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Introduction: We compared the effects of pharyngeal packing and gastric decompression with orogastric tube application on the incidence of nausea/vomiting, sore throat, and dysphagia. As a secondary objective, we assessed the effect of the selected method on the postoperative pain score and patient satisfaction. Methods: In this randomized, prospective study were 60 patients aged 18-50 years who underwent elective septorhinoplasty. Nasopharyngeal packing was performed in group 1 and gastric decompression with an orogastric tube in group 2, and both procedures were terminated by the practitioner before extubation. Between-group demographic data, duration of operation/ anesthesia, hemodynamic parameters, nausea, vomiting, additional antiemetic requirement, pain/dysphagia during swallowing, visual analogue scale (VAS), and patient satisfaction were measured at 24 h, and the group findings were compared. Results: The demographic findings and durations of anesthesia/operation were not statistically different between the groups, and there was no difference in postoperative nausea and vomiting, VAS, and satisfaction scores. In contrast, sore throat was twice as common in the nasopharyngeal pack group but decreased over time. Conclusion: The routine packing approach should be abandoned by anesthesiologists. Because pharyngeal packing is not a completely risk-free procedure, we do not recommend intraoperative packing during nasal surgery. If indicated for surgical reasons, however, protocols, checklists, and observation forms pre-prepared with the participation of the surgical and anesthesia teams should be used. All materials should be included in the surgical (scrub) count, and it should be ensured that all materials are removed before extubation with a matching count. Regardless of the method used, it should not be forgotten that the anesthesiologist is responsible for the examination of the oral cavity and throat via direct laryngoscopy and, if necessary, aspiration before extubation.

Objective: In this study, the aim was to investigate the prevalence of insomnia and related factors in Turkish pregnant women.Materials and Methods: This cross-sectional study was performed out with 467 pregnant women. The Personal Information Form, Insomnia Severity Index, and Epworth Sleepiness Scale (ESS) were used to collect the data.Results: The mean age of the participating pregnant women was 28.9 +/- 3.90 years. Of them, 28.5% suffered from insomnia, 30.8% were in the first trimester, 37.5% were in the second trimester, and 31.7% were in the third trimester. The results of the multivariate logistic regression analysis demonstrated that the ESS score, pregnancy trimester, daytime sleep, leg cramp during sleep, and edema were the risk factors affecting insomnia during pregnancy.Conclusion: In the study, it was determined that the daytime sleepiness score was one of the main factors affecting insomnia during pregnancy, that insomnia was more prevalent in the third trimester than it was in the other two trimesters, and that sociodemographic and other obstetric characteristics did not affect insomnia. Amaç: Bu çalışma, gebelerde uykusuzluk prevalansı ve ilişkili faktörlerin araştırılması amacıyla gerçekleştirildi. Gereç ve Yöntem: Bu kesitsel çalışma 467 gebe ile yapılmıştır. Verilerin toplanmasında Kişisel Bilgi Formu, Uykusuzluk Şiddet İndeksi ve Epworth Uykululuk Ölçeği (ESS) kullanılmıştır. Bulgular: Gebelerin yaş ortalaması 28,9±3,90 yıldı. Gebelerin %28,5’inin uykusuzluk yaşadığı, bunların da %30,8’inin ilk üç aylık dönemde, %37,5’inin ikinci üç aylık dönemde ve %31,7’sinin üçüncü üç aylık dönemde olduğu belirlendi. Çok değişkenli lojistik regresyon analizi sonuçları, ESS skorunun, gebelik trimesterinin, gündüz uykusunun, uykuda bacak krampı yaşama ve ödemin gebelikte uykusuzluğu etkileyen risk faktörleri olduğunu göstermiştir. Sonuç: Çalışmada, gündüz uykululuk puanının gebelikte uykusuzluğu etkileyen temel faktörlerden biri olduğu, üçüncü trimesterde uykusuzluğun diğer iki trimestere göre daha yaygın olduğu, sosyo-demografik ve diğer obstetrik özelliklerin uykusuzluğu etkilemediği saptandı.

Dermatofibrosarcoma protuberans (DFSP) is a rare sarcoma of the dermis. It is a malignant, locally aggressive, and infiltrative tumor with frequent recurrence. In this case, a 44-year-old woman presented with a 15-year history of a swelling in the medial canthus of the right eye that caused tearing. Imaging revealed a septated mass isodense to soft tissue that had eroded the medial wall of the orbit. Macroscopic examination showed an elastic, gray-brown, encapsulated, irregular mass measuring 45x35x22 mm. The surgical margins were positive, so adjuvant radiotherapy was started. The patient was followed for 2 years without recurrence. According to the literature, this mass is the largest orbital DFSP treated by globe-sparing primary resection.

This study aimed to evaluate the prognosis of a retinal autograft that was used to treat a macular hole that occurred after repeated vitreoretinal surgeries. A patient underwent repeated vitreoretinal surgery due to retinal detachment in the right eye, and the internal limiting membrane was also removed during the surgeries. After silicone oil removal, the patient developed recurrent retinal detachment and macular hole, and for this reason a retinal autograft was applied to the macular hole and silicone tamponade was administered. The silicone oil was removed at postoperative 7 months, and the macular hole was observed to be closed on fundus examination at 18 months. The final visual acuity was 5/100. On optical coherence tomography (OCT), the hole in the detached retina was measured as 600 µm in diameter preoperatively, 1020 µm on the first postoperative day, gradually narrowed to 765 µm, and graft integration occurred. During follow-up, the accumulation of hyperreflective spots persisted on the inner surface of the graft tissue and in all vertically extending sections. In en face sections, it appeared as a hyperreflective arc between the graft and host retina with a shadowing artefact. In OCT angiography evaluation, a punctate multiple blood flow signal in the vertical axis of the graft was detected in the early phase at 3 months. This finding persisted at 1 month after silicone removal, and the flow signal disappeared with resorption of the cystic edema. These flow signals were in the same location as the areas of hyperreflective spots on structural OCT. In conclusion, structural OCT and OCT angiography are effective methods for the follow-up of retinal autograft integration into host tissue.

OBJECTIVES: Coronavirus Disease-2019 (COVID-19) pandemic has a massive impact on human health, causing sudden lifestyle changes. As it affects health, determining the lifestyles of university students related to smoking has gained importance. This study provides evidence of change in smoking behavior among university students in Türkiye during the ongoing COVID-19 pandemic. MATERIALS AND METHODS: This cross-sectional survey study was conducted via an electronic questionnaire approximately 2020-2021 among university students in Türkiye. The study comprised a structured questionnaire that inquired about demographic information; and the Fagerström Test for Nicotine Dependence. The questionnaire was distributed randomly to university students; it required 6 min to complete. RESULTS: A total of 749 respondents were included in the study, aged between 19 and 35 years (54.8% females). Of 749 participants, 571 health science students (medicine, pharmacy, dentistry, etc.) completed the survey. The pre-pandemic and COVID-19 pandemic mean nicotine dependence scores were 3.03 and 2.97, respectively. A difference was seen pre-pandemic (p= 0.002) and during pandemic (p= 0.005) for those studying in health and other departments. Students who had middle socio-economical status had significantly higher nicotine dependence scores pre-COVID-19, compared to during the pandemic (p= 0.027). Compared to pre and during the pandemic, the mean score of dependence was significantly lower in students, whose parents were non-smokers during the pandemic. CONCLUSION: In this study, we have provided the first data on the Turkish university student’s nicotine dependence changes during the COVID-19 lockdown. The nicotine dependence level may change based on various factors including behavioral changes. Crucial times such as pandemics can affect individuals, thus, smoking addiction can increase. Behavioral support for quitting smoking such as digital platforms, internet, and television programs should also assist to support smokers quitting successfully during this supreme time.

To present coronavirus disease-2019 (COVID-19) related maternal mortality in relation to Delta and Omicron waves and to investigate the role of lung ultrasound (LUS) in estimating mortality.This retrospective cohort study was conducted in the obstetrics and gynecology clinic of a tertiary pandemic hospital between March 2020 and January 2022. The hospitalized pregnant women with COVID-19 diagnosis and maternal deaths were studied in relation with Delta and Omicron waves. The relationship between LUS scores of hospitalized patients and maternal mortality was explored.Thousand and sixty-five pregnant women were hospitalized because of COVID-19 infection. Fifty-one (4.79%) of these patients had critical sickness, 96 (9.01%) of them had severe illness, 62 (5.82%) of them were admitted to the intensive care unit and 28 (2.63%) of all hospitalized pregnant women had died. Of the 1.065 patients, 783 (73.5%) were hospitalized before the Delta wave and the maternal mortality rate was 1.28% (10/783), 243 (22.8%) were hospitalized during the Delta wave and the maternal mortality rate was 7% (17/243) [relative risk (RR)=5.478, 95% confidence interval (CI) (2.54-11.8), z=4.342, p0.001]. During the Omicron wave 39 (3.66%) patients were hospitalized and the maternal mortality rate was 2.56% (1/39). Maternal mortality rates, according to LUS scores, were 0.37% (1/273) for LUS 0, 0.72% (2/277) for LUS 1, 2.58% (10/387) for LUS 2 and 11.72% (15/128) for LUS 3 respectively (LUS 3 vs. others; maternal mortality: RR=8.447, 95% CI (4.11-17.34), z=5.814, p0.0001). There were no vaccinated patients in the study cohort.The maternal mortality rate was relatively high, particularly during the Delta wave at our referral center. The Delta wave, delayed vaccination and vaccine hesitancy of pregnant women might have important roles in maternal mortality. Higher LUS scores should warn clinicians of an increased risk of maternal death.

This review aimed to summarize key points that might suggest rheumatologic diseases to physicians dealing with musculoskeletal (MSK) complaints. Evaluation of a child presenting with MSK findings requires a comprehensive, multidisciplinary, and systematic approach. In children with MSK complaints, detailed anamnesis, appropriate physical examination and joint examination, and the use of correct laboratory tests will be helpful for accurate diagnosis. The algorithm we have suggested for MSK complaints of children will be a guide for the physicians.

Introduction: Trapezius myalgia (TM) is the chronic pain of trapezius muscle, one of the most common reasons for shoulder pain seen in a common population. The aim of our study is to determine the effects of an existence of preoperative TM to the postoperative pain in the patients, who underwent a laparoscopic cholecystectomy. Methods: After receiving an ethical committee approval, we have included 60 ASA 1-2 patients who underwent a laparoscopic cholecystectomy surgery in the general surgery operating room in University of Health Sciences Turkey, İstanbul Training and Research Hospital between January and June 2015. The patients who were classified as ASA 3-4, had head and neck surgery or trauma, operations which had started as the laparoscopic procedures but then had to be performed as an open surgery, patients who had rheumatological and neurological diseases, tendinitis that affects the shoulder joints, and patients who had to have the emergency surgeries were excluded in this study. Patients were divided into two groups, one with (TM+) and who were not having (TM), when evaluated preoperatively. Each group had analgesia by a patient-controlled device. Using Numeral Rating scale demographical data, shoulder and umbilical pain levels were evaluated, and postoperative analgesic needs and doses were recorded in the case files. Results: Five patients who were excluded; n=26 in TM+ group and n=29 in TM group were taken. There was no significant demographic difference found between two groups. No statistically significant difference was found between TM+ and TM- groups (p>0.05). While no statistically significant difference was established in the tramadol doses between two groups, a total of ten patients out of 26 TM+ had shoulder pain, and additional analgesic need was found statistically increased in TM+ group (p

Objective: to determine homocysteine, vitamin B12, and folate levels in patients with Parkinson's disease and to investigate the effect of entacapone use on homocysteine levels. Materials and methods: the records of patients who were followed up in our outpatient clinic between 2009 and 2010 were reviewed retrospectively. The demographic, clinical characteristics, and laboratory findings of the patients were recorded. The control group consisted of healthy subjects with similar demographic characteristics. The patients were divided into two groups according to the treatment they received. Results: the control group consisted of 22 healthy subjects (group 1), group 2 comprised 22 patients [entacapone (+)], and group 3 constitued 50 patients [entacapone (-)]. The homocysteine levels of the control group were significantly lower than the entacapone (-) and entacapone (+) groups. The vitamin B12 level of the control group was significantly higher than in the entacapone (-) group. The folate levels of the control group were significantly higher than those of the entacapone (-) group. There was no significant difference between the entacapone (-) and entacapone (+) groups in terms of homocysteine, vitamin B12, and folate levels. Conclusion: levodopa treatment affects homocysteine levels in patients with Parkinson's disease. The effect of levodopa + entacapone on plasma homocysteine levels should be evaluated together with basal vitamin B12 and folate levels and genetic features. / Amaç: parkinson hastalarında homosistein, vitamin B12 ve folat düzeylerinin belirlenmesi ve entakapon kullanımının homosistein düzeylerine etkisinin araştırılması amaçlanmıştır. Gereç ve yöntem: hareket bozuklukları polikliniğimizde 2009-2010 tarihleri arasında takipli olan hastaların dosyaları retrospektif olarak incelendi. Hastaların demografik, klinik özellikleri ve laboratuvar bulguları kayıt edildi. Benzer demografik özelliklere sahip laboratuvar değerleri incelenmiş olan sağlıklı kişiler kontrol grubunu oluşturdu. Hastalar aldıkları tedaviye göre 2 gruba ayrılarak değerlendirme yapıldı. Bulgular: grup 1: Yirmi iki sağlıklı kişiden (kontrol grubu), grup 2: Yirmi iki hastadan [entakapon (+)], grup 3: Elli hastadan [entakapon (-)] oluşmaktadır. Kontrol grubunun homosistein düzeyi entakapon (-) ve entakapon (+) gruba göre anlamlı derecede düşük saptandı. Kontrol grubunun vitamin B12 düzeyi entakapon (-) grupa göre anlamlı olarak yüksek saptandı. Kontrol grubunun folat düzeyi entakapon (-) gruba göre anlamlı olarak yüksek saptandı. Entakapon (-) ve entakapon (+) gruplar arasında homosistein, vitamin B12 ve folat düzeyleri açısından anlamlı fark saptanmadı. Sonuç: Parkinson hastalarında levodopa tedavisi homosistein düzeyini etkilemektedir. Levodopa + entakapon kullanımının plazma homosistein düzeylerine etkisinin plazmanın bazal vitamin B12 ve folat düzeyleri ve genetik özelliklerle birlikte değerlendirilmesi gerektiği düşünülmüştür., NA

Objective: Trigeminal autonomic headaches are the primary headache group that occurs with autonomic stimulation of the cranial nerves. The most common type of this group is cluster headache (CH). This study aimed to report the clinical features and pain characteristics of patients with CH. Materials and Methods: Patients of the outpatient headache center between 2010 and 2020 were retrospectively analyzed. Inclusion criteria were diagnosis of CH and a minimum of 1-year follow-up. Records were reviewed using the International Headache Classification-3β. The sociodemographic characteristics of patients, types of pain, pain characteristics, and treatments that were used were documented. Clinical features were compared with sociodemographic characteristics and factors that could affect the pain features. Results: The mean age of 32 patients (25 male and 7 female) was 41.8 (23-68) years, and the mean age at disease onset was 31.7 (15-65) years. Lacrimation followed by conjunctival injection were the most common autonomic findings. According to gender, no statistical significance was found between pain character (p=0.166), painful side (p=0.572), month of onset (p=0.562), accompanying autonomic findings (p=0.495), pain duration (p=0.650), pain occurrence time during the day (p=0.394), and localization (Retroorbital/orbital, p=0.602; temporal, p=0.650; and forehead p=0.394). Nine patients had migraine-like features (MLF). The pain duration of patients with MLF was found to be 1.14±0.6 months and this period was longer than the results of other patients. No statistically significant difference was found between pain characteristics. Conclusion: The delay in diagnosis due to MLF that may accompany shows the importance of increasing awareness in the definition of CH.

Objective:This study aimed to determine the factors affecting the mortality of patients in critical condition with coronavirus disease-2019 (COVID-19) in the intensive care unit (ICU).Materials and Methods:We included a total of 445 patients who are admitted in the ICU due to COVID-19. Patients were divided into two groups-those who survived and those who died during the ICU follow-up-and their demographic, clinical and laboratory characteristics were compared. Factors affecting mortality were also determined.Results:Older age, high Kidney Disease: Improving Global Outcome (KDIGO) stage and Sequential Organ Failure Assessment (SOFA) scores at first admission to the ICU, high neutrophil/lymphocyte ratio, high D-dimer levels, low bicarbonate (HCO3) values and high lactate dehydrogenase (LDH) and creatinine levels were determined as independent risk factors for mortality in patients in critical condition with COVID-19 admitted in the ICU. Particularly, a substantial relationship was observed between the KDIGO stage and mortality during the ICU admission.Conclusion:Age, KDIGO stage and SOFA scores at first admission, neutrophil/lymphocyte ratio and D-dimer, HCO3, LDH and creatinine levels were independent risk factors for mortality in patients in critical condition with COVID-19 admitted in the ICU.