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The chronotype, which reflects differences among individuals in daily activity patterns and sleep-wake cycles, is actually linked to being healthy. The most important factor that determines the chronotype is the environmental light-dark cycle. Chronotype is the study of classification as morning or evening types according to the physiological and genetic characteristics of the human. There are many factors that determine chronotypes. Although the evidence shows a negative picture for evening types, it should be emphasized that only eveningness cannot cause depression or other psychiatric disorders alone and additional effects may play a role. Conducting studies on mechanisms underlying the chronotype-psychopathology connection is important for interventions that can help reduce the incidence of psychiatric disorders in evening types; these interventions may include sleep training, dietary advice, and cognitive-behavioral techniques. The purpose of this review is to provide an overview of psychiatric disorders in children and adolescents and their relationship with the morning and evening types.

Objectives:In psychiatry, the inpatient observational follow-up model is important in the treatment of children and adolescents. The length of stay may vary depending on demographic and clinical features. In this study, it was aimed to share data on the relationship between the duration of hospitalization and clinical and demographic characteristics of a child and adolescent psychiatric inpatient clinic.Materials and Methods:The records of the patients who were followed up and treated after being hospitalized at İnönü University Faculty of Medicine, Child and Adolescent Psychiatric Inpatient Clinic were examined. The demographic and clinical features (psychiatric diagnoses, psychotherapy and psychopharmacological treatment, hospitalization features, psychometric scale scores) of 379 patients who were hospitalized and discharged from late 2013 to mid-2017 were recorded. The effects of all variables on the length of stay were evaluated. The Mann-Whitney U test, which is a non-parametric test, was used for the comparison of length of stay. The relationship of the applied psychometric tests with the length of stay was evaluated by the Pearson correlation coefficient.Results:The average length of stay was 20.05±19.69 days. The shortest hospital stay was 1 day, while the longest hospital stay was 135 days. The length of stay was significantly longer in adolescents, in those continuing education, in those having schizophrenia spectrum and other psychotic disorders, feeding and eating disorders, trauma and stressor related disorders, and in those taking cognitive behavioral therapy and psychopharmacological treatment (antipsychotic, antidepressant, anxiolytic). The length of stay was shorter in patients with neurodevelopmental disorders and intellectual disability. Children’s Depression Scale, State-Trait Anxiety Inventories And Scores Of Post- Traumatic Stress Reaction Index were found to be positively correlated with length of stay.Conclusion:Psychiatric diagnoses and treatment modalities can be decisive in the length of stay. In our country, inpatient psychiatric clinics in children and adolescents are very limited. More studies are needed to examine the relationship between the duration of hospitalization and demographic and clinical features.

Childhood attention deficit hyperactivity disorder (ADHD) is a risk factor for substance misuse and substance use disorder (SUD) in adolescence and (early) adulthood. ADHD and SUD also frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment and is associated with poor treatment outcomes. Research on the effect of treatment of childhood ADHD on the prevention of adolescent SUD is inconclusive, and studies on the diagnosis and treatment of adolescents with ADHD and SUD are scarce. Thus, the available evidence is generally not sufficient to justify robust treatment recommendations. The aim of the study was to obtain a consensus statement based on a combination of scientific data and clinical experience. To reach a consensus based on the combination of scientific data and clinical experience, a modified Delphi study was conducted with a multidisciplinary group of 55 experts from 17 countries. The experts were asked to rate a set of statements on the effect of treatment of childhood ADHD on adolescent SUD and on the screening, diagnosis, and treatment of adolescents with comorbid ADHD and SUD. After 3 iterative rounds of rating and adapting 37 statements, consensus was reached on 36 of these statements representing 6 domains: general (n=4), risk of developing SUD (n=3), screening and diagnosis (n=7), psychosocial treatment (n=5), pharmacological treatment (n=11), and complementary treatments (n=7). Routine screening is recommended for ADHD in adolescent patients in substance abuse treatment and for SUD in adolescent patients with ADHD in mental healthcare settings. Long-acting stimülants are recommended as the first-line treatment of ADHD in adolescents with concurrent ADHD and SUD, and pharmacotherapy should preferably be embedded in psychosocial treatment. The only remaining noconsensus statement concerned the requirement of abstinence before starting pharmacological treatment in adolescents with ADHD and concurrent SUD. In contrast to the majority, some experts required full abstinence before starting any pharmacological treatment, some were against the use of stimülants in the treatment of these patients (independent of abstinence), while some were against the alternative use of bupropion. This international consensus statement can be used by clinicians and patients together in a shared decision-making process to select the best interventions and to reach optimal outcomes in adolescent patients with concurrent ADHD and SUD.

Objectives:The aim of this study is to reveal how pediatrics residents’ anxiety levels and their approaches to children have been shaped during unexpected experience of COVID-19 outbreak and to evaluate the effects of working in pandemic clinics on anxiety.Materials and Methods:This study was planned as a cross-sectional study. Pediatrics residents working in Izmir Tepecik Training and Research Hospital Pediatrics Education Clinic were contacted and asked whether they wanted to fill the prepared electronic questionnaire. The information including informed volunteer consent form and questionnaires was sent to the acceptors via e-mail/Whatsapp. The sociodemographic data form and Spielberger State and Trait Anxiety Inventory (STAI-S and STAI-T) were sent to the participants.Results:Sixty four pediatrics residents participated. The average age of the participants in our study was 27.98±2.62 years. Of them, 79.7%(n=51) were female, while 20.3% (n=13) were male. While 7.8% (n=5) had a history of suffering from mental illness before COVID-19, there was no history of mental illness in 92.2% (n=59). 67.2% (n=43) of the pediatrics residents included in the study worked in the pandemic service and outpatient clinics. We found that pediatrics residents included in the study showed clinically significant anxiety symptoms at the rate of 89.1% (n=57) in terms of the Spielberger state anxiety scale and at the rate of 65.6% (n=42) in terms of the Spielberger trait anxiety scale. Considering whether the residents included in the study worked or did not work in the pandemic outpatient clinic/inpatient clinic, no statistically significant difference was found in terms of STAI scores (p>0.05).Conclusion:Our study is the first study to evaluate the anxiety levels associated with the COVID-19 outbreak among pediatrics residents in our country. In our study, both the state anxiety level and the trait anxiety level were found to be higher in pediatrics residents, with a higher level of state anxiety. The results of our study suggest the necessity of interventions for the concerns of all healthcare professionals, especially pediatrics residents.

Objectives:In this study, it was aimed to evaluate the anxiety levels and sleep problems experienced by the children of healthcare workers (HCWs) with Coronavirus disease-2019 (COVID-19) during the pandemic.Materials and Methods:The participants completed a sociodemographic data form, the Parent Screen for Child Anxiety and Related Disorders (SCARED) and Diagnostic and Statistical Manual of Mental Disorders-5 Level 2 Sleep Disorders Scale by using online applications. The child SCARED, which has a self- report scale for HCWs, was completed. Ninety-four healthcare workers and 94 HCWs’ children, including 30 HCWs with COVID-19 (Group 1) and 64 HCWs without COVID-19 (Group 2), were included in the study. The scale scores were compared between two groups.Results:There was no significant difference between the two groups in terms of sociodemographic characteristics. There was no significant difference in sleep disorders and anxiety disorders scale scores between Group 1 and Group 2. The proportion of those who reached the total anxiety cut-off point in both groups was between 27% and 45%. In the regression analyses, it was found that the parent’s chronic medical disease (p=0.028) and the child’s female gender (p=0.004, p=0.009) were found to be significant predictors of anxiety symptoms in the child. The presence of a psychiatric disorder in the child (p

Neuroleptic malignant syndrome is rare in neurology practice It may occur due to the use of high doses of antipsychotics It requires intensive care follow-up due to its severe complications and has high mortality Fever, rigidity, confusion, and respiratory distress are important symptoms of the condition It is important to note that this disease should be considered in the differential diagnosis of patients with fever, especially after the coronavirus disease-2019 disease that emerged in 2019-2020, and whose fever does not decrease as an important symptom For these reasons, we think that the presentation of this phenomenon will be useful (English) [ABSTRACT FROM AUTHOR] Noroleptik malign sendrom noroloji pratiginde az rastlanilan, yuksek doz antipsikotiklerin kullanilmasi sonucu ortaya cikan ve fatal seyretme riskinin yuksek olmasi nedeniyle yogun bakim izlemi gerektiren bir tablodur Hastada ates, rijidite, konfuzyon, solunum sikintisi gorulebilecek onemli semptomlardir Ozellikle 2019-2020 yilinda ortaya cikan ve onemli bir belirtisi de dusmeyen ates yuksekligi olan koronavirus hastaligi-19 hastaligindan sonra ates yuksekligi ile basvuran, anamnezi uygun olan hastalarin ayirici tanisinda akilda bulundurulmasi gereken bir hastalik oldugu konusunda farkindaligin olmasi onemlidir Bu amaclardan yola cikarak bu olgunun sunumunun yararli olacagini dusunmekteyiz (Turkish) [ABSTRACT FROM AUTHOR] Copyright of Turkish Journal of Intensive Care is the property of Galenos Yayinevi Tic LTD STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )

The cause of impairment in respiratory functions after open heart surgery is multifactorial. A 67-year-old female patient admitted to the intensive care unit (ICU) was intubated after mitral valve replacement and tricuspid annuloplasty. She was extubated on the first post-operative (post-op) day. On post-op day 5, the patient was re-admitted to the ICU due to respiratory distress and tachypnea. Non-invasive mechanical ventilation (NIMV) support and dobutamine 5 mcg/kg/min were started. Prior to diagnosis of septic shock, tazocin 3x4.5 grams was administered. The patient was intubated on the post-op day 6 because of the increase in respiratory distress. She was extubated on the post-op day 7, and NIMV commenced. On the 8th post-op day, she was consulted to the ear, nose and throat (ENT) department because of sore throat. Widespread mucosal aphthous lesions were observed in the uvula, soft and hard palate, mandible inner mucosa and alveolar process. Galactomannan was detected positive in bronchoalveolar lavage and treatment with fluconozole started. On post-op day 15, the patient was discharged. That same night, she was admitted to the ICU again due to sudden respiratory distress and was placed on NIMV support, but the patient whose respiratory distress increased and was unconscious was intubated. The next day, direct laryngoscopy was performed by the ENT department under operating room conditions, and a 3x4 cm polypoid lesion was removed from the vocal cord level. However, after 2 days, the patient was re-examined by direct laryngoscopy, necrotic crusts were removed under the cricoid cartilage posteriorly in the subglottic region. The patient recovered from post-op respiratory distress, was extubated on the 18th post-op day and his support with NIMV continued. The patient was discharged on the 33rd post-op day. Laryngeal granuloma and subglottic strictures should be considered in patients with post-op respiratory distress, no matter how short the intubation period is.

Objective:Current data in intensive care unit (ICU) suggest that at least 70-100% of patients’ energy have to met, while the effects of hypocaloric nutrition (HN) on patient outcomes are questioned. This study aimed to determine the relationship between renal replacement requirement and other organ failure and patient outcomes in normocaloric and hypocaloric fed patients.Materials and Methods:The data of patients followed up in the intensive care unit between 2003-2012 were retrospectively evaluated. Normocaloric nutrition (NN) group is determined as patients with 70%-110% of the daily energy requirement was reached, HN group is determined as patients with less than 70% of their daily energy requirement. Patient data were recorded for 14 days.Results:Data of 1,955 patients were evaluated and 92 patients were included to NN group, 199 patients were included to HN group. There was a significant decrease in Sequential Organ Failure Assessment score in the HN group compared to the hospitalization day (p0.05).Conclusion:There was no difference between NN and HN in critically ill patients in ICU. Although the duration of ICU stay was less in the hypocaloric group, no significant difference was found between low-calorie intake and 28th day and hospital mortality. There is still a need for a prospective, randomized controlled trial on this subject.

Objectives:Suicide attempts in children and adolescents are health problems all over the world. Substance use disorder is a frequent psychiatric comorbidity related to suicide attempts. Our aim in this study is to determine the sociodemographic differences between those with and without suicide attempts in children and adolescents with substance use.Materials and Methods:Within the scope of this study, archive files of children and adolescents who applied, which is the Ege University Child and Adolescent Addiction Center to (EGEBAM), were examined retrospectively. Variables such as suicide attempt, age of starting smoking or substance abuse, family history, previous treatment history, street life history, and forensic problems were evaluated.Results:8% of 371 cases who had applied to the EGEBAM outpatient clinic, had a history of suicide attempt. The variables that were statistically significantly related to the suicide attempt were as follows: Female gender, the presence of a previous treatment history, the presence of a substance abuse in the family, and the presence of a street life history (p

Objective:To evaluate the predicting factors affecting post-operative free flap complications in patients who underwent flap reconstruction due to tissue defect in the lower extremity and who were followed up in the intensive care unit (ICU) between 2014 and 2018.Materials and Methods:Demographic data, size of tissue defect, hemoglobin level, duration of anaesthesia and surgery, amount of blood transfusion, presence of post-operative complications, length of hospital stay, tissue culture results, and length of ICU stay were recorded, retrospectively. Statistical analysis was performed on SPSS.Results:The most common cause of tissue defect was traffic accidents and defect size was 118.35±74.74 cm2. Post-operative complications were observed in 12 (42.9%) patients. The most common complications were hematoma and partial flap necrosis. The culture results in 10 patients (35.7%) were found to be positive. Smoking, American Society of Anesthesiologists (ASA) score and age were significantly higher in patients who developed post-operative flap complications (p

Objective:The objectives of this study are to determine the problems of patients who underwent percutaneous tracheostomy opening in intensive care and then were discharged with a tracheostomy that had either spontaneous respiration or mechanical ventilation (MV) support, and decrease the morbidity and mortality of these patients by focusing on training their caregivers about potential problems.Materials and Methods:The files of 90 patients, who were admitted to the intensive care unit (ICU) between 2017 and 2018 with a tracheostomy, were analysed. Twenty-nine patients were discharged. Patients were grouped as cerebrovascular disease (CVD), respiratory failure (RF), neuromuscular diseases and others (Alzheimer’s, Parkinson’s). Patients and their caregivers were interviewed face-to-face or by telephone to obtain information about patients. The reasons for hospitalisation, Glasgow coma scale (GCS) score, feeding patterns, MV support, life expectancy and problems at home were recorded.Results:In 29 discharged patients, 14 of them were classified as CVD, five as RF, six as neuromuscular disease (NMD) and four as other. The mortality rates of patients with high GCS values (GCS-2) from ICU were found to be lower. The fatality rate for the NMD group (0%) was found to be significantly lower than that of CVD (64.3%) and RF (80%). Seven (50%) patients developed contracture or limited joint motion. Respiratory-related problems were the most common problems that patients experienced at home, and 12 (85.7%) had intense secretions. Constipation was the most common nutritional problem and was experienced by six patients (42.9%).Conclusion:The home care of patients with a tracheostomy requires specific procedures and may lead to the development of specific complications. In this study, we determined that the respiratory problems of home care patients, particularly those involving intense secretions, plugged the tracheostomy and required the need for MV. Another important problem is that patients have limited joint motion. Thus, before discharge, patients should be trained consistently.

Thyroid storm is a rare clinical condition, and failure in management can lead to multiorgan failure and carries a high mortality. The comprehensive treatment approach is the administration of antithyroid drugs and radioactive iodine and thyroidectomy. The treatment option of therapeutic plasmapheresis (TP) should be considered as a stabilizing measure, especially when patients have failed or can not tolerate conventional treatment. This case report aimed to share that TP might be an alternative approach to be added to standard treatment methods in life-threatening conditions.

Delirium is an organic dysfunction including the brain’s inflammatory response to injury, hormonal effects and changes in neurotransmission and neural network. Delirium is one of the major causes of weaning difficulty in intensive care unit (ICU) patients. In this case report, we tried to explain the successful weaning procedure in a patient using quetiapine after trying all treatment options due to delirium in the ICU. This report emphasizes that second-generation antipsychotics should be kept in mind in patients who cannot be disconnected from the mechanical ventilator due to delirium.

Objective:Low tidal volume (VT) and lung protective ventilation (LPV) are recommended to prevent lung injury associated with invasive mechanical ventilation (IMV). Present study aimed to determine the patients with risk of high VT application, whether VT calculated according ideal body weight (IBW) values are suitable for the recommended (6-8 mL/kg) and whether a questionnaire on the issue contributes to IMV suitable for LPV.Materials and Methods:Present study is conducted as a multicenter point - prevalence study in the intensive care units of three hospitals in Bursa. Non-ARDS patients receiving IMV and patients who were older than 18 years were included in the study. IMV parameters and demographic data of the patients were collected. Then, the physicians responsible of ventilatory management completed a questionnaire about LPV strategies and VT values required according to the IVA were shown. After 24 hours, mechanical ventilation parameters were re-collected. Body mass index (BMI), average tidal volume applied [VTmean = minute volume (MV)/respiratory rate (RR)] and VTmean for IBW (VTmean/IBW) values were calculated.Results:Fifty-six patients were included in the study. There were 33 male patients (58.9%) and the mean age of the patients was 65.43±18.87 years. The mean BMI of the patients was 27.84±7.0. The most commonly used ventilation mode was synchronized intermittent mandatory ventilation (75%). The VTmean was 549.32±151.00 mL (VTmean/IBW =9.31±3.07 mL/kg). According to VTmean/IBW, for the use of large VTs, being female (10.77±2.74 mL/kg) and having BMI ≥30 (10.82±3.80 mL/kg) posed significantly higher risk than being male (8.31±2.91 mL/kg) and having BMI

Objectives:The primary aim of this study was to compare depression, anxiety and alexithymia levels in children and adolescents with primary headache to the control group and to investigate the relationship between alexithymia and depression, anxiety levels. The second aim of the study was to compare maternal depression and anxiety levels between the case and the control groups.Materials and Methods:The study group was composed of 30 children and adolescents as a case group who were admitted to the Pediatric Neurology clinic of the Ankara University, with a diagnosis of primary headache. Thirty healthy children and adolescents matched in terms of age and sex were included in this study as a control group. All children and adolescents were applied Kiddie Schedule for Affective Disorders and Schizophrenia DSM-IV by the researcher. All children and adolescents participating in the study were assessed for The Children’s Depression Inventory and State-Trait Anxiety Inventory, Toronto Alexithymia scale and mothers completed Beck Depression Inventory and Beck Anxiety scale.Results:There was no significant difference among depression, anxiety and alexithymia levels in the case and control groups (p>0.05). The depression levels of mothers in the case group were significantly higher than in the healthy controls (p=0.01), whereas there was no difference in terms of anxiety levels (p=0.124).Conclusion:The higher levels of depression in mothers of children with primary headache show the importance of mothers’ psychiatric evaluation as well as the comorbid psychiatric disorders in children and adolescents. It should be kept in mind that the psychological support of the mother may be important for the prevention and treatment of children with primary headache.

Objective:Readmission rates of patients discharged from the intensive care unit (ICU) are high. The Stability and Workload Index for Transfer (SWIFT) score is an objective and validated scoring system that has been developed to prevent or predict readmission to ICU. We aimed to evaluate the usability of SWIFT score in a high occupancy ICU at our hospital settings.Materials and Methods:This study was performed between July 1, 2017 and December 31, 2017 as a prospective observational study in a tertiary training hospital ICU. The patients who were discharged to the ward or coronary ICU at least two days after hospitalization in ICU for non-surgical reasons and readmitted within the first seven days after discharge were included in the study. The SWIFT and Acute Physiology and Chronic Health Evaluation-2 (APACHE-2) scores of the patients were calculated according to the worst parameters of last 24 hours.Results:During the study period, 201 patients were discharged and 53 patients were included in the study. Of all patients, 20.75% were readmitted to ICU in the first seven days after discharge. There was no significant difference between re-admitted and non-re-admitted groups in terms of SWIFT and APACHE-2 scores, which were calculated with the worst values on the day of discharge. For the SWIFT score, we found the area under ROC as 0.458.Conclusion:The SWIFT score calculated on the day of discharge was not sufficient to determine re-admission in patients admitted to our ICU for non-surgical reasons.

Solid tümörlerin kemik iliğinde tutulum yaptığı bilinmektedir. Ancak kemik iliği tutulumu ile tanı alması nadirdir. Klinik ve laboratuvar bulguları karakteristik değildir ve farklı ön tanıların düşünülmesine yol açabilmektedir. Kemik iliğinde tutulum saptandığı zaman tedavi yaklaşımını da etkilemekte ve kötü prognozla ilişkilidir. AMAÇ: Kemik iliği tutulumu ile tanı alan solid tümörlü hastalarımızın klinik ve laboratuvar özelliklerini anlatmayı amaçladık. MATERYAL- METOD: Hematolojik malignite ön tanısı ile kemik iliği biyopsisi yapılan ve karsinom metastazı tanısı alan 7 hasta retrospektif olarak değerlendirildi. 3’ü erkek, 4’ü kadın hastanın median tanı yaşı 71 idi. Ortalama tanı yaşı 61,2±19,9 idi. 6 hasta halsizlik, 2 hasta nefes darlığı, 1 hasta da iştahsızlık şikayeti ile başvurmuştu. Hastaların hepsinde anemi, 6 hastada trombositopeni, 6 hastada eritrosit sedimentasyon hızı (ESH) yüksekliği, 3 hastada lökositoz mevcut idi. 4 hastada meme kanseri, 2 hastada mide, 1 hastada prostat karsinom tutulumu saptandı. Tanı konan hastaların median sağ kalım süreleri 20 ay (2-33 ay) olarak saptanmıştır. 2 meme kanseri ve 1 prostat kanserli hasta hormonoterapi ile yaşamlarını sürdürmektedirler. SONUÇ: Kemik iliği biyopsisi; kemik iliğinde tutulum yapan hastalıkları saptamada ucuz, kolay uygulanabilen ve etkin bir yöntemdir. It is known that solid tumors are involved in the bone marrow. However, it is rare to be diagnosed with bone marrow involvement. Clinical and laboratory findings are not characteristic and may lead to the consideration of different prediagnoses. When bone marrow involvement is detected, it also affects the treatment approach and is associated with a poor prognosis. We aimed to describe the clinical and laboratory characteristics of our patients with solid tumors diagnosed with bone marrow involvement. Seven patients who underwent bone marrow biopsy with the pre-diagnosis of hematological malignancy and were diagnosed with carcinoma metastasis were evaluated retrospectively. The median age at diagnosis of 3 male and 4 female patients was 71. The mean age at diagnosis was 61,2±19,9. 6 patients presented with fatigue, 2 patients with shortness of breath, and 1 patient with anorexia. All patients had anemia, 6 patients had thrombocytopenia, 6 patients had increased sedimentation, and 3 patients had leukocytosis. Breast cancer in 4 patients, gastric carcinoma in 2 patients, and prostate carcinoma in 1 patient were detected. The median survival time of the diagnosed patients was 20 months (2-33 months). 2 breast cancer and 1 prostate cancer patients continue their lives with hormone therapy. Bone marrow biopsy; is a cheap, easily applicable and effective method for detecting diseases involving the bone marrow.

Objectives: Genetic variations of LGALS3 (Galectin-3) were found to be associated with treatment resistance, mortality, recurrence, high tumor volume and multiple tumor involvement in solid organ cancers. The modulators of extracellular matrix (ECM), which is a dynamic factor in the larynx tissue with high biomechanical and regenerating ability, can play an important role. We aimed to investigate the relationship between the genetic variants of LGALS3, one of these modulators, with Laryngeal Squamous Cell Carcinoma (LSCC). Methods: LGALS3 gene variations were genotyped by PCR-RFLP method using genomic DNA samples obtained from peripheral blood samples of 74 patients diagnosed with LSCC and 94 healthy controls. Results: The C allele carriage for the Rs4652 genetic variant was found to be higher (p=0.017) in patients with LSCC. Statistical relationships were found between homozygous genotypes of this variant (CC/AA) with advanced tumor stage (p=0.017) and presence of reflux (p=0.036). CC genotype for rs4644 was found to be higher in cases with positive family history (p=0.036). Conclusions: Our findings of LGALS3 gene variants, which are also found to be associated with other solid cancers, suggest that they may play a role in LSCC pathophysiology similarly., Amaç: LGALS3’ün (Galectin-3) genetik varyasyonlarının, solid organ kanserlerinde tedaviye direnç, ölüm oranı, nüks, yüksek tümör hacmi ve çoklu tümör tutulumu ile ilişkili olduğu bulunmuştur. Biyomekanik açıdan rejenerasyon kabiliyeti yüksek larinks dokusunda, dinamik bir faktör olarak ECM modülatörleri önemli rol oynayabilir. Bu modülatörlerden LGALS3’ün genetik varyantları ile LSCC (Laringeal Skuamöz Hücreli Karsinom) arasındaki ilişkiyi araştırmayı amaçladık. Gereç ve Yöntem: LSCC tanısı almış 74 hasta ve 94 sağlıklı kontrolün periferik kan örneklerinden elde edilen genomik DNA örnekleri kullanılarak LGALS3’ün genetik varyantları PCR-RFLP yöntemiyle genotiplendirildi. Bulgular: LSCC’li hastalarda Rs4652 genetik varyantı için C aleli taşıyıcılığının daha yüksek olduğu tespit edildi (p=0.017). Bu varyantın homozigot genotipleri (CC/AA) ile ileri tümör evresi (p=0.017) ve reflü varlığı (p=0.036) arasında istatistiksel ilişkiler bulundu. Aile öyküsü pozitif olan olgularda ise rs4644 genetik varyantı için CC genotipinin diğer genotiplere göre daha yüksek olduğu tespit edildi (p=0,036). Sonuç: Diğer solid kanserler tipleriyle de ilişkisi tespit edilen LGALS3 gen varyantlarına ait bulgularımız benzer şekilde LSCC patofizyolojisinde rol oynayabileceğini göstermektedir.

Coronavirus disease-2019 (COVID-19) has affected more than 31 million individuals and has resulted in 965, 000 deaths on September 21, 2020. As the number of cases increases, clinical conditions such as prolonged viral release, reinfection, and reactivation are encountered more frequently. This report presents the case of a patient who was reinfected with COVID-19 that had a more severe disease course unlike other previous cases reported in literature. Possible reinfection with Severe Acute Respiratory Syndrome Coronavirus-2 in a splenectomy case may help understand immunity against COVID-19 and can be a guide for development of vaccines and new treatments.

The Coronavirus disease-2019 (COVID-2019) pandemic is a major global healthcare problem nowadays, and because of the high numbers of infected patients, it is vitally important to distinguish this from other types of viral pneumonia caused by influenza or adenovirus, which may have similar signs and symptoms. We conducted a narrative literature review and performed a PubMed and Scopus search for studies published up to November 18, 2020, using the following medical subject headings terms: [“comparison,” “comparisons” AND “severe acute respiratory syndrome coronavirus 2,” “ncov,” “2019 ncov,” “covid 19,” “sars cov 2,” “coronavirus,” “cov” AND (“influenzas,” “influenza,” “influenzae,” “human influenza” OR “adenoviridae,” “adenovirus,” “adenoviridae infections”)]. This narrative review aims to compare pneumonia caused by severe acute respiratory syndrome coronavirus-2, influenza, and adenovirus in terms of clinical, laboratory, and radiological characteristics. In conclusion, although these viral pneumonia clinics share the similar patterns of symptoms and laboratory findings; we believe that there have some distrinctions especially in radiological findings.

Introduction: There is no specific antiviral treatment with proven efficacy and safety in the management of Coronavirus disease-2019 (COVID-19) We aimed to compare the effectiveness of hydroxychloroquine (HQ) monotherapy and HQ-lopinavir/ritonavir (Lpv/r) combined therapy in patients with laboratory-confirmed COVID-19 and to determine the independent factors predicting mortality Materials and Methods: Retrospective observational multi-centered cohort study Results: In total, 151 patients (mean age 61 +/- 17 years, 66% male) with COVID-19 pneumonia were included: 68 patients received combination therapy, i e , Lpv/r in addition to HO, and 83 patients received only HQ The patients in both groups were similar regarding the majority of baseline variables except for white blood cell count, procalcitonin, lactate dehydrogenase levels, intensive care unit (ICU) admission rates, which were significantly higher, and decreased oxygen saturation in the combination group The mean duration of symptoms and hospital stay were 5 6 +/- 2 3 days and 12 7 +/- 9 4 days, respectively Nearly 43% (n=65) of patients were admitted to the ICU Patients in the HQ monotherapy group had a shorter stay in hospital than those in the combination group (10 vs 16 days, p

Introduction: Clinical picture of Coronavirus disease-2019 (COVID-19) ranges from mild respiratory symptoms to severe respiratory failure and death. To determine the severity of the disease; lymphocyte count, lactate dehydrogenase (LDH), C-reactive protein (CRP), D-dimer and interleukin-6 (IL-6) levels are the parameters that are used. In this study, it was aimed to evaluate effect of LDH/lymphocyte ratio on prognosis and whether there was a correlation between LDH/lymphocyte ratio and IL-6 in hospitalized patients with COVID-19. Materials and Methods: Patients who were aged 18 years and older, were positive for Severe acute respiratory syndrome-Coronavirus-2 polymerase chain reaction test, had COVID-19 pneumonia findings on tomography, and hospitalized for at least three days were included in the study. Results: The mean age of the patients was 59.35±15.23 year and 56 (59.6%) of patients were male. Fifty seven (60.6%) of the patients had comorbid diseases. The 14- and 28-day mortality rates were 14.9% and 27.7%, respectively. There was a statistically significant correlation between hospitalization in intensive care unit and LDH, lymphocyte count, LDH/lymphocyte ratio, CRP, highest D-dimer, initial IL-6, neutrophil/lymphocyte ratio, and highest IL-6 values (p

Aim: To evaluate obstetrical and perinatal outcomes of pregnancies with systemic lupus erythematosus (SLE). Materials and Method: This was a retrospective study evaluating obstetric outcomes of 35 patients with SLE who were followed up between 2010 and 2020. Lupus activity was based on SLE Disease Activity Index (SLEDAI) criteria and pregnancy outcomes were evaluated by grouping as active and inactive SLE. Results: The mean maternal age was 29 (21-39). The rate of antiphospholipid syndrome and active disease was 5% and 40% respectively. There were 30 live births. Two elective abortions were reported, one with major cardiac anomaly and the other with renal agenesis. One spontaneous abortion and 2 stillbirths were observed in the active SLE group. Overall rates of intrauterine growth retardation, preeclampsia, and preterm delivery were 8%, 20%, and 26%, respectively. Fetal loss and preterm delivery were significantly higher in the active SLE group (p=0,018, p=0,023). A higher rate of neonatal intensive care unit (NICU) admission was observed in the active SLE group (p=0,034) but Apgar scores less than 0,05). Conclusion: Despite advances in the medical sciences, an active disease with SLE has an elevated risk of inducing adverse pregnancy outcomes. Close follow-up could helps reduce pregnancy complications, especially preterm deliveries.

Aim: This study was planned to review current information on care in the intrapartum period during the COVID-19 pandemic.Material and Method: This study is a general review and made by summarizing the literature.Results: A global pandemic Coronavirus disease (COVID-19), which can cause severe acute respiratory syndrome, has had effects on health services, prenatal, natal and postnatal processes, as well as many areas of life. Especially maternal and newborn health services were affected, and quantitative and qualitative differences occurred in service delivery. Therefore, current recommendations regarding care in the intrapartum period in the COVID-19 pandemic should be addressed. It is important for women in the intrapartum period to apply to the hospital, to prevent infection in the hospital, to prevent transmission, to benefit from the care services of infected individuals and to provide management for maternal and fetal health. Protective measures such as reducing the contact of pregnant women with people infected or suspected with COVID-19 during the intrapartum period are stated as the main method of protection from the virus. Effective management of the intrapartum period depends on strong and coordinated health systems where pregnant women deliver safely and the needs of newborn babies are met. A strong cooperation should be established between midwives, nurses, obstetricians and neonatologists, who play an active role in this period. Having emergency strategic action plans created in this regard ensures that pregnant women can access appropriate care at the appropriate time.Conclusion: The care provided during the intrapartum period is important for the protection of maternal and fetal health, and effective control and management of infection, the use of appropriate protective equipment by health personnel and pregnant women, and isolation measures are required., ÖzAmaç: Bu çalışma, COVID-19 pandemi sürecinde intrapartum dönemde bakıma ilişkin güncel bilgilerinin gözden geçirilmesi amacıyla planlanmıştır.Gereç ve Yöntemler: Bu çalışma genel bir derleme olup literatürün özetlenmesiyle yapılmıştır. Bulgular: Şiddetli akut solunum sendromuna neden olabilen küresel bir pandemi Coronavirüs hastalığının (COVID-19) yaşamın birçok alanına olduğu gibi sağlık hizmetlerine, doğum öncesi, doğum ve doğum sonrası sürece etkileri olmuştur. Özellikle anne ve yenidoğan sağlığı hizmetleri etkilenmiş, hizmet sunumunda nicel ve nitel farklılıklar oluşmuştur. Bu nedenle COVID-19 pandemisinde intrapartum dönemde bakım ile ilgili güncel önerilerin ele alınması gerekmektedir. İntrapartum dönemdeki kadınların hastaneye başvuru zamanları, hastanede enfeksiyondan korunma, bulaşın önlenmesi, enfekte bireylerin bakım hizmetlerinden faydalanması ve yönetimin sağlanması maternal ve fetal sağlığın korunması açısından önemlidir. İntrapartum dönemde gebenin COVID-19 ile enfekte ya da şüpheli kişilerle temasının azaltılması gibi koruyucu önlemler virüsten korunmada temel yöntem olarak belirtilmektedir. İntrapartum dönemin etkin yönetilmesi gebelerin güvenli bir şekilde doğum yaptığı, yeni doğan bebeklerin ihtiyaçlarının karşılandığı güçlü ve koordineli sağlık sistemlerine bağlıdır. Bu dönemde etkin rol alan ebeler, hemşireler, kadın doğum uzmanları ve neonatologlar arasında güçlü bir iş birliği sağlanması gerekmektedir. Bu konuda oluşturulmuş Acil stratejik eylem planlarının olması, gebelerin uygun zamanda uygun bakıma erişebilmelerini sağlamaktadır. Sonuç: İntrapartum dönemde sunulan bakım maternal ve fetal sağlığın korunması açısından önemli olup, enfeksiyonun etkin kontrol ve yönetimi, sağlık personelinin ve gebenin uygun koruyucu ekipman kullanımının sağlanması ve izolasyon önlemlerinin alınması gerekmektedir.

Diabetes mellitus ve malnutrisyon, yaşlı hastalarda sık görülen sağlık problemleridir. Her ikisi de çok sayıda olumsuz sağlık durumlarıyla ilişkilidir. Çalışmamızın amacı, yaşlı diyabetik hastalarda malnutrisyon ile ayrıntılı geriatrik değerlendirme parametreleri arasındaki ilişkiyi değerlendirmektir. Kesitsel araştırma tasarımı kullanıldı. Çalışmaya geriatri polikliniğine başvuran ≥ 65 yaş, 506 diyabetik hasta dahil edildi. Hastaların demografik verileri, komorbiditeler, kullanılan ilaç sayısı, üriner inkontinans, ortostatik hipotansiyon varlığı ve laboratuar tetkikleri kaydedildi. Tüm hastalara ayrıntılı geriatrik değerlendirme yapıldı. Nörokognitif değerlendirme için Mini Mental Durum Değerlendirme testi (MMSE), duygu durum değerlendirmesi için Geriatrik Depresyon Skalası (GDS), fonksiyonellik değerlendirmesi için Temel Günlük Yaşam Aktiviteleri (TGYA) ve Enstrümantal Günlük Yaşam Aktiviteleri (EGYA) ölçekleri, yürüyüş ve denge fonksiyonları değerlendirmesi için Tinetti Denge ve Yürüme Testi ile Kalk ve Yürü testi (KYT), uyku durumu değerlendirmesi için Uykusuzluk Şiddet İndeksi (UŞİ) ve kas gücü için el kavrama gücü (EKG) testi dosya verileri kullanıldı. Çalışma grubu Mini Nutrisyonel Değerlendirme skorları>23,5, 17-23,5 ve, Diabetes mellitus and malnutrition are common health problems in older adults. Both are associated with numerous adverse health conditions. The aim of our study is to evaluate the relationship between comprehensivez geriatric assessment parameters and malnutrition in elderly diabetic patients. A cross-sectional study design was used. A total of 506 diabetic outpatients aged ≥ 65 years were included. Demographic data, comorbidities, number of drugs used, urinary incontinence, orthostatic hypotension and laboratory tests were recorded. All patients underwent comprehensive geriatric assessment. Mini mental state examination (MMSE) test was used for neurocognitive assessment, Geriatric Depression Scale (GDS) for mood assessment, Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL) scales for functionality assessment, Tinetti Balance and Gait Test and Time up and go test (TUG) for gait and balance assessment, Insomnia Severity Index (ISI) for sleep status assessment and hand grip strength for muscle strength assessment. Mini Nutritional Assessment (MNA) scores>23.5, 17-23.5, or

Aircraft maintenance technicians (AMT) are exposed to heavy and repetitive physical loads, and therefore the workloads of AMTs are increasing. In order to make the flight safely, it is extremely important to reduce the physical workloads of AMTs by examining them where necessary. Total workload assessment can be considered as a Multi-Criteria Decision Making (MCDM) problem that arises depending on physical workload factors. Within the scope of this study, the DEMATEL (Decision-Making Trial and Evaluation Laboratory) method, which is one of the MCDM methods, was used to calculate the prioritization of physical workload factors included in the total workload factors of AMTs. Body parts that affect working postures, waist, neck, shoulders, back, upper arms, forearms, elbows, wrists, hips, lower legs, ankles, knees and thighs were considered as physical workload factors. In this study conducted on AMTs working in an aircraft maintenance organization, the first four most important factors were identified as waist, back, hips and elbows. According to the findings obtained as a result of the study, the measures to be taken to reduce the workloads were presented to the AMTs., Uçak bakım teknisyenleri (UBT), ağır ve tekrarlı bir şekilde fiziksel yüklere maruz kalmakta ve bu nedenle UBT’lerin iş yükleri artmaktadır. Uçuşun emniyetli bir şekilde yapılması için UBT’lerin fiziksel iş yüklerinin incelenerek gerekli olduğu noktalarda azaltılması son derece önemlidir. Toplam iş yükü değerlendirmesi fiziksel iş yükü faktörlerine bağlı olarak ortaya çıkan bir Çok Kriterli Karar Verme (ÇKKV) problemi olarak ele alınabilir. Bu çalışma kapsamında ise UBT’lerin toplam iş yükü etkenleri içerisinde yer alan fiziksel iş yükü faktörlerinin önceliklendirilmesini hesaplayabilmek için ÇKKV yöntemlerinden biri olan DEMATEL (Decision Making Trial and Evaluation Laboratory) yöntemi kullanılmıştır. Fiziksel iş yükü faktörleri olarak çalışma duruşlarını etkileyen vücut kısımları bel, boyun, omuzlar, sırt, üst kol, ön kol, dirsekler, el bilekleri, kalça, alt bacaklar, ayak bilekleri, dizler ve uyluklar dikkate alınmıştır. Bir uçak bakım organizasyonunda çalışan UBT’ler üzerinde yapılan bu çalışmada en önemli ilk dört faktör bel, sırt, kalça ve dirsekler olarak tespit edilmiştir. Çalışmanın sonucunda elde edilen bulgulara göre UBT’lere iş yüklerinin azaltılması için alınması gereken önlemler sunulmuştur.

Renal hücreli karsinomların oral kaviteye metastazıoldukça nadirdir. Burada mandibulada berrak hücrelirenal hücreli karsinom metastazı olan 77 yaşındakierkek olgu sunulacak ve baş boyun bölgesinde görülenprimer ve metastatik tümörlerin ayırıcı tanısı tartışılacaktır., Metastasis of renal cell carcinomas to the oral cavity isextremely rare. Here, we present a 77-year-old malepatient with clear cell renal cell carcinoma metastasisin the mandible bone and discuss the differentialdiagnosis of primary and metastatic tumors in thehead and neck region.

A new coronavirus disease Covid-19 has been recorded in Wuhan, China since late December 2019 and later became a worldwide pandemic. It can result in death as a result of covid-19's damage to the alveoli and progressive respiratory failure. Although transcription polymerase chain reaction (RT-PCR) is the gold standard used for clinical diagnosis, tests can produce false negatives. In addition, in the event of a pandemic, the lack of RT-PCR testing resources may delay diagnosis and treatment. Under these circumstances, Computed Tomography (CT) scans have become a valuable tool for both early diagnosis and prognosis of Covid-19 patients. Recently, many studies developed with deep learning techniques have been proposed to facilitate the diagnosis of Covid-19 in CT scans and to assist healthcare professionals. This paper focuses on distinguishing Covid-19 from non-Covid-19 cases using DenseNet121, one of the deep learning techniques, with the CT dataset colored using the DeOldify library. At the end of our study, an accuracy of 0.98 was obtained., Aralık 2019'un sonlarından bu yana Çin'in Wuhan kentinde yeni bir koronavirüs hastalığı Covid-19 kaydedildi ve daha sonra dünya çapında pandemik hale geldi. Covid-19’un, alveollerde bıraktığı hasar ve ilerleyen solunum yetmezliğinin bir sonucu olarak ölümle sonuçlanabilir. Klinik tanı için kullanılan transkripsiyon polimeraz zincir reaksiyonu (RT-PCR) altın standart olmasına rağmen testler yanlış negatifler üretebilir. Ayrıca pandemik durumda RT-PCR test kaynaklarının yetersizliği, tanıyı ve tedaviyi de geciktirebilir. Bu koşullar altında göğüs BT görüntülemesi, Covid-19 hastalarının hem tanı hem de prognozu için değerli bir araç haline gelmiştir. Yakın zamanda BT taramalarında Covid-19 tanısını kolaylaştırmak ve sağlık çalışanlarına yardımcı olmak için derin öğrenme teknikleriyle geliştirilmiş birçok çalışma önerilmiştir. Bu makale, DeOldify kütüphanesini kullanarak renklendirilen BT veri seti ile derin öğrenme tekniklerinden DenseNet121’i kullanarak Covid-19'u, Covid-19 olmayan vakalardan ayırt etmeye odaklanmaktadır. Çalışmamızın sonunda %98’lik doğruluk elde edilmiştir.

Background: Oxidative stress status in different cancer types was investigated before, but not studied in gastric intestinal metaplasia to the best of our knowledge. Purpose of this study is to examine whether there is a difference between oxidative stress status in patients with intestinal metaplasia (IM) compared to individuals without IM, we compared the serum levels of disulfide (SS), total thiol (TT) and native thiol (NT). Methods: This was a prospective, non-randomized casecontrol study including 67 patients with histopathologically confirmed IM and 60 individuals demographically matched in terms of age, gender, BMI, smoking status, and chronic diseases as control group. Results: The mean NT, TT and NT to TT (NT/TT) ratios were statistically significantly higher in IM group compared to controls ((351.71 ± 81.9 _mol/L vs. 271.82 ± 54.13 _mol/L, p=0.000), (391.5 ± 92.69 _mol/L vs. 308.59 ± 55.53 _mol/L, p=0.000) and (0.89 ± 0.6 vs. 0.87 ± 0.29, p=0.022), respectively). The mean SS to TT (SS/TT) ratio was significantly lower in IM group than control group (0.050 ± 0.31 vs. 0.060 ± 0.014, P=0.022). Median SS and mean SS/NT ratio was similar in both groups (16.3 (3.3-78) vs. 18.3 (10-32.7), p=0.271 and 0.055 ± 0.041 vs. 0.070 ± 0.019, p=0.068, respectively). In ROC analysis, cut off value of SS/NT for IM was found 0.062, in regression analysis, SS/NT

The purpose of this study was to examine the relationship between Kick-Box athletes’ freedom perceived in time and thrill seeking levels. Appropriate sampling method was used for sample selection. Sample of the study was active kick-box athletes who live in Turkey. There were 355 male and 238 female, totally 593 participants voluntarily accepted to attend this study. Data were collected from demographic information form, the “Leisure Perceived Freedom Scale in Leisure-Time” developed by Witt and Ellis (1985) and “Thrill Seeking Scale” developed by Hoyle et al. (2002). In statistical analysis, one way ANOVA, t-test and follow-up TUKEY test were used. Before the statistical analysis, a normality test was checked and it was found that data were distributed normally. Results showed that males’ freedom perceived in time levels were significantly higher than those in females. Females’ thrill seeking level was significantly higher than males’ thrill seeking level. In the marital status variable, married participants’ thrill seeking level was higher than those in single participants., Bu araştırmanın amacı: Kick boks sporu ile ilgilenen bireylerin serbest zamanda algıladıkları özgürlük düzeyleri ve heyecan arayışı arasındaki ilişkiyi ortaya çıkarmaktır. Araştırmaya Türkiye sınırları içerisinde yaşayan ve kick boks branşında aktif olan sporculardan uygun örnekleme yöntemi ile belirlenmiştir. Bu araştırmada 355 erkek 238 kadın olmak üzere toplamda 593 katılımcı yer almıştır. Katılımcılardan kişisel bilgi formu, serbest zamanda algılanan özgürlük seviyelerini ölçmek için Witt ve Ellis tarafından (1985) geliştirilen “Serbest Zamanda Algılanan Özgürlük Ölçeği-SZAÖ” ve Hoyle ve arkadaşlarının (2002) geliştirdiği heyecan arayışı ölçeği kullanılmıştır. Veri analizinden önce normallik testi uygulanmış ve verilerin normal dağılım sağladığı belirlenmiştir. Veri analizinde tek yönlü ANOVA ve t-testi kullanılmıştır. Anlamlı farkın kontrolü için Tukey testi uygulanmıştır. Bulgulara göre serbest zaman algısının alt boyutlarından bilgi ve beceri alt boyutunda erkeklerini bilgi ve beceri değerlerinin kadın katılımcılara göre istatistiksel açıdan anlamlı olduğu tespit edilmiştir. Heyecan arayışı değerleri incelendiğinde ise kadın katılımcıların ortalama değerlerinin erkeklere oranla daha fazla olduğu tespit edilmiştir. Medeni durum değişkenine göre heyecan arayışı ölçeğinde bekâr katılımcıların evli katılımcılara göre daha yüksek bir ortalamaya sahip oldukları tespit edilmiştir.

Amaç: Bu araştırma, kronik hemodiyaliz tedavisi alan hastalarda anksiyete, depresyon, stres durumlarının belirlenmesi ve diyaliz semptomlarıyla ilişkisinin incelenmesi amacıyla yapılmıştır.Gereç ve Yöntemler: Tanımlayıcı ve ilişki arayıcı tipte olan bu araştırmanın verileri İstanbul ilinde bulunan özel bir diyaliz merkezinde Haziran ve Temmuz 2021 tarihleri arasında toplandı. Araştırmaya 128 hasta dahil edildi. Araştırma verileri Hasta Tanıtım Formu, Depresyon-Anksiyete-Stres Ölçeği-21 ve Diyaliz Semptom İndeksi kullanılarak toplandı. Bulgular: Araştırmaya dahil edilen hastaların yaş ortalaması 60,4815,01 yıl, hemodiyaliz tedavi süresi ortalaması 4,594,32 yıldır. Hastaların %45,3’ünün çok ileri derecede anksiyetesi ve %18’nin çok ileri düzeyde depresyonu bulunurken yarısından fazlasının (%59,4) stres düzeyi normaldir. Diyaliz Semptom İndeksi toplam puan ortalamasının 37,3218,12 olduğu belirlenmiştir. Hemodiyaliz tedavisi alan hastaların yaşı ile Diyaliz Semptom İndeksi ve anksiyete düzeyi arasında pozitif yönde istatistiksel anlamlılık olduğu saptanmıştır (p, Objective: This study was carried out to determine anxiety, depression, and stress levels in patients receiving chronic hemodialysis treatment and to evaluate their relationship with dialysis symptoms. Material and Methods: The data of this descriptive and correlational study were collected in a private dialysis center in stanbul between June and July 2021. 128 patients wereincluded in the study. Research data were collected using the Patient Description Form, Depression-Anxiety-Stress Scale-21 and Dialysis Symptom Index. Results: The mean age of the patients included in the study was 60.4815.01 years, and the mean duration of hemodialysis treatment was 4.594.32 years. While 45.3% of the patients had very severe anxiety and 18% had very severe depression, more than half of them (59.4%) had normal stress levels. It was determined that the average total score of the Dialysis Symptom Index was 37.3218.12. A positive statistical significance was found between the age of the patients receiving hemodialysis treatment and the Dialysis Symptom Index and anxiety level (p

Purpose: Breast cancer is one of the leading causes of cancer-related death in women all over the world. Studies on the ethiology of breast cancer have been carried out for many years. With the demonstration of the radiological breast density as a risk factor on breast cancer, studies on this subject have been accelerated. Studies have shown that breast density varies between societies with different ethnic origins. In our study, the relationship between breast density and breast cancer in Turkish breast cancer patients is investigated.Materials and methods: In our study, breast density, age, menopausal status, body mass index and pathological features of the tumor were evaluated retrospectively in Turkish breast cancer patients treated in our hospital between 01.01.2018-01.01.2021.Results: According to the data obtained, it has been shown that breast density is statistically significantly lower as age increases, in the post-menopausal period and as body mass index increases. However, no significant relationship was found between breast density and tumor size and pathological markers.Conclusion: Breast density is a risk factor for breast cancer that can be changed and modified throughout the life of the individual, primarily by obesity and hormonal changes. Patients with dense breast should be identified, taken measures to reduce the risk of breast cancer and followed more frequently with additional imaging methods if necessary., Amaç: Meme kanseri, kadınlarda kansere bağlı ölüm nedenleri arasında tüm dünyada çok büyük bir tehdit oluşturmaktadır. Uzun yıllardır meme kanseri etiyolojisine yönelik çalışmalar yapılmaktadır. Memenin radyolojik dansite yoğunluğunun meme kanseri üzerinde etkili olduğunun gösterilmesi ile bu konuda çalışmalar hızlanmıştır. Yapılan çalışmalarda meme dansitesinin farklı etnik kökenli toplumlar arasında değişiklikler gösterdiği sunulmuştur. Çalışmamızda Türk uyruklu meme kanseri hastalarının meme dansiteleri ile meme kanseri ilişkisi araştırılmıştır.Gereç ve yöntem: Çalışmamızda 01.01.2018-01.01.2021 tarihleri arasında hastanemizde tedavi edilen Türk uyruklu meme kanseri hastalarında meme dansitesi, yaş, menopoz durumu, vücut kitle indeksi ve tümörün patolojik özelikleri retrospektif olarak değerlendirilmiştir.Bulgular: Elde edilen veriler ışığında meme dansitesinin yaş arttıkça ve post-menopozal dönemde ve vücut kitle indeksinin arttığı durumlarda istatistiksel açıdan anlamlı olarak düşük olduğu gösterilmiştir. Ancak meme dansitesi ile tümör boyutu ve patolojik belirteçler arasında anlamlı bir ilişki saptanamamıştır.Sonuç: Meme dansitesi, meme kanseri için başta obezite durumu ve hormonal değişimler ile bireyin ömrü boyunca değişen ve modifiye edilebilen bir risk faktörüdür. Meme dansitesi yoğun hastaların tanınması, meme kanseri riskini azaltıcı önlemlerin alınması ve gereklilik halinde ek görüntüleme yöntemleri ile daha sık aralıklarla izlenmeleri gerekmektedir.

Dünya Sağlık Örgütü tarafından 11 Mart 2019’da pandemi olarak kabul edilen COVID-19 hastalığının pandeminin ilk döneminde öncelikle solunum yollarını etkileyen ve ciddi akut solunum yetmezliğine (SARS) neden olan bir viral enfeksiyon olduğu kabul edilmiştir. Zaman içinde vasküler sistemler başta olmak üzere diğer organ sistemlerini ve en önemlisi de diğer sistemlerle beraber nörolojik sistemleri ve hatta bazen sadece nörolojik sistemleri etkilediği ortaya konmuştur.Ciddi semptomu olmayan hastalarda bile koku alma kaybı sık olarak görülmekte olup bazı hastalarda ilk veya tek belirti olabilmektedir. Viral enfeksiyonun iyileşmesine rağmen koku alma fonksiyonunun aynı hızla kazanılamaması yaşam kalitesini etkileyen önemli bir nörolojik tutulumdur.Dünyada pandemi sürecinde vaka bildirimleri ve klinik verilerin analizleri ile hızlı bilgi akışı devam etmektedir. Bu yazıda literatür incelemesi ile dünyada bildirilen nörolojik tutulumlar ışığında kranial sinir tutulumları, serebrovasküler hastalıklar ve inme, ansefalit, epilepsi, Guillain Barré sendromu, psikiyatrik bozukluklar ile ilgili güncel bilgilerin paylaşılması amaçlanmıştır., COVID-19 disease was accepted as a pandemic by the World Health Organization in 11 March 2019. At the earlier period of the pandemic, it was first recognized as a viral infection that affects the respiratory tract and causes severe acute respiratory failure (SARS). Over time, it has been demonstrated that it affects other organ systems, primarily vascular systems, and most importantly, neurological systems together with other systems, and sometimes even only neurological systems.Loss of smell is common even in patients without serious symptoms, and may be the first or only symptom in some patients. Failure to regain the olfactory function as rapidly despite the recovery of viral infection is an important neurological involvement affecting the quality of life.During the pandemic process in the world, fast information flow continues with case reports and analysis of clinical data. In this article, it is aimed to share current information about cranial nerve involvement, cerebrovascular diseases and stroke, encephalitis, epilepsy, Guillain Barré syndrome, and psychiatric disorders in the light of neurological involvement reported in the world with a literature review.

Aim: To evaluate the effects of enteral nutritional support in gastric cancer patients who received chemoradiotherapy (CRT) aftergastrectomy.Materials and Methods: Patients who underwent total/subtotal gastrectomy due to gastric cancer and received postoperative CRTbetween January 1, 2010 and December 31, 2015 at Zonguldak Bülent Ecevit University Faculty of Medicine General Surgery Clinicwere included in the study. The nutritional risk of patients was recorded using NRS-2002. The values of patients at the scheduledroutine clinical follow-up at the end of the first year were compared with baseline values.Results: While 64.7% (n=22) of the patients continued to receive enteral nutritional support regularly (CNS group), 35.3% of thepatients (n=12) discontinued nutritional support (DNS group). Patients in the DNS group had significantly lower baseline NRS-2002scores (p=0.049). The NRS-2002 score of the CNS group decreased significantly at follow-up compared to the pre-CRT values. Atthe end of the first year, statistically significant increases were found in body weight, body mass index, transferrin level and vitamin Dlevel of both patient groups. While the mean RBC count decreased significantly in the CNS group (p=0.002), there was no significantdifference in the DNS group (p=0.382). When the amount of temporal change in RBC was evaluated, there was a significant differencebetween the DNS and CNS groups. Although vitamin B12 level and urea level increased in both groups, this increase was significantonly in the DNS group (p = 0.049).Conclusions: In this study, it was determined that gastric cancer patients who continued enteral nutrition in the first year after CRThad significantly higher nutritional risk before CRT. Enteral nutrition reduces nutritional risk and shows positive results on nutritionalparameters such as body weight, ferritin, transferrin, vitamin D, vitamin B12.

ÖZ Amaç: Bu araştırmanın amacı, vajinal doğum yapan kadınların yenidoğan ile ten tene temasları (kanguru anne bakımı) hakkında bilgilerini, uygulamalarını ve engellerini belirlemektir. Gereç ve Yöntem: Tanımlayıcı araştırmanın örneklemini bir kamu ve bir üniversite hastanesinde vajinal doğum yapan 108 kadın oluşturmuştur. Araştırmacılar tarafından oluşturulan veri formu kadınların tanıtıcı bilgilerini ve ten tene temas kavramı konusunda bilgi, uygulamalarına ve engellerine ilişkin verileri içermektedir. Veriler SPSS 15.0 programı kullanılarak değerlendirilmiş ve verilerin analizinde tanımlayıcı istatistikler ve kikare testi kullanılmıştır. Bulgular: Kadınlar doğumdan ortalama 32.74±25.61 dakika sonra bebeklerini kucaklarına aldıklarını ifade etmişlerdir. %13.0’ının ten tene temas uyguladığı belirlenmiştir. Kadınların ten tene temas tanımı ve yararları konusunda on üzerinden 1.07 puan ortalaması ile düşük düzeyde bilgiye sahip oldukları saptanmıştır. Kadınların %67.8’si ten tene temasın uygulanmasındaki engelin nedeni olarak ilk sırada bebeğinin giyinik olmasını belirtmişlerdir. Sonuç: Antenatal dönemde gebeler bilgilendirilmeli ve gebelerin farkındalıkları arttırılmalıdır. Bebeklerin giysileri olmadan bebeğin teninin anne tenine değmesi gerektiği anlatılmalı ve uygulamaları desteklenmelidir ABSTRACT Information, Practices, and Barriers Regarding Skin-to-Skin Contact of Mothers Giving Vaginal Birth Aim: This study aims to determine the knowledge, practices, and barriers of women who give vaginal birth about skin-to-skin contact (kangaroo mother care) with their newborn. Material and Methods: The sample of the descriptive study consisted of 108 women who gave vaginal birth in a public and university hospital. The data form created by the researchers includes women's descriptive characteristics and information about skin-to-skin contact, practices, and barriers. The data were evaluated using the SPSS 15.0 program, and descriptive statistics and chi-square test were used to analyze the data. Results: Women stated that they took their babies in their laps, on average 32.74 ± 25.61 minutes after birth. It was determined that 13.0% had skin-to-skin contact. It was determined that women had a low level of knowledge about the definition of skin to skin contact and its benefits, with an average of 1.07 out of ten. 67.8% of the women stated that the biggest obstacle in applying skin-to-skin contact was that their baby was dressed. Conclusion: Pregnant women should be informed during the antenatal period, and their awareness should be increased. It should be explained that baby's skin should touch mother's skin

Epidemic diseases caused by microorganisms have taken an important place in human history since ancient times. Vaccines play an important role in the prevention of epidemics. The emergence of the smallpox vaccine idea by Dr. Edward Jenner for the first time in 1798 brought along the refusal of the vaccine by the circles offering unscientific reasons. In vaccine rejection or vaccine hesitancy; Many factors such as people's past experience with vaccines, superstitions about vaccines, and lack of knowledge about vaccines play a role. The benefits and possible side effects of vaccines have been discussed in many scientific studies and still continue to be discussed. In our world, which has witnessed many epidemics, the Covid-19 pandemic caused by the globally devastating Coronavirus; It has led to a reconsideration of the importance of vaccines and the epidemics seen in human history. In this review; Epidemics witnessed by human history from past to present, the history of vaccines, the concepts of vaccine refusal and vaccine hesitancy, and the reasons that reveal these concepts are discussed., Eski zamanlardan günümüze kadar mikroorganizmaların neden olduğu salgın hastalıklar insanlık tarihinde önemli bir yer edinmiştir. Salgın hastalıkların önlenmesinde aşılar önemli bir yer tutmaktadır. İlk kez 1798 yılında Dr Edward Jenner tarafından Çiçek aşısı fikrinin ortaya çıkması, bilimsel olmayan nedenler sunan çevrelerce aşı reddini de beraberinde getirmiştir Aşı reddi veya aşı kararsızlığında; kişilerin aşılarla ilgili geçmiş tecrübeleri, aşılar ile ilgili hurafeler, aşılar hakkında yeterince bilgi sahibi olunmaması gibi birçok faktör rol almaktadır. Aşıların yararları ve olası yan etkileri bilimsel çevrelerce birçok çalışmada ele alınmış ve hala da ele alınmaya devam etmektedir. Birçok salgına tanıklık etmiş Dünya’mızda son olarak küresel boyutta yıkıcı olan Coronavirus’ün neden olduğu Covid-19 pandemisi; beraberinde aşıların önemini ve insanlık tarihinin gördüğü salgınları yeniden gözden geçirmeye neden olmuştur. Bu derlemede; geçmişten günümüze insanlık tarihinin tanık olduğu salgınlar, aşıların tarihçesi, aşı reddi ve aşı kararsızlığı kavramları, bu kavramları ortaya çıkaran nedenler ele alınmıştır.

Melatonin is the essential hormone that is regularly secreted by the pineal gland of mammals on a dailybasis. Melatonin is involved in many chemical, biological and physiological bio activity period in the body. The main task of melatonin is to preserve the biological clock known as 'jet lag' and to adjust its rhythm. Melatonin has antioxidant enzymes stimulating, reducing lipid peroxidation, protecting brain tissue from oxidative damage. It also prevents the proliferation of cancer cells and tumor growth. Melatonin is a compound highly soluble in water and oil. Melatonin, a bioactive compound, is found in oranges, tomatoes, strawberries, grapes, cherries, oliveoil, rice, barley and walnuts and in some medicinal and aromatic plants that constitute the source of functional food and pharmaceutical raw materials consumed for health.. The purpose of this review is to contribute to healthy nutrition and life by examining studies investigating the importance of melatonin, its functional properties, profile in foods, and the effect of food processing on melatonin content., Melatonin memelilerin pineal bezi tarafından günlük olarak düzenli şekilde salgılanan temel hormondur. Melatonin, vücutta birçok kimyasal, biyolojik ve fizyolojik faaliyette yer almaktadır. Melatoninin asıl görevi ‘Jet lag’ olarak bilinen biyolojik saatin korunması ve ritminin ayarlanmasıdır. Melatonin antioksidan enzimleri uyarıcı, lipit peroksidasyonunu azaltıcı, beyin dokusunu oksidatif hasardan koruyucu etkiye sahiptir. Ayrıca kanser hücrelerinin çoğalmasını, tümör büyümesini engellemektedir. Melatonin suda ve yağda çözünürlüğü oldukça yüksek bir bileşiktir. Biyoaktif bir bileşik olan melatonin; portakal, domates, çilek, üzüm, kiraz, zeytinyağı, pirinç, arpa, ceviz ve sağlığa yönelik tüketilen fonksiyonel gıda ve ilaç hammaddelerinin kaynağını teşkil eden bazı tıbbi ve aromatik bitkilerde farklı bileşimlerde bulunmaktadır. Bu derlemenin amacı melatoninin önemi, fonksiyonel özellikleri, gıdalardaki profili ve gıda işlemenin melatonin içeriğine etkisi konularını araştıran çalışmaları inceleyerek sağlıklı beslenme ve yaşama katkı sağlamaktır.

Yaşlı nüfusun oranı dünyada olduğu gibi ülkemizde de artmaktadır. Yaşlı nüfusun son beş yılda %22,5 varan artışı yaşlı bakımın gün geçtikçe daha önem kazanacağını ve hekimlerin geriyatrik hasta ile ilgili tanı ve tedavi alanında yeterli bilgi ve deneyime sahip olması gerektiği düşünülmektedir. Yaşlı ve kırılgan bireyler olarak da ifade edilen geriyatrik hastalarda en sık rastlanılan ve tedavi edilmediği takdirde mortaliteye dahi sebep olan infeksiyon, üriner sistem infeksiyonlarıdır. Üriner sistem enfeksiyonlarının tanı ve tedavisinin, doğru endikasyonda, yeterli süre ve dozda uygulanması gereklidir. Ayrıca tedavi uygulamalarında ilgili klinisyenlerce yan etki, antibiyotik direnci ve özel doz ayarı uygulamaları eşliğinde bilimsel esaslara göre uygulanmalıdır., The elderly population is increasing in our country as in the world. It is thought that the increase in the elderly population by 22.5% in the last five years will gain more importance day by day, and physicians should have sufficient knowledge and experience in the field of diagnosis and treatment of geriatric patients. The most common infection in geriatric patients, who are also expressed as elderly and frail individuals, and cause even mortality if left untreated, is urinary tract infections. Diagnosis and treatment of urinaary tract infections must be applied in the right indication, in sufficient time and dose. In addition, the treatment should be applied by the relevant clinicians according to scientific principles, accompanied by side effects, antibiotic resistance and special dose adjustment applications.

Adrenal yetmezlik olgulari, hayati tehdit eden sok ile karakterize adrenal kriz tablosu ile karsimiza cikabilecegi gibi ozgun olmayan belirtilerle de basvurabilir. Hastalarin, mortalite ve morbiditesi yuksek olan adrenal kriz tablosu oncesinde taninip tedavi edilmesi hayati oneme sahiptir. Bu makale ile Hashimoto tiroditi nedeniyle izlemde iken asiri kilo kaybi, halsizlik, cilt renginde koyulasma bulgulari gelisen ve Addison Hastaligi tanisi alan 16 yasindaki kiz olgu uzerinden cocukluk yas grubunda adrenal yetmezlik tablosunun vurgulanmasi amaclanmistir.

Amaç: Terapötik hipotermi tedavisi alan hipoksik iskemik ensefalopatili (HİE) yenidoğanların kardiyak bulgularının; biyobelirteçler, EKG ve ekokardiyografi ile değerlendirilmesi ve bu belirteçlerin hipoksik myokard hasarı şiddetinin belirlenmesindeki etkisinin araştırılması amaçlanmıştır.Gereç ve Yöntemler: Evre II ve III HİE tanısı alan ve terapötik hipotermi uygulanmış 50 yenidoğan bebeğin verileri retrospektif olarak incelendi. Demografik özellikler, sistemik ve kardiyak muayene bulguları, serum CK-MB, troponin-I, EKG ve ekokardiyografi raporları kaydedildi. Evre II ve Evre III HİE’li hastaların bulguları karşılaştırıldı.Bulgular: Elli olgunun 11’inde (%22) miyokardiyal disfonksiyon saptandı. EKG kayıtlarında tüm olgular normal sinüs ritmine sahipti. EKG’de patolojik bulgu evre II’de 2 (%8.3) olguda, evre III’de ise 5 (%19.8) olguda mevcuttu. Serum CK-MB ve troponin-I olguların 30’unda (%60) yüksek izlendi. Tüm olguların 5’inde (%10) orta derecede triküspit yetersizliği, 1’inde (%2) şiddetli triküspit yetersizliği, 4’ünde (%8) sağ ventrikül hipokinezisi, 6’sında (%12) sol ventrikül hipokinezi ve 1’inde (%2) biventriküler hipokinezi mevcuttu. Evre III HİE’li olgularda enzim düzeylerinin daha yüksek, EKG ve EKO anormalliklerinin daha yaygın olduğu görüldü (p, Objective: The aim of this study is to evaluate the severity of cardiac complications of hypoxic ischemic encephalopathy (HIE) according to the degree of hypoxia and to evaluate the efficacy of cardiac biomarkers, electrocardiography (ECG) and echocardiography (ECHO) for myocardial injury.Material and Methods: Fifty term babies with HIE without any additional disease were selected. Myocardial dysfunction was evaluatedusing clinical examination, serum CK-MB, troponin-I and ECG and ECHO.Results: According to Sarnat and Sarnat classificiation, 24 neonates were diagnosed stage II and 26 neonates were diagnosed stage IIIHIE. Among these 50 cases, 11 (22%) had evidence of myocardiac dysfunction. All the cases had normal sinus rhythm. ECG changes(ST depression, T wave inversion, pathological Q wave as signs of ischemia) were present in 2 (8.3%) cases in the stage II, and 5 (19.8%)cases in the stage HIE group. ECG showed. Serum levels of troponin-I and CK-MB were increased in 30 (60%) patients. Moderatetricuspid regurgitation was present in 5 (10%), severe tricuspid regurgitation in 1 (2%), right ventricular hypokinesia in 4 (8%), left ventricularhypokinesia in 6 (12%) and biventricular hypokinesia in 1 (2%) neonate among all the cases. Enzyme levels were higher, ECG and ECHOabnormalities were more common in the neonates with stage III HIE (p

İşletmelerin başarılı olabilmeleri için süreçlerini en iyi şekilde tanımlamaları ve yönetmeleri gerekir. Doğru bir süreç yönetimi gerçekleştiren işletmeler faaliyetlerinin gelişmesini sağlayacak, süreçlerin sonuçlarını değerlendirerek aksaklıklar söz konusu olduğunda performansın iyileştirilmesi için sürecin işleyiş biçimini yeniden tasarlayacaktır. Bu kapsamda performansın iyileştirilmesinde istenen başarı için gerekli olan en önemli adımlardan biri süreç iyileştirmedir.Bu çalışmada literatürde yer alan süreç iyileştirme yöntemleri kullanılarak dondurma imalatı yapan bir işletmede iyileştirme uygulaması gerçekleştirilmiştir. İşletmenin iş süreçlerinin bütün aşamaları incelenerek mevcut durum analizi yapılmıştır. Analiz sonrasında sorunlar tespit edilerek uygun yöntemlerin seçilmesiyle sorunların çözümü için çalışmalar gerçekleştirilmiştir. Yapılan uygulama sonucunda temel sorunlar tespit edilerek işçilik hataları, temizlik ve hijyen, fabrika düzeniyle ilgili çözümler üretilmiştir. Üretilen çözümlerin bir kısmı hayata geçirilerek kısa sürede önemli iyileştirmeler sağlarken, bir kısım öneriler ise işletmenin orta vadeli hedefleri içerisine alınarak değerlendirilmiştir., In order for businesses to be successful, they need to define and manage their processes in the best way. Businesses that perform a correct process management will ensure the development of their activities, evaluate the results of the processes and redesign the way the process works in order to improve performance in case of malfunctions. In this context, one of the most important steps required for the desired success in improving performance is process improvement. In this study, improvement process was applied to an ice cream manufacturing operation by using the process improvement methods in the literature. All phases of the business process of the business are examined and the current situation analysis is done. Problems were identified after the analysis and appropriate methods were selected to solve the problems. As a result of the application, basic problems were identified and workmanship errors, cleaning and hygiene, factory layout solutions were produced. While some of the solutions produced have been passed on to life and provided important improvements in a short period of time, some of the suggestions have been evaluated by taking into account the medium term objectives of the operator.

Literatürde larinks kanseri ve kan grupları arasındaki ilişkinin araştırıldığı çalışmalarda tartışmalı sonuçlar mevcuttur. Çalışmamızın amacı kan grubu farklılıkları ve larinks kanser gelişim evreleri arasındaki olası ilişkinin incelenmesidir. Çalışmamıza 3. Basamak bir sağlık kuruluşunda Kulak Burun Boğaz Hastalıkları ve Baş Boyun Cerrahisi Kliniği’nde 01 Ocak 2014- 31 Ekim 2020 yılları arasında, larinks patolojisi ön tanısı ile direkt laringoskopi altında biyopsi operasyonu geçirmiş olan 251 hastanın dosyaları geriye dönük olarak incelenmiştir. Hastaların yaş, cinsiyet, kan grubu verileri ve histopatolojik tanıları değerlendirilmiştir. Hastalar histopatolojik tanılarına göre % 32,65 oranında benign (n:64), %38,78 oranında premalign (n:76) ve %28,57 oranında malign (n:56) laringeal lezyon olarak gruplandırılmıştır. Gruplar yaş açısından karşılaştırıldığında yaş ortalaması malign laringeal lezyon grubunda premalign laringeal lezyon grubundan, premalign laringeal lezyon grubunda da benign laringeal lezyon grubundan anlamlı şekilde yüksektir (p, There are controversial results in studies investigating the relationship between laryngeal cancer and blood group in the literature. The aim of our study is to examine the possible relationship between blood group and laryngeal cancer. 251 cases who had undergone direct laryngoscopy and biopsy with the diagnosis of laryngeal pathology, in the Department of Otorhinolaryngology and Head and Neck Surgery of a 3rd level healthcare institution in the period between January 01,2014 and October 31,2020 were analyzed. The age, gender, blood group and histopathological diagnosis of the cases were evaluated. According to their histopathological diagnosis, the cases were grouped as benign (32,65%, n:64), premalignant (38.78%, n:76) and malignant laryngeal lesion (28.57%, n:56). When the groups were compared in terms of age, the mean age was significantly higher in the malignant laryngeal lesion group than in the premalignant group and in the premalignant laryngeal lesion group than in the benign group (p

SARS-CoV-2 infection has a more severe course in diabetic patients, intensive care needs and mortality related to the disease are more common in these patients. Angiotensin converting enzyme-2 (ACE2) is the main receptor of SARS-CoV-2. Increased ACE2 expression in the lungs of diabetic patients and glycolysis of these receptors with hyperglycemia make them more susceptible to COVID-19. In addition, acute or chronic hyperglycemia contributes to the severity of COVID-19 infection in patients with diabetes by impairing innate and acquired immune function. It is also thought that SARS-CoV-2 may cause the development of new diabetes cases and lead to an increase in the frequency of type 1 diabetes. Providing glycemic control is important in improving the prognosis of COVID-19 in diabetic patients. It provides significant reductions in mortality rates by providing glycemic regulation. Insulin therapy should be preferred in severe patients with respiratory distress and in critical COVID-19 cases. If glycemic control is achieved in mildly symptomatic or asymptomatic individuals, current treatment is continued. There is no need to discontinue oral antidiabetic therapies in these patients. If glycemic control cannot be achieved, their treatments are intensified according to the current diabetes treatment guidelines. Antidiabetic treatment revision should be made considering that dexamethasone and remdesivir treatments used in the treatment of COVID-19 may impair glycemic control. Blood glucose targets should be between 140-180 mg/dl in diabetic COVID-19 cases, and the lower limit can be reduced to 110 mg/dl in those who do not have hypoglycemia risk., Diyabetik hastalarda SARS-CoV-2 enfeksiyonu daha şiddetli seyretmekte, hastalığa bağlı yoğun bakım ihtiyaçları ve mortalite daha sık görülmektedir. Anjiyotensin dönüştürücü enzim-2 (ACE2), SARS-CoV-2'nin ana reseptörüdür. Diyabetli hastaların akciğerlerinde ACE2 ifadesinin artması ve hiperglisemi ile bu reseptörlerin glikozillenmesi onları COVID-19'a daha duyarlı hale getirir. Bununla birlikte akut veya kronik hiperglisemi doğal ve edinsel bağışıklık fonksiyonunu bozarak diyabetli hastalarda COVID-19 enfeksiyonunun ciddiyetine katkıda bulunur. SARS-CoV-2 yeni diyabet olguların gelişmesine neden olabileceği ve tip 1 diyabet sıklığında artışa yol açacağı da düşünülmektedir. Diyabetik hastalarda COVID-19 prognozunu iyileştirmede glisemik kontrolün sağlanması önemlidir. Glisemik regülasyonun sağlanması ile mortalite oranlarında önemli azalmalar sağlamaktadır. Solunum sıkıntısı olan ciddi hastalar ve kritik COVID-19 olgularında insülin tedavisi tercih edilmelidir. Hafif semptomatik veya asemptomatik bireylerde glisemik kontrol sağlanmışsa mevcut tedavisine devam edilir. Bu hastalarda oral antidiyabetik tedavilerin kesilmesine gerek yoktur. Glisemik kontrol sağlanamamışsa güncel diyabet tedavi klavuzlarına göre tedavileri yoğunlaştırılır. COVID-19 tedavisinde kullanılan deksametazon ve remdesivir tedavilerinin glisemik kontrolü bozabileceği öngörülerek antidiyabetik tedavi revizyonu yapılmalıdır. Diyabetli COVID-19 olgularında kan şekeri hedeflerini 140-180 mg/dl arasında tutmalı, hipoglisemi riski olmayanlarda alt sınır 110 mg/dl’ye düşürülebilir.

The new coronavirus disease 2019 (COVID-19) pandemic continues to exist as an unavoidable crisis that affects the whole world. The old drugs with anti-inflammatory activity have come to the fore again in the search for treatment to reduce the morbidity and mortality of the disease. Colchicine is an alternative drug with immunomodulatory and potential anti-viral properties. Control of hyper inflammation triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the most important stage for the development of acute respiratory disease syndrome (ARDS). Because of inhibiting different inflammation pathways, colchicine treatment may be effective in preventing the development of ARDS associated with mortality in COVID-19. Again, the lack of immunosuppression effect, ease of use, and being economical are its superior features compared to other drugs. In this review, along with colchicine treatment, non-steroidal anti-inflammatory drug (NSAID) applications used in COVID-19 mostly due to its acute anti-inflammatory effects will be discussed in the light of current information., Yeni koronavirus hastalığı 2019 (COVID-19) pandemisi tüm dünyayı etkileyen ve henüz önüne geçilemeyen bir kriz olarak varlığını devam ettirmektedir. Hastalığın morbidite ve mortalitesini azaltacak tedavi arayışları içinde anti-inflamatuar etkinliğe sahip eski ilaçlar tekrar gündeme gelmiştir. Kolşisin immünomodülatör ve potansiyel anti-viral özellikleri ile alternatif bir ilaçtır. Şiddetli akut solunum yolu sendromu koronavirus 2’nin (SARS-CoV-2) tetiklediği hiperinflamasyonun kontrol altına alınması akut solunumsal hastalık sendromu (Akut respiratuar distress sendromu, ARDS) gelişimi için en önemli aşamadır. Farklı inflamasyon yolaklarını inhibe etmesi nedeni ile kolşisin tedavisi COVID-19’da mortalite ile ilişkili ARDS gelişiminin önlemesinde etkili olabilir. Yine immunsupresyon etkisinin olmaması, kullanım kolaylığı ve ekonomik olması diğer ilaçlara göre üstün özellikleridir. Bu derlemede kolşisin tedavisi ile birlikte , akut anti-inflamatuar etkileri nedeni ile COVID-19’da kullanılan non-steroid anti-inflamatuar ilaç (NSAİİ) uygulamalarıda, güncel bilgiler eşliğinde tartışılacaktır.

Aim: It is known that approximately 10% of breast cancers are hereditary, and BRCA1/2 genes are responsible forapproximately 20% of these. Studies have shown that mutations of many genes other than BRCA1/2 in breast cancer alsocause this predisposition. In this study, it was aimed to investigate other causative cancer susceptibility genes in womenwith breast cancer.Material and Methods: In this retrospective study, 66 female patients who were evaluated in Ankara Dışkapı YıldırımBeyazıt Training and Research Hospital Genetics Department between 2016-2020 were included. Cancer susceptibilitygenes of the patients were examined using next-generation sequencing technique (NGS).Results: Mean age at diagnosis of the patients was 43 ± 8.0. By genetic analysis, causative genes were identified in 9(13.63%) of 66 patients. These genes are ATM (%11), BRIP1 (%11), CHEK2 (%34), FANCC (%11), MUTYH (%11) and PALB2(%22). Patients with a causal variant and others were grouped, and compared in terms of parameters such as age atdiagnosis, tumor localization, histopathological type of tumor, estrogen/progesterone receptor status, c-erbB2, stage,metastasis at diagnosis, and number of relatives with cancer. No statistical relationship was found between the groups.Conclusion: This study determined the rate of detection of causal variants of cancer susceptibility genes other thanBRCA1/2 in women with breast cancer who applied to the medical genetics department as 13.63%. Performing multiplegene tests with the NGS in cancer individuals will allow carrier individuals to receive correct diagnosis and appropriatetreatment and to be directed to necessary screenings., Amaç: Meme kanserlerinin yaklaşık %10'unun kalıtsal olduğu ve bunların yaklaşık %20'sinden BRCA1/2 genlerinin sorumlu olduğu bilinmektedir. Yapılan araştırmalar, meme kanserinde BRCA1/2 dışındaki birçok genin mutasyonlarının da yatkınlığa neden olduğunu göstermiştir. Bu çalışmada meme kanserli Türk kadınlarda diğer kanser yatkınlık genlerinin araştırılması amaçlanmıştır.Gereç ve Yöntemler: Bu retrospektif çalışmaya Ankara Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi Genetik Bölümü'nde 2016-2021 yılları arasında değerlendirilen 66 kadın hasta dahil edildi. Hastaların kansere yatkınlık genleri, yeni nesil dizileme tekniği (NGS) kullanılarak incelendi.Bulgular: Hastaların ortalama tanı yaşı 43 ± 8.0 idi. Genetik analiz ile 66 hastanın 9'unda (%13,63) nedensel gen tespit edildi. Bu genler ATM (%13), CHEK2 (%36), FANCC (%13), MUTYH (%13) ve PALB2'dir (%25). Nedensel varyantı olan hastalar ve diğerleri gruplandırılarak tanı yaşı, tümör lokalizasyonu, tümörün histopatolojik tipi, östrojen/progesteron reseptör durumu, cerbb2, evre, tanı anındaki metastaz ve kanserli akraba sayısı gibi parametreler açısından karşılaştırıldı. Gruplar arasında istatistiksel bir ilişki bulunamadı.Sonuç: Bu çalışmada meme kanserli Türk kadınlarında BRCA1/2 dışındaki kansere yatkınlık genlerinin nedensel varyantlarının saptanma oranı %13,63 olarak belirlendi. Kanserli bireylerde NGS ile çoklu gen testlerinin yapılması, taşıyıcı bireylerin doğru tanı ve uygun tedavi almalarını ve gerekli taramalara yönlendirilmelerini sağlayacaktır.

Central line-associated bloodstream infections are the most common and significant complications of central venous catheters. The development of central line-associated bloodstream infection in children is increasingly recognized worldwide, although it is often preventable. Guidelines recommend the application of a central catheter insertion bundle and appropriate catheter care to prevent central line-associated bloodstream infections. Central catheter insertion and maintenance care bundles consist of interventions that, when used together, are effective in preventing central lineassociated bloodstream infections. Recent literature on central line-associated bloodstream infection prevention shows that using a care bundle approach to improve central catheter insertion and maintenance practices reduces the rates of central line-associated bloodstream infections. Nurses have a direct and permanent role in the handling of central venous catheters. Therefore, they have a unique opportunity to contribute to the prevention of central line-associated bloodstream infections. However, prevention of central line-associated bloodstream infections is an important responsibility for nurses. The nurse’s knowledge of the evidence-based recommendations plays a key role in preventing catheter-related infections. This review summarizes recent literature regarding the prevention of central line-associated bloodstream infections in critically ill children.

Metal matrix composites are widely used in various fields such as aerospace, defense industry, automobiles and other important structural applications. Aluminum and its alloys have been increasingly used in the industry thanks to their lightness, strength and easy formability. Al2O3, SiC, TiC, MgO, CNT and B4C are widely used as reinforcing elements in aluminum matrix composites. In this study, mathematical and finite element modeling was used to examine the mechanical properties of Al-based metal matrix composites. Based on the pressure, sintering temperature and sintering time, the relative densities were successfully analyzed using the adaptive neuro-fuzzy extraction system (ANFIS) method and the artificial neural networks (ANN) method. The porosity content of aluminum-magnesium matrix composites produced by powder metallurgy method and reinforced with SiC were investigated using the ANFIS method. In the ANFIS approach, four input parameters, weight% SiC ratio, used pressure (MPa), sintering temperature (C), sintering time (min) and one output parameter porosity (%) ratio were used. Correlation coefficients and statistical error rates of the analyzed dataset were found to be good. The relative density values of Al-Mg-Al2O3 composites produced by powder metallurgy method were examined by ANN method. It can be said that the estimation rate of the system is 81% and that it is within acceptable limits. Besides, the relative density of composites with Al2O3 and SiC was examined using Taguchi method and the results were compared., Metal matris kompozitler havacılık, savunma sanayii, otomobiller ve diğer önemli yapısal uygulamalar gibi çeşitli alanlarda yaygın olarak kullanılmaktadır. Alüminyum ve alaşımları hafifliği yanı sıra sağlamlığı ve kolay şekillendirilebilme özellikleri sayesinde endüstride giderek artan kullanım alanına sahip olmuştur. Alüminyum matrisli kompozitlerde takviye elamanı olarak Al2O3, SiC, TiC, MgO, CNT ve B4C yaygın olarak kullanılır. Bu alışmada, Al-bazlı metal matris kompozitlerin mekanik özelliklerini incelemek için matematiksel ve sonlu eleman modellemesi kullanılmıştır. Basınç, sinterleme sıcaklığı ve sinterleme süresine bağlı kalarak porozite içeriği uyarlanabilir nöro-bulanık çıkarım sistemi (ANFIS) yöntemi kullanılarak relatif yoğunluklar ise yapay sinir ağları (ANN) yöntemi ile başarılı bir şekilde analiz edilmiştir. Toz metalürjisi yöntemiyle üretilen ve SiC ile güçlendirilmiş alüminyum-magnezyum matrisli kompozitlerin porozite içeriği ANFIS yöntemi kullanılarak incelenmiştir. ANFIS yaklaşımında, dört giriş parametresi, ağırlıkça %SiC oranını, kullanılan basıncı (MPa), sinterleme sıcaklığını (⁰C), sinterleme zamanını (dk) ve bir çıkış parametresi porozite (%) oranını kullanılmıştır. Analizlerin korelasyon katsayılarının ve istatiksel hata oranlarının iyi olduğu görülmüştür. Toz metalürjisi yöntemiyle üretilen Al-Mg-Al2O3 kompozitlerin relatif yoğunluk değerleri ANN yöntemiyle incelenmiştir. Sistemin tahmin oranın %81olduğu ve kabul edilebilir sınırlar içerisinde olduğu söylenebilir. Ayrıca, Taguchi yaklaşımı ile her iki güçlendirici içeren kompozitlerin relatif yoğunluklar analiz edilmiştir ve sonuçlar karşılaştırılmıştır.

We aim to explore the importance of early differential diagnosis of an organic etiology such as intestinal malrotation and psychiatric disorder. We present a child with an intestinal malrotation, who had no symptoms until she was 4 year old. The child presented with sudden cessation of oral food intake and constipation. The diagnosis was missed at another center, as there were many accompanying psychiatric symptoms. The child improved after surgery, and the severity of the psychiatric symptoms decreased. This case emphasizes that an organic disorder can be confused with a mental disorder. Many patients with intestinal malrotation present with abdominal discomfort since childhood, while others present with relatively sudden onset of symptoms. The clinician should consider all symptoms to avoid missing that important and treatable condition.