: Patients who applied to the urology clinic with lower urinary tract symptoms between February 2010 and August 2020 and who were found to have bladder diverticulum were evaluated retrospectively. Fifty patients who met the study inclusion criteria were considered. The medical histories, physical examinations, laboratory tests, imaging results, urodynamic study results, and the surgery reports of all the patients were reviewed retrospectively.
RESULTS: Of the patients included in the study, 18% were women and 82% were men. Fifty-four percent of the patients applied to the polyclinic with voiding symptoms. Four percent of the patients with bladder diverticulum were asymptomatic. It was determined that 60% of the male patients with a history of urological operation were treated for infravesical obstruction. Of the total patients, 22% were followed up without any surgical treatment. A urodynamic study was performed in 50% of the patients. The most common urodynamic finding was detrusor overactivity, followed by obstructed outflow function.
DISCUSSION AND CONCLUSION: As most of the patients with bladder diverticulum are asymptomatic, diverticulectomy is not indicated in every patient. First of all, patients should be investigated for the pathology causing diverticulum formation, and then the follow-up or the treatment options should be considered. Therefore, it could be argued that all patients with bladder diverticulum should be evaluated urodynamically. Further research is needed to explore this issue.

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GÝRÝÞ ve AMAÇ: Çalýþmamýzda hemotoraks, pnömotoraks ve nörolojik kayýp teþhisinde künt göðüs yaralanmalý hastalarda akciðer grafisi ile toraks bilgisayarlý tomografisi (BT) arasýndaki tanýsal farklýlýklarýn araþtýrýlmasý, hangi radyolojik yöntem ve/veya radyolojik taný kriterlerinin daha etkili ve öngörücü olduðunun belirlenmesi amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Bu çalýþmada Nisan 2011 ile Aralýk 2018 tarihleri arasýnda künt göðüs travmasý geçiren hastalarýn demografik ve radyolojik görüntüleme sonuçlarý analiz edildi ve 756 trafik kazasý hastasýnýn (%87) ve 113 (%13) yüksekten düþme hastasýnýn sonuçlarý çalýþmaya dahil edildi. Hastalarýn akciðer grafisi ve toraks BT sonuçlarý incelenerek kaburga, sternum, omurga kýrýklarý ve nörolojik kayýplarý, hemotoraks ve pnömotoraks bulgularý deðerlendirildi.
BULGULAR: Bilgisayarlý tomografide kaburga kýrýðý (p<0.001) ve vertebra kýrýðý (p<0.001) direk grafiye göre daha fazla saptandý. ROC-Curve testi, röntgen ve toraks BT’de saptanan vertebra kýrýðý, hemotoraks ve pnömotoraksýn nörolojik kayýp olasýlýðýný öngörebileceðini ortaya koydu. Lojistik Regresyon testi sonuçlarý, toraks BT görüntülemenin hemotoraks (p<0.001) ve pnömotoraks (p<0.001) tanýsýnda ve nörolojik kayýp (p<0.001) geliþme olasýlýðýný öngörebilmede kullanýlabilecek en iyi radyolojik inceleme yöntemi olabileceðini gösterdi.
TARTIÞMA ve SONUÇ: Çalýþma sonuçlarý kaburga kýrýðý, hemotoraks ve pnömotoraks olan olgularda vertebral hasarý gözden kaçýrmamak ve nörolojik kayýp olasýlýðýný öngörebilmek için ileri omurga radyolojik görüntüleme yöntemlerinin kullanýlmasýnýn gerekli olabileceðini gösterdi. Bu çalýþmanýn sonunda torakal vertebra ve diðer torakal kemik yapýlarýndaki travma sonrasý patolojik bulgularý saptamaya yönelik BT ile deðerlendirmenin ilk seçenek olabileceði savunuldu.

INTRODUCTION: The study was aimed to investigate the diagnostic differences between X-ray and thorax computed tomography (CT) scan in patients with blunt chest trauma and to determine which radiological method and/or radiological diagnostic criteria are more effective and predictive to diagnose the hemothorax, pneumothorax, and neurological deficit.
METHODS: The demographic and radiological imaging results of patients who had blunt chest trauma between April 2011 and December 2018 were analyzed. A total of 869 patients (male=548, female=321) were included in the study. Of the patients, 756 (87%) were assessed by a traffic accident and 113 (13%) by falling from a height. The findings of rib, sternum, and spine fractures, hemothorax, and pneumothorax detected on X-ray and/or thorax CT were evaluated.
RESULTS: Rib fractures (p<0.001) and vertebra fractures (p<0.001) were detected much more in CT scans than in chest X-rays. ROC curve test revealed that vertebra fracture, hemothorax, and pneumothorax could predict the development risk of the neurological deficit. The logistic regression test results revealed that thorax CT imaging could be the best radiological examination method to be used to diagnose hemothorax (p<0.001) and pneumothorax (p<0.001) and to predict the development risk of the neurological deficit (p<0.001).
DISCUSSION AND CONCLUSION: In cases with a rib fracture, hemothorax, and/or pneumothorax, advanced vertebral radiological imaging should be performed in order not to overlook vertebral fractures and to predict the development of neurological deficits. Therefore, a thorax CT scan may be the first choice to detect pathological findings in the thoracic vertebrae and other thoracic bone structures.

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GÝRÝÞ ve AMAÇ: Laboratuvarýmýzda rutin olarak kullanýlan kemilüminesans immunoassayn (CIA) test kiti absorbansýný esas alarak gerçek pozitif hastalarýn tanýsýnda anti-HCV’nin cut-off deðerini belirlemeyi ve yalancý pozitif örnekler için refleks tamamlayýcý test uygulamasýnýn potansiyel maliyet etkinliðini araþtýrmayý planladýk.
YÖNTEM ve GEREÇLER: Hastanemizde 2016–2019 yýllarý arasýnda yapýlan tüm anti-HCV CIA test sonuçlarý geriye dönük olarak tarandý ve hastalarýn S/Co deðerleri kaydedildi. Bunlar arasýnda HCV-RNA real-time PCR testi ile doðrulanan sonuçlar çalýþmaya dâhil edildi.
BULGULAR: Dahil edilen 257 hastanýn 84’ü (%32.68) HCV-RNA pozitifti. Anti-HCV deðerlerinin ROC analizine göre, en uygun S/Co deðeri 8.58 olup, duyarlýlýk ve özgüllük deðerleri sýrasýyla %95.24 ve %85.55’di. Bu deðere göre 105 olguda anti-HCV testi reaktifti ve bu olgularýn 80’inde (%76.2) aktif HCV enfeksiyonu vardý. Yanlýþ negatifliði önlemek için, kurumumuzda 1.0 S/Co deðeri kullanmanýn ek maliyeti 4114.64 USD idi. Kurumumuzda, HCV-RNA PCR testini tamamlamak için yaklaþýk 6.25 çalýþma saati gerekmektedir. S/Co deðeri 1.0 ve 8.58 alýndýðýnda gereken iþ saati sýrasýyla 1606.25 ve 658.25 idi.
TARTIÞMA ve SONUÇ: Yanlýþ pozitif anti-HCV sonuçlarý ülkelerin saðlýk ekonomisi üzerinde önemli bir yüktür. En azýndan, taramanýn amacýna (kan donörleri veya ameliyat öncesi tarama gibi) ve farklý laboratuvarlarda, farklý durumlarda ve farklý popülasyonlarda HCV enfeksiyonu yaygýnlýðýna göre farklý S/Co deðerleri kullanýlabilir.

INTRODUCTION: We aimed to determine the cutoff value of anti-hepatitis C virus (HCV) in the diagnosis of real positive patients based on the chemiluminescence immunoassay (CIA) test kit absorbance routinely used in our laboratory and to reveal the potential cost-effectiveness of confirmatory tests for false-positive samples.
METHODS: All anti-HCV CIA test results between 2016 and 2019 were retrospectively screened and sample/cutoff (S/Co) values of the patients were recorded. Among these, the results that were confirmed with HCV RNA polymerase chain reaction (PCR) test were included.
RESULTS: Of the 257 patients included in the study, 84 (32.68%) were positive for HCV RNA. The optimal S/Co value was 8.58 with sensitivity and specificity values being 95.24% and 85.55%, respectively. According to this 8.58 S/Co value, the anti-HCV test was reactive in 105 cases and 80 (76.2%) of these cases had active HCV infection. To prevent false negativity, the additional cost of using 1.0 S/Co value to our institution was 4114.64 USD. In our institution, approximately 6.25 working hours is spent to finalize the HCV RNA PCR test. The hours spent for S/Co of 1.0 and 8.58 was 1606.25 and 658.25, respectively.
DISCUSSION AND CONCLUSION: False-positive anti-HCV results are an economic burden on countries. At least, different S/Co values might be used in accordance with the purpose of screening and prevalence of HCV infection in different laboratories and different populations.

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GÝRÝÞ ve AMAÇ: COVID-19 enfeksiyonu, baþta saðlýk çalýþanlarý olmak üzere toplumun tüm kesimlerini etkilemiþtir. COVID-19 enfeksiyonu olan saðlýk çalýþanlarýnýn egzersiz kapasitesini ve kalp fonksiyonlarýný deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: COVID-19 enfeksiyonlu (21 kadýn, 19 erkek) tedavilerini tamamlayan 40 saðlýk çalýþaný, iyileþmelerinin otuzuncu gününde deðerlendirildi. Yirmi saðlýklý gönüllü kontrol grubu olarak eþleþtirildi. Egzersiz kapasitesi altý dakika yürüme testi (6DYT) ile ölçüldü. 6DYT sonuçlarý metre cinsinden mutlak deðer olarak verildi. Kalp fonksiyonlarý ekokardiyografi ile deðerlendirildi.
BULGULAR: COVID-19 enfeksiyonu geçirmiþ saðlýk çalýþanlarý ve saðlýklý kontrollerde yürüme mesafesi benzerdi. Saðlýk çalýþanlarýnda 0' nabýz ve 6' nabýz anlamlý olarak yüksek, 6DYT'de 0' SpO2 düþüktü. Toraks BT bulgularý, toplam semptom sayýsý ve klinik þiddet ile pozitif korelasyon gösterdi. Ejeksiyon fraksiyonu (EF) 6' nabýz ile negatif korelasyon ve RA alaný 6' SO2 ile negatif korelasyon bulundu. Yatan hastalar ve ayaktan hastalar tarafýndan yapýlan 6DYT'de ortalama mesafe sýrasýyla 546.9±36.8m ve 511.8±54.0m idi. Ayaktan hastalarýn yürüme mesafesi ve EF'si yatan hastalara göre daha düþüktü. Enoksaparin tedavisi baðýmsýz olarak yürüme mesafesi ve EF ile iliþkiliydi.
TARTIÞMA ve SONUÇ: COVID-19 enfeksiyonu ve hastanede yatýþ durumu, kardiyak fonksiyonlarý ve fiziksel fonksiyonel kapasiteyi etkilemektedir. Çalýþmamýzda, hafif ve orta dereceli COVID-19 enfeksiyonu geçirmiþ saðlýk çalýþanlarýnda, EF ve yürüme mesafesini etkileyen en güçlü baðýmsýz faktörün profilaktik enoksaparin kullanýmý olduðunu gösterdik. Saðlýk çalýþanlarýnýn COVID-19 enfeksiyonu sonrasý kardiyak fonksiyon ve egzersiz kapasitesinde olasý sorunlar açýsýndan takibinin önemli olduðu düþünmekteyiz.

INTRODUCTION: COVID-19 disease has affected all segments of society, especially healthcare workers. We aimed to evaluate the exercise capacity and cardiac functions of healthcare workers who had COVID-19 infection.
METHODS: Forty healthcare workers with COVID-19 infection (21 females, 19 males), who have completed their treatment, were assessed on the 30th day of recovery. Twenty healthy volunteers were matched as a control group. Exercise capacity was measured using the six-minute walk test (6MWT). The results of 6MWT were given as an absolute value in meters. Cardiac functions were evaluated by echocardiography.
RESULTS: Walking distances were similar in both healthcare workers with COVID-19 and healthy controls. 0´ pulse and 6´ pulse were significantly high in healthcare workers, whereas 0´ SpO2 was low in 6MWT. The thorax CT findings showed a positive correlation with the total number of symptoms and clinical severity. Ejection fraction (EF) showed a negative correlation with 6´ pulse, and the right atrial area revealed a negative correlation with 6´ SO2. The mean distance in 6MWT performed by inpatients and outpatients was 546.9±36.8 m vs 511.8±54.0 m, respectively. The walking distance and EF of outpatients were lower than inpatients. Enoxaparin treatment was independently associated with walking distance and EF.
DISCUSSION AND CONCLUSION: COVID-19 infection and hospitalization status affect cardiac functions and physical functional capacity. In our study, we showed that prophylactic enoxaparin use was the strongest independent factor affecting EF and walking distance in healthcare workers with mild to moderate COVID-19 infection. We think that it is important to follow up with healthcare professionals in terms of possible impairments in cardiac function and exercise capacity after COVID-19 infection.

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GÝRÝÞ ve AMAÇ: Bu çalýþmada amacýmýz, pandeminin bir çocuk acil servisi iþleyiþine etkisini araþtýrmaktýr.
YÖNTEM ve GEREÇLER: Geriye dönük kesitsel bu çalýþmada, çocuk acil servise 15 Nisan–15 Mayýs 2020 ile bir yýl önce ayný zaman diliminde baþvuran 0–18 yaþ aralýðýndaki hastalarýn dosya verileri incelendi. Hastalarýn demografik özellikleri, baþvuru tanýlarý, baþvuru saati ve izlem verileri hastanemiz bilgisayar veri tabanýndan elde edildi. Pandemi öncesi ve pandemi dönemi için veriler karþýlaþtýrýldý.
BULGULAR: Pandemide, seçilen ayda geçen yýla göre %78 oranýnda daha az hasta baþvurduðu görüldü. Yaþ gruplarý içerisinde 13–18 yaþ arasý hasta oraný pandemide seçilen ayda 2019 yýlýna göre daha çok (%20.2, %16; sýrasýyla), 1–6 yaþ arasý hasta oraný (%41, %43.7, sýrasýyla) ve 7–12 yaþ arasý hasta oraný (%24.6, %27.4, sýrasýyla ) ise daha düþük saptandý (p<0.001). 2020 yýlýnda hastalarýn daha çok mesai saati dýþýnda (%65.7) acile baþvurduðu, gözleme alýnan hasta oraný (%21.3) ve yatýþ oranýnýn (%18.6) daha yüksek olduðu saptandý (p<0.001). Pandemi döneminde onkolojik aciller (%0.4) dýþýnda tüm taný gruplarýnda acil baþvurular daha düþük saptandý.
TARTIÞMA ve SONUÇ: Pandemi sürecinde çocuk acile baþvuran hasta sayýsý ve baþvuru taný profili deðiþmiþtir.

INTRODUCTION: In this study, we aim to investigate the impact of the pandemic on the operation of pediatric emergency services
METHODS: In this retrospective cross-sectional study, the files of patients aged 0–18 years, who visited the pediatric emergency department (PED) between April 15 and May 15 in 2020 and the same period in the previous year, were reviewed. Demographic characteristics, admission diagnoses, admission time, and follow-up data of the patients were obtained from the computer database of our hospital. The data of the pre-pandemic and pandemic period were compared.
RESULTS: During the selected month in the pandemic year (2020), the number of patients admitted to the hospital was 78% less than that admitted in the previous year (2019). While the percentage of admitted patients aged 13–18 years in the selected month was higher during the pandemic period than in 2019 (20.2% vs. 16%), the percentages of patients aged 1–6 years (41% vs. 43.7%) and 7–12 years (24.6% vs. 27.4%) were lower (p<0.001) during the pandemic. In 2020, it was observed that most patients visited the emergency department outside of working hours (65.7%) and that the rate of patients who were observed (21.3%) and the rate of hospitalization (18.6%) were higher (p<0.001) than in 2019. During the pandemic period, emergency service admissions were lower in all diagnostic groups, exceptfor oncological emergencies (0.4%).
DISCUSSION AND CONCLUSION: During the pandemic period, the number of patients admitted to the PED as well as the admission diagnosis profile changed.

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GÝRÝÞ ve AMAÇ: Çalýþmamýzda iki merkezin acil servisine baþvuran olasý/kesin COVID-19 olgularýnýn verilerini deðerlendirerek kötü prognoz iliþkili
faktörleri belirlemeyi ve risk skorlama sistemi oluþturmayý amaçladýk.
YÖNTEM ve GEREÇLER: Bu çalýþma, COVID-19 olgularýnda geriye dönük olarak tasarlandý. Hastalarýn sosyodemografik verileri, þikayetleri, vital bulgularý, laboratuvar bulgularý, servis/yoðun bakým yatýþ durumu, ve ölüm varlýðý analiz edilmiþtir.
BULGULAR: Çalýþmaya 436 hasta dahil edildi. Olgularý kötü prognoz açýsýndan iki gruba ayýrdýk kötü prognozla iliþkili faktörler deðerlendirildiðinde; komorbidite varlýðý (p=0.001), 50 yaþ ve üzeri olmak (p<0.001), nefes darlýðý semptomunun olmasý (p<0.001), oksijen satürasyon deðerinin %95 altýnda olmasý (p<0.001), nötrofil sayýsýnýn 7x109/L–1 üzerinde olmasý (p=0.006), lenfosit sayýsýnýn 1.1×109/L–1 altýnda olmasý (p=0.020), Prokalsitonin düzeyinin 0.015 ng/mL ve üzerinde olmasý (p=0.001), D dimer deðerinin 500 mg/L ve üzerinde olmasý (p=0.009) istatistiksel olarak anlamlý bulundu.
TARTIÞMA ve SONUÇ: Kapsamlý risk skorlama sistemimizi oluþturduk. Modelimiz sekiz parametreden oluþmaktadýr. Kötü prognoza sahip hastalarýn puan ortalamalarý diðer hastalara göre anlamlý derecede yüksekti. Oluþturduðumuz skorlama sisteminin prognoz ve tedavi stratejisinin belirlenmesinde kapsamlý, kolay uygulanabilir ve güvenilir bir yöntem olduðu düþünülmektedir.

INTRODUCTION: In our study, we aimed to determine the factors associated with poor outcome by evaluating the data of possible/definite Coronavirus 2019 (COVID-19) cases coming to the emergency department in two centers and to establish a risk scoring system.
METHODS: This study has been designed as a retrospective study performed on COVID-19 cases. Patients’ sociodemographic data, complaints, vital signs, laboratory parameters, service/intensive care admission status, and the presence of death were analyzed.
RESULTS: A total of 436 patients were included in the study. We divided the cases into two groups in terms of poor outcome. The factors associated with poor outcome such as the presence of comorbid disease (p=0.001), being 50 years and older (p<0.001), symptoms of shortness of breath (p<0.001), saturation value <95% (p<0.001), neutrophil count >7×109 L–1 (p=0.006), lymphocyte count <1.1×109 L–1 (p=0.020), procalcitonin value ≥0.015 ng/mL (p=0.001), D-dimer value ≥500 mg/L (p=0.009) were found to be statistically significant.
DISCUSSION AND CONCLUSION: The scoring system we have created is considered to be a comprehensive, easily applicable, and reliable method in determining the prognosis and the treatment strategy.

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GÝRÝÞ ve AMAÇ: Neoadjuvan kemoterapi (NAK) sonrasý patolojik tam yanýt (pCR) daha yüksek hastalýksýz sað kalým (DFS) ve genel sað kalým (OS) ile iliþkilidir. Tedavi sonrasý klinik yanýt (cR) deðerlendirilmeli ve iliþkili faktörler belirlenmelidir. Çalýþmamýzdaki amacýmýz cR deðerlendirmede PET’nin etkinliðini ve pCR’ye etkili olasý faktörleri tanýmlamaktýr.
YÖNTEM ve GEREÇLER: Ocak 2015–Aralýk 2020 tarihleri arasýnda meme kanseri tanýsýyla opere edilen hastalarýn dosyalarý incelendi. Operasyon öncesi klinik yanýtlar PET ile deðerlendirildi. Patolojik yanýt deðerlendirilmesinde College of American Pathologists (CAP) 2019 skorlama sistemi kullanýldý. Hastalarýn menapozal durumu, taný anýndaki evresi, NAK öncesi ve sonrasý PET bulgularý, tümörün histopatolojik tipi, moleküler alt tipi ve KÝ-67 düzeyi incelenerek klinik ve patolojik yanýtý etkileyen faktörler araþtýrýldý.
BULGULAR: Toplam 234 kadýn hasta incelendi ve yaþ ortalamasý 52.5±12.1 yýl idi. Hastalarýn %28’inde patolojik tam yanýt (CAP=0) görülürken, klinik tam yanýt gözlenen 55 (%24) hastanýn 40’ýnda (%72.7) patolojik olarak da tam yanýt izlendi. KÝ-67 yüksekliði ve HER-2 pozitifliði patolojik yanýtý olumlu etkileyen faktörlerdi (p<0.05). Moleküler alt tiplerdeki patolojik tam yanýt oranlarý; lüminal A’da %0, lüminal B’de %21, HER-2 pozitifte %52, üçlü negatif grupta ise %44 olarak bulundu ve gruplar arasýndaki fark istatistiksel olarak da anlamlýydý (p<0.05).
TARTIÞMA ve SONUÇ: NAK, lokal ileri meme kanserli hastalarda tümör boyutunu küçültmek ve aksiller diseksiyondan kaçýnmak için kullanýlýr. NAK sonrasý klinik yanýt deðerlendirmesinde PET kullanýmý patolojik yanýtý öngörmede tek baþýna yeterli deðildir. Patolojik yanýt HER-2 pozitif ve triple negatif hastalarda belirgin derecede yüksektir. NAK kararý yanýtý etkileyen faktörler göz önünde bulundurularak verilmeli, gereksiz maliyet ve zaman kaybý önlenmelidir.

INTRODUCTION: Pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) is associated with higher disease-free survival and overall survival (OS). Posttreatment clinical response (cR) should be evaluated, and the associated factors should be identified. Our aim was to define the efficacy of positron emission tomography (PET) in cR evaluation and possible factors affecting pCR.
METHODS: The medical records of patients who were operated on for breast cancer between January 2015 and December 2020 were evaluated. Preoperative cRs were investigated with PET. College of American Pathologists (CAP) 2019 scoring system was used in the evaluation of pathological response. The factors affecting the clinical and pathological response were investigated by examining the menopausal status of the patients, the stage at the time of diagnosis, PET findings before and after NAC, histopathological type of the tumor, molecular subtype, and KI-67 level.
RESULTS: The data of 234 female patients were examined. The mean age was 52.5±12.1 years. The pCR (CAP=0) was observed in 28% of the patients, while the pCR was observed in 40 (72.7%) of 55 (24%) patients with cCR. KI-67 increase and HER2 positivity were factors that positively affected the pathological response (p<0.05). The pCR rates in molecular subtypes were 0% in luminal A, 21% in luminal B, 52% in HER2-positive, and 44% in triple-negative groups, and the difference between the groups was statistically significant (p<0.05).
DISCUSSION AND CONCLUSION: NAC reduces tumor size and avoids axillary dissection in patients with locally advanced breast cancer. The use of PET alone in evaluating cR after NAC is not sufficient to predict the pathological response. The pathological response is significantly higher in HER2-positive and triple-negative patients. The decision for NAC should be made considering the factors affecting the response to avoid unnecessary cost and time loss.

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GÝRÝÞ ve AMAÇ: Trakeal entübasyon, karmaþýk psikomotor beceriler ve tekrarlayan uygulamalar gerektirdiðinden klinik ortamlarda öðretilmesi zor bir iþlemdir. Bu çalýþmadaki amacýmýz, video temelli geri bildirimde eðitimsel bir üst basamak olarak kýsmi görev veya tam görev eðitimi ile öðrenilen trakeal entübasyonun baþarý ve komplikasyon oranlarýný deðerlendirmektir
YÖNTEM ve GEREÇLER: Kýsmi görev grubunda süreç üç adýmda öðretildi: 1. bölümde maske ventilasyonu, 2. bölümde laringoskopi, son adým olarak trakeal tüp yerleþtirme. Katýlýmcýlara bilgisayar oyunlarý oynama sýklýðý soruldu. Trakeal entübasyon süresi, müdahale sayýsý, diþ basýnç skorlamasý ve optimizasyon manevralarý kaydedildi. Toplam 63 týp öðrencisinin verileri kaydedildi.
BULGULAR: Ýlk denemede baþarýlý entübasyon oraný kýsmi görev ve tam görev gruplarýnda sýrasýyla %54.9’a karþý %45.1’di (p=0.033). 2. denemedeki
baþarýlý trakeal entübasyon oraný, kýsmi görev grubunda tüm görevden anlamlý olarak daha düþüktü.
TARTIÞMA ve SONUÇ: Video tabanlý geri bildirime göre, deneyimsiz kullanýcýlara trakeal entübasyon becerilerini öðretmek için kýsmi görev eðitim tekniklerinin kullanýlmasý, asistan eðitimine entegre edilebilirse baþarýnýn artmasýna sebep olacaktýr. Acemi kullanýcýlarda ise trakeal entübasyon eðitiminde, kýsmi görev eðitimi ve video tabanlý geri bildirim yöntemlerinin bir arada kullanýlmasýnýn komplikasyon oranýný artýrmadan baþarý þansýný yükselttiði gözlemlenmiþtir.

INTRODUCTION: Tracheal intubation is a difficult procedure to be taught in clinical settings because complex psychomotor skills and repetitive practices are required. In this study, we aimed to evaluate the success and complication rates of tracheal intubation through parttask and whole task training as educational upper steps in video-based feedback.
METHODS: In the part-task group, the process was taught in three steps: mask ventilation as step 1, laryngoscopy as step 2, and tracheal tube placement as step 3. Participants were questioned about the frequency of playing computer games. The duration of tracheal intubation, number of interventions, tooth pressure scoring, and optimization maneuvers were recorded. The data of 63 medical students were recorded.
RESULTS: Successful intubation rate in the first attempt was 54.9% and 45.1% in the part-task group and the whole task group, respectively (p=0.033). The successful tracheal intubation rate in the second attempt was significantly lower in the part-task group than in the whole task group (12.5% vs 87.5% respectively, p=0.033).
DISCUSSION AND CONCLUSION: In addition to video-based feedback, part-task training techniques to teach tracheal intubation skills to inexperienced users showed the success of these techniques, which can be integrated into resident training. Tracheal intubation training in novice users increased the chances of success without increasing the complication rate when applied using part-task training and video-based feedback methods together.

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GÝRÝÞ ve AMAÇ: Pnömotoraks ve/veya pnömomediastinum COVID-19 tanýsý ile yoðun bakýmda takip edilen ve adult respiratory disease syndrome geliþen mekanik ventilatör desteðindeki hastalarda görülebilen geç bulgular olarak ortaya çýkabilen antitelerdir. Bu çalýþmada, COVID-19 enfeksiyonuna ikincil geliþen pnömotoraks (PNX) ve/veya pnömomediastinum (PNM) nedeni ile, yönetimi kliniðimiz tarafýndan yapýlan hastalarýn geriye dönük analizi ile morbidite ve mortaliteye etki eden faktörlerin incelenmesi amaçlandý.
YÖNTEM ve GEREÇLER: Mart–Aralýk 2020 tarihleri arasýnda COVID-19 pnömonisi ile iliþkili PNX ve/veya PNM tanýsý konan, kliniðimiz tarafýndan yönetilen toplam 47 hasta geriye dönük olarak incelendi. Hastalarýn demografik verileri, muayene ve radyolojik bulgularý, ko-morbiditeleri, positive end-expiratory pressure (peep) deðerleri, fraction of inspired oxygen (FiO2) yüzdeleri, ile ilk 48 saat, 48 saat ile 7 gün arasý ve 7 gün sonrasý mortalite analiz edildi.
BULGULAR: Toplam 47 hastanýn sadece 2’si (%4) 20 ile 40 yaþ aralýðýnda olup istatiksel olarak anlamlý (p<0.03) olarak bulundu. Bilateral pnömotoraks 5 hastada (%11) görüldü. Hastalarýn 40’ýna (%85) tüp torakostomi uygulandý, 7 hasta ise konservatif yöntemle takip edildi. Hastalarýn 11’ inde (%31) sadece izole PM saptandý, hepsinde yaygýn cilt altý amfizemi mevcuttu. Bu hasta grubunda ortalama yaþ 62, MV ortalama PEEP deðeri 11 cmH2O ve ortalama FiO2 deðeri ise %84 olarak hesaplandý. Ýlk 48 saat ve ilk 7 günlük mortaliteleri karþýlaþtýrýldýðýnda istatistiksel olarak anlamlý fark saptanmazken, 7. günden sonra görülen mortalitelerde anlamlý fark bulundu (p<0.05). Çoklu deðiþken analizinde hastalarda yaygýn cilt amfizeminin eþlik etmesi 7. gün sonraki mortalitelerde istatistiksel olarak anlamlý bir risk faktörü olarak tespit edildi (p<0.05).
TARTIÞMA ve SONUÇ: Tüp torakostomi COVID-19 hastalarýnda görülen pnömotoraks tedavisinde oldukça etkili bir yöntemdir. Mekanik ventilatöre baðlý hastalarda pnömomediastinum geliþmesinin pnömotoraks için yüksek risk olmasý bakýmýndan bu hastalarda daha hassas ve daha erken akciðer koruyucu ventilasyon stratejilerinin uygulanmasý gerektiðinin önermekteyiz.

INTRODUCTION: Pneumothorax (PNX) and/or pneumomediastinum (PNM) is an entity that can occur as late findings in COVID-19 patients with mechanical ventilator support. The purpose of this study was to determine the parameters that influence morbidity and mortality associated with PNX and/or PNM secondary to COVID-19 infection.
METHODS: The study was performed on patients from March 2020 to December 2020. Demographic data, comorbidities, positive end-expiratory pressure (PEEP) values, and fraction of inspired oxygen (FiO2) percentage were analyzed. Mortality in the first 48 h, between 48h and 7 days, and after 7 days was assayed.
RESULTS: A total of 47 patients, only 2 of whom (4%) were in 20–40 years of age, were studied. The result was statistically significant (p<0.03). Bilateral PNX was seen in 5 patients (11%). Tube thoracostomy was performed in 40 patients (85%). The isolated PM was detected as a single finding in 11 patients (23%). The mean age was 62 years. The mean mechanical ventilator PEEP and the FiO2 values were 11 cmH2O and 84%, respectively. When the mortality of the first 48 h and the first 7 days was compared, no statistically significant difference was found. However, a significant difference in the mortality observed after the 7th day, which is consistent with the literature, and the presence of diffuse subcutaneous emphysema was detected (p<0.05).
DISCUSSION AND CONCLUSION: Tube thoracostomy is a highly effective method for treating PNX in all patients. Due to the elevated risk of PNX associated with the development of PNM in patients receiving mechanical ventilation, we suggest that more sensitive and earlier lung-protective breathing methods should be used.

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GÝRÝÞ ve AMAÇ: Herpetik keratite baðlý kornea neovaskülarizasyonunun (KNV) tedavisinde ince iðne diatermi (ÝÝD) tedavisinin uzun dönem sonuçlarýný deðerlendirmek.
YÖNTEM ve GEREÇLER: Herpetik keratit nedeniyle KNV geliþen ve ÝÝD uygulanan hastalarýn verileri geriye dönük olarak incelendi. Demografik veriler, intraoperatif ve ameliyat sonrasý komplikasyonlar, ameliyat öncesi ve sonrasý en iyi düzeltilmiþ görme keskinliði (EÝDGK), ÝÝD iþlem sayýsý kaydedildi.
BULGULAR: Herpetik keratite baðlý KNV geliþen 12 hastanýn 12 gözü çalýþmaya dahil edildi. Hastalarýn 2’si (%16.6) kadýn, 10’u (%83.4) erkekti. Ortalama yaþlarý 56.75±13.24 (39-88) idi. Ortalama takip süresi 20.58±9.79 (12–42) aydý. Ortalama ÝÝD sayýsý 1.33±0.65 idi. Ameliyat öncesi ortalama EÝDGK 1.40±0.44 log MAR ve ameliyat sonrasý ortalama EÝDGK 1.11±0.52 log MAR idi (p=0.018). Herpetik KNV’li tüm gözler, kornea vaskülarizasyonundaki gerileme ve görme keskinliðindeki iyileþmeye göre tam gerileme (n=6, %50), kýsmi gerileme (n=4, %33.3) ve deðiþim olmamasý (n=2, %16.7) þeklinde kategorize edildi. Ýki hastada (%16.7) subkonjonktival kanama geliþti. Bir hastada (%8.3) kornea perforasyonu geliþti ve konservatif olarak tedavi edildi. Takip süresi boyunca hiçbir hastada ÝÝD’den sonra KNV aktivasyonu olmadý.
TARTIÞMA ve SONUÇ: Herpetik keratite baðlý KNV’de ÝÝD tedavisinin KNV rekürrensini önlemede etkili olduðunu ve ÝÝD tedavisi sonrasý kazanýlan görme keskinliðinin uzun dönem takipte korunduðunu göstermiþtir.

INTRODUCTION: This study aimed to evaluate the long-term results of fine needle diathermy (FND) in the treatment of corneal neovascularization (CoNV) due to herpetic keratitis.
METHODS: We retrospectively reviewed the data of patients with herpetic keratitis CoNV who underwent FND. The demographic data, intraoperative and postoperative complications, preoperative and postoperative best corrected visual acuity (BCVA), and the number of FND procedure were recorded.
RESULTS: Twelve eyes of 12 patients with herpetic keratitis CoNV were included in the study. Two patients (16.7%) were females and 10 were males (83.3%). The mean age was 56.75±13.24 (39–88) years. The mean follow-up period was 20.58±9.79 (12–42) months. The mean number of FND was 1.33±0.65. The mean preoperative BCVA was 1.40±0.44 log MAR, and the mean postoperative BCVA was 1.11±0.52 log MAR (p=0.018). All eyes with herpetic CoNV were categorized based on the resolution of corneal vascularization and visual acuity improvement into complete regression (n=6, 50%), partial regression (n=4, 33.3%), and no regression (n=2, 16.7%). Subconjunctival hemorrhage developed in 2 patients (16.7%). Corneal perforation developed in 1 patient (8.3%) and was treated conservatively. During the follow-up period, no patient had CoNV activation after FND.
DISCUSSION AND CONCLUSION: Our results indicated that FND treatment in CoNV due to herpetic keratitis was effective in preventing CoNV recurrence, and the visual acuity gained after FND treatment was preserved in the long-term follow-up.

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GÝRÝÞ ve AMAÇ: Bu çalýþmada, diyabetin kronik komplikasyonlarýndan diyabetik nefropatinin göstergesi olan mikroalbüminüri üzerine Helicobacter pylori’nin (Hp) katkýsýnýn gösterilmesini ve Hp eradikasyonun diyabetik hastalarda teröpatik bir seçenek olabileceðini göstermeyi amaçladýk.
YÖNTEM ve GEREÇLER: Bu çalýþma, geriye dönüktür. Gastroenteroloji ve diyabet polikliniðinde takipli olan tip 2 diyabetik hastalar üzerinde yapýldý. Dispepsi nedeniyle gastroskopi yapýlan hastalarda patoloji bulgularý eþliðinde Hp varlýðý karþýlaþtýrýldý ve mikroalbüminüri, laboratuvar bulgularý, demografik özellikleri ve klinik bilgileri arasýndaki iliþki analiz edildi.
BULGULAR: Çalýþmaya, yaþlarý 35 ile 85 arasýnda, yaþ ortalamasý 61.12±9.78 yýl olan 75’i erkek (%48.1), 81’i kadýn (%51.9) olmak üzere dýþlama kriterlerini karþýlayan toplam 156 olgu alýndý. Olgularýn 71’inde (%45.5) Hp pozitif olarak saptandý. Hp varlýðý ile eþlik eden hastalýklar, demografik özellikler, kullanýlan ilaç tedavileri, biyokimyasal parametreler, albüminüri düzeyleri (mikro-normo-makro), endoskopi ve patoloji sonuçlarý karþýlaþtýrýldý. Kadýnlarda Hp pozitifliði görülme oraný, erkek olgulara göre istatistiksel olarak anlamlý düzeyde yüksek saptandý (p=0.048; p<0.05). Asetilsalisilikasit (ASA) kullanýmýnýn Hp üzerine etkisinin odds oranýný 2.105 (%95 CI: 1.05–4.23) kat arttýrdýðý görüldü. Diðer deðiþkenlerin deðerlendirilmesinde anlamlý bulgular saptanmadý (p>0.05).
TARTIÞMA ve SONUÇ: Hp pozitifliði ile mikroalbüminüri arasýnda anlamlý bir iliþki görülmedi. Kadýn cinsiyet ve ASA kullanýmý, Hp enfeksiyonu için baðýmsýz risk faktörü olarak saptandý. Bu konuda daha geniþ popülasyonda yapýlacak daha uzun süreli yeni araþtýrmalara ihtiyaç olduðunu düþünüyoruz.

INTRODUCTION: In this study, we aimed to demonstrate the contribution of Helicobacter pylori (Hp) to microalbuminuria, which is an indicator of diabetic nephropathy and one of the chronic complications of diabetes, and to show that Hp eradication can be a therapeutic option in diabetic patients.
METHODS: This study is a retrospective study conducted with type 2 diabetic patients who were followed up in the Gastroenterology and Diabetes Outpatient Clinics. The presence of Hp in pathology findings was investigated in patients who underwent gastroscopy for dyspepsia, and the relationship between microalbuminuria, laboratory findings, demographic characteristics, and clinical information was analyzed.
RESULTS: A total of 156 cases meeting the inclusion criteria, 75 males (48.1%) and 81 females (51.9%) between the ages of 35 and 85 years with a mean age of 61.12±9.78 years, were included in the study. Hp was positive in 71 (45.5%) cases. Hp positivity and accompanying diseases, demographic characteristics, drug therapies used, biochemical parameters, albuminuria levels (micro–normo–macro), endoscopy, and pathology results were compared. The rate of Hp positivity in females was found to be statistically significantly higher than that in males (p=0.048, p<0.05). The effect of using acetyl salicylic acid (ASA) on Hp increased the Odds ratio by 2.105 (95% CI: 1.05–4.23) times. No significant findings were found during the evaluation of other variables (p>0.05).
DISCUSSION AND CONCLUSION: There was no significant relationship between Hp positivity and microalbuminuria. Female gender and ASA use were identified to be risk factors for Hp infection. Studies with larger patient populations and requiring longer follow-ups are recommended.

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GÝRÝÞ ve AMAÇ: Ameliyat sonrasý erken dönemde maske oksijen veya yüksek akýmlý nazal oksijen uygulanan hastalarda yaþamsal parametreleri, arteriyel kan gazlarýný, ameliyat sonrasý derlenme düzeylerini, akciðerle iliþkili komplikasyonlarý karþýlaþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Bu ileriye yönelik ve randomize çalýþma, perkütan nefrolitotomi cerrahisi için planlanan ASA I-II-III risk skoruna sahip 18 yaþýn üzerinde, iki cinsiyette 60 hastayý içermektedir. Hastalar rastgele ayrýldý; yüksek akýmlý oksijen grubu (Grup HF, n=30), maske oksijen grubu (Grup Maskesi, n=30). Perkütan nefrolitotomi ameliyatý sýrasýnda ve ameliyat sonrasý arteriyel kan gazlarý deðerlendirildi. Ameliyat sonrasý erken dönemde iki grubun vital parametreleri (kalp hýzý, SpO2, arteriyel kan basýncý, solunum hýzý) karþýlaþtýrýldý. Ameliyat sonrasý iyileþme için QoR-40 anketi kullanýldý.
BULGULAR: Demografik veriler açýsýndan gruplar arasýnda istatistiksel olarak fark yoktur. Ameliyat sonrasý birinci saatte arteriyel kan gazý analizinde yüksek akým grubunda SpO2 düzeyleri daha yüksek, PaO2 ve SaO2 artýþlarý istatistiksel olarak anlamlý bulundu (sýrasýyla p=0.01 p<0.001 p=0.03). Ekstübasyon sonrasý kan gazlarý ile bir saatlik oksijen tedavisinden sonraki kan gazlarýný karþýlaþtýrdýðýmýzda, bir saatlik oksijen tedavisinden sonra yüksek akým grubunda düþük solunum hýzý ve pH artýþý istatistiksel olarak anlamlýdýr (sýrasýyla p<0.001 p=0.007). PaCO2 seviyelerinde istatistiksel olarak anlamlý bir fark yoktur. Ýki grup arasýnda sistolik diyastolik kan basýncý, kalp hýzý, ameliyat sonrasý 24. saatte iyileþme düzeyi, ameliyat sonrasý akciðer komplikasyonlarý, mortalite, hastanede kalýþ süresi, yeniden entübasyon oraný açýsýndan herhangi bir fark görmedik.
TARTIÞMA ve SONUÇ: Yüksek akýþlý oksijen tedavisi, ameliyat sonrasý erken dönemde kan gazlarýnda oksijenasyonu ve pH’ý artýrýr ve solunum hýzýný azaltýr. Ameliyat sonrasý iyileþme ve akciðer komplikasyonlarý açýsýndan bir fark yoktur.

INTRODUCTION: We aimed to compare vital parameters, arterial blood gases, postoperative recovery levels, and lung-related complications in patients with mask oxygen or high-flow nasal oxygen during the postoperative early period.
METHODS: This study included 60 patients over 18 years old with a risk score of the American Society of Anesthesiologists (ASA) I–II–III planned for percutaneous nephrolithotomy surgery. Patients were separated randomly as high-flow oxygen group (group HF, n=30) and mask oxygen group (group mask, n=30). During surgery and after wake up and after postoprative first hour O2 treatment, arterial blood gases were evaluated. Heart rate, SpO2, arterial blood pressure, and respiratory rate of two groups were compared in the postoperative early period. QoR-40 survey was used for postoperative recovery.
RESULTS: There was no statistical difference between groups in terms of demographic data. In arterial blood gas analysis at postoperative 1 h, SpO2 levels were higher and PaO2 and SaO2 increases were statistically significant in the high-flow group (p=0.01, p<0.001, p=0.03, respectively). Lower respiratory rate and pH increase were statistically significant in the high-flow group after 1-h of oxygen therapy when we compared blood gases at post-extubation versus after 1 h oxygen therapy (p<0.001 vs p=0.007, respectively). There was no statistically significant difference in PaCO2 levels. We did not see any difference in systolic– diastolic blood pressure, heart rate, recovery level in postoperative 24 h, postoperative lung complications, mortality, hospital stay, and reintubation rate between the two groups.
DISCUSSION AND CONCLUSION: High-flow oxygen therapy increases oxygenation and pH in blood gases and decreases respiratory rate in the postoperative early period. There is no difference in terms of postoperative recovery and lung complications.

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GÝRÝÞ ve AMAÇ: Burada urapidilin (Ura), iskemi reperfüzyon (I/R) ile oluþan böbrek hasarýna karþý potansiyel koruyucu etkileri incelenmiþtir.
YÖNTEM ve GEREÇLER: Bu amaçla deney hayvanlarý sham, I/R, I/R+Ura 0.5 mg/kg ve I/R+Ura 5 mg/kg gruplarýna ayrýldý. Total antioksidan statüsü (TAS), süperoksid dismutaz (SOD), total oksidan statüsü (TOS), miyeloperoksidaz (MPO), oksidatif stress indeksi (OSI) ve malondialdehit (MDA) parametreleri belirlendi.
BULGULAR: I/R grubunda MDA, TOS, MPO ve OSI deðerleri yükselirken TAS ve SOD seviyeleri azaldý. Ura tedavisi bu parametreleri tersine çevirdi. Ek olarak interlökin-1 beta (IL-1β) ve tümör nekrozis-alfa (TNF-α) immünopozitifliði I/R grubunda þiddetli idi, ancak Ura uygulamasý bu deðerleri azalttý.
TARTIÞMA ve SONUÇ: Mevcut çalýþma sonuçlarý, Ura’nýn I/R menþeili böbrek hasarýna karþý oldukça etkili olduðunu göstermiþtir.

INTRODUCTION: The potential protective effects of urapidil (Ura) against renal injury composed by ischemia reperfusion (I/R) were examined.
METHODS: The experimental animals were assigned to sham, I/R, I/R + Ura 0.5 mg/kg, and I/R + Ura 5 mg/kg groups. Total antioxidant status (TAS), superoxide dismutase (SOD), total oxidant status (TOS), myeloperoxidase (MPO), oxidative stress index (OSI), and malondialdehyde (MDA) parameters were determined.
RESULTS: MDA, TOS, MPO, and OSI values elevated, but TAS and SOD levels declined in the I/R group. Ura treatment reversed these parameters. In addition, immunopositivity of interleukin-1 beta and tumor necrosis factor-alpha were severe in the I/R group but declined due to Ura administration.
DISCUSSION AND CONCLUSION: The results of the study showed that Ura is highly effective against renal damage induced by I/R.

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GÝRÝÞ ve AMAÇ: Kanal içi vestibüler schwannomalar, tüm vestibüler schwannomalar içerisinde küçük bir yüzdeye sahiptir. Kanal içi vestibüler schwannomalarda iþitmenin korunmasý, hasta yönetiminin temel amaçlarýndandýr. Bu çalýþmanýn amacý, kanal içi vestibüler schwannomalarda Gamma-Knife radyocerrahinin (GKR) tümör kontrolü ve iþitmenin korunmasý üzerine etkisinin incelenemesidir.
YÖNTEM ve GEREÇLER: Bu geriye dönük çalýþmada, Gamma-Knife Radyocerrahi Merkezi’mizde Ocak 2010–Ocak 2020 arasýnda kanal içi vestibüler schwannoma tanýsý ile stereotaksik radyocerrahi almýþ, klinik, odyometrik ve radyolojik takibi bulunan hastalar deðerlendirildi. Tümör kontrolü manyetik rezonans görüntüleme yönteminde tümör boyutlarýnýn ölçülmesi ile takip edildi. Ýþitme seviyeleri Gardner-Robertson (GR) iþitme sýnýflamasý yöntemine göre deðerlendirildi.
BULGULAR: Ortalama 48.23 aylýk takipte, çalýþmaya dahil edilen toplam 45 hastadan 44’ünde tümör kontrolü saðlandýðý görüldü (%97.7). Tümör büyümesi görülen bir hastada ise, ek bir tedavi uygulanmasý gerekmedi. Ek tedavi gerekliliðine göre deðerlendirildiðinde tüm hastalarda tümör kontrolü saðlandý (%100). Tedavi öncesi fonksiyonel iþitmesi olan (GR derece I ve II) toplam 29 hastadan, ortalama 70.42 aylýk takip sonrasýnda, toplam 13 hastada fonksiyonel iþitme korundu (%44.8). GR derecesinde kayýp, ameliyat öncesinde yüksek GR derecesine sahip olmak ile korelasyon gösterdi (Rs=0.459, p=0.002). Tedavi dozu iþitme kaybý ile korelasyona sahipti ve daha yüksek doz alan hastalar daha kötü sonuçlara sahipti (Rs=0.459, p=0.002).
TARTIÞMA ve SONUÇ: Kanal içi vestibüler schwannomalarda GKR uzun dönemli takiplerde mükemmel tümör kontrolü saðlamaktadýr. Beþ yýlýn üzerindeki takip sürelerinde fonksiyonel iþitmenin korunma oraný azalabilir. Kanal içi vestibüler schwannomalarda GKR sonrasý iþitmenin seyrini ortaya koyabilmek için uzun takip süreli daha fazla çalýþma gerekmektedir.

INTRODUCTION: Intracanalicular vestibular schwannomas (IVS) constitute a small percentage of all vestibular schwannomas (VS). Hearing preservation is one of the most important goals in IVS management. The aim of this study was to delineate the long-term outcomes of gamma-knife radiosurgery (GKR) for IVS regarding tumor control and hearing preservation.
METHODS: Patients with IVS who were irradiated at our Gamma-Knife Radiosurgery Center between January 2010 and January 2020 with clinical, audiometric, and radiological follow-up were included in this retrospective study. Tumor control was evaluated with magnetic resonance imaging by tumor dimensions. Hearing status was classified according to Gardner–Robertson (GR) classification system.
RESULTS: Tumor control was achieved in 44 of 45 eligible patients by dimensional measuring (97.8%), and the remaining patient did not require further treatment (2.2%). In 29 patients who had functional hearing (GR grades I and II), only 13 patients preserved their functional hearing with a mean of 70.42 months follow-up (44.8%). A GR grade loss in hearing was correlated with a high GR grade preoperatively (Rs=0.459, p=0.002). Treatment dose was also found to be correlated with hearing loss, and higher doses resulted in worse outcomes (Rs=0.459, p=0.002).
DISCUSSION AND CONCLUSION: GKR has excellent results on tumor control on long-term follow-up in IVS. Follow-up duration over 5 years may diminish functional hearing preservation rates, and more studies are needed with long-term follow-up to clarify the actual course of hearing status after GKR in IVS.

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Kompozit lenfomalar iki farklý lenfomanýn ayný anda tek lokalizasyonda bulunmasýdýr. Literatürde farklý klonlardan geliþmiþ kompozit lenfomalar nadir olup olgu sunumu þeklindedir. Mantle hücreli lenfoma ve Klasik Hodgkin lenfoma (HL) birlikteliði çok nadir bildirilmiþtir. Olgumuz 53 yaþýnda erkek hastadýr. Sol kasýðýndaki lenf nodu biyopsisinde lenfositten zengin Hodgkin lenfoma, kemik iliðinde mantle hücreli lenfoma saptanmýþtýr. Lenf nodunun tekrar deðerlendirilmesinde kompozit lenfoma (mantle hüceli lenfoma+ lenfositten zengin Hodgkin lenfoma) tanýsý almýþtýr. Olgumuz lenf nodunda iki ayrý klondan geliþim gösteren kompozit lenfoma (EBV pozitif klasik HL ve mantle hücreli lenfoma), dalak ve kemik iliðinde ise mantle hücreli lenfoma tutulumu göstermektedir. Literatürde çok nadir olmasý yanýltýcý morfolojiye sahip olmasý, en genç ve en uzun sað kalým gösteren biklonal kompozit lenfoma olmasý nedeniyle olgumuzu literatür bilgileri ýþýðýnda sunduk.

Composite lymphomas are two different lymphomas existing in the same location, synchronously. In the literature, composite lymphomas developed from different clones are rarely found as case reports. The coexistence of mantle cell lymphoma and classical Hodgkin lymphoma (HL) is very uncommon. The case we present was a 53-year-old male patient with a lymphocyte-rich HL in the left inguinal lymph node biopsy and a mantle cell lymphoma in the bone marrow. The diagnosis was composite lymphoma (mantle cell lymphoma + lymphocyte-rich HL) in the re-evaluation of the lymph node biopsy. Our case shows composite lymphoma developing from two separate clones (EBV positive classical HL and mantle cell lymphoma) in the lymph node and mantle cell lymphoma in the spleen and bone marrow. This case was presented and discussed because of its rarity and misleading morphology and because it is the youngest biclonal composite lymphoma with the longest survival.

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Dyke-Davidoff-Masson sendromu (DDMS) serebral hemiatrofi, paranazal sinüslerin hiperpnömatizasyonu, homolateral kafatasý hiperplazisi, mental retardasyonla birliktelik gösterebilen nöbetler ve kontralateral hemiparezi ile karakterize nadir bir sendromdur. Hastalarda fokal baþlangýçlý nöbetler görülebilmektedir. Bu hastalarýn interiktal EEG kayýtlarý, etkilenen hemisferlerde daha düþük amplitüd ve yavaþ zemin aktivitesi þeklinde deðerlendirilmiþtir. Olgularýn çoðunda lateralize, lezyonla uyumlu epileptiform bozukluk görülürken litetatürde nadir olarak EEG’de sürekli diskordans izlenen olgular sunulmuþtur. Epileptiform diskordans veya diðer bir deyiþle yanlýþ lateralizasyon bizim olgumuzda da olduðu gibi nadir de olsa görülebilir; irritatif alan tespiti yaparken özellikle geniþ lezyonu olabilecek hastalarda bu durumunun akýlda tutulmasý önem teþkil eder. Dyke-Davidoff-Masson sendromu tanýsý alan ve literatürde nadir olarak bildirilen epileptiform diskordansý olan bir hastayý tartýþmayý ve bu olgudan yola çýkarak litetatürü gözden geçirmeyi amaçladýk

Dyke–Davidoff–Masson Syndrome (DDMS) is a rare syndrome characterized by cerebral hemiatrophy, hyperpneumatization of the paranasal sinuses, homolateral skull hyperplasia, seizures that may be associated with mental retardation, and contralateral hemiparesis. Focal onset seizures may be seen in patients. Interictal Electroencephalogram (EEG) recordings of these patients were evaluated as lower amplitude and slow background activity in the affected hemispheres. While most of the cases have lateralized epileptiform disorder compatible with the lesion, cases with continuous discordance in EEG are rarely presented in the literature. Epileptiform discordance occurs infrequently, as in our case; it is crucial to keep this in mind when finding irritative areas, particularly in patients with big lesions. We aimed to discuss a patient who had epileptiform discordance and was diagnosed with DDMS, which is an uncommon condition in the literature, and examine the literature based on this case.

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