Search

Objective: Resistant gram-negative bacterial infections that cause hospital-acquired infections are becoming increasingly problematic. Due to the carbapenem resistance that develops in these bacteria, treatment options are restricted, the duration of hospitalization is longer and the mortality increases. This requires the addition of options such as tigecycline and colistin to treatment. The aim of this study is to determine the susceptibility of gram-negative bacteria isolated from various clinical specimens in a private hospital and to determine the appropriate antibiotics in patients. Methods: In our study, 1109 bacterial strains which were produced in various clinical samples were examined in Private Kadıköy Florence Nightingale Hospital between February 2018 and February 2019. Bacteria in the samples are defined in accordance with the recommendations of the manufacturer of the conventional methods, Vitec 2 (Biomeriux, France) automated system. Sensitivity tests were performed by Vitec 2 (Biomeriux, France) automated system and interpreted according to EUCAST criteria. The data were retrospectively evaluated. Results: The most common samples of the study were blood and urine. The most effective antibiotics for Escherichia coli (50.9%), based on the type and sensibility of the identified bacterides, were meropenem (99.6%), imipenem (99.2%), fosfomycin (98.5%), amikacin (96.7%), colistin (98.3%), tigecycline (96.7%). Klebsiella spp. the most effective antibiotics were amikacin (95.2%) and meropenem (92.6%), imipenem (92%), colistin (95.8%) and tigecycline (96.7%). The most effective antibiotics for Proteus spp. were meropenem (95.7%), piperacillin/tazobactam (95.7%) and phosphomycin (91.2%). The sensitivity of tigecycline was found to be 15.4%. The most effective antibiotics for Enterobacter spp. were imipenem (100%), amikacin (100%) and ciprofloxacin (93.1%). The most effective antibiotics for Pseudomonas aeruginosa were amikacin (80.3%), ciprofloxacin (77.4%), colistin (94.7%) was determined. Conclusion: Each center is supposed to know the distribution of gram-negative bacteria, resistance patterns and changes in years, isolated from their own clinical samples. In order to prevent hospital infections and antibiotics, there must be an antibiotic management plan under the responsibility of the infection control committee that is applied by the hospital. [ABSTRACT FROM AUTHOR]

Objective: Hemifacial spasm (HFS) is a movement disorder of the seventh nerve which is characterised by involuntary clonic or tonic contractions of the muscles innervated by the facial nerve. In this study, we aimed to search whether there was a relationship between vitamin D status and severity of disease. Methods: Forty-six HFS patients were included to the study, who have been followed up in University of Health Sciences Antalya Training and Research Hospital, Neurology Department Movement Disorders outpatient clinic. Patients were regularly receiving botulinum toxin injections. Demographic features and vitamin D, calcium and phosphate levels were measured in winter. Severity of disease was rated on a 0-4 scale. The relationship between vitamin D status and the severity of disease was evaluated. Results: The mean age of the patients was 59.58±9.8 years. Thirty-five patients (76.1%) were female and 11 patients (23.9%) were male. Mean duration of disease was 5.30±4.59 years. Moderate and severe functional impairment were seen in most of the patients (n:18 (39.1%), moderate); n:15 (32.6%), severe, respectively). There was no significant difference between duration and severity of disease (p=0.512). Vitamin D levels were compared between four groups according to severity of disease scale and there was no significant difference (p=0.291). Conclusion: Even though there was no relationship between the severity of HFS and vitamin D status, further controlled studies in a larger population were needed to enlighten this finding. [ABSTRACT FROM AUTHOR]

Objective: Carpal tunnel syndrome (CTS) is diagnosed by clinical findings, physical examination and electromyography (EMG). Body mass index (BMI) is an important risk factor in the development of CTS. Numerous factors such as diabetes, hypothyroidism, hormone replacement therapy and corticosteroid use cause carpal tunnel syndrome. Metabolic syndrome components have been reported as the causes of carpal tunnel syndrome. However, there are few studies on the relationship between CTS and metabolic syndrome. In this study, we aimed to reveal the relationship between metabolic syndrome and carpal tunnel syndrome. Methods: A total of 160 (30 male and 130 female) right-hand dominant patients, who were referred to our EMG laboratory with CTS pre-diagnosis and electrophysiologically diagnosis verification of CTS, were included in the study. Patients were divided into two groups as those with metabolic syndrome and those without metabolic syndrome, according to the 2005 International Diabetes Federation metabolic syndrome diagnosis criteria. Age, gender, dominant and affected hands, height, and weight of all patients were recorded. The relation between metabolic syndrome and CTS was statistically compared in patients grouped as mild, moderate and severe according to electrophysiological evaluation. Results: Mean age of the patients included in the study was 46.49±11.75 years, and 130 (81.3%) of them were female. Average BMI of all patients was 29.80±5.28. Of the patients, 58.8% (n=94) was diagnosed with metabolic syndrome. Metabolic syndrome was present in 83 (75.5%) out of 110 patients with electrophysiologically diagnosed CTS. Metabolic syndrome was found in 11 (22%) of 50 patients with no CTS electrophysiologically. A significant relationship was found between metabolic syndrome and CTS. Conclusion: As a result, the metabolic syndrome is higher in patients electrophysiologically diagnosed with CTS. In obese patients with CTS, the risk of having metabolic syndrome should be considered, and correct referral should be made in addition to the treatment that may be applied for CTS. [ABSTRACT FROM AUTHOR]

Objective: Investigation of the prevalence of Charles Bonnet syndrome (CBS) among cases with low visual acuity. Methods: Patients admitted to İstanbul Medipol University Ophthalmology Clinic were investigated retrospectively from the outpatient clinic records. Patients with best corrected visual acuity of 0.3 or less were noted in the screening results, and were examined for CBS at the next follow-up examinations. Visual acuity measurements were done according to the Snellen chart. Patients with schizophrenia, depression and alcohol use were not included in the study. Only cases with complex visual hallucinations were evaluated as CBS. Patients with simple visual hallucinations such as lightning flashes or light rays were not considered to be CBS. Results: As a result of the investigation, 208 cases compliant with visual loss were detected. In the follow-up examinations of these patients, there CBS findings were observed in 12 patients. The mean age of these cases was 71±1.4 (between 61-77) years. Seven patients (58.3%) were female and 5 patients (41.7%) were male. Conclusion: CBS is a relatively common disease which should not be underestimated among low vision patients. We think that the diagnosis of the disease is extremely important for avoiding the medico-social problems due to hallucinations as well as the negative conditions caused by the existing ocular diseases of these group of patients. [ABSTRACT FROM AUTHOR]

Objective: Coronary artery abnormalities (CAA) are critical complication of Kawasaki disease (KD). Several inflammatory biomarkers have been identified for occurrence and progression of KD. Discovering new biomarkers of inflammation becomes important in order to help diagnostic accuracy of CAA and to provide prognostic information for KD. LMR, are simple and inexpensive methods for assessing inflammation, which have been also investigated as predictors of several cancers, cardiovascular and inflammatory diseases. In this study we aimed to investigate whether LMR is a risk factor of CAA of KD. Methods: We retrospectively reviewed patients with KD from 2005 to 2016. Demographic features, diagnostic clinical features of KD, laboratory findings, complications were recorded prior to IVIG administration. The patients were divided into two groups according to the development of CAA. The LMR was calculated by dividing the number of lymphocytes by the number of monocytes in the peripheral blood count. To identify CAAs risk factors, and to exclude the possible influence of other variables, multivariate analysis was performed by entering significant variables from the univariate analyses. Results: LMR was significantly lower in patients with CAA comparison to the patients without CAA (p<0.05). LMR was found as the only independent variable in multivariate analysis to determine CAA. Conclusion: The findings of this study showed a relationship between lower LMR and a high risk of CAA in children with KD. We suppose that LMR can be used as a predictor of coronary arter involvement in KD as a readily available and inexpensive marker in clinical practice. [ABSTRACT FROM AUTHOR]

Objective: In acromegaly, the incidence of cardiovascular disease is higher compared to healthy population because of the association of secondary cardiovascular disease risk factors such as hypertension, glucose intolerance, dyslipidemia, and insulin resistance. This study aimed to evaluate the relationship between Growth Hormone (GH), Insulin-like Growth Factor-1 (IGF-1), and lipid profiles in patients with newly diagnosed acromegaly. Methods: This study included 57 newly diagnosed acromegaly patients and 31 healthy control cases. Blood samples were taken after a 12-hour night fasting to analyze the levels of the hormones, the lipid profiles, and the fasting blood glucose. Results: The mean of LDL-C level in the acromegaly group and control group were respectively 140.2±61.3 mg/dL and 115.6±30.4 mg/dL, (p=0.029), triglyceride level 137.6±84.0 mg/dL and 102.9±43.0 mg/dL, (p=0.027) and HDL-C level 41.5±10.5 mg/dL and 50.5±10.6 mg/dL, (p=0.001). There was a significant positive correlation between GH levels of LDL (r=0.375, p=0.002), TG (r=0.302, p=0.01), IGF-1 (r=0.634, p=0.0001) and HOMA-IR (r=0.699, p=0.0001), IGF-1 and LDL levels (r=0.295, p=0.01) and TG (r=0.476, p=0.0001). There was a negative correlation between HDL and GH (r=-0.399, p=0.001) and HDL with IGF-1 (r=-0.310, p=0.01). Conclusions: Acromegaly is a disorder characterized by an excess of GH and GH appears to adversely affect the lipid profile. It can be considered that this risk factor may be eliminated by the control of the levels of GH and IGF-1 in acromegaly patients. Further studies seem necessary for more clarifica-tion. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the characteristics of suicide attempts in children and adolescents who were followed up and treated as a result of suicide attempts and to pay attention to the subject. Methods: We aimed to evaluate the socio-demographic and clinical characteristics of children and adolescents who were hospitalized in the Pediatric Intensive Care Unit of Erciyes University Faculty of Medicine between 2010 and 2015. Also we determined triggering factors, the nature of suicide attempt, drug use. Results: The study included 52 cases with a mean age of 14.5±1.2 years (min: 10.5-maks: 17) and 46 girls (88.5%). Twenty-four (46.1%) of the patients attempted suicide by taking one drug, 28 (53.9%) attempted suicide by taking multiple drugs. Analgesics (42.3%) are the most frequently taken drug group, respectively anti-depressants (28.8%), antihypertensives (15.3%) followed it up. In 24 (46.1%) patients psychiatric evaluations performed during the hospitalization period and no mental problems were detected and they were evaluated as impulsive suicides. Major depression (28.8%) was the most frequent mental disorder in the cases, followed by conduct disorder (11.5%), adjustment disorder (7.6%), impulse control disorder (3.8%). The most common trigger factor was family conflict (53.8%). Conclusion: Identifying the characteristics of suicide attempts and identifying risk factors will guide the follow-up of the cases and take protective measures. It is especially important for adolescents with depression to closely monitor and treat it. In addition, adolescents and families need to be supported in order to prevent impulsive suicide attempts. Precautions should be taken to prevent the access of adolescents to drugs within and outside the home. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine the patients who were followed up and treated in pediatric emergency service due to foreign body aspiration. Methods: Patients admitted to Erciyes University Pediatric Emergency Unit in 2017 due to foreign body aspiration were evaluated retrospectively. Results: 23.9% of the patients in the study were female and 76.1% were male and 76.1% was under three years old. The ages of the patients were between 7 and 72 months. Duration of admission to hospital after aspiration was between 15 minutes and 22 days. The most common symptom of patients was coughing (%38) and the most frequent finding of physical examination was unilateral decrease in breathing sounds (47.6%). The most common symptom of lung graph was elevation of ventilation (61.9%) and 30.9% of the patient's chest X-ray was normal. Bronchoscopy was performed in all 42 patients. Sunflower (33.3%) seed were found as the most common aspirated foreign body. The right main bronchus (33.3%) was the most common area where the foreign bodies were found. Conclusion: To suspect foreign body and getting a good medical history are the most important step in foreign body aspiration. According to our study, especially in the event of a choking cough, which starts in the story of boys under 3 years of age while playing games or eating food, the clinician must suspect foreign body aspiration. Normal radiological images do not exclude foreign body aspiration. Emergency bronchoscopy reduces morbidity and mortality in all suspected cases. [ABSTRACT FROM AUTHOR]

Objective: In this study we aimed to investigate whether there is a difference in osteoporosis detection rates with dual energy x-ray absorbsiometry (DXA) and Quantitative Computed Tomography (QCT) and relationship between bone-related biochemical markers. Methods: 34 postmenopausal women who admitted to Physical Medicine and Rehabilitation Clinic with complaints of dorsalgia. Lumbar and thoracal X-rays were obtained in all patients. Bone mineral density measurements were performed with DXA and QCT. Therefore, osteoporosis and osteopenia rates were detected. Serum levels of calcium, phosphorus, bone-spesific alkaline phosphatase (BAP), osteocalcin, parathormone, calcitonin and 25-OH vitamin D3 were measured. Results: The mean age of patients was 63.44+9.34 years. L2-L4 vertebrae T-score in 6/34 (17.64%) patients and Femoral neck T-score in 3/34 (8.82%) patients were <2.5 in DXA evaluation. With QCT evaluation, L2-L4 vertebrae T-score in 31/34 (91.1%) patients and femoral neck T-score in 2/34 (5.88%) patients were <2.5. Osteoporosis detection rates were higher with QCT compared to DXA and it was found statistically significant (p<0.005). Statistically significant relationship was found between lumbar and femur T scores of bone mineral density and calcitonin (p<0.005). Conclusion: Osteoporosis detection rates were higher with QCT compared to DXA. QCT seems to be more valuable to detect osteoporosis. [ABSTRACT FROM AUTHOR]

Objective: Schizophrenia is a chronical disorder that commonly starts in younger ages, leads to disability and early death. From the onset of the disease, close follow-up for general medical condition is of vital importance in prevention of pysical illnesses and extention of the lifetime as well as psycological benefits. In our study, the determination of physical comorbidity and causes of death among schizophrenia patients who hospitalized for treatment in chronic psychiatry services was aimed. Methods: The files of 45 patients, hospitalized and treated at least five years in Bakirkoy Prof. Dr. Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery chronic psychiatry services between January 2006 and January 2013, diagnosed as schizophrenia according to the diagnostic criteria of DSM IV-TR, who died while their treatment and follow-up continuing were scanned retrospectively. Physical comorbidity present in admission files were determined according to ICD 10 diagnosis system. The sociodemographical and clinical findings were recorded to the data scan form prepared by researchers. The approval was got from ethical committee of our hospital. The data were analyzed by using statistical methods. Results: The patient with a mean age of death was 58.8±9.2 (range= 39-76). In 28.9% (n=13), there was falling story. The most common seen physical illnesses were; in 37.8% (n=17) chronic obstructive lung disease, in 33.3% (n=15) hypertension, in 17.8% (n=8) stroke and in 17.8% (n=8) coronary artery disease. It is determined that 48.9% (n=22) of the patients died because of circulating system disorders, 33.3% (n=15) died because of respiratory system disorders and 13.3% (n=6) died because of falling and secondary to trauma. Discussion: According to our findings, schizophrenia patients hospitalized and treated in chronic psychiatry services die at earlier ages than general population. Physical comorbidity and risk of fall trauma are high. The most common causes of death are circulating and respiratory system disorders. Results should be supported with prospective and comparative studies having more population numbers. [ABSTRACT FROM AUTHOR]

Objective: To determine the incidence of incidental prostate cancer and its association with prostate specific antigen (PSA) as a result of final pathological examinations of patients undergoing open prostatectomy. Methods: The data of 124 patients who underwent open prostatectomy between 2008 and 2018 were analyzed retrospectively. Demographic information, preoperative PSA values, transrectal prostate needle biopsy (TRIB) results, prostate size and final pathology results were analyzed. Results: As a result of open prostatectomy specimens, benign prostatic hyperplasia was detected in all patients and prostate adenocancer was detected in 5 (4%) and chronic prostatitis in 68 (54.8%) patients. All patients with prostate cancer had preoperative TRIB and the mean PSA and prostate size were 10 ± 5.4 ng/mL, 134 ± 29.6 g, respectively. No significant difference was found between preoperative PSA values and prostate sizes in patients with and without prostate cancer (p>0.05). Incidental prostate cancer was in the Gleason 3+3=6 pattern in all patients and no increase in PSA was observed in any patient. Conclusion: The incidental prostate cancer rate found in our study was lower than the literature. In the pathology specimen, patients with incidental prostate cancer, especially those with low grade, can be followed without additional treatment. [ABSTRACT FROM AUTHOR]

Objective: Lymph node metastasis is known to be an important prognostic factor in the gastric cancers. In different staging classifications, the nodal involvement is evaluated in terms of the location and/or number of the metastatic lymph nodes. However, in the Western countries the minimum number of 15 lymph nodes required for an evaluation has been obtained in only 30% of the radical resections performed in the gastric cancer cases; and due to the heterogeneous survival responses in the same stage patients and the phase shifts, use of the metastatic lymph node ratio (N-ratio) rather than of the total number of positive nodes has recently been recommended for the nodal evaluation. In this study, our main objective is to retrospectively analyze the effect of the prognostic parameters to the five-year survival in the gastric cancers, and to particularly investigate the prognostic value of the N-ratio. Methods: The clinical records and the pathology and operation reports of the 511 patients who underwent curative surgery with a diagnosis of gastric cancer between January 2002 and December 2009 were analyzed retrospectively. The Kaplan-Meier estimator was used in the calculation of survival. The effects of the existing prognostic factors to the five-year survival were studied in univariate analyses (log-rank test) and in multivariate analyses (Cox regression model). The results were examined in a 95% confidence interval and at a p<0.05 significance level. In the N-ratio classification, the cut-off values of N0 (0%), N1 (1-10%), N2 (11-25%), and N3 (25-100%) were used. Results: The general rates of five-year survival were calculated as N0=74.3%, N1=66.3%, N2=59.8%, and N3=30%. When the N-ratio survival rates were compared by log-rank test, a statistically significant difference was observed among the five-year survival rates (p<0.001). The multivariate analysis (Cox regression model) involving all the prognostic factors showed that, in addition to the pT and N stages, the N-ratio was an effective independent prognostic factor in the five-year survival of the gastric cancer patients who underwent a radical resection (p<0.01). In multivariate statistical analyses in which the 6th and 7th AJCC/UICC pathological staging classifications effective to the five-year survival in the univariate analyses, and the N-ratio were involved, the N-ratio was found to be the only independent prognostic factor effecting the survival (p=0.008). Conclusion: The N-ratio is an easy, practical, effective and rational prognostic indicator in the gastric cancers with a lymph-node metastasis. [ABSTRACT FROM AUTHOR]

Objective: Retention cysts and rhinosinusitis is seen separately frequent in otorhinolaryngology practice. In this study, the coexistence of retention cysts and rhinosinusitis is evaluated and discussed in scope of literature. Methods: All cases who admitted to our tertiary hospital between January 2010 and December 2016 who had paranasal sinus computed tomography for any reason included in the study. All cases was recorded in terms of age, gender, presence of retention cyst and if present which side and Lund-Mackay scores of two sides. Patients were evaluated for existence of retention cyst and rhinosinusitis. Rhinosinusitis evaluation was made with Lund-Mackay score. Cases were evaluated for the statistically significance relationship between retention cyst and Lund-Mackay scores. Results: Six hundred cases included in the study. In 36.2% (n=217) of the reviewed 600 computed tomography scans, retention cyst was present and 63.8% (n=383) retention cyst was not present. Among retention cyst positive cases, 82 (37.9%) was right sided, 68 (31.4%) was left sided and 66 (30.5%) was bilateral. According to the Lund-Mackay score, 2.7% (n=130) case was valued as grade 1, 13.2% (n=79) case was valued as grade 2. In the light of this information, there seems to be a statistically significant relationship between the side with retention cyst and Lund-Mackay score. (p<0.01). Conclusion: Lund-Mackay scores of the retention cyst sinus side was statistically significant high in our study (p<0.01). In this context there was significant relationship between rhinosinusitis and presence of retention cyst. However, because there is opposed data in the literature, further study is required to investigate the relationship of rhinosinusitis and retention cysts. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine the frequency, clinical and demographic characteristics of inpatients in pediatric rehabilitation services. Methods: One hundred and fifty-three inpatients were evaluated. The gender, age, type of disease, etiology, orthoses, deformities, duration of hospitalization were recorded. Results: The mean age of one hundred and fifty-three patients (92 male, 61 female) was 5.5±3.7 years. The most commonly seen disorder was cerebral palsy with a 66.7% percentage. Spina bifida was noted as the second most common disease (8.5%). While the most common etiologic causes were prematurity in the prenatal period (45.8%), convulsion (36.6%) and trauma (10%) in the postnatal period. 81% of the patients had a foot deformity and 39.9% of them were using an Ankle Foot Orthosis (AFO). The other deformities and frequencies were noted as 57.5% knee deformity, 49% hip deformity, 23% upper extremity deformity and 11.8% axial deformities. 19% of the patients have had an operative procedure. Mean hospital stay duration was 36.3±3.7 months. Conclusion: The majority of patients in the pediatric rehabilitation service were patients with cerebral palsy, while one third were patients with other neurodevelopmental disorders. This study is important to determine the diseases of inpatients and to be aware of the existing deformities and orthoses. [ABSTRACT FROM AUTHOR]

Objective: The study was conducted to determine upper extremity problems and quality of life in patients with breast cancer who underwent breast surgery and axillary dissection. Methods: This descriptive and cross-sectional research was included 64 patients who admitted for outpatient clinic between 01.01.2015-01.01.2016 in university hospital in western of Turkey and previously undergone surgery for breast cancer. The data was collected personal information form, Shoulder Pain and Disability Index (SPADI) the Shortened Disabilities of the Arm, Shoulder and Hand Questionnaire (Q-DASH), Breast Cancer Module Quality of Life Scale (EORTC QLQ-BR23) and Short Form-36 (SF-36). Statistical analyses were performed using descriptive statistics, Chi Ssquare test, Mann Whitney U test, Kruskal Walles test and the Spearman's correlation coefficient. Results: Mean age of the study group was 52.36±12.25 years. It was found that 54.7% of the patients were applied modified radical mastectomy and axillary dissection, and average time passed after surgery 11.27±10.00 months. Affected arm had shoulder pain (53.1%), restrictions on shoulder (51.6%) and lymphedema (21.9%).It was determined that patients were received low scores from SPADI and Q-DASH, and SF-36 physical and mental summary scores of below the average. The EORTC QLQ-BR23 functional status and symptom subscales scores of patients were low. Conclusion: It was seen that patients' quality of life was low, their functional status was poor, and cancer-related symptoms to be less. The working with multidisciplinary team on preoperative and postoperative will help prevent complications and increase the quality of life. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the efficacy and safety of trabeculectomy performed with mitomycin C (MMC) at a concentration of 0.2 mg/mL for 3 minutes in glaucoma patients with high risk of surgical failure. Methods: Forty-seven eyes of 45 patients (30 male, 15 female) undergoing glaucoma filtration surgery using MMC were retrospectively reviewed. All patients who had chronic closed angle, neovascular, aphakic, pseudophakic, pseudoexfoliation glaucoma and glaucoma after keratoplasty had a high risk of surgical failure. During standard trabeculectomy, triangular sponges impregnated with MMC at a concentration of 0.2 mg/mL were applied to tenon and episcleral space in sub-conjunctival regions and under the scleral flap for 3 minutes. Postoperative IOP, appearance of filtration bleb, anterior chamber depth, leakage detected with Seidel test and other complications were recorded. The patients were evaluated on the 1st day, 1st week, 1st month, 3rd month, 6th month and 12th month. Results: The mean preoperative IOP values of patients with a mean age of 64.5 (7-83 years) were 31.6 mmHg (17-60 mmHg). Mean postoperative IOP values of patients were 15.08 mmHg at 1st week, 15.32 mmHg at 1st month, 15.57 mmHg at 3rd month, 16.42 mmHg at 6 months, 16.28 mmHg at 12 months, and 16.87 mmHg at the last follow-up. Conclusion: For eyes with high risk of surgical failure, trabeculectomy performed with MMC at low dose and optimal time is an effective and reliable method with high success rate. [ABSTRACT FROM AUTHOR]

Objective: The use of a cardiopulmonary machine during cardiac surgery causes a non-physiological circulation in the brain and the other body organs. This situation usually causes brain ischemia. Due to this or other factors, neurological disorders such as stroke and psychiatric disorders are encountered during the perioperative period. In this study, it was aimed to compare neuroelectrical activity measured during extracorporeal circulation in coronary bypass surgery with preoperative values of the patient. Materials and Methods: Six male patients who underwent coronary artery bypass surgery in cardiovascular surgery participated in the study. Both the preoperative (PrO) and during operation (InO) electroencephalography (EEG) data obtained from the frontal region. The delta (δ; 0.5-3.5 Hz), theta (ϑ; 3.5-7 Hz), alpha (α; 8-14 Hz), beta (β; 15-30 Hz) ve gamma (γ; 30-48 Hz) frequency power components were calculated. An equal number of PrO and InO period EEG power values from each participant were taken and used for statistical analysis. Results with a p-value of less than 0.05 were considered statistically significant. Results: The main finding of the study is that the frequency power spectrum values show a decrease in the extracorporeal circulation. When the percentage reduction is compared, it is seen that the fast frequencies decrease at a statistically significant with respect to the slow frequencies. Conclusion: Changes in the EEG frequencies of this preliminary study indicate that brain functions are reduced during extracorporeal circulation. In a broader group of patients, the study included a multi-channel EEG, as well as near-infrared spectroscopy for cortical blood flow monitoring and the addition of neurocognitive assessment tests, will give us some indicator parameters calculated by meta-analyses from all these data. Early detection of the brain damage and take precaution may be achieved with this indicator data. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the differences between shear wave elastography findings responders and non-responders in the follow-up of breast cancer patients receiving neoadjuvant chemotherapy (NAC). Materials and Methods: Between September 2015 and August 2018, 47 patients were evaluated retrospectively. The patients were measured by tru-cut biopsy before and after the diagnosis and at the end of the treatment with shear wave elastography (SWE). Measurements were taken from the hardest part of the mass and from the environment normal parenchyma. In addition, the ratio of the mass and parenchyma to each other (R) was recorded. Patients were followed up in the interim period. Results: The SWE value of the mass was higher in the patients who responded to NAC, whereas the SWE value decreased after the treatment (p=0.00). In patients without response, SWE values of the mass did not decrease significantly at the end of NAC. After the NAC, parenchymal SWE values were found to be increased in all patients. In patients without response, SWE values of the masses were significantly higher than those in patients with no response (p=0.029). When the values at the end of NAC treatment were examined, the patients with unresponsive response had higher SWE values than the patients with response (respectively; p=0.05, p=0.02). Conclusion: There is a statistically significant relationship between the response of NAC to breast tumors and the SWE values measured before and after treatment. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to evaluate the clinical and radiological results of surgically treated pediatric medial humeral epicondyle fractures which were fixed with screw or K wire. Materials and Methods: The study was designed retrospectively. Twenty two patients were evaluated clinically and radiologically. Functional outcomes were assessed with the Mayo elbow performance index (MEPI) and the Turkish language version of the shortened version of the Disabilities of Arm, Shoulder, and Hand (Quick DASH) scale. Results: All fractures were healed. The mean MEPI was 99.3 points (range, 85-100), with 21 patients as excellent and 1 good results. The mean MEPI was 100 points for patient who was fixed with K wires (group A). Excellent results were obtained for all patients. The mean MEPI was 97.9 points (range, 85-100) for patients with screw fixation (group B). Excellent results were obtained for all patients, except one. The mean Quick DASH score was 0.63 (range, 0-9). It was found 0.33 (range 0-5) and 1.3 (range, 0-9) for group A and group B, respectively. Two (13%) minor complications were developed in group A and 4 (57.3%) in group B. The difference for Quick DASH and MEPI scores were statistically insignificant (p>0.05). Conclusion: Both of fixations with K wire or screw provide enough stability until the fracture healed. Fracture union could be obtained for both fixation type and the clinical and radiological results were similar. The need for secondary operation for implant removal and higher complication rates seems the negative side of screw fixation. [ABSTRACT FROM AUTHOR]

Objective: Evaluation of patient satisfaction is an important aspect of hospital management. It is crucial to improve quality of service. In our study, we aimed to evaluate the effects of specialized outpatient clinics on patient satisfaction and quality of service at Bakırköy Dr. Sadi Konuk Training and Research Hospital. Materials and Methods: A total of 1238 patients were included in our study between January 11, 2016 and February 8, 2016. Patients were applied with 12 questions survey. Results: 88.5% of patients stated that they would recommend our specialized outpatient clinics to other patients and 89.7% would come back again in the future if they need to. Also, as the number of their visits increased, the level of satisfaction also increased (p<0.01). Conclusion: As in any service, the expectations of the customers (in that case patients) is decisive in the quality of service. As a result, the satisfaction levels are generally accepted as an indicator of service quality. As seen in our results, the specialized outpatient clinic practice has positive effects on both patient satisfaction and quality of service. [ABSTRACT FROM AUTHOR]

Objective: Applications to health institutions by parents requesting that their children's school entry be postponed have increased in recent years. The purpose of this study was to examine the validity of parental opinions regarding the readiness of their children and the effect of child-rearing attitudes on school maturity. Materials and Methods: Seventy-one children aged 69-72 months were included in this study. The sample group consisted of parents and children requesting postponement of school entry reports from our hospital. A "Family Information Form" was used to collect participant data, the "Metropolitan Readiness Test (MRT)" to evaluate children's school maturity levels, and the "Parental Attitude Research Instrument (PARI)" to assessment parents' family lives and child-raising attitudes. The data obtained were subjected to statistical analysis. Results: According to the MRT results, 22 participants were ready to start elementary school while 49 were not. MRT total scores were significantly negatively correlated with overprotection (p=0.011), refusal to be a housewife (p=0.019), husband-wife conflict (p=0.003), and strict discipline (p=0.011) subscale scores. As children's MRT scores increased, we observed a decrease in parental overprotection, refusal to be a housewife, husband-wife conflict, and strict discipline scores. Mean scores for refusal to be a housewife, husband-wife conflict, and strict discipline were higher among parents of unready children than among those who were ready for school. Conclusion: Family opinions are not a sufficient basis for school entry postponement. Negative family attitudes reduce children's school readiness. We believe that parents should receive training and counseling on childrearing attitudes in the preschool period. [ABSTRACT FROM AUTHOR]

Objective: Gonarthrosis is a chronic non-inflammatory, degenerative disease that starts with joint pain, movement limitation, as a result of joint cartilage damage in the knee joint. In gonarthrosis, patient education, rest, preventive measures, pharmacological, physical therapy and surgical treatment methods can be used alone or together according to the stages of the disease. Intra-articular injections are used to reduce pain and increase functional movements in gonarthrosis. The aim of this study is to evaluate the effect of intra-articular knee steroid injection on the knee pain. Materials and Methods: A total of 151 knees from 108 patients who were admitted to the orthopedics clinic with long-lasting knee pain and who had radiological grade 3-4 gonarthrosis according to the Kellgreen-Lawrence classification were included in the study. Pain scores were compared according to the Visual Analogue scale (VAS) and Verbal Category scale (VCS) before the injection and at 6-week post injection. Combination of 9 ccs 2% prilocaine and 1 cc triamcinolone hexacetonide injection was applied intra-articular. Results: A total of 151 knees from 101 patients aged between 48 to 88 (67.49±8.99) (F=77, M=31) were included. Of the cases, 55.6% (n=84) right and 44.4% (n=67) left knee were injected; 29.8% (n=45) were stage 3 and 70.2% (n=70.2) were stage 4. Pre-injection VAS score was 8.34±0.75, the VCS was 4.29±0.48; post-injection VAS score was 3.68±1.59, and VCS was 2.22±0.8 (p<0.001). Conclusion: Different treatment options are applied according to the stage of knee osteoarthritis. Intra-articular injections, physiotherapy and non-steroid anti-inflammatory drugs are commonly used conservative treatment modalities. Steroids and hyaluronic acid derivatives can be administered separately or together at intra-articular knee injections. Intra-articular knee injections are preferred in combination treatment of early-stage gonarthrosis due to rapid pain relief and replicable. Intra-articular knee steroid injections suggested for patients who don't consider the surgery or want to save time. [ABSTRACT FROM AUTHOR]

Objective: Adhesive capsulitis (AC) is a pathology that characterizes with shoulder pain and progressive restriction in active and passive range of motion of the shoulder joint. In recent years, ultrasonography has been widely used in the evaluation of shoulder pathologies. The diagnostic value of ultrasonography in AC has been researched but not fully explained. Materials and Methods: We retrospectively evaluated patients aged between 30 and 65 years who were admitted to our Physical Medicine and Rehabilitation Department with complaints of shoulder pain, restriction of shoulder movements and who were followed up with the diagnosis of AC and evaluated as stage 2 and 3. Patients were assessed with ultrasonography in terms of presence of effusion around the biceps tendon, presence of subdeltoid bursitis, presence of intraarticular effusion at the posterior region, appearance of rotator interval, coracohumeral ligament thickness, presence of rupture or calcified lesions in rotator cuff tendons. Results: A total of 33 patients (17 females, 16 males) were included in the study who were diagnosed as AC. 57.57% of the patients had effusion around the biceps tendon, 63.63% had subdeltoid bursitis, and 69.69% had intraarticular effusion. A total of 4 patients had appearance of partial tear at the rotator cuff tendons. In three patients, calcific lesions were detected in rotator cuff tendons (supraspinatus tendon in 2 patients, subscapulars tendon in 1 patient). Conclusion: Ultrasonography is valuable both in terms of the diagnosis of AC and the detection of secondary causes of AC. [ABSTRACT FROM AUTHOR]

Objective: It can be said that the level of knowledge about health/disease concepts is one of the factors determining individual health perception and health concern. Health perception and anxiety can also be an important factor in the willingness of the individual to receive health care services. For this reason, this research was carried out as descriptive study to determine the health perception, health anxiety and the affecting factors among nursing students. Method: The research was carried out on 56 students who were educated in the 2nd year of Nursing Department of Health Sciences Faculty of Ondokuz Mayıs University between September 2015 and February 2016. The data were collected with a 12-items sociodemographic data form, the Health Perception Scale and the Health Anxiety Scale. The analysis of the data was performed by SPSS 21 statistical program. Mean and percentage values calculated and t test, variance analysis and correlation analysis performed. Results: Total 92.9% of the students were in the 17-21 age group, 60.7% were graduated from Anatolian High School.The 44.6% of student had primary school graduated mothers, 41.1% of them fathers, 80.4% of them have housewife mothers and 30.4% of them have unskilled worker fathers. The mean score of the health perception scale of the students was determined as 50.57±4.60. When the mean scores of the health perception scale sub-dimensions were examined, the control center subscale had highest mean score as 17.37±2.87 and followed by 11.75±2.24 precision, 10.73±1.95 health and 10.48±1.89 with self awareness sub-dimensions respectively. Student's health anxiety scale score means were determined as 34.33±6.50. Conclusion: It has been determined that the average scores of health perception and health anxiety of students are moderate. [ABSTRACT FROM AUTHOR]

Objective: This study was conducted with the aim of determining knowledge and behavior of nurses about pain management. Material and Method: The study was designed as a cross-sectional study. The study was performed on 560 nurses between February and April 2014. Data were collected by using Nursing Information Form and The Survey Regarding Nurses' Knowledge and Behavior Regarding Pain. Data were evaluated by using descriptive statistical methods, Student's t-test, One-way ANOVA and Kruskal-Wallis tests. Results: Out of total 560 nurses, 45.2% were in the age group of 29-38 years, 88.6% were female, 66.1% had a graduation degree, 69.8% were working in internal diseases units and 91.6% were working as a bedside nurse, 39.5% of nurses had an experience less than 5-year, 56.2% of nurses had no in-service training regarding pain, and 76.6% did not follow the literature about pain. One-third of nurses (35.2%) were not using scales for pain often. In the survey, nurses scored 4.95±2.16 points in knowledge and behavior about pain. The average knowledge and behavior in pain scores of nurses with post graduate degrees (6.31±2.19, p=0.002), of nurses who followed nursing publications (5.30±2.25, p=0.03) and of nurses those always used the pain scales (5.26±2.38, p=0.02) were significantly high. Longer the working times, lower the average knowledge and behavior scores of the nurses (p>0.05). The average knowledge and behavior score of nurses working in internal diseases units were higher than the scores of ones working in surgical units (p>0.05). The nurses who had in-service training in pain had higher average scores (p>0.05). Conclusions: The study indicates that nurses do not have sufficient knowledge about diagnosis and management of pain [ABSTRACT FROM AUTHOR]

Objective: The aims of the study were to determine nurses' level of knowledge of pressure sore prevention and treatment on the hospitalized patients and affecting factors. Material and Methods: This descriptive, cross-sectional study was conducted on 523 nurses working in a university and state hospitals in Zonguldak. Data were collected between March and May 2014, using a personal information form, questionnaire which was developed based on European Pressure Ulcers Advisory Panel and National Pressure Ulcers Advisory Panel guidelines. Data were analyzed by Independent samples t test, One way ANOVA, Kruskal-Wallis, and Pearson correlation tests. Results: The mean knowledge score about prevention of pressure sore of the nurses was 15.63±1.82. The mean knowledge score about management of pressure sore of nurses was 15.69±2.01. The knowledge scores about prevention for pressure sore were significantly increased among nurses worked in state hospital and medical department, attended in-service training (p<0.05). The knowledge scores about management for pressure sore were significantly increased among nurses worked in state hospital and emergency department, attended in-service training (p<0.05). The mean age, working years, gender, department, knowledge sources of nurses showed significantly an association with knowledge score of management for pressure sore (p<0.05). Conclusions: Knowledge about pressure sore prevention and management of nurses was moderate level. The knowledge scores were significantly affected by the nurses' characteristics. These results will contribute to studies and education strategies in this area. [ABSTRACT FROM AUTHOR]

Objective: Toxoplasmosis involving all organs is a protozoal infection caused by Toxoplasma gondii. It is usually asymptomatic. Since T. gondii is very difficult to show directly or to produce on cultural media in diagnosis serological methods are preferred. But IgM antibodies which occur in the acute phase lasts very long in serum. So this leads to wrong acute infection diagnoses. Studies conducted show us that low avidity means the infection occurred in the last 3-4 months, high avidity means the infection occurred at least 6 months before. Due to this, avidity tests are used often in differentiation between acute and chronic disease. In our study we aimed to determine Toxoplasma seroprevalence and avidity values in pregnants. Material and Methods: 102 healthy pregnants with gestational ages between 5 and 30 weeks are examined. Anti toxoplasma IgM and IgG antibodies are searched with ELISA (Meddens Diagnostics). Toxoplasma IgG avidity tests were done with ELISA (Radim-WELL) which were IgG positive. Results: 50% of the pregnants were IgG positive, while none were IgM positive. Low avidity value was not found in 51 pregnants who were determined IgG positive. Intermediate avidity values were in 3.9%; high avidity values were in 96.1% of cases. Conclusion: As a result we found Toxoplasma seropositivity 50% in healthy pregnant. High IgG avidity was found conform with past infections. We observed that seropositivity increased with raw meat consumption, cat contact and low economic income but there was no statistical significance. [ABSTRACT FROM AUTHOR]

Objective: To examine the effective factors on illness perception of patients before gynecological surgery. Material and Methods: This cross-sectional and descriptive study was conducted on 120 female patients who were admitted to Gynecological Clinic of Trakya University Medical Faculty Hospital for gynecologic surgery between August and December 2015. Patients filled out an information form consisting socio-demographic and illness characteristics, and Brief Illness Perception Scale (IPQ-B). Results: Mean age of patients was found 51.5±15.5. The treatment control (p=0.010), compliance (p<0.001) and total (p=0.022) scores of IPQ-B in patients who hadn't information about illness were found significantly higher. The treatment control (p=0.010), compliance (p<0.001) and total (p=0.036) scores of IPQ-B in patients who uninformed in clinic about the illness were found significantly higher. Compliance subscale (p=0.005) in patients who uninformed about operation, compliance subscale (p=0.001) in patients who thought that giving knowledge was insufficient were found significantly higher. The results (p=0.044), anxiety (p<0.001), emotional representation (p=0.002) and total (p=0.004) scores of IPQ-B in patients who were anxious for postoperative period were found significantly higher. Conclusion: Preoperative adequate information of patients in clinic about illness and surgical procedure, and less anxiety for postoperative period are positively effective factors on illness perception. [ABSTRACT FROM AUTHOR]

Objective: Considering brain death as legal death plays an important role in both provision of organ transplants and cessation of medical support. Another aspect of this issue is to decide who will have authorization for cessation of medical support. In this study, medical, legal and ethical aspects of the issue were dealt with data collected through a questionnaire. Material and Methods: Volunteering 279 nurses and 179 doctors working in intensive care units of research and education hospitals in Istanbul completed the questionnaire. Obtained data were statistically analyzed and available regulations, medical requirements and ethical values regarding brain death were examined based on results of the analyses. Results: Of all the participants, 40.9% of the nurses and 5.6% of the doctors agreed that diagnosis of brain death should allow cessation of medical support. Forty-three percent of the nurses and 55.9% of the doctors thought that patients whose brain death has occurred should be withdrawn from life support systems and devices so that other patients in need can benefit from them, with a significant difference (p<0.01). Fifty-two percent of the nurses and 36.7% of the doctors found it right to let relatives of patients decide cessation of life support, with a significant difference (p<0.01). Conclusion: It is important that legal problems concerning decisions about and authorization for cessation of medical support given to patients whose brain death has occurred should be solved so that uncertainties experienced in practice can be eradicated. [ABSTRACT FROM AUTHOR]

Objective: Extremity thromboembolism is a serious cause of morbidity and mortality in cardiovascular diseases. Comparing with the lower extremity arteries, upper extremity acute arterial occlusions are rarer and constitute 15-32% of all cases. Trauma, collagen vascular diseases, malignant tumors, myxoma, subclavian artery stenosis, myocardial infarction and thromboangiitis obliterans are often identified as etiologic factors. The first option in the treatment of these patients is surgical embolectomy. Endarterectomy, patchplasty and arterial bypass operations can be counted in treatment options of chronic patients. Material and Methods: In this study, we retrospectively analyzed clinical features and prognosis of 58 patients consisting of 31 women and 27 males who were admitted to our emergency department with acute arterial embolism. Results: Mean age of our group was 67.05±17.09. Proximal brachial artery thrombosis was found in 3 patients. The other 55 patients had thrombosis in the brachial artery and its distal branches. After the diagnosis of patients in the emergency room 100 units/kg of subcutaneous enoxaparine was applied. Selective arterial embolectomy surgery was performed under local anesthesia in all patients with access from the antecubital region. Arteriotomy was closed using saphenous patch plasty technique in two patients. Compared with preoperative demographic data and thromboembolism etiology, 21 (36%) patients were diagnosed as atrial fibrillation. Those patients had not been followed and treated for atrial fibrillation. In 5 (8.6%) patients malignancy was detected as an etiologic factor. Four (6.8%) patients died during their follow-ups in the clinic, 3 (75%) of those patients had an atrial fibrillation. Conclusion: Acute peripheral arterial occlusion constitutes a significant part in emergency vascular surgery. Therefore early diagnosis and prompt surgical treatment are very important for the results. Atrial fibrillation (AF) holds an important place in upper extremity acute arterial occlusion, but other etiological factors such as malignancy is necessary to not forget. AF who has acute upper extremity arterial embolism patients with AF have higher mortality rates and the clinical management and treatment of those patients must be monitored more closely. We believe that the development of treatment modalities and further work needs to be done in order to find an appropriate treatment. [ABSTRACT FROM AUTHOR]

Objective: The aim of our study was to investigate safety and effectiveness of titanium elastic nailing (TEN) in paediatric tibia shaft fractures caused by high-energy pedestrian versus motor vehicle accidents. Material and Methods: We conducted a retrospective review for children with unstable tibial shaft fractures treated with TEN caused by pedestrian versus motor vehicle accidents between June 2010 and December 2012. Eleven patients were included in study. Six patients (54.5%) were boys and five patients (45.5%) were girls. The mean age of the patients was 7.4 years (3-12). Five patients (45.5%) had closed and six patients (54.5%) had open fractures according to Gustilo-Anderson classification. At the follow-ups, patients were evaluated clinically and radiologically. Also, we investigated tibial torsion deformity by using MRI in our patients at last follow-up. Results: In all patients were obtained complete bone healing radiologically and clinically. In our patients, the average angulation was 1.5 degrees (0-3.9) on the coronal plane and the average angulation was 2.6 degrees (0-8.4) on the sagittal plane at the last follow-up. In four patients (36.4%) were found more than 10 mm the tibial length discrepancy. Also, we encountered more than 10 degrees the external tibial torsion deformity in three patients. Conclusion: TEN is a safe and effective treatment options in the high-energy pediatric open or closed tibia shaft fractures caused by pedestrian versus motor vehicle accidents. It should be kept in mind that these fractures also might develop in the tibial torsional deformity. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to evaluate the compliance with medication in geriatric patients with hypertension. Material and Methods: The study was conducted in 107 patients at the age of 65 and over with hypertension who were recieving antihypertensive treatment and following at the Ankara Gulhane Military Medical Academy Geriatric Outpatients in May to July 2012. The data collection form involves patient demographic data,16 questions on chronic diseases and treatment the patients have, and the Medication Adherence Self-Efficacy Scale-Short Form (MASES-SF) consisting of 13 questions. The data were analyzed through calculating percentage, the Student t-test and one way ANOVA. Results: The mean age of participants was 74.7±6.0 (for man 77.2±6.7, for woman 73.5±5.3). In addition to hypertension, 93.4% of patients had comorbid diseases. 36.4% of patients had type 2 diabetes, 27.1% had hyperlipidemia, 26.2% had coronary artery disease (CAD) and 12.1% had chronic obstructive pulmonary disease (COPD). It has been identified that 34.6%, 21.5%, 44% of participants were taking drugs in number of 3,4,5 and above a day, respectively. It was found the mean drug compliance score of self-efficacy scale in geriatric patients was high (45.05±6.06). The mean score of geriatric patients who didn't need to be reminded of the drug intake time, and who were living alone were high and the result was statistically significant (p<0.05). Conclusion: It was confirmed that geriatric patients with hypertension had compliance with drug treatment. To provide and increase the compliance with medication, it is essential to control whether the treatment way is understood or not. That's why, it is necessary to evaluate the compliance with drug treatment in 65 year-old and above patients for an effictual treatment. [ABSTRACT FROM AUTHOR]