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Background: Corona Virus Disease 2019 (COVID-19) in pregnant women has important impacts on perinatal and neonatal outcomes. However, there are a limited number of studies investigating the effect of the pandemic period on newborns. With this study, we aimed to determine the impact of the 2020 COVID-19 outbreak on prenatal care, obstetric outcomes, neonatal mortality and morbidity. Methods: The retrospective results of patients hospitalized to the Tertiary Neonatal Intensive Care Unit between 1 March and 30 May 2020, the first peak period of the pandemic in our country, were compared with the data of the same period of the previous year. Results: A total of 307 cases were included in our study. The mean gestational weeks of the neonates hospitalized in the Neonatal Intensive Care Unit during the COVID-19 period were higher than those in the control group (p: 0.003). During the pandemic period, an increase was found in the frequency of pregnant women presenting to obstetric emergency services in emergencies requiring acute intervention (p: 0.01). Compared to the control group, there was an increase in the number of infants with small for gestational age (SGA) diagnosis, 5th-minute Apgar score of 0.05). Conclusions: During the COVID-19 pandemic, it was shown that pregnant women disrupted their regular antenatal care, and more pregnant women were admitted to the obstetric emergency department with emergencies requiring acute intervention. This led to an increase in the number of cases diagnosed with SGA and hypoxic-ischemic encephalopathy in newborns. Our results will be useful for better management of current and future pandemic periods.

An esophageal stricture may develop during healing of a large esophageal perforation. When such a stricture occurs, mechanical dilatation is the treatment of choice. As in our case, if a cervical esophageal stricture and leakage are present together, the treatment becomes even more challenging. As a new treatment method, we made spherical ice globes of various sizes using molds created with a 3D printer to treat the esophageal stricture and prevent its progression. This method can be used to safely treat leaking cervical esophageal strictures. A step-by-step of how to do it has been described.

To determine the correlation between musculoskeletal system disorders and the physical activity levels of nursing students. A total of 489 nursing students included in this cross-sectional study. Self-administered questionnaire included Nordic musculoskeletal questionnaire and International physical activity questionnaire short form (IPAQ-SF). The standardized Nordic musculoskeletal questionnaire showed that 358 students (%73.2) reported having musculoskeletal disorders in one or more body parts, while 131 students (26.8%) had no complaints. The mean weekly energy consumption as linked to the physical activity of the participants was found to be 1542.96±1949.35 MET-min/wk. 51.5% of the individuals exhibited low levels of activity. Statistically significant correlation was found between experiencing upper back pain during the last year and the participants physical activity levels. The current study has shown that the prevalence of MSDs was high among nursing students, with a correlation being found between low physical activity and upper back pain. Physical activity levels should hence be considered when evaluating young adults with musculoskeletal disorders. [Med-Science 2020; 9(2.000): 462-7]

Purpose The aim of this study was to examine changes in the electromyographic activity, thickness, width, and hardness of the masseter muscle from before to after orthognathic surgery. Material and methods The study included 15 patients with Class III dentofacial deformities who were treated with combined orthodontic and orthognathic surgery. Fifteen individuals with normal occlusion and no signs or symptoms of temporomandibular joint dysfunction were used as controls. All records were obtained bilaterally in the study group before surgery (T1), at 3 months after surgery (T2), and in the control group (CG) while at rest and in maximum voluntary contraction (MVC). Results There was no difference in resting masseter muscle activity between T1, T2, and CG. Resting thickness and width of the masseter muscle did not differ significantly between T1 and T2. MVC masseter muscle activity and thickness increased significantly and width decreased significantly from T1 to T2 but did not reach CG values. Muscle hardness increased from T1 to T2. Conclusions The authors' findings indicate that despite improved muscle activity and dimensions, postoperative 3 months is still early period for adaptation of the masseter muscles to the new occlusion and skeletal morphology.

BACKGROUND Skincare products and cosmetic procedures are used as an adjunct or complementary to conventional drug therapy for acne vulgaris (AV). OBJECTIVE To evaluate the use of skincare products and the frequency of cosmetic procedures in AV treatment. METHODS A total of 1,755 patients with AV completed the survey prepared by the researchers and the Cardiff Acne Disability Index (CADI) questionnaire. The clinical findings and the Food and Drug Administration (FDA) severity scores were recorded by the dermatologists. RESULTS For AV, 66.7% of the patients stated that they used skincare products and 26.7% had undergone cosmetic procedures. The use of skincare products was statistically significantly higher in women (female: 74.5%, male: 57.7%, p

Introduction: Mastocytosis is characterized by the excessive proliferation and accumulation of mast cells in organs such as the spleen, liver, lymph nodes, skin, gastrointestinal tract, and bone marrow. Cutaneous mastocytosis, which is only presented with skin involvement, is frequently seen in childhood. Objective: It was aimed to determine the demographic and clinical characteristics of patients with cutaneous mastocytosis and the knowledge level of families about the disease, and to raise awareness about this disease. Material and Methods: The records of 25 cases with cutaneous mastocytosis were evaluated retrospectively and the knowledge levels of the families were measured with a questionnaire. Results: The mean follow-up period of 25 patients was 39 months. The most common type of the disease was urticaria pigmentosa (60%). Itching (n=14) was the most common symptom in patients. Only 2 patients were carrying adrenaline auto-injectors. While 60% of the families (n=15) had fears about the disease; of these 15 families, 53.3% (n=8) were afraid of the re-spread of the disease, 13.3% (n=2) turning of the disease into skin cancer, 13.3% (n=2) occupation of the internal organs, 13.3% (n=2) having a new attack, and 0.4% (n=1) re-forming of the spots. Conclusion: The cutaneous forms of mastocytosis are mostly observed in childhood, and systemic involvement is rare. Mastocytosis progresses with rashes in childhood and its findings are limited to the skin. Families should be better informed about mastocytosis and the need for patients to carry an adrenaline auto-injector due to the risk of attacks should be explained to them., Giriş: Mastositoz, mast hücrelerinin dalak, karaciğer, lenf nodu, deri, gastrointestinal yol, kemik iliği gibi organlarda aşırı çoğalması ve birikmesi ile karakterize bir hastalıktır. Sıklıkla çocukluk çağında sadece deri tutulumu ile seyreden kutanöz mastositoz tipi görülür. Amaç: Kutanöz mastositozlu hastaların demografik ve klinik özelliklerini belirlemek, ailelerin hastalık hakkında bilgi düzeylerini ölçmek ve bu hastalık hakkında farkındalık oluşturmak amaçlanmıştır. Gereç ve Yöntemler: Kutanöz mastositoz tanısı alan 25 olgunun dosyası geriye dönük olarak değerlendirildi ve ailelere kutanöz mastositoz ile ilgili bilgi düzeylerini ölçmek için anket uygulandı. Bulgular: İzlem süresi ortalama 39 ay olan 25 kutanöz mastositozlu hasta çalışmaya dahil edildi. Hastaların %60’ı ürtikerya pigmenzota tipinde idi. Kaşıntı en sık olarak görülen semptom (n=14) idi. Sadece 2 hastamız adrenalin oto enjektörü taşımaktaydı. Ailelerin %60’ında (n=15) hastalık ile ilgili korkular mevcuttu; bu 15 ailenin %53,3’ü (n=8) hastalığın tekrar yayılmasından, %13,3’ü (n=2) cilt kanserine dönüşmesinden, %13,3’ü (n=2) iç organların tutulmasından, %13,3’ü (n=2) atak geçirmesinden, %0,4’ü (n=1) lekelerin tekrar oluşmasından korkmakta idi Sonuç: Mastositoz çocukluk çağında döküntülerle beraber seyreden ve kendini cilt bulguları ile sınırlayan bir hastalıktır. Çocukluk çağında daha çok kutanöz formu görülen hastalığın sistemik tutulumu nadir görülür. Ailelerin mastositoz hastalığı hakkında bilgilendirilmesi ve atak geçirme riskine yönelik adrenalin oto enjektörü taşıması gerekliliği anlatılmalıdır.

Aim: In this study, we aimed to determine whether an increased monocyte count to high-density lipoprotein (MHR) would predict increased carotid intima-media thickness (IMT). Material and Method: All consecutive subjects presenting to the cardiology outpatient clinic of our institute were enrolled in this cross-sectional study. Subjects with cardiovascular and inflammatory diseases were excluded. Subjects were divided into two groups according to carotid IMT: those with carotid IMT >0.9 mm (increased) and those with carotid IMT ≤0.9 mm (normal). The difference in MHR between the two groups was the primary outcome measure of the study.Results: The MHR of the subjects with increased IMT was significantly higher than that of subjects with normal IMT (16.7 ± 5.7 vs. 12.8 ± 5.5, p 0.9 mm. ROC curve analysis revealed an MHR value of 13.4 as a cut-off in the identification of subjects that had increased IMT, with a sensitivity of 72% and specificity of 60.7%.Conclusion: The inflammation marker MHR can be used as a simple and cost-effective marker to predict increased carotid IMT which is accepted as the indicator of subclinical atherosclerosis.

Amaç: Tüm vücut difüzyon ağırlıklı görüntüleme (DWI), tümörlerin tespiti ve karakterizasyonu ve tedavi yanıtının izlenmesi için onkolojik vakalarda giderek daha fazla kullanılmaktadır. DAG'nin tümör saptama kapasitesi ve tanısal doğruluğunu altın standart olarak kabul edilen pozitron emisyon tomografi / bilgisayarlı tomografi (PET / CT) ile karşılaştırdık.Gereç ve Yöntemler: Çalışmaya 38-86 yaşları arasında çeşitli kanser türleri olan ve tedaviye yanıtın evrelendirilmesi veya değerlendirilmesi için PET / BT endike olan 29 erişkin hasta (13 erkek ve 16 kadın) dahil edildi. DWI görüntülerinde FDG-PET / BT'de pozitif olan toplam 240 lezyon belirlendi ve her lezyon için DWI sinyal yoğunluğu ve görünür difüzyon katsayısı (ADC) değeri ölçüldü. Her iki yöntem için PET-pozitif lezyonların ve lezyon alanlarının SUVmax, ADC ve DWI yoğunluk değerleri Mann-Whitney U testi ve Spearman korelasyon testi kullanılarak karşılaştırıldı.Bulgular: Lezyonların SUVmax ve DWI yoğunlukları anlamlı korelasyon gösterdi (Spearman korelasyon katsayısı = -0.296, p, Objective: Whole body diffusion-weighted imaging (DWI) has been increasingly used in oncological cases for detection and characterization of tumors and monitoring of treatment response. We compared the tumor detection capacity and diagnostic accuracy of DWI with positron emission tomography/computed tomography (PET/CT), which is regarded as the gold standard.Materials and Methods: The study included 29 adult patients (13 men and 16 women) aged between 38 and 86 years who had various types of cancer, and for whom PET/CT was indicated for staging or evaluating treatment response. A total of 240 lesions that were positive in FDG-PET/CT were identified in the DWI images, and DWI signal intensity and apparent diffusion coefficient (ADC) value were measured for each lesion. SUVmax, ADC, and DWI intensity values of PET-positive lesions and lesion areas for both methods were compared using Mann-Whitney U test and Spearman correlation test.Results: SUVmax and DWI intensities of the lesions showed significant correlation (Spearman correlation coefficient= -0.296, p

Background/Aim: Patient comfort is greatly affected during videonystagmography (VNG), and more comfortable tests are needed for diagnosis. This study aims to evaluate the modified tandem walking test (MTWT) as an alternative pre-assessment method to the VNG test.Methods: A total of 3348 patients were recruited in this retrospective cohort study between 2015-2019 based on the inclusion criteria of having chronic dizziness (>3 months), being aged between 18-65 years, and having an interpretable VNG test result. All patients were examined by an otolaryngologist, and the examination phase consisted of three parts: Physical examination, VNG test, and performing MTWT. The sensitivity, specificity, and likelihood ratio of the MTWT were calculated with the relevant formulas.Results: The female/male ratio was 2.19, and there was no significant difference between the groups in terms of age (P=0.334). The number of patients who were VNG positive (regardless of MTWT), both VNG and MTWT positive, both VNG and MTWT negative, and VNG negative (regardless of MTWT) were 2519, 2000, 699, and 2519, respectively. The sensitivity and specificity of MTWT were 79.37%, and 84.31%, respectively. Conclusion: MTWT has good sensitivity and specificity, and we think that it can be a safe, simple, and accessible pre-diagnostic tool when VNG is not available or cannot be tolerated by the patients.

Background: Coronavirus disease 2019 (covid-19), which causes a pandemic in the world, has started to appear in turkey since March 2020. Healthcare workers are at the top of the groups most at risk for covid-19 infection, which can have a negative impact on psychological state. Objectives: It was aimed to evaluate anxiety and depression levels among healthcare workers. Methods: this cross-sectional study performed via an online survey in april 2020. Participants answered questions about sociodemographic features, personal views and experiences about covid-19 and the hospital anxiety and depression scale (hads). Results: A total of 300 healthcare workers,193 men and 107 women, participated in the survey. According to hads, 44.6% of participants scored above anxiety and 68.2% scored above depression cut-off points. Being younger than 50 and taking care of covid-19 patients in hospitals were independently associated with anxiety risk. Female gender, young age (less than 50) and having comorbidity were independent risk factors for depression. Conclusion: Healthcare workers were at high risk of anxiety and depression during covid-19 outbreak. For this reason, psychological support should be given, especially to the group with high risk. Keywords: Healthcare workers; anxiety; depression; covid-19

Improving business processes provides companies with advantages in terms of efficiency and profitability, as well as competitiveness against other companies in the market. Companies that integrate business processes with enterprise resource planning (ERP) systems into digital platforms also have the opportunity to strengthen their weaknesses by recognizing disruptions and bottlenecks in inefficient business processes thanks to this digital transformation. Descriptive and bibliometric analyses were performed in this study for a systematic evaluation of studies on artificial intelligence (AI) in the ERP literature. The studies in which the keywords determined from the AI literature were firstly used together with ERP were investigated from the Scopus database. 837 publications meeting the search criteria were reached and a descriptive analysis of these publications was presented. Then, bibliometric analysis was performed using common author, common citation, and common keyword analysis methods for 296 publications in the article type. Tsinghua University and Obuda University have the most publications according to the results. The most commonly used AI keywords in the ERP studies were “genetic algorithm”, “fuzzy logic”, and “machine learning”. This study aims to guide future studies by providing a systematic and new perspective to researchers and experts working on ERP-AI.

Background Acne vulgaris (AV) may affect external appearance and significantly deteriorate the quality of life of patients. Therefore, patients make various inquiries about their disease and seek treatment options. Aims To investigate the social media usage habits of patients with AV concerning their diseases, and their recommendations for dermatologists related to social media use. Methods A total of 1609 patients with AV completed the survey prepared by the authors and the Cardiff Acne Disability Index questionnaire. The Food and Drug Administration severity scores and clinical information of the patients were noted by their physicians. Results Of the 1,489 patients who stated that they used social media, 46.31% regularly and 28.77% sometimes referred to these sources to make inquiries about AV. Social media usage for AV was statistically significantly higher in women, participants with short term and severe disease, those with a moderate income level, and those using topical treatment and cosmetics. They mostly used Google (67%), Instagram (54%), and YouTube (49%). While 76% of the participants stated that they did not share what they saw on the Internet with their doctor. Of the respondents, 18.5% were trying to contact their dermatologists through the Internet, and 69.73% would prefer experts such as dermatologists to post-AV-related content. Conclusions Our study shows that patients frequently resort to social media to seek information about AV. In the changing digital world order, it is observed that there is a need for dermatologists to use social media more actively to share accurate information about AV.

Objective: Multiple sclerosis (MS) is a condition involving central nervous system invasion by immune-inflammatory cells. In this study, we investigated whether the systemic immune-inflammation index (SII) could predict disability cross-sectionally as a novel and useful tool in patients with MS. Materials and Methods: We retrospectively reviewed the medical records of 148 patients with MS and 84 healthy controls and gathered the relevant clinicallaboratory data. SII in the remission period was calculated using the equation (SII: Platelet count x neutrophil count/lymphocyte count). The odds ratio of each immune formulation index was calculated by logistic regression analysis. In addition, the cut-off value, sensitivity and specificity of SII were calculated using receiver operating characteristics curve analysis. Results: Age and sex characteristics were similar in the groups (p>0.05). All values obtained through complete blood counts were significantly lower in the patient group (p

Objective The study aimed to analyze the risk factors and clinical features of metabolic bone disease of prematurity (MBDP) in premature infants compared with infants of similar gestational age and birth weight without MBDP. Study Design This retrospective case–control study was performed by comparing 81 cases of MBDP with 63 controls to identify potential risk factors. Premature infants with a gestational age ≤33 weeks and birth weight Results Bone fractures and invasive ventilator dependence were the most common clinical features of MBDP. Duration of invasive ventilation and total mechanical ventilation days, necrotizing enterocolitis, corticosteroid use, anticonvulsive drug use, duration of dexamethasone and caffeine use, total parenteral nutrition, and length of hospitalization were significantly higher in neonates with MBDP (p Conclusion Our results show that anticonvulsive drug use is a significant risk factor for the development of MBDP. If long-term use is not required, anticonvulsive drugs should be stopped as soon as possible. Further studies involving patients with MBDP are required to determine the risk factors and clinical features. Key Points

Objective: The disease caused by Coronavirus 19 is a pandemic disease that emerged at the end of 2019 and has spread worldwide. Although it progresses as a classical upper respiratory tract infection in mild cases, it causes death by causing pneumonia and respiratory distress in severe cases. Although various drugs have been tried, there is still no specific drug treatment. The aim of this study is to investigate the demographic characteristics, risk factors, drugs used and the effects of these drugs on mortality of patients who were infected with Coronavirus 19.Materials and Methods: A total of 71 patients hospitalized in Malatya Training and Research Hospital with the diagnosis of COVID-19 due to positive test results between March 2020 and May 2020 were retrospectively rewieved and recorded from the hospital's database and the Public Health Management System. The demographic characteristics of these patients, the service they were hospitalized, the duration of hospitalization, additional diseases, survival status, and the drugs they used were recorded. statistical analyses were performed by using SPSS (IBM SPSS for Windows, ver.24) and Minitab (Statistical Software for Windows, ver.17) statistical package programs.Results: The number of male patients was statistically significantly higher than female patients (p: 0.001). Mortality rate was higher in males than females (p: 0.001). 73% of the patients had at least one additional disease. The most common additional disease was hypertension (48%). The mortality rate of patients with comorbidities was statistically significantly higher than those without (p: 0.001). In our institution 5 drug groups, including hydroxychloroquine, oseltamivir, azithromycin, favipiravir, ritonavir and lopinavir have been were routinely used against COVID-19. The most frequently used drug was hydroxychloroquine (77%). The drugs used had no effect on mortality (p: 0582).Conclusion: The results of our study indicate that the majority of those who get COVID 19 are men, age is an important risk factor, additional diseases increase the risk of mortality, and all the drugs used have no effect on mortality., Amaç: Corona Virüs 19’un neden olduğu hastalık, 2019 yılının sonunda ortaya çıkan halen Dünya genelinde yaygın olarak görülen pandemik hastalıktır. Hafif vakalarda klasik bir üst solunum enfeksiyonu şeklinde seyretse de ağır vakalarda pnömoni ve solumun sıkıntısına yol açarak ölüme neden olur. Günümüzde halan spesifik bir ilaç tedavisi bulunmamakta ve çeşitli ilaçlar tedavi için denenmektedir. Bu çalışmada, Corona Virüs 19’a yakalanan hastaların demografik özellikleri, risk faktörleri, kullanılan ilaçlar ve bu ilaçların mortalite üzerine etkilerinin araştırılması amaçlandı.Materyal ve Metot: Malatya Eğitim ve Araştırma Hastanesi’nde 2020 yılı Mart-Mayıs ayları arasında Covid 19 tanısı ile yatan ve test sonucu pozitif olan toplam 71 hasta, hastanenin veri tabanından ve Halk Sağlığı Yönetim Sisteminden retrospektif olarak taranarak kaydedildi. Bu hastaların, demografik özellikleri, yattıkları servis, yatış süreleri, ek hastalıkları, sağ kalım durumları, kullandıkları ilaçlar tespit edildi. İstatiksel analiz için SPSS (IBM SPSS for Windows, ver.24) ve Minitab (Statistical Software for Windows, ver.17) istatistik paket programları kullanılmıştır.Bulgular: Erkek hastaların sayısı kadınlara göre istatiksel anlamlı olarak yüksekti (p:0,001). Ölüm oranı erkeklerde kadınlara göre daha yüksekti (p:0,001). Hastaların 73%’de en az bir ek hastalık vardı. En fazla görülen ek hastalık hipertansiyondu (48%). Ek hastalığı olan hastaların ölüm oranı olmayanlara göre istatiksel anlamlı olarak yüksekti (p:0,001). Hastanemizde Covid 19’a karşı rutin olarak hidroksiklorokin, oseltamivir, azitromisin, favipiravir, ritonavir ve lopinavir olmak üzere beş ilaç grubu kullanılmıştı. Bu ilaçlar içerisinden en fazla kullanılan hidroksiklorokin’di (77%). Kullanılan ilaçların mortalite üzerine herhangi bir etkisi yoktu (p:0582).Sonuç: Çalışmamızın sonuçları, Covid 19 hastalığına yakalananların çoğunluğunun erkek olduğunu, yaşın önemli bir risk faktörü olduğunu, ek hastalıkların mortalite riskini artırdığını, kullanılan bütün ilaçların mortalite üzerinde herhangi bir etkisinin olmadığını göstermektedir.

BACKGROUND: Sedation is recommended during fiberoptic bronchoscopy, which is a common procedure in clinical pulmonary practice. However, there is no consensus or a standard approach globally. The present study aimed to assess the approaches of pulmonologists to sedation before bronchoscopic procedures in Turkey. MATERIALS AND METHODS: The study is designed as a cross-sectional study, based on survey-generated data. Pulmonologists working in Turkey were sent a 23-item survey via E-mail. The recipients were sent three reminders to complete the survey, and the responses were analyzed. The data analysis was carried out using the Statistical Package for the Social Sciences for Windows 15.0 package program. RESULTS: A total of 79 pulmonologists participated in the survey, with a mean age of 43.8 ± 7.7 years. Among the respondents, 92.4% stated that they applied sedation before bronchoscopic procedures. Of the total, 92% of the respondents stated that they used midazolam for sedation, while 20% used propofol, 18.7% used fentanyl and 9% used diazepam. All of the respondents reported using local anesthesia before the bronchoscopic procedure, with lidocaine being preferred by all. CONCLUSIONS: It was determined that most of the pulmonologists applied sedation during bronchoscopy usually in the form of mild-to-moderate sedation, with midazolam being the preferred medication. Of the respondents, 75% believed that the applied sedation was sufficient. Surveys like this could play a role in improving the implementation and application of international guidelines in Turkey.

Torticollis is one of the common causes of admission to the emergency department among children which can make parents worried. This could be related to many traumatic and non-traumatic conditions. One of the rare causes of acute onset of torticollis is atlantoaxial rotatory subluxation, which is characterized by limitation of neck rotation, increased pain by movement. It is generally associated with a past trauma history. Although it is known as a temporary and self-resolving condition, if it is not diagnosed earlier it may lead to severe rotational deformity of the cervical spine. Therefore, detecting certain causes and providing proper treatment are highly important. Physical examination and history are usually enough to make the diagnosis, yet cervical X-ray and computed tomography scan can be considered for indefinite cases. Even though treatment options depend on symptoms and the patient's general status, conservative approach with cervical collar and anti-inflammatory drugs are recommended as a first step. We would like to present our case, a 13 year-old girl who has been diagnosed with atlantoaxial rotatory subluxation in our clinic to increase awareness of this condition which is often misdiagnosed in children., Tortikollis, özellikle aileleri endişelendirebilmesi nedeniyle, çocuklarda yaygın acile başvuru nedenlerinden birisidir. Bu durum travmatik veya non travmatik olmak üzere pek çok durumla ilişkili olabilir. Ani başlangıçlı tortikolisin nadir nedenlerinden biri de, boyunda rotasyon kısıtlılığı ve hareketle artan ağrı ile karakterize olan atlantoaksiyel rotasyonel subluksasyondur. Genellikle geçirilmiş bir travma öyküsü ile ilişkilidir. Geçici ve kendini sınırlayan bir durum olarak bilinse de, erken tanı konmadığı takdirde ciddi rotasyon deformitelerine neden olabilmektedir. Bu sebeple, nedeni saptamak ve uygun tedaviyi sunmak oldukça önemlidir. Tanı için fizik muayene ve anamnez büyük ölçüde yeterli olsa da, arada kalınmış vakalarda direkt grafi ve bilgisayarlı tomografi göz önünde bulundurulabilir. Tedavi seçenekleri semptomlara ve hastanın genel durumuna göre değişmekle birlikte, ilk aşama olarak boyunluk kullanımı ve anti inflamatuar ilaçlarla konservatif yaklaşım önerilir.Çocuk yaş grubunda çoğunlukla atlanan bu tanı açısından farkındalığı arttırmak adına, kliniğimizde atlantoaksiyel rotatuar subluksasyon tanısı koyduğumuz 13 yaşındaki kız hastamızı sunmak istedik.

Çalışmanın amacı, Çanakkale İli, Kumkale Ovasında buğday yetiştiren tarım işletmelerinin Çiftlik Muhasebe Veri Ağı (ÇMVA) sistemine göre ekonomik büyüklüklerini ve standart sonuçlarını tespit etmektir. Bu sebeple, buğday üretiminin yoğun olarak yapıldığı Kumkale Ovası‘nda basit tesadüfi örnekleme yöntemine göre yapılan örneklemede 59 işletmeye anket yapılarak verilerin elde edilmesi sağlanmıştır. İşletmelerin ekonomik büyüklüklere göre sınıflandırılması 5 gruba göre yapılmıştır. Tarımsal işletmelerin %32,20‘si I. ekonomik büyüklük işletme grubunda, %15,25‘i II. ekonomik büyüklük işletme grubunda, %18,64‘ü III. ekonomik büyüklük işletme grubunda, %16,95‘i IV. ekonomik büyüklük işletme grubunda ve %16,96‘sı V. ekonomik büyüklük işletme grubunda bulunduğu tespit edilmiştir. Araştırma kapsamında bulunan işletmelerden elde edilen sonuçlara göre, ekonomik büyüklükleri 2,14 ve 98,86 ESU değeri arasında değişmektedir. İşletmeler ortalaması 24,03 ESU‘dur. Tarımsal işletmelerin ekonomik büyüklük gruplarına göre toplam gelir 32.669,96 TL ile 1.008.939,30 TL, brüt işletme karı 7.953,32 TL ile 754.769,83 TL, işletme net katma değeri 4.184,66 TL ile 736.240,61 TL, net işletme aile geliri -13.049,82TL ile 631.720,36 TL arasında değişmektedir. I. ve II. ekonomik büyüklük grubundaki işletmelerde net işletme aile değeri negatif olarak bulunmuştur. Analiz edilen işletmelerde ekonomik büyüklük gruplarına göre karlılığın arttığı tespit edilmiştir.

Objective: In the early stages of any epidemic caused by new emerging pathogens healthcare personnel is subject to a great risk. Pandemic caused by SARS-CoV-2, proved to be no exception. Many healthcare workers died in the early stages of pandemic due to inadequate precautions and insufficient protection. It is essential to protect and maintain the safety of healthcare personnel for the confinement of pandemic as well as continuity of qualified healthcare services which is already under strain. Educating healthcare personnel on appropiate use of personal protective equipment (PPE) is as essential as procuring them. Material and Methods: A survey is conducted on 4927 healthcare personnel working solely with pediatric patients from 32 different centers. Education given on PPE usage were questioned and analyzed depending on age, sex, occupation and region. Results: Among four thousand nine hundred twelve healthcare personnel from 32 different centers 91% (n= 4457) received education on PPE usage. Of those who received education only 36% was given both theoretical and applied education. Although there was no differences among different occupation groups, receiving education depended on regions. Conclusion: It is essential to educate healthcare personnel appropiately nationwidely for the continuity of qualified healthcare services during the pandemic.

Coronavirus directly infects the nervous system and may cause the course of the existing neurological disease to get worse in those with a chronic neurological disease People with dementia, which is the most common chronic neurological disease over 65 years old, have serious difficulties in terms of follow-up and treatment of their diseases in the social isolation process However, due to the risk factors caused by coronavirus disease 2019 (COVID-19), it has become easier for them to go into delirium These risk factors can be listed as social isolation, inactivity, intense stress, as well as direct invasion of the virus to the central nervous system, the effect of inflammatory cytokines, the effect of sedative drugs used and the effect that develops secondary to other accompanying diseases This paper provides an assessment regarding the problems experienced by dementia patients in the pandemic process, and their solutions, accompanied by a case presentation © 2020, Duzce University Medical School All rights reserved

Sacral stress fractures (SSF) are one of the rare causes of lumbar and hip pain during pregnancy. The purpose of this report is to present a case of SSF diagnosed in the second trimester of pregnancy along with its diagnosis and treatment as wells as the type of birth. A 27-year-old primigravid patient presented with lumbar and hip pain at 25 weeks of gestation. Magnetic resonance imaging revealed SSF. The patient was followed up with conservative treatment. She gave birth by caesarean section at 38 weeks of gestation. Bone mineral density analysis revealed pregnancy-related osteoporosis in the postpartum period. Two months later, the patient’s symptoms were completely resolved. SSF should be considered in the differential diagnosis of lumbar and hip pain during pregnancy, and it should be kept in mind that these fractures may also occur in the prepartum period. Pregnancy-related osteoporosis is a risk factor for SSF. Caesarean section can be recommended as the type of birth in the women with SSF while considering the possible displacement risk for the fracture.

DergiPark: 762683 tmsj Aims: Neural tube defects are among the most common congenital anomalies worldwide, with a wide range of subtypes. The aim of this case report is to present a patient with cervical meningocele, a rare type of neural tube defect. Case Report: A 33-year-old pregnant woman with a story of bearing an anencephalic baby was referred to Trakya University Hospital with a probable cystic hygroma diagnosis on the 31st week of pregnancy. An antenatal ultrasound revealed a protrusion on the posterior cervical regi- on. Two days before the planned delivery, fetal magnetic resonance imaging was performed by the decision of the council. The 61 x 37 millimeters cyst was planned to be removed upon birth. On the 38th week, the baby was delivered by cesarean section with no other complications. After a preoperative magnetic resonance imaging, surgical procedure including the excision of the cyst and the duroplasty was performed. Conclusion: A rare and devastating congenital anomaly, cervical meningocele, requires accurate diagnosis and prompt surgical involvement for effective treatment and good prognosis.

Spinal dural arteriovenous fistula (SDAVF) is a rarely seen vascular lesion in the spinal cord and is often overlooked. If left untreated in the early stages, it is associated with severe morbidity and may lead to progressive myelopathy and bladder and bowel dysfunction. A 55-year-old male patient was admitted with complaints of lower extremity weakness, gait disorder, urinary retention, and stool retention. Based on physical examination and magnetic resonance imaging findings, a preliminary diagnosis of SDAVF was made. The diagnosis was confirmed by spinal angiography showing SDAVF on the left T6. Microsurgery was planned, once endovascular embolization failed. Although symptoms of progressive myelopathy and bladder and bowel dysfunction are rarely seen, SDAVF diagnosis should not be overlooked, and it should be kept in mind that early diagnosis and treatment prevent severe morbidities.

Patients with multiple sclerosis (MS) often report fatigue, poor sleep and complaint of sleep disorders. Neurofilament light chain (NF-L) has been identified as a potential biomarker for disease progression in MS patients. In this study, we aimed to evaluate sleep characteristics in MS patients and its relationship with the level of serum NF-L. In the present study carried out as a prospective and cross-sectional study, 32 relapsing–remitting MS (RRMS) patients and 32 control subjects were included. Epworth Sleepiness Scale and Fatigue Severity Scale tests were applied to the groups and the full night polysomnography was performed. Serum samples were obtained for NF-L analysis. Apnea–hypopnea index (AHI), AHI in rapid eye movement sleep (AHI REM), percentage of NonREM stage 1 (N1) and NonREM stage 3 (N3) values were significantly different in RRMS patients (p

Following the first reported cases of pneumonia of unknown etiology at the end of 2019 in Wuhan city, Hubei province, China, the causative agent was demonstrated to be a new coronavirus that has not been defined in humans before. The World Health Organization (WHO) named this virus as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the disease caused by the virus as coronavirus disease-19 (COVID-19). The disease spread rapidly to other countries through human-to-human transmission, and WHO declared a pandemic on March 11, 2020. As of April 2020, the number of individuals infected with SARS-CoV-2 and COVID-19 related deaths continue to increase rapidly worldwide. The main reason for the increase in the rate of infection is person-to-person transmission, while the main reason for the increase in mortality rate is the lack of a proven medical treatment specific to COVID-19 and the severe course of the disease in the elderly with low immunity. While a vast majority of individuals infected with SARS-CoV-2 are asymptomatic or recover after displaying mild symptoms, hospitalization is required in 14% of cases and severe disease requiring intensive care admission is seen in 5% of the infected individuals. WHO and national guidelines do not make clear recommendations regarding treatments for symptomatic patients. Currently, there is no vaccine or specific antiviral treatment for COVID-19, however supportive care, isolation and protective measures and experimental drugs/treatments are being used for the management of COVID-19. Medical treatments being used for COVID-19, aim to prevent the entry of the virus into the cell, to inhibit or reduce its replication, and to suppress the increased inflammatory response. In addition, “convalescent” plasma, which includes antibodies of patients who were completely recovered from the infection, is among the treatment options.

Background: in 2019, SARS-CoV-2 causing COVID-19 emerged. Severe COVID-19 symptoms may evolve by virtue of hyperactivation of the immune system. Equally, immunocompromised patients may be at increased risk to develop COVID-19. However, treatment guidelines for children following liver transplantation are elusive. Methods: as a liver transplantation center, we diagnosed and followed up 10 children (male/female: 8/2) with a median age of 8.5 years (IQR: 5.2-11.0), with COVID-19 post-liver transplant between March 2019 and December 2020. COVID-19 diagnosis was based on PCR test and or florid X-ray findings compatible with COVID-19 in the absence of other cause. We retrospectively collected clinical and laboratory data from electronic patient records following written consent from patients/parents. Results: nine patients were diagnosed as definitive (PCR positive) with one patient being diagnosed as probable COVID-19. Seven patients recovered without any support whereas three were admitted for non-invasive oxygenation. Lymphopenia and/or high levels of serum IL-6 were detected in four patients. Six patients mounted anti-SARS-CoV-2 antibodies at median 30 days (IQR: 26.5-119.0) following COVID-19 diagnosis. Antibiotic therapy, favipiravir, anakinra, and IVIG were used as treatment in 4,1,1 and 2 patients, respectively. Furthermore, we kept the tacrolimus with or without everolimus but stopped MMF in 2 patients. Importantly, liver allograft function was retained in all patients. Conclusions: we found that being immunocompromised did not affect disease severity nor survival. Stopping MMF yet continuing with tacrolimus was an apt treatment modality in these patients., NA

Objectives: the aim of this study is to identify the epidemiological, clinical, and laboratory features of coronavirus disease 2019 (COVID-19) in children.Methods: a retrospective study was conducted by pediatric infectious disease specialists from 32 different hospitals from all over Turkey by case record forms. Pediatric cases who were diagnosed as COVID-19 between March 16, 2020, and June 15, 2020 were included. Case characteristics including age, sex, dates of disease onset and diagnosis, family, and contact information were recorded. Clinical data, including the duration and severity of symptoms, were also collected. Laboratory parameters like biochemical tests and complete blood count, chest X-ray, and chest computed tomography (CT) were determined. Results: there were 1,156 confirmed pediatric COVID-19 cases. In total, male cases constituted 50.3% (n = 582) and females constituted 49.7% (n = 574). The median age of the confirmed cases was 10.75 years (4.5-14.6). Of the total cases, 90 were younger than 1 year of age (7.8%), 108 were 1-3 years of age (9.3%), 148 were 3-6 years of age (12.8%), 298 were 6-12 years of age (25.8%), 233 were 12-15 years of age (20.2%), and 268 cases were older than 15 years of age (23.2%). The most common symptom of the patients at the first visit was fever (50.4%) (n = 583) for a median of 2 days (IQR: 1-3 days). Fever was median at 38.4 degrees C (38.0-38.7 degrees C). The second most common symptom was cough (n = 543, 46.9%). The other common symptoms were sore throat (n = 143, 12.4%), myalgia (n = 141, 12.2%), dyspnea (n = 118, 10.2%), diarrhea (n = 112, 9.7%), stomachache (n = 71, 6.1%), and nasal discharge (n = 63, 5.4%). When patients were classified according to disease severity, 263 (22.7%) patients were asymptomatic, 668 (57.7%) patients had mild disease, 209 (18.1%) had moderate disease, and 16 (1.5%) cases had severe disease. One hundred and forty-nine (12.9%) cases had underlying diseases among the total cases; 56% of the patients who had severe disease had an underlying condition (p < 0.01). The need for hospitalization did not differ between patients who had an underlying condition and those who do not have (p = 0.38), but the need for intensive care was higher in patients who had an underlying condition (p < 0.01). Forty-seven (31.5%) of the cases having underlying conditions had asthma or lung disease (38 of them had asthma). Conclusions: to the best of our knowledge, this is one of the largest pediatric data about confirmed COVID-19 cases. Children from all ages appear to be susceptible to COVID-19, and there is a significant difference in symptomatology and laboratory findings by means of age distribution., NA

INTRODUCTION: Roseola infantum is always considered to be among the differential diagnosis of young patients with fever and leukopenia whom to be strictly isolated with the preliminary diagnosis of COVID-19 until otherwise proven during the pandemic. RESULTS: Human herpes virus-6 (HHV-6) polymerase chain reaction (PCR) blood test was performed in 4 of 7 patients with a clinical diagnosis of roseola infantum and all found to be HHV-6 PCR positive. The most striking laboratory finding in all patients was leukopenia. HHV-6 PCR tests were found to be positive. Severe acute respiratory syndrome coronavirus-2 testing were found to be negative in all patients. CONCLUSION: During the peak of the pandemic, children continued to present with fever because of viral infections other than COVID-19.

Objective: To evaluate the outcomes of patients who were followed up and treated for serous epithelial ovarian tumor. Materials and Methods: This retrospective study included 260 patients who were diagnosed with serous epithelial ovarian cancer, treated and followed up at Kanuni Sultan Suleyman Training and Research Hospital between January 2002 and December 2019. Results: The mean age of the patients participated in the study was 53.4±11.6 years. Of the patients, 79.7% had advance stage and 82.4% had grade 3 tumors. The rate of complete or optimal surgery was 88.2%, while the rate of suboptimal surgery was 11.2%. While 82% of the patients received adjuvant chemotherapy, 15.7% received neoadjuvant chemotherapy. Of the patients, 80.2% had a Ca 125 value higher than 35. Despite primary cytoreductive surgery and platinum-based adjuvant chemotherapy, the recurrence rate was 66.2%, and the PFS and OS rates were 34.7±41.0 and 50.5±40.0 months, respectively. Conclusion: The majority of serous epithelial ovarian cancers are diagnosed at an advanced stage. Despite primary situ reductive surgery and subsequent platinum-based chemotherapy, the recurrence rates are quite high.

Background: understanding SARS-CoV-2 seroprevalence among health care personnel is important to ex-plore risk factors for transmission, develop elimination strategies and form a view on the necessity and frequency of surveillance in the future. Methods: we enrolled 4927 health care personnel working in pediatric units at 32 hospitals from 7 different regions of Turkey in a study to determine SARS Co-V-2 seroprevalence after the first peak of the COVID-19 pandemic. A point of care serologic lateral flow rapid test kit for immunoglobulin (Ig)M/IgG was used. Seroprevalence and its association with demographic characteristics and possible risk factors were analyzed. Results: SARS-CoV-2 seropositivity prevalence in health care personnel tested was 6.1%. Seropositivity was more common among those who did not universally wear protective masks (10.6% vs 6.1%). Having a COVID-19-positive co-worker increased the likelihood of infection. The least and the most experienced personnel were more likely to be infected. Most of the seropositive health care personnel (68.0%) did not suspect that they had previously had COVID-19. Conclusions: health surveillance for health care personnel involving routine point-of-care nucleic acid testing and monitoring personal protective equipment adherence are suggested as important strategies to protect health care personnel from COVID-19 and reduce nosocomial SARS-CoV-2 transmission., NA

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has caused a pandemic affecting many countries and millions of people. Physicians have encountered some rare and challenging cases related to SARS-CoV-2, a novel virus with still many unknowns. In order to share our experience of a such clinical picture, we present here a child with SARS-CoV-2-induced macrophage activation syndrome in the setting of juvenile idiopathic arthritis., NA

Background Autonomic dysfunction may occur during the acute phase of COVID‐19. Heart rate variability (HRV) is a useful tool for the assessment of cardiac sympathetic and parasympathetic balance. We aimed to evaluate cardiac autonomic function by using HRV in subjects after recovery from COVID‐19 who had previously symptomatic and were followed outpatiently. Methods The study group composed of 50 subjects with a confirmed history of COVID‐19 and the control group composed of 50 healthy subjects without a history of COVID‐19 and vaccination. All the study participants underwent 2‐dimensional, pulsed‐ and tissue‐Doppler echocardiographic examinations and 24‐hour Holter monitoring for HRV analysis. Results Time domain parameters of SDNN, SDANN, SDNNi, RMSSD, pNN50, and HRV triangular index were all decreased in the study group when compared with the control group. Frequency domain parameters of TP, VLF, LF, HF, and HFnu were also decreased in the study group in comparison with the control group. LFnu was similar between groups. Nonlinear parameters of HRV including α1 and α2 decreased in the study group. By contrast, Lmax, Lmean, DET, REC, and Shannon entropy increased in the study population. Approximate and sample entropies also enhanced in the study group. Conclusions The present study showed that all three domain HRV significantly altered in patients after recovery from COVID‐19 indicating some degree of dysfunction in cardiac autonomic nervous system. HRV may be a useful tool for the detection of preclinical autonomic dysfunction in this group of patients.

Covid-19 pandemic required all the world to use internet more actively. As a result, individuals and businesses are more open to digital threats. In order to provide security within the network, firewalls should be used. Firewalls act as a gateway between the corporate and the external networks. Therefore, it is more important than ever to choose the right firewall for each network. In this study, a new linear decision making model is proposed in order to find out the most suitable firewall and the estimates are completed according to this new model. Also, this model is compared with multi-objective optimization on the basis of ratio analysis (MOORA) method. This study distinguishes from other studies by proposing a new solution which ranks the firewall alternatives using linear and MOORA approaches. These approaches are used in many fields before but not in information technologies. Thus, this study can be considered quite innovative in terms of the problem it handles and the approaches used. It offers up-to-date and practical suggestions related to a decision making problem that has not been previously studied in the literature.

Immunocompromised patients may be at increased risk to develop COVID-19 during the 2019 β-coronavirus infection. We present the unique opportunity we had to monitor the liver, IL-6 and immune cell course before, during and after COVID-19 in a boy with autoimmune hepatitis (AIH) and type 1 diabetes (T1D). CD4+and CD8+T cells frequencies decreased because of prednisolone, followed by a plateauing increase whereas CD19+CD20+B cell increased strongly and was unaffected by COVID-19 infection. Moreover, the percentage of activated CD8+T cells expressing HLA-DR (CD8+HLA-DR+) increased during COVID-19 and subsided after its clearance. Total regulatory T cells (Tregs: CD4+CD25+CD127lowFOXP3+) remained stable. Although activated Tregs (CD4+CD45RA-FOXP3high) strongly increased upon prednisolone, it decreased afterwards. Furthermore, regulatory B cells (Bregs: CD19+CD20+CD24highCD38high) declined sharply owing to prednisolone. Serum IL-6 remained undetectable at all times. We demonstrated for the first time immune monitoring in a child with AIH and T1D before, during and after COVID-19. We hypothesize that continuing with low level of prednisolone without azathioprine may have abrogated activated Tregs, Bregs and IL-6 production and therefore permitting the activation of CD8+T cells, clearing the virus., Koç University Seeds Funding 2019–2021

Purpose The current study investigated the effects of depression, personal characteristics, and some habits on physical activity levels among the elderly. Design and methods This study followed a descriptive design. The population of the study consisted of 11 750 individuals at least 65 years old. The sample size of the study was determined to be 967 by power analysis. Descriptive statistics and logistic models were used for data analysis. Results Together, age, the presence of a caregiver, chronic disease, and the Geriatric Depression Scale (GDS) score explained 32% of the variance in the physical activity of the elderly. Among these factors, the GDS score alone had the greatest effect. Practical implications To maintain health, it is important to reduce depression and increase physical activity among the elderly.

Context/Objective: The present study was designed to determine the spiritual belief levels of patients with spinal cord injury as well as to examine the socio-demographic factors that affect their spiritual beliefs. Design: This study was designed as a descriptive study. Setting: The physical therapy and rehabilitation unit of a city Education and Research hospital. Participants: All patients over the age of 18 years who have had spinal cord injuries. Outcome Measures: Data for the study were collected using a questionnaire and the FACIT-Spiritual Well-Being Scale. Results: People with SCI in the eastern region of Turkey demonstrate moderately high levels of spiritual well-being. A significant correlation was identified between socio-demographic characteristics, such as age, marital status, level of income, status of receiving care, and duration of diagnosis, and the spiritual well-being of patients with spinal cord injury. While previous studies have been conducted in Christian communities, the current study was the first to be conducted in a Turkish (primarily Muslim) community. Therefore, the current study will significantly contribute to the literature an explanation of the spiritual well-being of patients with spinal cord injuries in Muslim communities. Conclusions: Degree of spiritual well-being in Turkey is similar to other regions studied to date. Spiritual well-being is important in coping with the physical, social, economic, and emotional problems experienced by patients after a spinal cord injury. Healthcare professionals are encouraged to support the spiritual needs of their patients.

To determine the correlation between musculoskeletal system disorders and the physical activity levels of adolescents. A total of 417 high school students were included in this cross-sectional study. To explain the musculoskeletal pain and physical activity, a self-administered questionnaire which included the Nordic International Physical Activity Questionnaire Short Form (IPAQ-SF) was distributed. The standardised Nordic musculoskeletal questionnaire showed that 57.3% of the students reported having musculoskeletal disorders in one or more body parts, and 52.2% of them consisted of girls. The mean weekly energy consumption as linked to the physical activity of the participants was found to be 2534.58 (± 2371.31) metabolic equivalent task (MET/wk): 45.8% of the individuals exhibited low levels of activity. A statistically significant relationship was found between experiencing upper/low back pain and the participants’ low physical activity levels. The current study has shown that the prevalence of MSDs was high among high school students, with a correlation being found between low physical activity and back pain. Physical activity levels should hence be considered when evaluating adolescents with musculoskeletal disorders.

Background To identify the clinical findings and outcomes of children with coronavirus disease 2019 (COVID-19) and factors predicting reverse transcription polymerase chain reaction (RT-PCR) positivity. Methods The data were analyzed retrospectively for suspected and confirmed pediatric COVID-19 patients between March 20 and May 31, 2020. Results There were 404 children, of them, 176 (43.6%) patients were confirmed to have COVID-19, and 228 (56.4%) were considered suspected cases. Confirmed cases were less symptomatic on admission (67.6%-95.6%). Cough (44.9%), fever (38.1%), sore throat (18.5%), and smell-taste loss (12.7%) were the most common symptoms. Confirmed cases had a 92.6% identified history of contact with COVID-19. Close contact with COVID-19 positive family members and sore throat increased the RT-PCR positivity 23.8 and 5.0 times, respectively; while positivity decreased by 0.4 times if fever was over 38 degrees C. Asymptomatic and mild cases were categorized as "group 1" (n = 153); moderate, severe, and critical cases as "group 2" (n = 23) in terms of disease severity. Group 2 cases had higher C-reactive protein (40.9%-15.9%) and procalcitonin (22.7%-4.9%) levels and had more frequent lymphopenia (45.5%-13.1%). Out of 23 cases, 19 had abnormal chest radiograph findings; of them, 15 patients underwent chest computed tomographies (CTs), and all had abnormal findings. However, 26.0% of them needed respiratory support, and no patient required invasive ventilation. Conclusions Children with COVID-19 have a milder clinical course and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rarely causes severe disease in children. Contact history with COVID-19 and sore throat are the most important predictors for RT-PCR positivity. Consequently, the role of asymptomatic children in the contamination chain must be fully established and considered for the control of pandemic.

BACKGROUND The optimal timing of intervention for aneurysmatic subarachnoid hemorrhage is one of the historically controversial issues in neurosurgery. Although numerous studies investigated the subject, they had many limitations due to the nature of the disease. Early and ultra-early interventions have gained more and more supporters in recent decades. Nevertheless, the effects of the early and ultra-early intervention on the outcome of the disease are far from clarity. METHODS A single-center retrospective cohort study was carried out at Trakya University Medical Faculty Training and Practice Hospital. The study includes data on all patients admitted with an aneurysmal subarachnoid hemorrhage between January 1, 2001, and December 31, 2005. Patients were divided into two groups according to their WFNS grade status: Good (I-III) or poor (IV-V) grades. Patients are also classified according to their Glasgow Outcome Scale score: Unfavorable (1-2) or favorable (3-5) outcomes. Data were analyzed statistically, and the effects of the early and ultra-early intervention on the outcome were assessed. RESULTS A total of 580 patients were admitted in the study period. Among them, 494 were eligible for the study. The median age (interquartile range) was 55 (18) years. While 244 (49.4%) patients were women, 250 (50.6%) patients were men. Three hundred and fourteen (63.6%) patients were operated, and 25 patients (5.1%) were undergone endovascular treatment. The ultra-early intervention was achieved in 60 (12.1%) patients and 142 patients (28.7%, including the previous ultra-early intervention group) early intervention was achieved. A meaningful outcome difference was present between the poor-grade ultra-early treatment group and the rest (p=0.007). Analogously, a meaningful outcome difference was present between the poor-grade early treatment group and the rest (p

Şeyletiella dermatiti (şeyletielloz); ana rezervuarı kedi, köpek ve tavşanlar olan Cheyletiella cinsi parazitlerin rastlantısal olarak insana bulaşması sonucu oluşan bir dermatit tablosudur. Hayvanların birbirleriyle ve dış ortamla temasının arttığı bahar aylarında sık görülür. Şeyletiella dermatiti hayvanla temastan ortalama 1-2 gün sonra ortaya çıkan sıklıkla eritemli ödemli papüllerle karakterizedir. Nadiren vezikülobüllöz ve nekrotizan lezyonlar da oluşabilir. Evcil hayvan taşıyıcı olduğu için insanla her temasdan sonra lezyonlar tekrarlayabilir. Lezyonlar dışında deride parazitin kendisi de nadiren görülebilmektedir. Ancak klinik olarak şüphelenilmediği takdirde tanı konulması zordur.Burada elli sekiz yaşında şeyletiella dermatiti tanısı konulan bir kadın hasta sunulmaktadır. Tekrarlayan kaşıntılı döküntü şikayeti ve özellikle kedi olmak üzere evcil hayvan yetiştirme öyküsü olan kişilerde ayırıcı tanıda şeyletiella dermatitinin de düşünülmesi gerektiğini vurgulamak için olgumuz sunulmuştur., Cheyletiella dermatitis (cheyletiellosis) is a dermatitis that occur as a result of incidental contamination of cheyletilla mites whose main reservoir is cats, dogs and rabbits. It is relatively common seen in spring time when the contact of animals with each other and with the external environment increases. Cheyletiella dermatitis is characterized by erythematous edematous papules that occur on average 1-2 days after contact with the animal. Rarely, vesiculobullous and necrotizing lesions may also occur. Since the pet is a carrier, lesions can recur after every contact with the human. Apart from the lesions, the parasite itself is rarely seen. However, it is difficult to diagnose unless clinically suspected.Here we report a fifty-eight-years-old female patient diagnosed as cheyletiella dermatitis. Our case is presented to emphasize that cheyletiella dermatitis should also be considered in the differential diagnosis in people with recurrent itchy rash complaints and pet breeding history, especially cats.

Vitamin D is a pleiotropic steroid hormone that modulates the autonomic balance. Its deficiency has been described as an environmental risk factor for multiple sclerosis (MS). The aim of this study was to investigate the serum levels of vitamin D, vitamin D binding protein (VDBP) and vitamin D receptors (VDR) and to evaluate cardiac dysautonomia in MS patients due to bidirectional interaction between vitamin D and the autonomic nervous system. Methods: The current cross-sectional study was conducted on 26 patients with relapsing-remitting MS and on 24 healthy controls. Twenty-four-hour ambulatory blood pressure variability (BPV) was calculated and the participants were evaluated for orthostatic hypotension and supine hypertension. Serum levels of vitamin D, VDBP and VDR were measured. Results: The mean serum vitamin D level was significantly lower in MS patients than in controls (p = 0.044); however there was no significant difference in terms of VDR and VDBP levels between the groups. Supine hypertension and orthostatic hypotension were significant and the 24-hour systolic BPV was significantly decreased in patients with MS (p < 0.05) compared to controls. No correlation was found between vitamin D, VDBP and VDR with supine hypertension, orthostatic hypotension and systolic BPV values (p > 0.05). Also, there was a negative correlation between VDBP and the EDSS (p = 0.039, r = −0.406). Conclusion: There was no correlation between orthostatic hypotension, supine hypertension and systolic BPV values and serum vitamin D, VDBP and VDR in MS patients. Future prospective studies with large number of patients may help us to better understand the relationship between vitamin D and the autonomic nervous system. RESUMO A vitamina D é um hormônio esteroide pleiotrópico que modula o equilíbrio autonômico. Sua deficiência tem sido descrita como fator de risco ambiental para esclerose múltipla (EM). O objetivo deste estudo foi investigar os níveis séricos de vitamina D, proteína de ligação à vitamina D (VDBP) e receptor de vitamina D (VDR) e avaliar a disautonomia cardíaca em pacientes com EM devida à interação bidirecional entre vitamina D e sistema nervoso autônomo. Métodos: O presente estudo transversal foi realizado em 26 pacientes com EM remitente-recorrente e em 24 controles saudáveis. A variabilidade da pressão arterial ambulatorial (BPV) por 24 horas foi calculada e os participantes foram avaliados quanto à hipotensão ortostática e hipertensão supina. Os níveis séricos de vitamina D, VDBP e VDR foram medidos. Resultados: O nível sérico médio de vitamina D foi significativamente menor nos pacientes com EM do que nos controles (p = 0,044); no entanto, não houve diferença significativa em termos de níveis de VDR e VDBP entre os grupos. Hipertensão supina e hipotensão ortostática foram significativas e a BPV sistólica de 24 horas diminuiu significativamente em pacientes com EM (p < 0,05) em comparação aos controles. Não foi encontrada correlação entre vitamina D, VDBP e VDR com hipertensão supina, hipotensão ortostática e BPV sistólica (p > 0,05). Também houve correlação negativa entre VDBP e EDSS (p = 0,039, r = −0,406). Conclusão: Não houve correlação entre hipotensão ortostática, hipertensão supina e valores de BPV sistólica e vitamina D sérica, VDBP e VDR em pacientes com EM. Futuros estudos prospectivos com grande número de pacientes podem nos ajudar a entender melhor a relação entre vitamina D e sistema nervoso autônomo.

Objective Although the frequency of metabolic syndrome has been studied separately in psoriasis, psoriatic arthritis (PsA), and rheumatoid arthritis (RA) patients, there is no study that compares the prevalence of metabolic syndrome in all three diseases. The purpose of this study is to evaluate the relationship between metabolic syndrome (MetS) and chronic low-grade inflammatory diseases, and to determine the frequency of MetS and insulin resistance in psoriasis and PsA as compared to RA. Methods A total of 155 patients were included in this cross-sectional study. Fifty patients who were diagnosed with psoriasis, 55 PsA patients who were diagnosed according to the CASPAR criteria, and 50 seropositive RA patients who were diagnosed according to the ACR/EULAR 2010 classification criteria were included in this study. MetS was diagnosed by the 2005 criteria of International Diabetes Federation. The cardiovascular risk factors and parameters associated with MetS were evaluated. Results The patients' mean age was significantly higher in the RA. MetS was determined in 33.5% of all patients and MetS and insulin resistance showed no significant difference among the three groups (psoriasis: 36%, PsA: 29%, RA: 36%; p: 0.684 and psoriasis: 70%, PsA: 64%, RA: 66%, respectively; p: 0.785). Triglyceride levels were higher in psoriasis and PsA as compared to the RA (psoriasis: 34%, PsA: 32.7%, RA: 16%, respectively; p: 0.045). The frequency of hypertension was 38% in the RA, which was higher than PsA and psoriasis (p: 0.011). Conclusion In all three groups, the prevalence of MetS was shown to be higher than the general population. The lack of difference between these groups may be due to the small number of patients, the retrospective study design, and the inequality of the population with respect to age and gender.

OBJECTIVES: In patients with chronic obstructive pulmonary disease (COPD), the inspiratory capacity–to–total lung capacity (IC/TLC) ratio has been found to be correlated with mortality and a reduced exercise capacity. Pulmonary rehabilitation (PR) is known to improve the exercise capacity and respiratory functions of patients with COPD. Our study aims to examine the impact of PR on the IC/TLC ratio in patients with COPD. MATERIALS AND METHODS: We included a total of 122 patients with COPD who received PR therapy twice a week over a period of 8 weeks in an outpatient clinic. RESULTS: Patients’ mean age was 62.5 (±8.2), and 15 patients (12.3%) were female. Post-PR FEV(1), TLCO, and pO(2) values, and the 6mWD, dyspnea, and quality-of-life (QoL) scores indicated a statistically significant improvement (p0.25 as Group 1 and IC/TLC ≤0.25 as Group 2. Both groups exhibited a significantly increased post-PR 6 mWT distance (375–420, 336–400 meters) with no difference between the groups. We observed a significantly increased FEV(1)% in both groups after the PR (p=0.007, 0.004). Again, QoL questionnaires and Modified Medical Research Council scores significantly improved for both groups (p0.25.

Freezing of gait (FOG) is a disabling symptom that affects the quality of life of patients with Parkinson’s disease (PD) and its pathophysiology is not fully understood yet. The aim of the present study is to evaluate the relationship between FOG and other clinical characteristics in patients with PD. The clinical characteristics, modified Hoehn and Yahr (mHY) stages, Unified Parkinson’s Disease Rating Scale (UPDRS) scores, and total Freezing of Gait Questionnaire (FOG-Q) scores of the patients with PD were recorded. FOG-Q item 1.3 was used to evaluate patients with or without FOG. A total of 65 patients with PD (32 with FOG and 33 without FOG) were included to the study. Disease duration was longer, mHY stages were higher, bradykinesia and dyskinesia were more common in patients with FOG compared to patients without (p = 0.001, p = 0.036, p = 0.019 and p = 0.021; respectively). Patients with FOG had lower UPDRS part III tremor subscores (p = 0.020), although gait, postural balance subscores and part IV motor fluctuations scores were higher (p = 0.003, p = 0.023 and p

INTRODUCTION[|]The aim of this study was to determine the frequency of metabolic syndrome (MetS) in patients with schizophrenia and bipolar disorder (BD) receiving antipsychotic (AP) medications.[¤]METHODS[|]A total of 207 patients with schizophrenia and BD, diagnosed according to the DSM-IV criteria and receiving a regular AP treatment, were followed up in the Community Mental Health Center. The MetS was diagnosed according to the diagnostic criteria of the International Diabetes Federation. Patients with MetS were compared to those without it in terms of sociodemographic and clinical characteristics, as well as the AP medications administered.[¤]RESULTS[|]MetS was detected in 28.5% of patients. The most commonly identified clinical finding was a large waist circumference (61%). Of the clinical characteristics among the patients using AP, a large waist circumference and high blood glucose levels were found to be significantly different. MetS was found to be more common in patients with schizophrenia on AP who used the clozapine monotherapy (18.6%), and in patients with BD who used quetiapine (11.9%). Valproate was found to be more commonly used in patients with BD in whom MetS was detected.[¤]DISCUSSION AND CONCLUSION[|]A large waist circumference and high blood glucose levels are the most important follow-up criteria.[¤]

The relationship between sleep and brain lesions remains unknown in patients with multiple sclerosis (MS) and is currently under investigation. Sleep deprivation and reduction in the quality of sleep occur as a result of the direct involvement of the specific central nervous system structure. Therefore, we investigated the relationship between demyelination locations and sleep parameters such as sleep efficiency and respiratory disorders. The polysomnography measurements and brain magnetic resonance imaging (MRI) of 28 patients with relapsing–remitting MS were examined. The MRI results were evaluated using standardized maps to depict voxel-wise probability distribution of demyelination lesion load for patients. First, supratentorial and infratentorial lesion loads were evaluated. Subsequently, the procedure was completed by measuring the lobes and brainstem lesions loads in the brain. There was a negative correlation between the percentage of REM (%) and infratentorial and brainstem lesion loads ( $$\rho$$ : − 0.396, − 0.418; p 0.05). Although sleep-related breathing disorders are commonly seen in MS, this study shows that the polysomnography parameter most affected by brain lesion load distribution is REM sleep.

Amaç: Servikal bölge problemine sahipbireyler daha çok medikal yöntemler ile tedavi edilmeye çalışılmaktadır.Kullanılan ilaçların birçoğu, hastaların semptomlarını baskılama eğilimindedir.Yapacağımız bu çalışma ile hastalara uygulanan tedavi yöntemlerininsemptomlarda meydana getirdiği değişiklikler fiziki muayene yöntemleri ilekontrol edilecektir. Yöntem: Çalışmaya 50 yaşın üstünde, 3 aydandaha uzun süredir boyun ağrısı çeken ve boyun eklem hareketlerinde kısıtlılık şikâyetibulunan, radyolojik grafilerinde dejeneratif değişiklikler tespit edilen,Servikal spondiloartrit (SSA) tanısı almış toplam 60 kişi dahil edilmiştir.Daha önceden fraktür veya servikal bölgeyi içeren operasyonlar geçiren veya birhastalığa bağlı olarak gelişen sekonder osteoartrit hastaları çalışmaya dahiledilmedi. Hastalara ayrıntılı olarak fizik ve nörolojik muayene testleriuygulandı. Postürü, servikal hareketleri, boyun çevresi muayenesini, derintendon reflekslerini, duyu ve nörolojik muayeneleri kapsayan testler yapıldı.Bütün katılımcılara servikal distraksiyon, kompresyon, valsalva manevrası,vertebro-basiler provakasyon testleri uygulandı. Hastalar 2 tedavi grubunaayrıldı. Birinci gruba 15 seans klasik fizik tedavi ajanları ile hastalaraizometrik boyun egzersizleri ve izotonik kuvvetlendirme egzersizlerini içerenegzersiz programı uygulandı. İkinci gruba ise ilk gruptaki modalitelere ekolarak asemetasine 60 mg (2x1 gün) ve tizanidin 2 mg (2x1 gün) olarak verildi. Bulgular: Cinsiyet dağılımına bakıldığındakatılımcıların 63’ü (%70) kadın, 27’si (%30) erkekti. Hastaların yaş ortalamasıise 62,81±6,98 olarak tespit edildi. Fizik tedavi ve medikal tedavi alan tedavigrubun tüm parametrelerde istatistiksel olarak anlamlı sonuçlar eldeedilmiştir. Fizik tedavi grubunda ise tedavi öncesine göre kas spazmı ve boyunfleksiyonunda anlamlı derecede değişiklikler tespit edildi. Bu hastalarda boyunekstansiyonu, duyu muayenesi servikal kompresyon ve vertebrobaziler provakasyontestlerinde değişiklik saptanmadı.Sonuç: Çalışma grubumuzda; ilaç tedavisi vefizyoterapi yöntemlerinin beraber uygulandığı grubumuzda boyun hareketlerindediğer gruplara oranla daha fazla artış gözlemlenmiştir. Ayrıca boyun bölgesineyönelik servikal testlerde de olumlu iyileşmeler gözlemlenmiştir. Çalışmanınsonuçlarına göre; medikal tedavi ile birlikte alınan fizyoterapi modaliteleriuygulandığında klinik olarak daha anlamlı sonuçlar elde edilmektedir., Aim: Generally, medical interventions are used for cervical region’streatment. Most of the medicines areused for repress the symptoms. In thisstudy; we will have checked the alterations with a physical examination afterthe different treatment methods which applied to patients.Method: In this study; we included 60 subjects diagnosed with SSA. Inclusioncriteria; over the 50-y, cervical region pain and limitation of cervical jointmovement for more than 3 months, degenerative changing radiological screens.Exclusion criteria; cervical fracture, cervical region’s surgery, seconderosteoarthritis after different disease. Physical and neurological tests asposture assessment, cervical movements, deep tendon reflexes, sense tests wereapplied. Also; cervical distraction, compression, Valsalva maneuver,vertebrobasilar provocation were applied. Patients divided to 2 groups. Togroup 1; conventional physical therapy interventions, isometric neck exercises,and isotonic strength exercise programs were applied. To Group 2; conventionalphysical therapy interventions, isometric neck exercises, isotonic strengthexercise program and asemetasine 60 mg (2x1 day), tizanidine 2 mg (2x1 day)were applied. Findings: In this study; there are 63 (%70) women, 27 (%30) men. Subject’s ageaverage is 62,81±6,98. Group 2 have significantly differences in allparameters. Group 1 have significant differences just in muscle spasm and neckflexion movement parameters. There is no significant differences in neckextension, sense examination, cervical compression, and vertebrobasilarrprovocation tests. Conclusion: While physical therapy interventions and medical treatment are appliedtogether, there is a further increase in neck movements compared with othergroups. Combined treatment method is more effective clinically.