INTRODUCTION: Category 1 cesarean section (C1CS) is described as an emergency that threat-ens the life of the mother or fetus. Spinal anesthesia has become the standard technique in categories 2, 3, and 4 because it causes less maternal and neonatal morbidity than general anesthesia. However, due to hypoxia, the risk of aspiration, and discussions about drug doses, if spinal anesthesia can be performed more quickly, it will become a more acceptable option in a C1CS. Within the scope of this study,it was aimed to evaluate the applicability of rapid sequence spinal anesthesia (RSSA) in C1CS.
METHODS: Retrospectively, 177 patients who underwent C1CS between September 2019 and September 2020 and were successfully administered spinal anesthesia by the same anesthesiologist were included in the study. In these cases, preparation time for spinal anesthesia, application time, time to start surgery, delivery time and the 1-minute (1-min) and 5-minute (5-min) Activity Pulse Grimace Appearance Respiration (APGAR) scores were recorded and statistically analyzed.
RESULTS: The mean age of the patients was 31.1±0.3 years, mean height was 154.61±3.65 cm, and mean weight was 63.55±3.95kg. The preparation time was 52.1±0.4 s, the application time was 47.3±1.6 s, the time to start surgery was 193.6±2.1 s, and the duration of delivery was 215.0±3.1 s. the mean 1-min APGAR score was 7.7±0.0, while the mean 5-min APGAR score was 8.9±0.0. A very weak but negative statistically significant correlation was found between the 1-min APGAR score and the time to start surgery. A very weak but statistically significant negative correlation was found with the 5-min APGAR score and time to start surgery, while a weak but statistically significant negative correlation was found with the duration of delivery.
DISCUSSION AND CONCLUSION: In conclusion, considering the benefits of this method for both mother and baby, RSSA in C1CS if performed as described to achieve rapid and safe block, can be a fast, effective, and reliable option in such surgeries.

Objective: The aim of this study was to evaluate the follow-up results of patients diagnosed with angle closure glaucoma (ACG) and the factors affecting the final intraocular pressure (IOP) level in these patients.
Methods: The data from 63 eyes of 43 patients diagnosed with ACG between January 2016 and December 2019 were retrospectively analyzed. Six-month follow-up results of the patients were evaluated. Best corrected visual acuity (BCVA), biomicroscopic examination findings, IOP level, and treatment-related complications, if any, were examined at the time of admission and at the last examination.
Results: The mean IOP level of 13 (30.3%) male and 30 (69.7%) female patients with a mean age of 62.24±12.5 years (36–84 years) was 32.23±14.3 mmHg at the time of admission, while it was 14.41±8.4 mmHg at the last examination. AAC was observed in 23 (34%) eyes. The most common treatment methods were peripheral laser iridotomy (PLI) and the surgical lens extraction (LE). The mean IOP reduction was 19.71±4.3, 20.6±9.5, 31.03±12.20, and 17.73±2.8 mmHg in the PLI, LE, PLI, and LE groups, respectively. At the end of 6 months, the IOP level in 55 (88%) eyes was between 10 and 21 mmHg. Blindness developed in three eyes.
Conclusion: In our study, 6-month follow-up data of newly diagnosed ACG patients were presented. A greater IOP reduction was achieved in groups where LE or trabeculectomy was performed using PLI. There was no statistically significant difference in IOP reduction and surgical complications with LE and trabeculectomy (p=0.3).

INTRODUCTION: In this study, we aimed to evaluate the processes of informed consent and identify factors affecting the comprehension and decision-making of the patient who undergoes hyperbaric oxygen treatment (HBOT).
METHODS: This cross-sectional study group consisted of patients admitted to the Department of Underwater and Hyperbaric Medicine. Patients were verbally informed about the process and allowed to read the informed consent form before they received HBOT. Having provided the information of consent, the participants completed a questionnaire including the descriptive features, an informed consent checklist form, a Standardized Mini Mental Test (SMMT), and screening tests for decisional conflict. The results were evaluated.
RESULTS: Fifty-six patients participated in the study. The mean age was 46.4±13.5 years and 75% of patients were men. Among the participants, 5.4% tended to feel uncomfortable with the decision they made, and 7.1% experienced decisional conflict. When the patients were asked “Who is the best person to decide about the treatment recommended for you?”, 53.6% of patients responded as “The doctor.” When the scales and form points used in the study were compared in terms of gender and educational level, statistically significant differences were observed between the points for SMMT (0.048) according to gender and the points for SMMT (0.001) as well as the screening test for decisional conflict (0.027) according to educational status.
DISCUSSION AND CONCLUSION: The current research is the first study in the literature to show the crucial role of informed consent and the factors affecting comprehension as well as the decision of the patient undergoing HBOT. As a result, Underwater and Hyperbaric Medicine physicians must consider various aspects of the consent process to reduce the risk of malpractice and ensure good clinical practice.

INTRODUCTION: Hyperthyroidism is a clinical condition caused by inappropriate secretion of excess thyroid hormone (t4 and t3) from the thyroid gland. It is characterized by high t4, t3, and suppressed thyroid-stimulating hormone levels. In addition, studies conducted in recent years have shown that the rates of thyroid cancer with especially aggressive histology in-crease in patients with hyperthyroidism. The aim of this study is to determine the incidence of thyroid cancer in patients who underwent surgery for hyperthyroidism and to determine the patient groups that should be evaluated more carefully before surgery.
METHODS: The study was designed as a retrospective and cohort study. A total of 301 patients who underwent surgery for hyperthyroidism between January 2012 and February 2022. The patients were divided into three groups: Graves’ disease (GD), TMG, and toxic adenoma (TA). Age, gender, type of surgery, post-operative pathology results, tumor characteristics, and post-operative complications of the patients were recorded.
RESULTS: Thyroid cancer was detected in 65 (22%) patients. The incidence of thyroid carcinoma in GD, TMNG, and TA was 16%, 24%, and 50%, respectively. The final pathology results of patients with malignancy were as follows: Classical variant of papillary thyroid carcinoma (PTC) in 23% (n=15) of patients, follicular variant of PTC in 63% (n=41) of the patients, diffuse sclerosing variant of PTC in 7% (n=4) of patients, and 7% (n=5) of patients had papillary thyroid microcarcinoma. Overall, multifocality (39%) was the most common finding, followed by lymphovascular invasion (13%) and finally extrathyroidal invasion (6%).
DISCUSSION AND CONCLUSION: The results of our study show that the risk of thyroid cancer is not low in patients with hyperthyroidism. The risk of malignancy should not be ignored during the evaluation and management of patients with hyperthyroidism. Therefore, careful histopathological examination may help reveal an incidental tumor located in a hyperfunctional nodule or extranodular thyroid tissue.

INTRODUCTION: The incidence of perioperative vision loss after non-ocular surgeries range from 0.002% of all surgeries to 0.2% of heart and spine surgeries. The aim of the study was to examine the effect of prone position on intraocular pressure (IOP) and to evaluate other factors affecting IOP in the prone position.
METHODS: Patients, aged between 18 and 65, years who underwent an elective surgical operation in prone position were included in this prospective study. After standard monitoring conditions and bispectral index score (BIS) monitoring, patients’ IOP was recorded at preoperatively, after induction, position, 60th–120th and 180th min. Peak inspiratory pressure, desflurane amount in inhaled air, and end-tidal carbon dioxide monitoring were added after position. Student’s t-test and correlation graphics were performed.
RESULTS: The right and left IOP values decreased significantly after induction (respectively; p<0.001, p<0.001) and increased significantly at 60-120th and 180th min after position (in the right order; p=0.001, p<0.001). 0.001, p=0.003, p=0.01), (left order; p<0.001, p<0.001, p=0.02, p=0.01) were observed. When the correlation between IOP values and systolic blood pressure was evaluated; direct proportion at pre-operative time, inverse proportion post-induction and post-positioning, a plateau at the 60th min, direct proportion on the 120th and 180 min were observed. When the correlation between IOP values and diastolic blood pressure was evaluated; inverse proportion during pre-operative time and post-induction, and plateau post-induction, inverse proportion at minute 120 and direct proportion at minute 180 was observed.
DISCUSSION AND CONCLUSION: Although the relationship between IOP and systolic and diastolic pressures is variable depending on measurement times, especially measurements with inverse proportions are particularly risky in terms of visual damage.

INTRODUCTION: Acute pancreatitis is one of the most common causes of gastrointestinal dis-eases. Furthermore, it is a very common disease diagnosed in the emergency department (ED). However, the diagnosis of acute pancreatitis cannot be made with simple and inexpensive methods in the ED. The systematic immune-inflammation index (SII) is a scoring system that has recently been introduced for diagnosing inflammatory diseases. This study investigates the use of SII in diagnosing acute pancreatitis and predicting its severity.
METHODS: This study was carried out retrospectively, in a single center, in the ED of a tertiary education and research hospital. The study included patients who presented to the ED between June 2021 and December 2021 and were diagnosed with acute pancreatitis and who met the inclusion criteria. Of 207 patients diagnosed with acute pancreatitis, 150 patients who met the inclusion criteria were included in the study.
RESULTS: Comparison of SII and neutrophil-to-lymphocyte ratio (NLR) in diagnosing pancreatitis and predicting its severity showed that SII with a cutoff value of 938.82×109/L had 78.7% sensitivity and 46% specificity in diagnosing pancreatitis (area under the curve [AUC]: 0.685; 95% confidence interval [CI]: 0.626–0.745). NLR, with a cutoff value of 4.45, on the other hand, had 74.7% sensitivity and 50% specificity in diagnosing pancreatitis (AUC: 0.677; 95% CI: 0.617–0.737). SII performed better than NLR in diagnosing acute pancreatitis.
DISCUSSION AND CONCLUSION: SII is more sensitive in the diagnosis of acute pancreatitis, and NLR is more sensitive in disease severity. SII can be used in the diagnosis of acute pancreatitis.

INTRODUCTION: Tenofovir disoproxil fumarate (TDF) and entecavir (ETV) are the first-line drugs in the treatment of chronic hepatitis B virus (HBV) infection. In our study, the development of renal side effects related to the use of TDF and ETV in chronic HBV patients without renal risk factors was evaluated.
METHODS: Patients with chronic HBV infection followed up between 2014 and 2018 were evaluated retrospectively. The patients were divided into ETV-group and TDF-group. Demo-graphic and laboratory findings of the patients were recorded. The change in renal functions was evaluated with the definition of “Decrease in Renal Function (DRF);” a decrease of ≥20% in Estimated Glomerular Filtration Rate (e-GFR) and/or an increase of ≥0.2 mg/dL in serum creatinine compared to the base-level was considered significant. The patients who developed DRF were determined by comparing the creatinine and e-GFR results at the 12th, 24th, 48th, 96th, 144th, 192th, and 240th weeks of treatment with those before treatment.
RESULTS: Of the 126 patients, 77 (61.2%) were in the ETV-group and 49 (38.8%) were in the TDF-group. The groups were homogeneous in terms of demographic characteristics. Pre-treatment mean ALT values were 62.40U/L and 64.88U/L (p=0.273), AST values were 43.77U/L and 44.02 U/L (p=0.720), fibrosis 3.02 and 2.59 (p=0.159) in the TDF and ETV-groups, respectively; and statistically no difference was detected. According to creatinine values, DRF developed in one patient in the TDF-group at week 240, and in two patients in the ETV-group at weeks-48 and 240 (p=0.457). According to e-GFR values, DRF developed in the TDF-group in one patient at week 240. In the ETV group, DRF developed in one patient at week-48, and in two other patients at week-240 (p=0.198) in terms of e-GFR values. There was no statistically significant difference between two-treatment groups in terms of DRF levels.
DISCUSSION AND CONCLUSION: There is no difference between TDF and ETV treatments in terms of the development of renal toxicity in treatment-naive chronic HBV patients. However, patients who are using these two treatments should be closely monitored in terms of serum creatinine and e-GFR values.

INTRODUCTION: Influenza and pneumococcal vaccines are recommended for chronic obstructive pulmonary disease (COPD) cases in national and international guidelines. In this study, it was aimed to determine the vaccination rates for influenza and pneumococcal diseases in COPD patients and to determine the demographic and clinical, characteristics that affect the vaccination of the patients.
METHODS: Our study included 297 COPD patients aged 18 years and older who were diagnosed with COPD for at least 1 year according to the Global Initiative for Chronic Obstructive Lung Disease criteria. Pulmonary function tests of the patients, staging of the disease, and the Modified Medical Research Council scale were recorded.
RESULTS: When the 297 patients included in the study were evaluated according to the inclusion and exclusion criteria. In the study, the rate of influenza vaccination in COPD patients in the last year was 29.4% and the rate of pneumococcal vaccination at least once in their lifetime was 34.5%. Vaccination rates of patients aged 65 and over were significantly higher in influenza vaccination (p=0.036). In pneumococcal vaccination, the vaccination rate was statistically high in those with a high education level (p=0.001). It was observed that the vaccination rates were significantly lower in patients with low-income levels in both vaccine groups (p=0.044, p=0.034). When asked about the reason for the unvaccinated patients, they were told that they were not aware of the vaccine (41.3%, 76.0%) in the first place and that their doctor did not recommend it (28.2%, 27.6%) in the second place for influenza and pneumococcal vaccines.
DISCUSSION AND CONCLUSION: Influenza and pneumococcal vaccine application rates in patients with COPD were found to be low in our country, in line with the literature. The lack of doctor’s advice and lack of knowledge about the vaccine was important factors in unvaccinated individuals.

INTRODUCTION: The novel coronavirus disease 2019 (COVID-19) has spread all over the world from the first case. Although some criteria used in diagnosis, the diagnosis of COVID-19 in asymptomatic patients and patients with non-respiratory symptoms remains a big con-cern. The patients with COVID-19 could apply to the hospital with non-specific symptoms. Therefore, we aimed to evaluate the incidence of missed diagnosed COVID-19 pneumonia on abdominal computed tomography (CT) performed in patients admitted to our urology outpatient clinic in this study.
METHODS: The files of patients admitted to the urology outpatient clinic were evaluated retrospectively from April 1 to November 1, 2020. The patients with pulmonary symptoms and previously diagnosed with COVID-19 were excluded from the study. The patients who underwent abdominal CT at the urology outpatient clinic for any reason were included in this study. The demographic data and CT findings of these patients were recorded. The rates of missed diagnosed COVID-19 pneumonia detection on the lung base images of abdominal CT were evaluated. In addition, the patients without abdominal CT were excluded from this study.
RESULTS: One thousand and twenty-four patients were included in this study. We observed that 99 (9.7%) of these patients had findings related to COVID-19 pneumonia on the lung base images of abdominal CT. Although 885 (86.4%) patients had no pathological pulmonary findings, 40 (3.9%) patients had other pathological pulmonary findings.
DISCUSSION AND CONCLUSION: COVID-19 disease has become a pandemic worldwide and continues to exist as a significant problem. All health-care professionals, including urologists, play an active role in the diagnosing and treating this disease. Therefore, it should be kept in mind that COVID-19 pneumonia should be evaluated in patients admitted to the urology outpatient clinic with renal colic or abdominal pain.

INTRODUCTION: This study analyzed the demographic and clinical characteristics of patients who were admitted to the emergency department (ED) with stab wounds and compared the Glasgow coma scale (GCS), Revised Trauma Score (RTS), Shock Index (SI), Modified Shock Index (MSI), and Age-Adjusted Shock Index (ASI) between patients who received a blood transfusion and those who did not.
METHODS: This retrospective, cross-sectional, single-center study included 308 consecutive patients admitted to the ED due to stab wounds. We assessed patients’ demographics and clinical features, trauma scores (GCS and RTS), SIs (SI, MSI, and ASI), the timing of trauma, intervention and blood transfusion need, and clinical outcomes. Data were compared among the groups who received blood transfusions and those who did not.
RESULTS: A total of 308 patients, 288 male (93.5%) and 20 female (6.5%), were included in the study. The mean age was 28.30±11.90 years. 235 (76.3%) cases were admitted due to assaults, 64 (20.8%) traffic accidents, and 9 (2.9%) self-harm. The most common anatomi-cal site of injury was the lower extremity (39%). The soft tissue repairs were done in 173 (56.20%), vascular surgical repair in 22 (7.10%), laparotomy in 22 (7.10%), and tube thoracostomy in 18 (5.80%). The highest number of patients (n=38, 12.3%) were in July and August and (n=153, 49.7%) between 18: 01 and 00: 00. The mean GCS and RTS values were significantly lower, and mean SI, MSI, and ASI values were higher in patients who received blood transfusions (p<0.001 for all comparisons). Finally, elevated SI, ASI, and MSI remained independent predictors of the need for blood transfusion.
DISCUSSION AND CONCLUSION: The most common anatomical site for stab wounds was extremities and the most common required procedure was soft tissue repairs. In addition, elevated SI, MSI, and ASI were independent predictors for blood transfusion requirement in patients admitted to the ED with stab wounds.

INTRODUCTION: In this study, we aim to determine the condition of the breast cancer patient’s axilla after neoadjuvant chemotherapy (NACT) with PET/CT, evaluate our approach to the axilla after sentinel lymph node biopsy (SLNB), and examine the axillary lymph node dissection (ALND) and its results in the light of the literature.
METHODS: In Kartal Dr. Lütfi Kýrdar City Hospital, 100 women patients who were diagnosed with breast cancer and operated after NACT between 2016 and 2019 were evaluated retrospectively. Patients were evaluated in terms of tumor size, stage, presence or absence of axillary involvement before and after NACT, age, the operation performed, follow-up time, recurrence, pathological status of the axilla, and mass.
RESULTS: In this study, the mean age was 53.4±11 years (26–75 years). The mean tumor diameter was 29.06±13 mm (10–80 mm) before NACT and 13.42±17 mm (0–80 mm) (p<0.001) after NACT. The mean tumor diameter in the pathogen specimen was 14.91±19 mm (0–80 mm). Before NACT, 36 of our patients were stage III and 64 were stage II. After NACT, 79 of our patients were downstage (p<0.001), 18 patients did not change in stage, and 3 patients progressed from stage II to III. Pathological complete response was obtained in a total of 34 patients (38%). Before NACT, all patients had axillary lymph node (LN) positivity clinically and visually. SLNB was negative in 51 of 100 patients who underwent SLNB and positive in the remaining 49 patients. After ALND of positive patients, it was seen that the positive LNs of 25 patients were removed by SLNB. Metastasis to other LNs was also detected in 24 patients.
DISCUSSION AND CONCLUSION: We concluded that it would be appropriate to consider NACT for breast can-cer and it would be appropriate to make a surgical decision for axilla after SLNB.

INTRODUCTION: In children, refractive status is affected by a lot of factors such as congenital disorders, prematurity, and retinopathy of prematurity (ROP). Our study aimed to evaluate the effect of ROP development on visual acuity, strabismus, and refractive errors in children born premature.
METHODS: The study included 60 eyes of 30 premature infants born <36 weeks. The infants were divided into two groups as; which developed ROP (Group I) and group which undeveloped ROP (Group II). First year refractive status, refractive status on the control examination of the fifth age, visual acuity, strabismic examination findings, anterior, and posterior segment findings were recorded. Two groups were statistically compared in terms of refraction status of both first and fifth age and visual acuity of fifth age.
RESULTS: There were 16 (53.3%) male and 14 (46.67%) female premature infants borned before 36 weeks. Group I developed of ROP comprised of 22 eyes and Group II comprised of 38 eyes with no ROP. A statistically significant difference was found between the rates of myopia at the age of 1 and 5 years. The incidence of myopia was found statistically high in both ages (p=0.0001 and p=0.006, respectively) in Group I patients. There was no statistically significant difference in both first age and fifth age examination findings in terms of hypermetropia and astigmatism(p=0.475 and p=0.694, respectively, p=0.103 and p=0.81, respectively). There was no significant difference between the two groups in terms of mean visual acuity values measured at the age of 5 (p=0.054).
DISCUSSION AND CONCLUSION: It was concluded that prematurity alone did not lead to an increase in the incidence of myopia, but there was a significant relationship between the development of the ROP and myopia incidence. Infants with ROP should be closely followed in subsequent years.

INTRODUCTION: Acute abdomen is a dangerous condition that necessitates attentive care. The etiology of acute abdomen is quite complex and alternative diagnostic methods are very valuable as it may indicate life-threatening conditions. The purpose of this study was to ex-amine the role of physical examination and laboratory indicators in relation to surgical and medical treatment options in the emergency department (ED).
METHODS: This single-center retrospective study was conducted on 735 patients aged be-tween 18 and 90 years admitted to the ED of our hospital between January 01, 2019, and January 01, 2020. Patients’ demographics (age and gender), hospitalization data, presence of rebound and involuntary guarding, differential diagnosis, treatment approach (medical or surgical treatment), and laboratory parameters were analyzed.
RESULTS: The mean age of all patients was 45.5±18.6 years and male patients were dominant (51.1%). The most common diagnoses were acute appendicitis, acute gastroenteritis, and acute cholecystitis, respectively. Patients who had surgical treatment were significantly younger than those who received medical treatment (p<0.001). Rebound tenderness and involuntary guarding were more pronounced in the patients who received medical treatment. Inflammatory laboratory parameters were higher in patients who received surgical treatment. The presence of rebound tenderness, decreased age, elevated leukocyte, and neutrophil levels, as well as decreased red cell distribution width showed significant associations in favor of surgical treatment.
DISCUSSION AND CONCLUSION: Results suggest that the presence of rebound tenderness, elevated neutrophil, and decreased age may be predictive for the treatment modality in patients with acute ab-domen.

INTRODUCTION: The study aimed to investigate the relationship between mid-trimester cervical length and pre-term delivery and maternal characteristics.
METHODS: Cervical length measurement was carried out in 98 pregnant women who presented to antenatal outpatient clinic between 20 and 24th weeks’ pregnancy. Age, obstetric history, gravida, parity, the number of abortion, and body mass index (BMI) were also recorded. Births before 37th week formed preterm birth group, and those after 37th week formed term birth group.
RESULTS: Of pregnant women included in the study, 77 (78.6%) gave birth after 37th week of pregnancy, while 21(21.4%) gave birth before 37th week of pregnancy. Fourteen cases (14.3%) with cervical length under 25 mm, while 84 (85.7%) cases with cervical length over 25 mm. Twelve (12.24%) of the study group had a history of preterm birth. Of these cases, 11 (91.7%) had a recurrent pre-term birth. The rate of pre-term birth was higher in cases with a cervical length less than 25 mm compared to other cases (p<0.05). There was a significant relation between cervical length and age and BMI levels (p<0.05). No significant relation was found between parity and term and pre-term births (p>0.05). There was a significant relation between BMI and term and pre-term birth rates (p<0.01). The rate of pre-term birth was significantly higher in cases with previous history of pre-term birth (p<0.05).
DISCUSSION AND CONCLUSION: Mid-trimester short cervical length associated with presence of funneling, his-tory of preterm birth, and obesity. Both a history of pre-term birth and a short cervix were associated with preterm birth. Therefore, in this patient group, routine cervical length measurement at 20–24 pregnancy weeks is recommended.