GÝRÝÞ ve AMAÇ: Uzun süreli invaziv mekanik ventilasyon trakeal stenozun (TS) ana nedenidir. COVID-19 pandemisi boyunca uzun süreli invaziv mekanik ventilatör desteði altýnda tedavi gören hasta sayýsý da artmýþtýr. Bu çalýþmanýn amacý pandemi dönemi öncesi ve sonrasý TS nedenli hastane baþvurlarýnýn incelenmesidir.
YÖNTEM ve GEREÇLER: Bu çalýþma Ekim 2017–Ekim 2022 yýllarý arasýndaki beþ yýllýk dönemde retrospektif, gözlemsel olarak tasarlanmýþtýr. Trakeal stenoz nedenli hastaneye baþvuran tüm hastalar, hastane otomasyon sisteminden taranmýþtýr. Verisine ulaþýlamayan, eksik ya da yanlýþ bilgi içeren, tedavi ve takip amaçlý baþka hastaneye nakil edilen hastalar çalýþmadan dýþlandý. Hastalar pandeminin baþladýðý Mart 2020 öncesi ve sonrasý olarak pandemi öncesi (PÖ) ve pandemi sonrasý (PS) olarak iki gruba ayrýldý. Hastalarýn yaþý, cinsiyeti, baþvuru þekli, baþvuru þikayeti, komorbiditeleri, trakeal stenoz etyolojisine dair bilgiler, yoðun bakým yatýþý, mekanik ventilatör ile tedavi ihtiyacý, mekanik ventilatör ile tedavi süresi, trakeostomi varlýðý, geçirilmiþ cerrahi müdahale varlýðý, tedavi þekli veri formuna kaydedildi. Tüm deðiþkenler pandemi öncesi ve sonrasý þeklinde kýyaslandý. Ýstatistiksel analizler için SPSS version 25 istatistik paket programý kullanýlmýþtýr. Yapýlan tüm testler için anlamlýlýk düzeyi 0.05 olarak alýnmýþtýr.
BULGULAR: Araþtýrmaya dahil edilen TS tanýlý hasta sayýsý 60 olup, 21’i PÖ, 39’u ise PS tedavi gören hastalardýr. Hastalarýn 40’ý erkek, 20’si kadýndýr ve yaþlarý 3 ile 77 arasýnda deðiþmektedir. PÖ dönemde ortalama olarak 5.25 olan baþvuru sayýsý PS döneminde 13’e çýkmýþ ve sonuçta COVID-19 nedeniyle baþvuru sayýsý 2.47 kat artmýþtýr. Gruplar incelendiðinde PS dönemde ortalama yaþ, diabetes mellitus ve hipertansiyon varlýðý, stridor bulunmasý, dilatasyon ve stent uygulamasý artmýþtýr (p<0.05).
TARTIÞMA ve SONUÇ: Sonuçlarýmýza göre COVID-19 enfeksiyonu sebebiyle artmýþ invaziv mekanik ventilasyon ihtiyacý, trakeal stenoz görülme sýklýðýný da arttýrmýþtýr. Bulgularýmýza göre, hastalarýn COVID-19 enfeksiyonu ve invaziv mekanik ventilasyon öyküsü sorgulanarak potansiyel trakeal stenoz vakalarý predikte edilebilir.

INTRODUCTION: Prolonged invasive mechanical ventilation (IMV) is the main cause of tracheal stenosis (TS). During the COVID-19 pandemic, the number of patients treated with long-term invasive mechanical ventilator support also increased. This study aimed to examine hospital presentations due to TS before and during the pandemic period.
METHODS: This retrospective observational study was planned over the 5-year period from October 2017 to October 2022. The data of all patients who presented to the hospital due to TS were screened through the hospital’s automation system. The age, gender, presentation unit and complaints, comorbidities, etiology of TS, intensive care admission, mechanical ventilation requirement and duration, the presence of a tracheostomy, the presence of previous surgical intervention, and treatment modalities were recorded in the data form. All variables were compared between the pre-pandemic and pandemic periods. SPSS version 25 statistical software package was used for statistical analyses. The significance level was taken as 0.05 for all tests.
RESULTS: The study included a total of 60 patients diagnosed with TS, of whom 21 presented to the hospital before and 39 during the pandemic. Forty of the patients were male and 20 were female, and their ages ranged from 3 to 77 years. The mean number of presentations was 5.25 before the pandemic and increased to 13 during the pandemic, indicating a 2.47-fold increase due to COVID-19. When the groups were examined, the mean age, the presence of diabetes mellitus and hypertension, the presence of stridor, tracheal dilatation, and stenting significantly increased during the pandemic period (p<0.05).
DISCUSSION AND CONCLUSION: According to our results, the increased requirement for IMV due to COVID-19 infection also increased the frequency of TS. Due to our findings, potential cases of TS can be predicted by inquiring about the patient’s history of COVID-19 infection and IMV.

GÝRÝÞ ve AMAÇ: Çalýþmamýzda non-bilier akut pankreatit (AP) olgularýnda HAPS skorunun güvenirliðinin; yaygýn, sýk kullanýlan ve güvenilir bir skorlama sistemi olan Ranson skoru ile prognoz tahmini açýsýndan karþýlaþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Ocak 2016–Haziran 2021 arasýnda klinik takibi yapýlan yaþ ortalamasý 48 olan Non Bilier AP tanýlý 73 hasta çalýþmaya dahil edildi. Ranson ve HAPS skoru ile klinik seyirleri mukayese edildi. Klinik seyirde yatýþ süreleri, nihai son karar ve lokal ya da sistemik komplikasyon varlýðý deðerlendirildi.
BULGULAR: HAPS ve Ranson skorun mukayese edildiðinde hastalarýn prognoz tahmininde istatistiksel olarak anlamlý fark tespit edilmemiþtir (p>0.05).
TARTIÞMA ve SONUÇ: Güvenirliði yüksek bir skorlama sistemi olan Ranson skorlama sistemi 48 saatte tamamlanmakta olup HAPS skoru ise hastanýn ilk klinik kabulünde deðerlendirilen 3 kriter ile hesaplanmaktadýr. Kullaným kolaylýðý olan HAPS skoru gerek hafif gerekse þiddetli olgularda prognoz tahmininde Ranson skoru kadar güvenilir tespit edilmiþ olup Ranson skorunun kullanýlmayacaðý durumlarda NonBilier AP olgularýnda prognoz tahmininde güvenle kullanýlabilir.

INTRODUCTION: In our study, we aimed to compare the reliability of the Harmless Acute Pancreatitis Score (HAPS) score with the widespread, commonly used and reliable scoring system of the Ranson score in terms of prognosis prediction for non-biliary acute pancreatitis (AP) cases.
METHODS: The study included 73 patients with diagnosis of non-biliary AP with mean age 48 years, admitted for clinical follow-up from January 2016 to June 2021. The Ranson and HAPS scores and clinical progression were compared. For clinical progression, duration of admission, final outcome, and presence of local or systemic complications were assessed.
RESULTS: When HAPS and Ranson scores are compared, there was no statistically significant difference identified in the prognosis predictions for patients (p>0.05).
DISCUSSION AND CONCLUSION: The Ranson scoring system, a scoring system with high reliability, is completed in 48 h, while the HAPS score is calculated with three criteria assessed on the patient’s initial clinical admission. The HAPS score, with convenient use, was identified to be as reliable as the Ranson score for prognosis prediction of both mild and severe cases and may be safely used for prognosis of non-biliary AP cases in situations, where the Ranson score cannot be used.

GÝRÝÞ ve AMAÇ: Memede erken zamanda yakalanan þüpheli malign lezyonlarýn eksizyonunda uygulanan iþaretleme yöntemlerinden radyo kýlavuzlu (ROLL) ve Tel ile iþaretlemenin karþýlaþtýrýlmasý ve varsa birbirlerine üstünlüklerinin bulunmasý.
YÖNTEM ve GEREÇLER: 23 Eylül 2014 ile 02 Þubat 2017 tarihleri arasýnda hastanemizde tarama amaçlý yapýlan mammografi ve ultrasonografide tespit edilen ancak muayenede palpe edilemeyen þüpheli malign lezyonu olan 79 hasta çalýþmaya dahil edildi. Bu hastalarýn 42 tanesine ROLL, 37 tanesine tel ile iþaretleme uygulandý. Hastalarýn iþaretlemeye baðlý komplikasyonlarý, piyes hacmi, operasyon süresi, son patoloji raporlarý ve rerezeksiyon ihtiyacý deðerlendirildi.
BULGULAR: Hastalarýn tümü kadýndý. Hastalarýn yaþ ortalamasý 53.2 ve vücut kitle indeksi ortalamasý 28.7 olarak bulundu. Olgularýn son patoloji raporlarýnda 43’ünün (%54.5) malign, 9’unun (%11.4) premalign, 27’sinin (%34.2) benign olduðu görüldü. Piyes hacmi ROLL hastalarýnda ortalama 36.2cc±19.6, Tel hastalarýnda ise 40.8cc±22.8 olarak bulundu (p=0.34). Ameliyat süresi ROLL hastalarýnda ortalama 13.2 dk±4.2, Tel hastalarýnda ise 18.2 dk±6.7 olarak bulundu (p=<0.001). ROLL hastalarýnda toplam 8 hastaya rerezeksiyon gerekliliði oldu. Tel hastalarýn-da ise toplam 14 tanesinde rerezeksiyon yapýldý (p=0.07).
TARTIÞMA ve SONUÇ: Non-palpabl meme lezyonlarýnýn tanýsal amaçlý veya küratif eksizyonlarýnda, ROLL ile yapýlan ameliyatýn süresi tele göre anlamlý de-recede kýsa ve rerezeksiyon ihtiyacý daha azdýr. ROLL yönteminde tele özgü komplikasyonlardan kaçýnmak mümkündür.

INTRODUCTION: Breast cancer is the most commonly diagnosed malignancy and the second leading cause of cancer-related deaths in women. It is estimated that one in 11 women in developed societies, one in nine women in the UK, and one in eight women in the USA experience breast cancer at some point in their lives. Early diagnosis of breast cancer reduces mortality and morbidity. According that, in this retrospective study, the superiority of the radio-guided occult lesion localization (ROLL) method and the wire-guided localization(WGL) method to one another was investigated considering the data including lesion size, duration of surgical excision, surgical margin, and the need for re-resection in non-palpable lesions suspected of malignancy.
METHODS: The study included 79 female patients who had non-palpable breast lesions and suspicious findings for malignancy on mammography and breast ultrasonography. The mark-ing was made on the operation day at the radiology clinic for all patients. All surgeries were performed under general anesthesia.All surgical operations were performed by the same surgeon, all markings were made by the same radiologist, and the material was prepared for ROLL by the same nuclear medicine clinic.
RESULTS: The specimen volume was 36.2±19.6 cc in the ROLL group and 40.8±22.8 cc in the WGL group (p=0.34). The duration of surgical excision was 13.2±4.2 min in the ROLL group and 18.2±6.7 min in the WGL group (p<0.001). The closest distance to the lesion was 4.5±3.0 mm in the ROLL group and 4.0±3.1 mm in the WGL group (p=0.52). Eight patients in the ROLL group and 14 patients in the WGL group required re-resection (p=0.07). No significant difference was found between the groups except for the duration of surgical excision.
DISCUSSION AND CONCLUSION: n the ROLL method, the duration of the operation significantly shortens compared to WGL, and the re-resection rate is lower.

GÝRÝÞ ve AMAÇ: COVID-19 takibinde, hastalýðýn þiddetli seyretmesi ve ölümle sonuçlanabilmesi nedeniyle, prognoz ve mortaliteyi öngören belirteçle-rinin ortaya konulmasý önem arz etmektedir.COVID-19 hastalarýnda erken mortalite belirteci olarak biyokimyasal parametrelerin kullanýldýðý bilinmektedir ancak oksijen belirteçleri ile yapýlan yeterli sayýda çalýþma bulunmamaktadýr. Bu çalýþmada yoðun bakým kabulü yapýlan þiddetli COVID-19 hastalarýnda, mortalite üzerine etkisi olabilecek oksijenasyon indikatörlerinin belirlenmesi amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Prospektif olarak planlanan ve yerel etik kurul onayý alýnan çalýþmamýza (2021/514/200/33) üçüncü basamak yoðun bakým ünitesine, Nisan-Eylül 2021 tarihleri arasýnda kabulü yapýlan COVID-19 baðlý Akut Respiratuvar Distres Sendromu (CARDS) tanýlý 122 hasta dahil edildi. Ölüme neden olabilecek komorbiditesi, hematolojik hastalýðý olan hastalar çalýþma dýþý býrakýldý. Hastalar exitus ile sonuçlanan (Grup-E) ve taburcu-discharge edilen olarak (Grup-D) iki gruba ayrýldý. Hastalarýn demografik verileri, APACHI-II ve SOFA skoru, arteriyel kandaki kýsmi oksijen basýncý (PaO2), oksijen satürasyonu (SpO2), arteriyel oksijen kontenti (CaO2), PaO2/FiO2 (P/F) oraný, SpO2/FiO2 (S/F) oraný, santral venöz oksijen satürasyonu (ScvO2), arteriyel oksijen indeksi (OI), oksijen satürasyon indexi (OSI), laktat, IL-6 ve ferritin, lenfosit düzeyi, ortalama arter basýncý, yoðun bakým gün sayýsý, entübe gün sayýsý, taburculuk ve mortalite durumlarý kaydedildi.
BULGULAR: Yatýþ anýnda ölçülen SPO2, PaO2, CaO2 deðerleri açýsýndan iki grup arasýnda anlamlý fark yoktu. OI, OSI, P/F, S/F, ScvO2, APACHEII ve SOFA skoru, entübe gün sayýsý, laktat, ferritin, IL-6 parametreleri açýsýndan iki grup arasýnda anlamlý iliþkili bulundu. Bu deðiþkenler için ROC ve lojistik regresyon analizi yapýldý, kesme noktalarý hesaplandý. OI (>7, AUC: 0.798, p=0.001) ve OSI (>4.5, AUC: 0.805, p=0.001) indikatörlerinin mortalitenin en belirgin baðýmsýz deðiþkenleri olduðu tespit edildi. AyrýcaOI≥7 olmasý durumunda mortalitenin 23 kat, OSI ≥4.5 olmasý durumunda mortalitenin 40 kat artýrdýðý görüldü.
TARTIÞMA ve SONUÇ: CARDS tanýsý ileyoðun bakým ünitesine yatýþlarda mortaliteyi öngörmedeOI ve OSI’nin anlamlý baðýmsýz deðiþkenler olduðu görüldü. Ayný zamanda çalýþmamýzda bu non-invaziv bakýlan parametrelerden S/F oranýnýn; P/F kadar deðerli, OI oranýnýn; OSI kadar güçlü bir prediktör olduðu tespit edildi.

INTRODUCTION: In the follow-up of Coronavirus disease 2019 (COVID-19), the predictors of prognosis and mortality are important for early initiation of treatments to reduce the se-verity of disease and for preventing death. There are many biochemical parameters used as early mortality markers in COVID-19 patients. However, there is not a sufficient number of studies on the predictive role of oxygen markers.
METHODS: Prospectively designed study which was approved by the local ethics committee (2021/514/200/33) included 122 patients with COVID-19-associated acute respiratory dis-tress syndrome (CARDS). The patients were divided into two groups discharged (Group-D) and deceased (Group-E). Demographic data och oxygenation and biochemical values of the patients, length of stay in intensive care unit (ICU), intubation duration, the status of dis-charge and mortality were recorded for each patient.
RESULTS: There was no significant difference between the two groups in terms of the values of Oxygen saturation, partial pressure of oxygen, and arterial oxygen content first measured at the ICU. On the other hand, a significant difference was observed between the two groups in the parameters of oxygenation index (OI), oxygenation saturation index (OSI), P/F, S/F, ScvO2, and the APACHE II and SOFA scores, the number of intubated days, and lactate, ferritin, and IL-6 (p<0.05). ROC curve and logistic regression analyses were performed for these variables and cut-off points were calculated. The OI (>7, AUC: 0.798, p=0.001) and OSI (>4.5, AUC: 0.805, p=0.001) indicators were determined to be the strongest independent variables for mortality. It was observed that mortality increased 23 times when OI ≥7, and 40 times when OSI ≥4.5.
DISCUSSION AND CONCLUSION: OI and OSI were found to be significant independent variables in predicting mortality in ICU admissions with the diagnosis of CARDS. In addition, in our study, it was determined that among these noninvasively studied parameters, the S/F ratio was as valuable as P/F and OI was as a strong predictor as OSI.

GÝRÝÞ ve AMAÇ: Anormal uterin kanamasý olan hastalarda menstrüel siklusun düzenliliði, kan hemoglobin ve lipid seviyeleri, endometrial kalýnlýk açýsýndan oral ve vajinal mikronize progesteronun etkisini karþýlaþtýrmak.
YÖNTEM ve GEREÇLER: Anormal uterin kanamasý olan toplam 80 hasta iki gruba ayrýldý: oral mikronize progesteron grubu (n=40) ve vajinal mikronize progesteron grubu (n=40). Üç aylýk tedaviden sonra hastalarýn tedaviye uyumu, tedaviden memnuniyeti (memnun-memnun deðil), düzenli bir siklusu olup olmadýðý ve tedavinin yan etkileri sorgulandý. Tedavi öncesi ve sonrasý hastalar endometrial kalýnlýk, hematolojik ve biyokimyasal parametreler açýsýndan karþýlaþtýrýldý.
BULGULAR: Toplam 66 hasta, birinci grup (oral progesteron) ve ikinci grup (vajinal progesteron) olarak ayrýldý. Ýki grup arasýnda yaþ, parite ve vücut kitle indeksi (VKÝ) açýsýndan istatistiksel olarak belirgin fark yoktu. Her iki grupta da tedaviden sonra hemoglobin düzeylerinin önemli ölçüde arttýðý bulundu (p=0.0001). Tedavi öncesi ve sonrasý lipid deðerleri açýsýndan her iki grupta da istatistiksel olarak belirgin grup içi veya gruplar arasý fark bulunmadý. Her iki grupta da tedaviden sonra endometriyal kalýnlýkta anlamlý bir azalma oldu (p=0.0001). Tedavi sonrasý oral progesteron grubunda 26 (%81.25) hastada, vajinal progesteron grubunda 30 (%88.23) hastada menstrüel siklus düzenli hale gelmesine raðmen gruplar arasýnda anlamlý fark bulunmadý. Birinci grupta (n=25/32) hastalarýn %78.12’si tedaviden memnun kalýrken, ikinci grupta (n=28/34) %82.35’i tedaviden memnun kaldý ve gruplar arasýnda anlamlý fark bulunmadý.
TARTIÞMA ve SONUÇ: Etkinliði ve güvenliði, kolay tolere edilmesi ve az yan etkisi göz önüne alýndýðýnda, vajinal mikronize progesteron, anormal uterin kanamanýn tedavisinde oral preparatlara iyi bir alternatif olabilir.

INTRODUCTION: To compare the effect of oral and vaginal micronized progesterone in terms of regularity of menstrual cycle, blood hemoglobin and lipid levels, and endometrial thickness in patients with abnormal uterine bleeding (AUB).
METHODS: A total of 80 patients with AUB were randomized into two groups: the oral micronized progesterone group (n=40) and the vaginal micronized progesterone group (n=40). After 3 months of treatment, patients were inquired about compliance to treatment, treatment satisfaction (satisfied-unsatisfied), whether a regular cycle was present, and side effects. Pre- and posttreatment parameters were compared in terms of ultrasonographic endometrial thickness measurement, and hematologic and biochemical parameters.
RESULTS: Overall 66 patients, the first group (oral progesterone) and the second group (vaginal progesterone) were evaluated. There was no statistically significant difference between the two groups in terms of age, parity, and body mass index. In both groups, hemoglobin levels were found to be significantly increased after treatment (p=0.0001). No statistically significant intragroup or intergroup difference was found in either group in terms of lipid values before and after treatment. There was a significant decrease in endometrial thickness after treatment in both groups (p=0.0001). After treatment, in the oral progesterone group, the menstrual cycle became regular in 26 (81.25%) patients while in the vaginal progesterone group, it became regular in 30 (88.23%) patients, with no significant difference between groups. In the first group (n=25/32), 78.12% of patients were satisfied with the treatment, whereas in the second group (n=28/34) 82.35% were satisfied with the treatment, with no significant difference between groups.
DISCUSSION AND CONCLUSION: Considering its efficacy and safety, easy toleration, and few side effects, vaginal micronized progesterone may be a good alternative to oral preparations in the treatment of AUB.

GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý, acil departmanýnda (AD) pulmoner emboli (PE) tanýsý alan hastalarýn ilk baþvuru anýndaki þok indeksi (ÞÝ) deðer-leri ile hastane içi mortalite arasýndaki iliþkiyi incelemektir.
YÖNTEM ve GEREÇLER: Ýki yüz beþ hastanýn verileri retrospektif olarak analiz edildi. ÞÝ ile hastane içi mortalite arasýndaki iliþkiyi incelemek için lojistik regresyon modeli kullanýldý. Alýcý çalýþma karakteristik eðrisi kullanýlarak ÞÝ’nin hastane içi mortaliteyi tahmindeki kestirim deðeri hesaplandý.
BULGULAR: Çalýþmaya alýnan hastalarýn yaþ ortalamasý 67.1±16.6 olup bunlarýn 114’ü (%55.6) kadýn idi. Mortalite oraný %24.9 idi. Çok de-ðiþkenli lojistik regresyon modelinde hastane içi mortaliteyi öngörmede ÞÝ’nin anlamlý-baðýmsýz etkisi gözlendi (p<0.05). ÞÝ’nin hastane içi mortaliteyi belirlemede kestirim deðeri >0.87 olduðunda duyarlýlýðý %100.0, özgüllüðü %90,9, pozitif prediktif deðeri %78.5 ve negatif prediktif deðeri %100.0 bulundu.
TARTIÞMA ve SONUÇ: Þok indeksi; kolay, hýzlý ve ucuz olarak hesaplanabilir özelliklerine sahiptir. PE hastalarýnda SI kullanýlarak prognozun daha doðru tayini ile hastalara daha hýzlý ve doðru bir tedavi verilebilir ve böylece PE kaynaklý ölümlerin azalmasýna katký saðlanabilir.

INTRODUCTION: This study aimed to investigate the association between the shock index (SI) values at primary admission and inhospital mortality. Patients diagnosed with pulmonary embolism (PE) in the emergency department have been covering this study.
METHODS: Data of 205 patients were analyzed retrospectively. Logistic regression model was used to examine the relationship between SI and inhospital mortality. The predictive value of SI in estimating inhospital mortality was calculated using the receiver operating characteristic curve.
RESULTS: Patients’ mean age included in the study was 67.1±16.6, of which 114 (55.6%) were female. The mortality rate was 24.9%. A significant independent effect of SI was observed in predicting inhospital mortality during a multivariate logistic regression model (p<0.05). When the cutoff value of the SI in determining inhospital mortality is >0.87, the sensitivity of the score was found to be 100.0%, specificity 90.9%, negative predictive value 100.0%, and positive predictive value 78.5%.
DISCUSSION AND CONCLUSION: SI; It has features that can be calculated easily, quickly, and cheaply. By using SI in PE patients, more accurate prognosis can be determined, and a faster and more accurate treatment can be given to patients, thus contributing to the reduction of PE-related deaths.

GÝRÝÞ ve AMAÇ: KBH hastalarýnda hacim fazlalýðý sýklýkla gözlenir ve zamanla diyastolik disfonksiyona ve bunun devamýnda kalp yetmezliðine neden olabilir. Bu çalýþmada, sol ventrikül dolum basýncý ile iliþkili ve son zamanlarda kullanýma giren E/e’ oraný ile kalp yetmezliðinde önemli bir belirteç olan NT-proBNP arasýndaki iliþkiyi belirlemeyi amaçladýk.
YÖNTEM ve GEREÇLER: Çalýþmaya normal sol ventrikül ejeksiyon fraksiyonu olan ve kardiyovasküler hastalýðý olmayan (25 kadýn, 19 erkek) 44 övolemik KBH hastasý ve 26 saðlýklý gönüllü (15 kadýn, 11 erkek) dahil edildi. Plazma NT-proBNP seviyeleri ELISA yöntemiyle ölçüldü ve tüm katýlýmcýlar, NT-proBNP seviyeleri ile tepe erken diyastolik mitral hýz ile tepe erken diyastolik mitral anüler hýz oraný arasýndaki iliþkiyi araþtýrmak için transtorasik konvansiyonel doppler ve doku doppler ekokardiyografi ile deðerlendirildi (E/ e').
BULGULAR: Hasta grubu 25 kadýn (%56.8) ve 19 erkek (%43.2) olup, yaþ ortalamasý 59.36±9.26 yýl idi. Saðlýklý gönüllüler, yaþ ortalamasý 58.58±10.39 yýl olan 15 kadýn (%57.7) ve 11 erkek (%4.23) oluþturmuþtur. Hasta grubunda NT-proBNP düzeyleri ve E/e’ deðerleri kontrol grubuna göre daha yüksek bulundu (p<0.001). NT-proBNP için 300 pg/mL cut-off deðeri baz alýndýðýnda duyarlýlýk %53.66 ve özgüllük %100 olarak bulundu. E/e’ cut-off deðeri 15 ile duyarlýlýk %86.36 ve özgüllük %73.08 olarak belirlendi.
TARTIÞMA ve SONUÇ: Çalýþmamýzda NT-proBNP ve E/e’ deðerlerinin klinik kalp yetmezliði bulgusu olmayan kronik böbrek yetmezliði hastalarýnda diyas-tolik disfonksiyonu öngörmede önemli parametreler olduðu belirlendi. Hem NT-proBNP’nin hem de E/e’ oranýnýn klinik pratikteki yerini ve kullanýþlýlýðýný doðrulamak için bu konuyu araþtýran daha geniþ, kapsamlý ve ileriye dönük çalýþmalara ihtiyaç vardýr.

INTRODUCTION: Volume excess is frequently observed in chronic kidney disease (CKD) patients and over time may induce diastolic dysfunction and its continuation of cardiac failure. It was aimed to identify the correlation between E/e’ ratio, entering use in recent times and asso-ciated with left ventricle filling pressure, and NT-proB-type natriuretic peptide (proBNP), a substantial indicator in heart failure.
METHODS: The study included 44 euvolemic CKD patients with preserved left ventricular ejection fraction and without cardiovascular disease (25 women, 19 men) and 26 healthy controls (15 women, 11 men). NT-proBNP levels were measured with the ELISA method and all participants were assessed with transthoracic conventional Doppler and tissue Dop-pler echocardiography to examine the relationship between NT-proBNP values with E/e’ ra-tio which is the peak early diastolic mitral rate to peak early diastolic mitral annular velocity.
RESULTS: The patient group comprised 25 women (56.8%) and 19 men (43.2%) and the mean age was 59.36±9.26 years. Healthy controls comprised 15 women (57.7%) and 11 men (4.23%) with mean age of 56.58±10.39 years. NT-proBNP measurements and E/e’ ratios were concluded to be higher in the patient group compared to the control group (p<0.001). Taking cutoff value of 300 pg/mL for NT-proBNP as the basis, the sensitivity was 53.66% and specificity was 100%. With E/e’ cut-off value of 15, the sensitivity was 86.36% and specificity was identified as 73.08%.
DISCUSSION AND CONCLUSION: In our study, NT-proBNP and E/e’ values were identified to be important pa-rameters for the prediction of diastolic dysfunction in chronic renal failure patients without clinical findings of heart failure. Larger, extensive, comprehensive, and prospective studies investigating this issue are necessary to confirm the value and usefulness of both NT-proBNP and the E/e’ ratio in clinical practice.

GÝRÝÞ ve AMAÇ: Literatürde kýrýk riski ile kýrýlganlýk arasýndaki iliþkiyi deðerlendiren veri bulunmamaktadýr. Çalýþmamýzda FRAX adý verilen Kýrýk Riski Deðerlendirme Aracý ile kýrýlganlýk ve kýrýk riski arasýndaki iliþkinin deðerlendirilmesi amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Tek merkezli kesitsel bir çalýþmadýr. Çalýþmaya 65 yaþ ve üzeri toplam 120 hasta dahil edildi. Tüm hastalara kýrýlganlýk-larýný belirlemek için Kanada Saðlýk ve Yaþlanma Çalýþmasý (CHAS) Kriterleri uygulandý. Bu hastalarýn kýrýk riskleri, Kýrýk Riski Deðerlendirme Aracý (FRAX) uygulanarak tespit edildi. Plazma kalsiyum, 25-hidroksi D vitamini, albümin ve parathormon düzeyleri ölçüldü.
BULGULAR: Yüz yirmi hastanýn 78’i kadýn (%65) ve 42’si erkek (%35) olarak deðerlendirildi. Kýrýlganlýk ile FRAX arasýnda pozitif yönde anlamlý korelasyon saptandý (p<0.01). Kalça kýrýðý riski yüksek olan grupta kýrýlganlýk riski 1.228 kat daha yüksekti (p=0.023). Majör osteoporotik kýrýk riski açýsýndan yüksek risk altýnda olan grupta kýrýlganlýk riski 2,755 kat daha yüksekti (p=0.027).
TARTIÞMA ve SONUÇ: Altmýþ beþ yaþ ve üzeri bireylerde kýrýlganlýk ile FRAX ile deðerlendirilen kýrýk riski arasýnda pozitif bir iliþki vardýr. Kýrýlganlýk arttýkça majör osteoporotik kýrýk riski ve kalça kýrýðý riski de artmaktadýr.

INTRODUCTION: There is no information in the literature examining the relationship between frailty and fracture risk. Our study used the fracture risk assessment tool (FRAX) to assess the link between frailty and fracture risk.
METHODS: A single-center cross-sectional study. There were 120 patients overall who were 65 years of age or older. We assessed each patient’s frailty using the Canadian Health and ag-ing study (CHAS) Criteria. By using the FRAX, these patients’ fracture risks were identified (FRAX). Measurements were made of the amounts of albumin, parathormone, 25-hydrox-yvitamin D, calcium, and plasma.
RESULTS: Forty-two men and 78 women out of 120 patients were evaluated. Frailty and FRAX showed a substantial positive connection (p=0.01). Frailty risk was 1.228 times greater (p=0.023) in the group with a high risk of hip fracture. The risk of frailty was 2,755 times higher in the group, which is a high risk for significant osteoporotic fracture risk (p=0.027).
DISCUSSION AND CONCLUSION: There is a positive relationship between frailty and risk of fracture evaluated by FRAX in individuals aged 65 years or older. Hip fracture risk and significant osteoporotic fracture risk both rise with increasing frailty.

GÝRÝÞ ve AMAÇ: Sünnetin monosemptomatik enürezis üzerindeki etkisini incelemek. Faydalý mý yoksa travmatik mi sorunsalýný göz önünde bulundurarak deðerlendirmek.
YÖNTEM ve GEREÇLER: Kültürel ve dini nedenlerle sünnet için baþvuran 5-9 yaþ arasý toplam 130 erkek çocuk prospektif olarak incelendi ve dýþlama kriterlerinden sonra 107 erkek çocuk anestezi altýnda sünnet edildi. Olgular enürezis negatif ve enürezis pozitif olarak ikiye ayrýldý. Enürezis varlýðý ameliyat öncesi ve ameliyat sonrasý 3., 6. ve 9. aylarda deðerlendirildi.
BULGULAR: Tüm olgularýn ortalama yaþý 6.7 idi ve gruplar arasýnda anlamlý bir yaþ farký yoktu. Enürezisi pozitif grubun sünnet sonrasý enürezis durumu arasýnda anlamlý istatistiksel fark saptandý (p=0.001). Sünnetten öncesi haftalýk yatak ýslatma sayýsý ortalama 2.89 ve sünnet sonrasý 9. ayda 1.93 idi. Enürezisi negatif grupta sünnet sonrasý dönemde enürezis sýklýðýný artýrdýðýna dair istatistiksel olarak anlamlý bir sonuç bulunmadý.
TARTIÞMA ve SONUÇ: Sünnet, enürezis için predispozan bir faktör deðildir. Ayrýca, bu ameliyatýn monosemptomatik enürezis üzerinde olumlu etkisi ve yatak ýslatma sýklýðýnda azalma olmasý muhtemeldir.

INTRODUCTION: This study aims to examine the effect of circumcision on monosymptomatic enuresis and to evaluate by considering whether it is beneficial or traumatic.
METHODS: A total of 130 boys aged 5–9 years who applied for circumcision for cultural and religious reasons were prospectively analyzed and after exclusion criteria, 107 boys were circumcised under anesthesia. The cases were divided into enuresis negative and enuresis positive. The presence of enuresis was evaluated preoperatively and at the 3rd, 6th, and 9th months postoperatively.
RESULTS: The mean age of all cases was 6.7 years and there was no significant age difference between the groups. A statistically significant difference was found between the enuresis statuses of the enuresis-positive group after circumcision (p=0.001). The mean number of bedwetting before circumcision was 2.89 per week and 1.93 at the 9th month after circumcision. There was no statistically significant result that increased the frequency of enuresis in the enuresis-negative group in the post-circumcision period.
DISCUSSION AND CONCLUSION: Circumcision is not a predisposing factor for enuresis. Furthermore, this surgery is likely to positively affect monosymptomatic enuresis and a reduction in bedwetting frequency.

GÝRÝÞ ve AMAÇ: Hiperbilirubinemi geç preterm ve term bebeklerin en önemli sorunlarýndan biridir. Çalýþmamýzda kordon kaný bilirübin deðerleri, kordon kan gazý asidoz belirteçleri ile tedavi gerektiren hiperbilirubinemi arasýndaki iliþkiyi deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Çalýþmamýza 812 bebek dahil edildi. Göbek kordonu kan örneðinde bilirubin ve kan gazý parametreleri çalýþýldý. Bebekle-rin postnatal 0., 12., 24 ve 48. saatlerde transkutan (TcB) bilirubin düzeyleri ölçüldü. Transkutan bilirubin deðeri 75% persantil üzerindekiler çalýþma grubuna; altýndakiler ise kontrol grubuna dahil edildi. Bebeklerin demografik doðum kayýtlarýndan elde edildi.
BULGULAR: Bebeklerin ortalama gestasyon haftalarý 38.57±1.44 hafta, doðum tartýlarý ise 3265.99±482.14 gramdý. Bebeklerin ortalama pH, PCO2, HCO3, BE ve laktat ölçümleri sýrasýyla 7.28±0.06, 49.26±8.04 mmHg, 22.45±2.46 mmol/L, −3.99±2.45 mmol/L ve 2.91±1.108 mmol/L olarak saptandý. Ortalama kordon bilirubin deðeri 1.99±0.66 mg/dl idi. Postnatal 0., 12., 24. ve 48. saat transkutan bilirubin ölçümleri sýrasýyla 1.92±0.85, 3.75±1.26, 6.01±1.91 ve 8.63±2.36 mg/dl olarak saptandý. PN 0. saat TcB ile kordon bilirübini arasýnda istatistiksel anlamlý bir iliþki bulunmuþtur. Kordon bilirübin deðeri ile 0. saat TcB arasýnda yüksek korelasyon (r=0.638; p<0.01), kordon bilirübin ile 12., 24. ve 48. saat TcB arasýnda ise orta düzeyde korelasyon bulundu (r=0.573; p<0.01), (r=0.559; p<0.01) ve (r=0.482; p<0.01). Ciddi hiperbilirubinemi geliþen ve geliþmeyen bebeklerin pH, PCO2, HCO3 ve laktat ölçümleri, istatistiksel olarak anlamlý farklýlýk göstermemekte iken (p>0.05), baz açýðý ölçümleri hiperbilirubinemi geliþen grupta anlamlý düzeyde yüksek bulundu (p=0.001).
TARTIÞMA ve SONUÇ: Çalýþmamýzda 0. saat TcB ölçümü ile kord bilirübin ölçümleri arasýnda korelasyon olduðunu saptadýk. Postnatal 0.saat TcB ölçümü ciddi hiperbilirübinemi geliþimini öngörmede kullanýlabilir.Kan gazý baz açýðý düzeyi ile ciddi hiperbilirubinemi geliþimi arasýnda da anlamlý bir iliþki saptadýk. Kordon kaný baz açýðý deðeri hiperbilirübinemiyi öngörmede önemli olabilir.

INTRODUCTION: Hyperbilirubinemia is one of the most common problems of late preterm and term babies. The aim of our study was to evaluate the relation between cord blood bilirubin levels. blood gas parameters. and the development of significant hyperbilirubinemia.
METHODS: Our study included 812 babies who met the inclusion criteria. Umbilical cord blood bilirubin levels and blood gas analysis were determined. Transcutaneous bilirubin (TcB) values were recorded at postnatal 0, 12, 24, and 48 h. Babies with TcB levels above the 75% percentile were classified as severe hyperbilirubinemia; babies whose bilirubin level was below the 75% percentile were included in the control group. Demographic data were obtained from the birth records of babies.
RESULTS: The average birth weight and gestational age were 3265.99±482.14 g and 38.57±1.44 weeks. respectively. The mean pH, pCO2, HCO3, BE, and lactate levels were 7.28±0.06, 49.26±8.04, 22.45±2.46, −3.99±2.45, and 2.98±1.08, respectively. The mean cord bilirubin measurements were found to be 1.99±0.66 mg/dl. TcB levels at 0, 12, 24, and 48 h were found to be 1.92±0.85, 3.75±1.26, 6.01±1.91, and 8.63±2.36 mg/dl, respectively. We found a statistically significant correlation between PN 0 h TcB measurements and cord blood bilirubin levels. While cord blood bilirubin and PN 0 h TcB measurements were found to be highly correlated (r=0.638; p<0.01), cord blood bilirubin and 12, 24, and 48 h TcB measurements were moderately correlated (r=0.573; p<0.01), (r=0.559; p<0.01) (r=0.482; p<0.01). There was not any statistically significant difference regarding cord blood pH, PCO2, HCO3, and lactate levels between groups with or without significant hyperbilirubinemia (p>0.05). Only cord blood base access levels were found to be significantly higher in group with significant hyperbilirubinemia (p=0.001).
DISCUSSION AND CONCLUSION: We found a statistically significant correlation between PN 0 h TcB measurements and cord blood bilirubin levels. Postnatal 0 h TcB measurements may be used to screen significant hyperbilirubinemia. We also found a significant relation between cord blood base access levels and development of significant hyperbilirubinemia. Cord blood base access levels may help to screen significant hyperbilirubinemia.

GÝRÝÞ ve AMAÇ: COVID-19 pandemi periyodunun birinci pik dönemi ile bir önceki yýlýn ayný döneminde acil servislere baþvuran ve acil cerrahi servi-sine konsulte edilen hasta sayýlarýný ve daðýlýmýný karþýlaþtýrýlarak pandeminin etkisini deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Türkiye’nin nüfusu en fazla ili olan Ýstanbul’dur. Ýstanbul’da üçüncü basamak düzeyinde hizmet veren beþ hastanenin acil servisine baþvuran hastalar retrospektif olarak deðerlendirildi. Þubat-Haziran 2020 pandemi dönemi ve Þubat-Haziran 2019 pandemi öncesi dönemi olarak 2 gruba ayrýldý. Her iki dönemde de acil servisine baþvuran hastalar ile genel cerrahiye konsulte edile hasta sayýlarý ve geliþ nedenlerine göre daðýlýmlarý analiz edildi.
BULGULAR: 2020 yýlýndaki pandemi dönemindeki beþ aylýk dönem içinde acil servise baþvuran toplam hasta sayýsý pandemi dönemi ve 2019 yýlýndaki 5 aylýk dönem de pandemi öncesi için sýrasýyla 548509 ve 742064 idi. Acil genel cerrahiye baþvuran veya konsulte edilen toplam hasta sayýsý sýrasýyla 21399 ve 30868 idi. Toplamda acil servise gelen hasta sayýsýnda pandemi döneminde %26.1, acil genel cerrahiye konsulte edilen hasta sayýsýnda %30.7 azalma (p<0.001) görüldü. Pandemi döneminde de Acil cerrahi servisinde yapýlan toplam ameliyat sayýlarýnda %23.9 (p=0.62), travmaya baðlý yapýlan ameliyatlarda %11.9 (p=0.59) azalma görülmüþtür. Travma dýþý nedenlerle ameliyat edilen hasta sayýlarý pandemi döneminde %24.4 (p<0.004) azalýrken, konservatif takip edilen travma dýþý hasta sayýsý ise %54.6 (p<0.0001) artmýþtýr.
TARTIÞMA ve SONUÇ: Ýstanbul’da COVID-19 salgýnýnýn birinci pik döneminde üçüncü basamak hastanelerde acil servislere gelen hasta sayýlarý, acil cerrahi birimlerine baþvuran ve ameliyat edilen hasta sayýlarý azalmýþtýr. Travma ve travma dýþý nedeniyle acil cerrahi hasta ameliyat sayýlarýnda azalma saptanmýþtýr. Travma dýþý konservatif takip ve tedavi edilen acil cerrahi hasta sayýlarýndada artýþ izlenmiþtir.

INTRODUCTION: We aimed to evaluate the effect of the pandemic by comparing the number and distribution of patients who applied to the emergency services and were consulted to the emergency surgery service in the first peak period of the COVID-19 pandemic period with the same period of the previous year.
METHODS: Istanbul is the province with the highest population in Turkey. Patients who applied to the emergency departments of five hospitals serving at tertiary level in Istanbul were evaluated retrospectively. It was divided into two groups as the February–June 2020 pandemic period and the February–June 2019 pre-pandemic period. In both periods, the number of patients admitted to the emergency department and the number of patients who were consulted to general surgery and their distribution according to the reasons for their visit were analyzed.
RESULTS: The total number of patients admitted to the emergency department in the 5-month period during the pandemic period in 2020 was 548,509 and 742,064 for the pandemic period and the 5-month period in 2019, respectively. The total number of patients admitted or consulted to emergency general surgery was 21,399 and 30,868, respectively. In total, there was a 26.1% decrease in the number of patients who came to the emergency department during the pandemic period, and a 30.7% decrease in the number of patients consulted to the emergency general surgery (p<0.001). During the pandemic period, there was a decrease of 23.9% (p=0.62) in the total number of surgeries performed in the emergency surgery service, and 11.9% (p=0.59) in the surgeries performed due to trauma. The number of patients operated for non-traumatic reasons was 24% during the pandemic period. 0.4 (p<0.004) decreased, while the number of conservatively followed non-traumatic patients increased by 54.6% (p<0.0001).
DISCUSSION AND CONCLUSION: In the first peak period of the COVID-19 epidemic in Istanbul, the number of patients coming to the emergency services in tertiary hospitals and the number of patients admitted to emergency surgery units and operated on decreased. There was a decrease in the number of surgeries in emergency surgery patients due to trauma and non-traumatic. An increase was observed in the number of non-traumatic conservative follow-up and emergency surgery patients treated.

GÝRÝÞ ve AMAÇ: COVID-19 salgýný bireyleri sosyal, ekonomik ve ruhsal yönden etkilemektedir. Salgýnla birlikte uygulanan kýsýtlamalar ve karantina uygulamalarý bireylerin yaþam tarzýný ve beslenme alýþkanlýklarýný da deðiþtirmiþtir. Bu çalýþmanýn amacý; COVID-19 pandemisinin oluþturduðu korku ve bu korkunun beslenme alýþkanlýklarý üzerine etkisini incelemektir.
YÖNTEM ve GEREÇLER: Bu araþtýrma Saðlýk Bilimleri Üniversitesi Konya Eðitim Araþtýrma Hastanesi 78 no’lu Eðitim Aile Saðlýðý Merkezi’ne herhangi bir nedenle baþvuran ve çalýþmaya katýlmayý kabul eden 622 kiþi ile yapýldý. Çalýþmaya dahil edilen tüm hastalarýn antropometrik ölçümleri kaydedildi. Katýlýmcýlara sosyodemografik bilgi formu, Koronavirüs Fobisi Ölçeði ve Üç Faktörlü Beslenme Anketi doldurtuldu. Verilerin analizinde SPSS 22.0 programý kullanýldý.
BULGULAR: Çalýþmaya alýnan 18–65 yaþ arasý katýlýmcýlarýn %54.8’i (n=341) kadýn, %45.2’si (n=281) erkekti. Katýlýmcýlarýn yaþ ortalamasý 34.29±0.49 olarak bulundu. Koronavirüs Fobisi Ölçeði’nde psikolojik (p<0.001), somatik (p=0.002), sosyal (p=0.002), ekonomik (p=0.003) alt boyutlarda ve toplam puanda (p<0.001) kadýnlarýn puanlarý erkeklerden daha yüksek bulundu. Kronik hastalýðý olanlarýn Koronavirüs Fobisi Ölçeði’nin psikolojik (p=0.007), somatik (p<0.001), ekonomik alt boyutlarýnda (p=0.002) ve toplam (p=0.001) puanlarý daha yüksek bulun-du. COVID-19 testi pozitif olanlarýn (p=0.013) ve saðlýk çalýþanlarýnýn (p=0.001) duygusal yemek yeme seviyeleri daha yüksek bulundu. Üç Faktörlü Beslenme Anketi’nin toplam puanýyla Koronavirüs Fobisi Ölçeði’nin somatik (p<0.001), sosyal (p=0.004) ve ekonomik (p<0.001) alt boyutu arasýnda pozitif yönde korelasyon tespit edildi.
TARTIÞMA ve SONUÇ: COVID-19 korkusunun ileri yaþta, kadýn cinsiyette, kronik hastalýðý olanlarda, yakýnlarýnda COVID-19 hastasý olanlarda ve pandeminin ilk aylarýnda daha yüksek olduðu saptandý. COVID-19 fobisi yüksek olanlarda, 35 yaþ altýnda, kadýnlarda, saðlýk çalýþanlarýnda ve obezlerde duygusal yemek yeme seviyesi yüksek bulundu. COVID-19 pandemi döneminde riskli olan gruplarda psikiyatrik hastalýklar ve beslenme bozukluklarý için önleyici tedbirler alýnmasý önerilmektedir.

INTRODUCTION: Restrictions and quarantine practices imposed with the epidemic have also changed the lifestyle and food habits of individuals. The aim of this study is to examine the fear created by the coronavirus disease 2019 (COVID-19) pandemic and the effect of this fear on dietary habits.
METHODS: This research was conducted with 622 people who applied to the Health Sciences University Konya Training and Research Hospital Training Family Health Center No. 78 for any reason and agreed to participate in the study. Participants filled out the sociodemographic information form, Coronavirus Phobia Scale (C19P-S), and Three-Factor Eating Questionnaire (TFEQ). The SPSS 22.0 program was used for data analysis.
RESULTS: 54.8% (n=341) of the participants aged 18–65 included in the study were female and 45.2% (n=281) were male. In the C19P-S, scores of women in the subdimensions and their total score (p<0.005) were found to be higher than men. In the C19P-S, scores of those with chronic diseases in the psychological (p=0.007), somatic (p<0.001), and economic subdimensions (p=0.002) and their total score (p=0.001) were found to be higher. Emotional eating levels of those who test positive for COVID-19 (p=0.013) and health-care workers (p=0.001) were found to be higher. A positive correlation was detected between the total of the TFEQ and the somatic (p<0.001), social (p=0.004), and economic (p<0.001) subdimensions of the C19P-S.
DISCUSSION AND CONCLUSION: COVID-19 fear was found to be higher in the 1st month of the pandemic and in people who are older, female, who have chronic diseases, and COVID-19 patients nearby. Emotional eating levels were found to be high in those with high COVID-19 phobia, who are under 35 years old, women, health-care workers, and obese. During the COVID-19 pandemic period, it is recommended to take preventive measures for psychiatric diseases and nutrition disorders in risk groups.

GÝRÝÞ ve AMAÇ: Baðýþýklama çocuklarý çok ciddi hastalýklardan ve ölümden koruyan, bilinen en etkili koruyucu saðlýk önlemidir. Ancak gerek geliþmiþ gerek geliþmekte olan ve geliþmemiþ ülkelerde çeþitli nedenlerle ebeveynler çocuklarýný aþýlamaktan çekinebilmektedirler. Bu çalýþma ile konumu itibariyle her sosyoekonomik ve kültür düzeyinden hastalarýn baþvurduðu hastanemizde ebeveynlerin bu konudaki tutumlarýný raporlamayý hedefledik.
YÖNTEM ve GEREÇLER: Nisan 2016–Ekim 2016 tarihleri arasýnda 3.düzey eðitim araþtýrma hastanesinde çocuk polikliniklerine çeþitli nedenlerle baþvuran yaþlarý 0–14 arasýnda deðiþen çocuklarýn ebeveynlerine aþýlama konusundaki bilgi düzeylerini ve tutumlarýný deðerlendirmek amacýyla bir anket uygulandý.
BULGULAR: Çalýþmaya katýlan ebeveynlerin %98.1’nin Saðlýk Bakanlýðý aþý takvimini uyguladýklarý görülmüþtür. Ebeveynlerin %29.5’i aþýlama sonrasý yan etki gördüklerini belirtmiþtir. En sýk görülen yan etkiler sýrasýyla; ateþ (%19), aþý bölgesinde hassasiyet (%3.8), ishal (%2.9), aþý böl-gesinde kýzarýklýk (%1.9) ve havale (%1.9) olarak belirlenmiþtir. Ebeveynlerin %75.2’si aþýlar ile ilgili olumsuz bir þey duymadýklarýný belirtmiþtir. Bildirilen olumsuz etkiler ise sýrasýyla; ateþ (%4.8), alerji (%4.8), kusma (%3.8), kýsýrlýk (sterilite) (%3.8), felç (%2.9), havale (%1.9), otizm (%1), alüminyum içermesi (%1) ve hastalýk yapmasý (%1) olarak belirtilmiþtir. Ebeveynlerin %94.3’nün çocuklarýna aþý yaptýrmak istedikleri, %1.9’nun medyada çýkan olumsuz haberler nedeniyle, %1.9’nun doktorlar arasýnda farklý söylemler olmasý nedeniyle, %1.9’nin ise hastalýklarý doðal yolla geçirmenin daha doðru olduðunu düþünmeleri nedeniyle aþý yaptýrmak istemedikleri görülmüþtür.
TARTIÞMA ve SONUÇ: Bu çalýþmamýz ile ebeveynlerin çok büyük kýsmýnýn Saðlýk Bakanlýðý aþý takvimini uyguladýklarý görülmüþtür. Gerek bireysel gerek halk saðlýðýnýn korunmasý amacýyla aþýlamanýn önemini unutmamalý, bu konuda ebeveynlerin gereksiz ön yargýlarýný yok etmek için önlemler alýnmasý gerektiðini düþünmekteyiz.

INTRODUCTION: Immunization is the most effective preventive health measure known to protect children from serious diseases and death. However, in both developed and developing countries, parents may hesitate to vaccinate their children for various reasons. With this study, we aimed to report the attitudes of parents on this issue in our hospital, where patients from all socioeconomic and cultural levels applied due to its location.
METHODS: A questionnaire was applied to the parents of children aged 0–14 years, who applied to the pediatric outpatient clinics in the 3rd level education and research hospital between April 2016 and October 2016, to evaluate their knowledge and attitudes about vaccination.
RESULTS: It was observed that 98.1% of the parents participating in the study applied the Ministry of Health vaccination schedule. 29.5% of the parents stated that they experienced side effects after vaccination. The most common side effects are fever (19%), tenderness at the vaccination site (3.8%), diarrhea (2.9%), rash at the vaccination site (1.9%), and convulsion (1.9%), respectively. 75.2% of the parents stated that they did not hear anything negative about vaccines. The reported negative effects are fever (4.8%), allergy (4.8%), vomiting (3.8%), sterility (3.8%), paralysis (2.9%), seizure (1.9%), autism (1%), aluminum content (1%), and disease (1%), respectively. It was observed that 94.3% of the parents wanted their children to be vaccinated, 1.9% did not want to be vaccinated because of the negative news in the media, 1.9% because of different discourses among doctors, and 1.9% because they thought it would be better to pass the diseases naturally.
DISCUSSION AND CONCLUSION: It was seen that most of the parents applied the vaccination schedule of the Ministry of Health. We should not forget the importance of vaccination to protect both individual and public health, and measures should be taken to eliminate unnecessary prejudices of parents in this regard.

GÝRÝÞ ve AMAÇ: Hepatik steatoz (HS), canlý karaciðer donör adaylarýnýn deðerlendirilmesinde kritik bir unsurdur. Bu çalýþmada, bilgisayarlý tomografi (BT) tabanlý atenüasyon deðerlendirmelerini canlý karaciðer donör adaylarýnýn klinik parametreleriyle iliþkilendirirken karaciðer yaðlanmasýnýn öngörücülerini bulmayý amaçladýk.
YÖNTEM ve GEREÇLER: Çalýþmaya toplam 524 canlý karaciðer donör adayý dahil edildi. Bunlardan 227’si BT ile tespit edilen HS nedeniyle redde-dildi ve 297’si baþarýlý baðýþ süreci geçirdi. Bu iki grup, HS’nin öngörücülerini bulmak için BT tabanlý karaciðer atenüasyon indeksleri, klinik ve laboratuvar parametreleri açýsýndan istatistiksel olarak deðerlendirildi.
BULGULAR: Gruplar arasýnda düþük yoðunluklu lipoprotein, nötrofil sayýsý, nötrofil/lenfosit oraný, trombosit daðýlým geniþliði, trombosit sayýsý ve alfa fetoprotein dýþýndaki tüm laboratuvar parametreleri farklýydý (p<0.05). Kabul edilen vericilerde ortanca karaciðer atenüasyon deðeri 64, reddedilen vericilerde ise 51’di (p<0.001). Vücut kitle indeksi (BMI), HS için en yüksek tanýsal doðruluða sahipti ve bunu alanin aminotransferaz (ALT) izledi. BMI (%72 duyarlýlýk) için cut-off deðeri 26.3 kg/m2 ve ALT için 21 IU/L (%69 duyarlýlýk) idi.
TARTIÞMA ve SONUÇ: BMI >26.3 ve ALT >21, HS ile iyi koreledir ve daha uygun donör adayý varsa bu denekler daha sonra deðerlendirilmelidir.

INTRODUCTION: Hepatic steatosis (HS) is a critical element in evaluation of living liver donor candidates (LLDC). We aimed to find predictors of HS while correlating computed tomography (CT) based attenuation assessments with clinical parameters of LLDC.
METHODS: A total of 524 LLDC were included in the study. From those, 227 of them were declined due to HS detected by CT and 297 of them underwent successful donation process. These two groups were evaluated statistically in terms of CT based liver attenuation indices, clinical and laboratory parameters to find predictors of HS.
RESULTS: Other than low-density lipoprotein, neutrophil count, neutrophil/lymphocyte ratio, platelet distribution width, platelet count, and alpha fetoprotein, all of the laboratory parameters were different between the groups (p<0.05). The median liver attenuation value in accepted donors was 64 and in declined donors, it was 51 (p<0.001). Body mass index (BMI) had the highest diagnostic accuracy for HS followed by alanine aminotransferase (ALT). The cutoff value for BMI (72% sensitivity) was 26.3 kg/m2 and it was 21 IU/L for ALT (69% sensitivity).
DISCUSSION AND CONCLUSION: BMI>26.3 and ALT>21 correlate well with HS and those subjects should be evaluated later if more appropriate donor candidate is present.

GÝRÝÞ ve AMAÇ: Salgýn sürecinde koruyucu saðlýk hizmetleri önemli hale gelerek, salgýnýn önlenmesi ve kontrolünde aile hekimlerinin kilit rol oynadýðý görülmektedir. Dolayýsýyla bu çalýþma, aile saðlýðý merkezinde çalýþan hekimlerin Covid-19 pandemisinde aile hekimliði uygulamasý ve yönetimi iliþkin görüþlerini deðerlendirmek amacýyla yürütülmüþtür.
YÖNTEM ve GEREÇLER: Tanýmlayýcý ve kesitsel türden olan çalýþma, Türkiye’nin doðusunda yer alan iki ilde Eylül-Kasým 2021 tarihlerinde, 204 aile hekimiyle yürütüldü. Araþtýrma verileri anket formu ile toplandý. Veriler SPSS Windows 24.0 paket programýnda, sayý ve yüzdelik ile analiz edildi.
BULGULAR: Aile hekimlerinin %69.6’sý salgýnda binanýn fiziki yapýsý ve donanýmýnýn yetersiz olduðunu, %68’i bireysel koruyucu ekipman temininde sorun yaþadýðýný, %59.3’ü personel sýkýntýsý yaþadýðýný ve %96.6’sý salgýn koþullarýna baðlý hastalarý evde ziyaret edemediðini belirtti. Covid-19 salgýnýyla birlikte; %55.9’u etkin yönetimle birlikte nitelikli yöneticiye ihtiyaç olduðunu, %42.2’sý salgýnýn yönetimi ve kontrolü için sahadan hekimlerin görüþünün alýnmasý gerektiðini belirtti.
TARTIÞMA ve SONUÇ: Aile hekimleri salgýn sürecinde binalarýn fiziki yapýsý ve donanýmý, týbbi-araç gereç temini, personel sayýsý, evde hasta ziyaretleriyle ilgili bazý sorunlar yaþamýþtýr. Aile hekimleri salgýn yönetiminde etkin hizmet sunumunda yeterli kaynak desteðinin saðlanmasýný, iþ yükünün azaltýlmasýný, personel desteðinin saðlanmasýný, aile hekimliði politikalarýnýn yeniden oluþturulmasýný ve bu süreçte aile hekimlerinin görüþle-rinin alýnmasýný önermektedir.

INTRODUCTION: Preventive health services have become more important during the epidemics, and family physicians play a key role in the prevention and control of the epidemics. There-fore, this study was conducted to evaluate the opinions of physicians working at the family health centers on the practice and management of family medicine during the COVID-19 pandemic.
METHODS: The descriptive and cross-sectional study was conducted with 204 family physicians in two provinces in the east of Turkey between September and November 2021. The study data were collected using a questionnaire. The data were analyzed by number and percentage distributions.
RESULTS: The descriptive and cross-sectional study was conducted with 204 family physicians in two provinces in the east of Turkey between September and November 2021. The study data were collected using a questionnaire. The data were analyzed by number and percentage distributions.
DISCUSSION AND CONCLUSION: There were some problems in the family health centers regarding the equipment and physical structure of buildings, the supply of personal and protective equipment, the number of staff, and home visits to patients during the COVID-19 pandemic. Furthermore, family physicians recommend providing adequate resource support in effective service delivery in epidemic management, reducing the workload, providing personnel support, re-forming family medicine policies, and taking the opinions of family physicians in this process.

GÝRÝÞ ve AMAÇ: Çocuklarda trakeotomi için en önemli endikasyon kardiyopulmoner ve nörolojik hastalýklar nedeniyle uzun süreli entübasyondur. Pediatrik trakeostomi %10 ile %58 arasýnda deðiþen bir komplikasyon oraný ve %0 ile %3,6 arasýnda deðiþen bir ölüm oraný ortaya koymaktadýr. 12 yýllýk trakeostomi deneyimlerimizi anlatmayý amaçladýk.
YÖNTEM ve GEREÇLER: Bu çalýþma, Türkiye’de Çocuk Cerrahisi Kliniðimizde 2009-2021 yýllarý arasýnda trakeostomi uygulanan çocuk hastalarýn týbbi kayýtlarýnýn retrospektif olarak incelenmesidir.
BULGULAR: Bölümümüzde 12 yýl boyunca 37 çocuða trakeostomi açýldý. 17’si erkek (%45.9), 20’si kadýn (%54.1) idi. Ortanca trakeostomi yaþý 5 aylýktý (min: 2ay-maks: 14yýl). Acil trakeostomi 8’inde (%21,6), planlanan trakeostomi 29’unda (%78,4) yapýldý. Ameliyat sýrasýnda ve ame-liyat sonrasý erken günlerde 34 hastada (%91,9) herhangi bir sorun yaþanmadý, trakeal atrezili 2 yenidoðan (%5,4) birinci ve ikinci günlerde kaybedildi. Bir hastada pansuman sýrasýnda kanülün yanlýþ yerleþtirilmesi nedeniyle desatüre (%2.7) oldu, kanül entübasyondan sonra tekrar güvenli bir þekilde yerleþtirildi. Trakeostomi komplikasyonlarý olarak 2-kanül çýkmasý, 1-granülasyon, 2-kanül oklüzyonu (biri postoperatif 2.günde ve diðeri ise postoperatif 10.günde) görüldü. 23 olgu (%62.2) hayatta kaldý, 14 olgu (%37.8) kaybedildi. Hayatta kalan hastalardan 3 yýl sonra KDH’li bir erkek çocukta ve EA+Distal TEF+Þiddetli Trakeomalazi+Fallot Tetralojisi olan bir kýz çocuðunda iki trakeostomi kapatýldý.
TARTIÞMA ve SONUÇ: Pediatrik trakeotomi, uygun cerrahi teknik ve yeterli postoperatif bakým ile minimal komplikasyon oranlarý ile baþarýyla gerçekleþtirilebilir.

INTRODUCTION: The most important indication for tracheotomy in children is long-term intubation due to cardiopulmonary and neurological diseases. Pediatric tracheostomy is associated with varying complication (10–58%) and mortality (0–3.6%) rates. Herein, we aimed to pres-ent the results of our 12 years of pediatric tracheostomy experience.
METHODS: This was a retrospective study of medical records of pediatric patients who underwent tracheostomy in our pediatric surgery department from 2009 to 2021.
RESULTS: During 12 years, 37 tracheostomies were performed in 17 (45.9%) males and 20 (54.1%) female children, and the median age was 5 months (min: 2 months–14 years). Emergency tracheostomy was performed in 8 (21.6%), while planned tracheostomy in 29 (78.4%). During the operation and early postoperative days, any medical problem was detected in 34 (91.9%) patients, while 2 (5.4%) neonates with tracheal atresia were lost in the first and second postoperative days. One patient was desaturated (2.7%) due to decannulation during the tracheostomy dressing; however, tracheostomy cannula was safely inserted again after intratracheal intubation. Two cannulas were removed; granulation tissue was formed in 1 case, and occlusion of the cannula was observed in 2 cases (one on the post-operative 2nd day, and the second one on the post-operative 10th day) as complications of tracheostomy. Twenty-three patients (62.2%) survived, and 14 (37.8%) patients died. Among the surviving patients, two tracheostomies were closed in a boy (with congenital diaphragmatic hernia), and in a girl (with esophageal atresia, distal tracheoesophageal fistula, severe tracheomalacia, and Fallot tetralogy), 3 years postoperatively.
DISCUSSION AND CONCLUSION: Pediatric tracheotomy can be successfully performed with minimal complication rates through appropriate surgical technique and adequate postoperative care.

Amaç: 19. yüzyýldan beri birçok hastalýða karþý çok etkili bir silah olmasýna raðmen, aþýlar dünya çapýnda birçok insan için tartýþmalý olmuþtur. Bu tereddütlü yaklaþým her zaman birey ve toplum saðlýðýný tehdit etmiþtir. Bu çalýþma, aþý tereddüdünü, tarihsel kökenini kapsamlý bir þekilde tanýmlamayý ve COVID-19”un yaný sýra çocukluk çaðý aþýlarýnýn yaygýnlýðýný ortaya çýkarmayý amaçlamaktadýr. Ayrýca, aþý tereddüdü sorunlarýna sürekli olarak tanýklýk eden hekimler için faydalý olabilecek birkaç yöntem sunmayý amaçladýk.

Gereç ve Yöntem: PubMed’de ve Google Akademik’de yayýnlanan ‘aþý tereddüdü ve COVID-19’u kapsayan literatür verileri, yazarlar tarafýndan baðýmsýz ve toplu olarak gözden geçirildi. Veriler, son 20 yýlda yayýnlanan 28 çalýþmadan Pubmed ve Google Akademik aracýlýðýyla toplanmýþtýr.

Bulgular: Bu derlemede, aþý tereddüdü ve bu fenomenin hikayesi, insanlarýn bu fikri neden geniþ kanýtlara raðmen benimsediði açýklanmakta-dýr. Takipte, aþý tereddüdünün tüm dünyada yaygýnlýðý ve saðlýk üzerindeki etkilerini azaltmak için neler yapýlabileceði tartýþýlmaktadýr.

Sonuç: Aþý tereddüdü günümüzde büyüyen, karmaþýk ve toplumsal bir saðlýk sorunu haline gelmiþtir. Aþý ile önlenebilir hastalýklarýn artmasý gibi halk saðlýðý için uzun vadeli sonuçlara neden olabilir. Örneðin CASE (Corroborate, About me, Science, Explain) ve SAGE (Strategic Advisory Group of Experts)’den öneriler gibi geliþtirilmiþ bazý yöntemlerle ele alýnabilir.

Objective: Despite being a very effective weapon against many diseases since the 19th century, vaccines have been controversial for many people across the world. This hesitant approach has always threatened individual and community health. This study aims to com-prehensively identify vaccine hesitancy, and its historical root and reveal the prevalence of hesitancy against COVID-19 vaccines as well as childhood vaccines. Furthermore, we aimed to offer several methods that can be beneficial for physicians who are consistently testifying to the problems of vaccine hesitancy.

Methods: Literature data published in PubMed and Google Scholar that covered “vaccine hesitancy and COVID-19” was reviewed by the authors independently and collectively. The data were collected from the 28 studies published in the past 20 years through Pubmed and Google Scholar.

Results: In this review, vaccine hesitancy and the story of this phenomenon are explained, along with why people embrace the idea despite ample evidence. Following up, the prevalence of vaccine hesitancy around the world and what can be done to diminish its effects on health are discussed.

Conclusion: Vaccine hesitancy has been a growing, complex and societal health-care problem nowadays. It may cause long-term consequences for public health, for example, the rise of vaccine-preventable diseases. It might be dealt with some methods that have been developed for instance Corroborate, About me, Science, Explain and recommendations from Strategic Advisory Group of Experts (SAGE).