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PurposeThis study explores the effectiveness of a comprehensive structured teaching model - the PaFein - for instructing postgraduate pediatric dental residents in the provision of pain-free local anesthesia to children. MethodsTen postgraduate pediatric dental residents and 172 children between the ages 5 and 13 participated in the study following ethical approval. The previously measured baselines guided the randomization of study and control groups. The study group (five residents) attended the PaFein course (9 hours). Based on power calculations, residents performed dental injections (8 mandibular block, 8 palatal/lingual and 14 buccal infiltrations) in randomly assigned child patients. Demographic data of residents/children, parental and self-report anxiety scores and Visual Analogue Scale (VAS) pain scores were noted to examine children's anxiety and pain during dental injections. ResultsChildren's mean anxiety score did not differ significantly between groups; however, VAS pain reports during dental injections (a, b, c, d) were found lower in the PaFein study group than the control group (p < 0.05). VAS pain reports for (a) buccal injections were 1.08 and 1.9 (p = 0.02); (b) inferior alveolar nerve blocks were 1.58 and 3.37 (p = 0.0002); (c) palatal/lingual injections were 1.34 and 3.02 (p < 0.0001); (d) total means were 1.28 and 2.59, respectively (p = 0.0001). VAS pain reports of anxious and non-anxious children in the PaFein study group (1.63 and 1.17) were also lower than the control group (3.33 and 2.39) (p p = 0.005). ConclusionThe PaFein teaching model was found to be effective in training dental residents to reduce dental injection pain in children, including the anxious ones. WOS:000888423800001 36394566 Q3

Objective: This study aimed to retrospectively analyze the 3-year findings of bacterial and fungal pathogens isolated from infections in patients with hematological malignancies.Methods: A retrospective analysis of 158 patients with hematological malignancies treated between January 2015 and December 2017 in Okmeydanı Training and Research Hospital, Istanbul, Turkey. A total of 3374 non-consecutive blood samples (n=1954) from 158 patients, urine samples (n=1024), wound swabs (n=94), respiratory samples (n=87), and other samples (CSF, body fluids, etc.) (n=215) were collected. Results: Pathogen growth was detected in 6% (203/3374) of the samples. The most frequently isolated pathogens are coagulase-negative staphylococci (CNS, 20%), E. coli (19%), Klebsiella sp. (17%), and yeasts (16%), followed by Pseudomonas sp., Acinetobacter sp. and Enterococcus sp. (7%, 6%, and 6%, respectively). Candida species were dominant in fungal isolates (26/32; 81.2%). The most commonly detected antibiotic resistance patterns and organisms are carbapenem-resistant Acinetobacter sp. (92%), methicillin-resistant CNS (83%), carbapenem-resistant Klebsiella sp. (65%), MRSA (57%), and vancomycin-resistant Enterococci (VRE, 42%). Conclusion: Bloodstream infections accounted for more than half of all infection episodes. Periodic examination of the clinical and microbiological profiles of infections developing in patients with malignancy is essential for successful treatment management.

Giriş ve Amaç:Türkiye’de Covid-19 pandemisi ile mücadele kapsamında 13 Ocak 2021’den itibaren inaktif aşı olan Sinovac/Coronovac ve 12 Nisan 2021 tarihinden itibaren mRNA aşısı olan Pfizer/BioNTech uygulanmaya başlamıştır. Özellikle bir flakonunda birden fazla doz bulunan Pfizer/BioNTech aşısının kullanıma girmesi ile birlikte aşının uygulama alanına ulaştırılması, saklanması ve uygulanması sırasında çeşitli sorunlar yaşanmıştır. Bu çalışma, aşılamada etkin görev alan Aile Sağlığı Merkezleri (ASM) çalışanlarının Covid-19 aşılama sürecinde yaşanan zorluklara ilişkin deneyimlerini, aşılamayı etkileyen faktörler hakkındaki düşüncelerini ve çözüm önerilerini değerlendirmeyi ve bu bulgular ışığında benzer sorunların endüstri mühendisliği literatüründeki strateji ve yöntemleri kullanarak nasıl ele alınabileceğini tartışmayı amaçlamaktadır.Gereç ve Yöntem:Tanımlayıcı bir araştırmadır. ASM’de çalışan ve Covid-19 aşılaması yapan aile hekimi ve aile sağlığı çalışanları araştırmanın evrenini oluşturmuştur. Örneklem hesaplanmamış, çevrimiçi platformlar aracılığı ile katılımcılara erişilmiştir. Veriler 10.8.2021-10.10.2021 tarihleri arasında google forms kullanılarak bir anket ile toplanmıştır. Verilerin sıklık dağılımları Microsoft® Excel® for Microsoft 365 MSO (Version 2203 Build 16.0.15028.20152) 64-bit programda hesaplanmıştır.Bulgular:Araştırmamız toplamda 124 ASM çalışanı ile yürütülmüştür. Bunların 102’si hekim (%82,2), 22’si (%17,8) ise diğer sağlık çalışanlarından oluşmaktadır. Katılımcıların %80,6’sı bir flakonu açmak için aşı olacak 6 kişinin beklenmesi gerekliliğinin aşılama etkinliğini düşürdüğünü belirtmişlerdir. Covid-19 aşılama sürecinde yaşanan sorunları aşmak için katılımcıların % 75,2’si gün içinde mola vermeden çalıştıklarını ifade etmişlerdir.Sonuç:Covid-19 aşı uygulamalarında çok dozlu flakonlardaki aşılarda bir flakonu açmak için altı kişinin gerekliliği, randevu sisteminin etkin tasarlanamaması ve ASM’lerin günlük işleri ile aşılama randevularının çakışması benzeri aşı lojistiği ve yönetimi ile ilgili problemler yaşanmıştır. Bu sorunların endüstri mühendisliğinde yaygın şekilde kullanılan strateji ve yöntemler ile ele alınıp çözülebilecek nitelikte olduğu görülmektedir. Introduction and Aim: To overcome the effects of the Covid-19 pandemic, in Turkey, the inactivated vaccine Sinovac/ Coronovac and the mRNA vaccine Pfizer/BioNTech have been applied since January 13, 2021 and April 12, 2021 respectively. Especially with the introduction of Pfizer/BioNTech vaccine, which contains more than one dose in one vial, various problems have been experienced during the delivery, storage and application of the vaccine. This study aims to understand the challenges faced by practitioners in the Covid-19 vaccination process in Family Health Centers (FHC), determine the factors causing these difficulties and the solutions produced by the practitioners, and discuss how similar problems encountered in vaccination processes are addressed by the strategies and the methods in the industrial engineering literature. Materials and Methods: A descriptive study was planned. Family physicians and family health workers working in the FHC and vaccinating against Covid-19 formed the universe of the research. The sample was not calculated, the participants were accessed via online platforms (Google forms). Data were collected between 10.8.2021 and 10.10.2021. The frequency distributions of the data were calculated in Microsoft® Excel® for Microsoft 365 MSO (Version 2203 Build 16.0.15028.20152) 64-bit program. Results: Our research was conducted with a total of 124 FHC employees. Of these, 102 (82.2%) are physicians and 22 (17.8%) are other healthcare professionals. To the question “What are the factors that reduce the effectiveness of the vaccination that you experience during the Covid-19 vaccination process?” we asked the participants, 80.6% answered that 6 people to be vaccinated should wait to open a vial. 75.2% of the participants stated that they worked without taking a break during the day to overcome the problems during the Covid-19 vaccination process. Conclusion: Various problems related to vaccine logistics and management have been identified such as the requirement of gathering six people to be able to administer the Pfizer/BioNTech vaccine, the inability to design an effective appointment system, and the conflicts of the routine work of FHCs and the vaccine administration tasks. These problems can be handled and solved with the strategies and methods commonly used in the industrial engineering literature

Objective: Electrocardiographic alterations were investigated following the second dosage of COVID-19 mRNA vaccination. Methods: A total of 260 individuals after two doses of COVID-19 vaccine with Pfizer-BioNTech were included in the study. The electrocardiographic parameters recorded at baseline and approximately one week later after two doses of Pfizer-BioNTech vaccine were compared for all patients. Results: PR interval was increased and QTc maximum interval was decreased significantly after second dose COVID-19 mRNA vaccination. Baseline and post-second dose vaccination states regarding P wave dispersion and QT dispersion/Tp-e interval which have been recognized to imply inhomogeneous atrial conduction and heterogeneity in ventricular repolarization were similar between groups. Conclusion: Our findings suggest that there should be no concern related to asymptomatic involvement of the myocardium subsequent the second dose of COVID-19 mRNA vaccination., Amaç: Bu çalışmanın amacı, ikinci doz COVID-19 mRNA aşılamasından sonra elektrokardiyografik değişi-klikleri değerlendirmektir. Yöntem: Çalışmaya Pfizer-BioNTech ile iki doz COVID-19 aşısı yapılan toplam 260 hasta dahil edildi. Başlangıçta ve iki doz Pfizer-BioNTech aşısından yaklaşık 1 hafta sonra kaydedilen elektrokardiyo-grafik parametreler tüm hastalar için karşılaştırıldı. Bulgular: İkinci doz COVID-19 mRNA aşılamasından sonra PR aralığı arttı ve QTc maksimum aralığı önemli ölçüde azaldı. Sırasıyla ventriküler repolarizasyonda homojen olmayan atriyal iletimi ve heterojenliği yansıttığı varsayılan P dalgası dispersiyonu ve QT dispersiyonu/Tp-e aralığı ile ilgili olarak başlangıç ve ikinci doz aşılama durumları arasında anlamlı bir fark yoktu. Sonuç: Bulgularımız, ikinci doz COVID-19 mRNA aşılamasından sonra miyokardın asemptomatik tutulumu ile ilgili herhangi bir endişe olmaması gerektiğini düşündürmektedir.

Objective: To investigate the factors which predict treatment strategy in patients with adhesive small bowel obstruction.Study Design: Descriptive study.Place and Duration of Study: General Surgery Clinic, Marmara University Medical Faculty, Istanbul, Turkey, between January 2016 and December 2020. Methodology: Data of the patients with adhesive small bowel obstruction (ASBO) was retrospectively collected. The demo-graphic characteristics and laboratory findings were evaluated. Patients, who underwent conservative treatment and surgical intervention, were compared. Differences between the two groups in terms of demographic characteristics, prognostic nutri-tional index (PNI) scores, and neutrophil (NEU)-to-lymphocyte (LYM) ratio (NLR), were evaluated.Results: One-hundred thirty-seven patients were included in the study. Seventy-four (54%) of the patients had conservative treatment. There was no statistically significant difference between the surgical and conservative treatment groups according to the age, gender, and ASA score (p=0.77, 0.21 and 0.95 respectively). The patients with congenital aetiology and low PNI scores were in significantly higher numbers among the surgical treatment group (p

Amaç: Bu çalışmanın amacı cerrahi olarak menopoz oluşturulan sıçanların böbrek ve karaciğerlerinde gözlenen histopatolojik ve fonksiyonel değişiklikleri ve östrojen veya egzersizin ya da östrojen-egzersiz kombinasyonunun oksidan hasar üzerine etkilerini araştırmaktır.Materyal ve Metot: Anestezi altında Sprague Dawley dişi sıçanlara (n=32) bilateral overiektomi uygulandı ve tüm sıçanlar rastgele olarak iki gruba ayrıldı. Sıçanların yarısına normal içme suyu, diğer yarısının içme sularına östrojen (1mg/kg/gün) eklendi. İki hafta sonra gruplar kendi içlerinde sedanter ve egzersiz (5 gün/hafta, 30 daki-ka, 8 hafta) gruplarına ayrıldı. Deney protokolünün sonun-da serum, karaciğer ve böbrek örnekleri biyokimyasal ve histopatolojik incelemeler için alındı. Femurda da histopa-tolojik değerlendirme yapıldı.Bulgular: Cerrahi olarak menopoz oluşturulan sıçan-larda östrojenin böbrek dokusunda nötrofil infiltrasyonunu ve reaktif oksijen türlerinin üretimini baskılayarak koruyu-cu etki gösterdiği, kemik kütlesinde hafif düzeyde artışa neden olduğu, ancak karaciğerin antioksidan glutatyon düzeyinde azalmaya yol açtığı belirlenmiştir. Buna karşın, östrojen uygulaması menopozda yapılan egzersiz nedeniy-le karaciğerde oluşan oksidan stresi engellemiştir. Egzer-sizle veya egzersize östrojen tedavisinin eklenmesiyle böbrek fonksiyonları önemli ölçüde etkilenmezken, kemik yapısında tek başına östrojene kıyasla daha olumlu deği-şiklikler gözlenmiştir.Sonuç: Östrojen replasmanı kemik dokusundaki olum-lu etkilerinin yanı sıra karaciğer ve böbrekte oksidan stresi azaltmakta ve özellikle karaciğerde egzersize bağlı gelişen oksidan stresi baskılayarak koruyucu etki göstermektedir. Objective: The aim of this study was to investigate the effects of estrogen or exercise or estrogen-exercise combi-nation on oxidant damage and histopathological and func-tional changes observed in kidney and liver of rats with surgical menopause.Materials and Methods: Bilateral ovariectomy was performed on female Sprague Dawley rats (n=32) under anesthesia and all rats were randomly divided into two groups. Half of the rats were given normal drinking water, and the other half had estrogen (1mg/kg/day) added to their drinking water. Two weeks later, the groups were divided into sedentary and exercise (5 days/week, 30 mi-nutes, 8 weeks) groups. At the end of the experimental protocol, serum, liver and kidney samples were taken for biochemical and histopathological examinations. Femur was also examined histopathologically.Results: In ovariectomized rats, estrogen showed a protective effect by suppressing neutrophil infiltration and production of reactive oxygen species in kidney tissue, causing a slight increase in bone mass, with a decrease in hepatic antioxidant glutathione level. On the other hand, estrogen application prevented the oxidant stress in the liver due to the exercise performed in menopause. While kidney functions were not significantly affected by exerci-se or the addition of estrogen therapy to exercise, more favorable changes were observed in bone structure compa-red to estrogen alone.Conclusion: In addition to the positive effects of estro-gen replacement on bone tissue, estrogen reduces oxidant stress in the liver and kidney and shows a protective effect by suppressing the oxidant stress that develops especially in the liver due to exercise.

Kalp ile böbrek hastalığı arasındaki etkileşim çift yönlüdür. Kalbin veya böbreklerin akut veya kronik hasarı, diğer organda akut veya kronik hasara neden olabilir. Bu durum 'Kardiyorenal Sendrom' (KRS) olarak tanımlanır. Kalp yetmezliği olan hastaların %25 ile %63'ünde KRS gelişmektedir. Tedavide loop diüretikler, renin angiotensin sistem antagonistleri, tolvaptan ve ultrafiltrasyon (UF) uygulanabilir. UF, akut dekompanse kalp yetmezliği tedavisinde, diüretik direnci ve/veya böbrek fonksiyonlarında bozulma varlığında faydalı olabilir. KRS'da ultrafiltrasyon uygulamasında periton diyalizi alternatif bir tedavi yöntemidir. Hemodiyaliz ile karşılaştırıldığında, hemodinamiyi daha az etkilediği için, hipotansif komplikasyonların gelişme riski daha düşüktür ve hastaların idrarı uzun yıllar boyunca korunabilir. Rezidüel renal fonksiyonun korunması ise hasta sağ kalımı açısından avantaj sağlamaktadır. Yapılan çalışmalarda KRS tanılı hastalarda periton diyalizi ile UF yapılarak; kalp yetmezliğinin fonksiyonel sınıflaması ile sol ventrikül ejeksiyon fraksiyonunda iyileşme ve hastaneye yatış oranları ile yatış süresinde azalma olduğu gösterilmiştir. The interaction between heart and kidney disease is bi-directional. Acute or chronic damage to the heart or kidneys can cause acute or chronic damage to the other organ. This condition is defined as 'Cardiorenal Syndrome' (CRS). Between 25% and 63% of patients with heart failure (HF) develop CRS. Loop diuretics, renin angiotensin system antagonists, tolvaptan and ultrafiltration (UF) can be used in the treatment. UF may be beneficial in acute decompensated HF in the presence of diuretic resistance and/or impaired renal function. Peritoneal dialysis is an alternative treatment method used for UF in CRS. Compared with hemodialysis, due to its lower impact on hemodynamic stability, the risk of developing hypotensive complications is lower and patients' urine can be preserved for many years. Residual renal function is a strong predictor of patient survival. Studies conducted in CRS patients using peritoneal dialysis for UF have shown improvement in heart failure functional class, left ventricular ejection fraction, as well as reductions in hospitalization rates and hospital stay.

Objectives: To investigate growth differentiation factor-15 (GDF-15) levels and the thickness of epicardial adipose tissue (EAT) in patients with axial spondyloarthritis (axSpA) and to evaluate their relationship with functional status, disease activity, disease duration, and the type of medical treatment received by the patients.Methods: This cross-sectional study was carried out at Kirsehir Ahievran University School of Medicine between February and June 2020. Twenty-nine healthy controls and 44 patients with axSpA were included in the study. Gender, age, erythrocyte sedimentation rate, GDF-15, body mass index, complete blood count, ejection fraction, the EAT thickness, and C-reactive protein of all participants were recorded. Ankylosing Spondylitis Quality of Life Index, Bath Ankylosing Spondylitis Functional Index, the disease duration, Bath Ankylosing Spondylitis Metrology Index, and Bath Ankylosing Spondylitis Disease Activity Index scores of patients with axSpA were noted.Results: Epicardial adipose tissue thickness values (0.35 +/- 0.09 cm) in the AxSpA group were higher compared to the control group (0.26 +/- 0.06 cm) (p

ObjectiveTo evaluate the success of artificial intelligence for early prediction of severe course, survival, and intensive care unit(ICU) requirement in patients with acute pancreatitis(AP).MethodsRetrospectively, 1334 patients were included the study. Severity is determined according to the Revised Atlanta Classification(RAC). The success of machine learning(ML) method was evaluated by 13 simple demographic, clinical, etiologic, and laboratory features obtained on ER admission. Additionally, it was evaluated whether Balthazar-computerized tomography severity index(CTSI) at 48-h contributed to success. The dataset was split into two parts, 90% for ML(of which 70% for learning and 30% for testing) and 10% for validation and 5-fold stratified sampling has been utilized. Variable Importance was used in the selection of features during training phase of machine. The Gradient Boost Algorithm trained the machine by KNIME analytics platform. SMOTE has been applied to increase the minority classes for training. The combined effects of the measured features were examined by multivariate logistic regression analysis and reciever operating curve curves of the prediction and confidence of the target variables were obtained.ResultsAccuracy values for the early estimation of Atlanta severity score, ICU requirement, and survival were found as 88.20%, 98.25%, and 92.77% respectively. When Balthazar-CTSI score is used, results were found as 91.02%, 92.25%, and 98% respectively.ConclusionsThe ML method we used successfully predicted the severe course, ICU requirement and survival, with promising accuracy values of over 88%. If 48-h Balthazar-CTSI is included in the calculation, the severity score and survival rates increase even more.

Aim: For the thoracotomy pain relief, opioids, thoracic paravertebral and epidural interventions are frequently used practices. In recent years, interfascial blocks such as the erector spinae plan block (ESPB) and rhomboid intercostal block (RIB) have started to be used for analgesia. We aimed to compare the postoperative analgesic effect of ESPB, RIB, and a control (C) group in pain management after open thoracotomy. Material and Methods: This is a single-centered randomized controlled trial. A total of 75 patients were included in the study in three groups as the ESPB, RIB and control (C) groups. Under general anesthesia, in block groups, blockage was performed with 20 ml 0.25% bupivacaine. In Group C, no procedures other than the standard postoperative analgesia protocol were performed. The amount of postoperative analgesic consumption by the patients, and visual analogue scale (VAS) values were recorded. Results: In group ESPB and RIB, the mean 24-hour tramadol consumption was 124 +/- 29.08 mg and 116 +/- 28.65 mg, respectively (p>0.05). In Group C, the consumption was 204 +/- 44.06 mg, significantly higher than in group ESPB and group RIB (p=0.004). The VAS values (p

Giriş ve Amaç: Üniversite öğrencileri beslenme sorunlarının en fazla görüldüğü gruplardan biridir. Çalışmada, üniversite öğrencilerindealgılanan stres düzeyi ve yeme farkındalığı arasındaki ilişkiyi belirlemek amaçlanmıştır. Yöntem ve Gereçler: Tanımlayıcı tipteki bu çalışma, İstanbul’da bir devlet üniversitesinin Sağlık Yönetimi (SY), Beslenme ve Diyetetik (BVD) ve Beden Eğitimi ve Spor Öğretmenliği (BESÖ) bölümlerinin 1. ve 4. sınıf öğrencileri ile yürütülmüştür. Katılımcılara sosyodemografik sorular ve Yeme Farkındalığı Ölçeği (YFÖ), Algılanan Stres Ölçeği (ASÖ), Beslenme-Egzersiz Davranış Ölçeği (BEDÖ)’nin egzersizle ilgili 6 sorusu olmak üzere toplam 65 soruluk anket uygulanmıştır. Örneklem hesabı, öğrencilerde yeme farkındalığı yüksekliği oranı %50, güven düzeyi %95, hata payı %5 kabul edilerek toplam 384 kişi bulunmuştur. Her üç bölümün 1. ve 4. sınıf öğrencileri birer tabaka kabul edilerek her sınıftan listeden randomize şekilde 64’er kişinin örnekleme dahil edilmesi hedeflenmiştir. Bulgular: Araştırmaya katılım oranı %68,5’tir (n=263). Katılımcıların %76,4’ü (n=201) kadındır ve %44,1’i (n=116) beslenme ve diyetetik (BVD), %31,2’si (n=82) sağlık yönetimi (SY), %24,7’si (n=65) beden eğitimi ve spor öğretmenliği (BESÖ) bölümündendir. Öğrencilerin %51,0’i (n=134) 1.sınıfa; %49,0’u (n=129) 4.sınıfa devam etmektedir. Katılımcıların %77,1’inin (n=202) yeme farkındalığı yüksek bulunmuştur. Yeme farkındalığı yüksekliği oranı açısından bölümler arasında istatistiksel anlamlı fark bulunmuştur (p=0,007). Öğrencilerin ASÖ puanları ile BEDÖ ve YFÖ puanları arasında anlamlı negatif korelasyon bulunmuştur (sırasıyla r= -0,209, p=0,001; r= -0,224, p

Objective: To compare conventional fluid management (CFM) with pleth variability index (PVI) guided goal-directed fluid management (GDFM) during elective total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH+BSO) operations. Study Design: Randomised controlled trial. Place and Duration of Study: Department of Anaesthesiology and Reanimation, Faculty of Medicine, Health Sciences University, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey, from February to July 2021. Methodology: This trial included 78 patients aged 18-65 years with ASA I-III who would undergo elective TAH-BSO under general anaesthesia. Following randomisation with the closed envelope method, standard monitoring, and 250 ml crystalloid infusion during anaesthesia induction, maintenance fluid therapy was administered at 8-10 ml/Kg/hour to the control group and 2-3 ml/Kg/hour to the PVI group. If the mean arterial pressure (MAP) was ≤65 mmHg and/or the MAP was decreased by more than 20%, and the PVI was >13%, a 250 ml colloid bolus was given. When there was no response, a vasoactive agent was administered. Vital signs, laboratory findings, and postoperative complications were evaluated. Results: Age, weight, BMI, urine output, bleeding, hospital stay, comorbidities, intraoperative use of blood products, and complication rates were not significantly different between the PVI and CFM groups (p>0.05). The PVI group had shorter operational times and used less crystalloid than the control group (p=0.033 and p0.05). Conclusion: PVI-GDFM is equally safe as CFM for intraoperative fluid management during elective complete abdominal hysterectomy and bilateral salpingo-oophorectomy procedures.

This study was implemented to assess the opinions of forensic science experts and techni cians of The Ministry of Justice Council of Forensic Medicine on global pandemic management strategies including new technologies and future scenarios through SARSCov2 pandemic. This prospective and descriptive research was carried out with a questionnair e that was asked to 244 personnel (forensic medicine specialist, forensic medicine resident, technician, other specialist from a different field, other specialist phsician) working at The Ministry of Justice Council of Forensic Medicine. The 40question su rvey included questions about participants’ level of knowledge perception about the pandemic and attitudes on measurestheir adequacynecessity, technological applications and the future of global management strategies. 93.8% (n=229) of the participants th ought they had knowledge about the pandemic and its transmission routes, 54.1% (n=132) found the applied pandemic management strategies effective and correct, and 76.6% (n =187) stated that it is necessary to use technological infrastructures in future sce narios. As a result, through hundreds of descriptive statictics results in 80 tables classified according to education level, occupation type and occupational experience level, in general, despite the changes in group tendencies according to different fact ors, the majority of participants were found to be obeying the routine necessities of the pandemic, hesitating on the global strategies, feeling closer to habitual technologies, feeling far to technologies which have never experienced before in daily life, giving answers with a high ratio of \"no opinion\" due to feeling obliged to give decisions gropely among unproven propabibilities or due to their hesitation on sharing their opinion even if they had an opinion. Moreover according to results, it was interpr eted that social engineering could easily be performed in any spesifically designed group.

Berln Anket, Stop-Bang Anket Yrd. Doç. Dr. Ferda İlgen Uslu Bezmialem Vakıf Üniversitesi Tıp Fakültesi, Nöroloji Anabilim Dalı, İstanbul Obstrüktif uyku apne sendromu (OUAS), her ırk, cinsiyet ve sosyoekonomik düzeyde sık görülen bir uyku bozukluğudur. Tanısı esas olarak anamnez ve polisomnografi (PSG) incelemesinde dayansa da PSG çalışmaları; pahalı, eğitimli eleman ve deneyim gerektiren, zaman alan incelemelerdir. Ayrıca toplumda sık görülen uyku hastalıklarını incelemek için yeterli uyku laboratuvarı da yoktur (Netzer ve ark., 1999; Chung ve ark., 2008a) Bu nedenle hastaları inceleme öncesi taramak hasta seçimi açısından gereklidir ve anketler bu aşamada en önemli yol göstericilerdir. İdeal bir solunumsal uyku bozukluğuna ait hastalıkları tarama anketi, yanlış negatif sonuçlardan kaçınmak için yüksek bir duyarlılığa sahip olmalı, ayrıca düşük riskli hastaların maliyetli ve zaman alıcı incelenmelerini önleyecek kadar da özgün olmalıdır (Marti-Soler ve ark., 2016). Erişkinlerde uykuda apne varlığının anket yolu ile taranması hem pratik olması hem de maliyet etkinliği açısından önemlidir. Bu bölümde günlük pratikte ve klinik çalışmalarda en sık kullanılan iki anket olan Berlin anketi (BA) ve STOPBANG anketinden bahsedilecektir.

RASopatiler, RAS/MAPK yolağının bileşenlerini kodlayan genlerdeki patojenik değişimler sonucu ortaya çıkan ve ortak klinik özellikleri olan bir hastalık grubunu tanımlar. Noonan sendromu (NS) en sık görülen ve en bilinen RASopati olmakla birlikte, Noonan sendromu-multipl lentigines (NS-ML), kardiyofasiyokutanöz sendrom (KFKS), Costello sendromu (CS), nörofibromatozis tip 1 (NF1), Legius sendromu (LS) gibi sendromlar bu gruba dahil edilmektedir. Günümüzde RAS/MAPK yolağında RASopati veya Noonan spektrumu bozukluklara yol açan çok sayıda gen bildirilmiştir. Yeni nesil dizileme tekniklerindeki ilerlemeler ile de bu fenotipe yol açan pek çok yeni gen tanımlanmaktadır. Bu sendrom grubunu tanımlayan ortak bazı klinik özellikler olsa da genetik ve allelik heterojenite sınıflandırmayı zorlaştırmaktadır. Bu bölümde, RAS/MAPK yolağı ile RASopatilere yol açan farklı genlerin özellikleri ve bu hastalıklardaki genotip-fenotip ilişkisi anlatılmıştır. RASopathies are a group of diseases with common clinical features caused by the pathogenic variants in genes encoding the RAS/MAPK pathway components. Although, Noonan syndrome (NS) is the most common type RASopathy, Noonan syndrome and multiple lentigines (NS-ML), Cardiofasciocutaneous syndrome (CFCS), Costello syndrome (CS), neurofibromatosis type 1 (NF1), Legius syndrome (LS) are also included in this group. Numerous genes have been reported as a cause of RASopathies or NS-related disorders in the RAS/MAPK pathway. Recent advances in next-generation sequencing techniques will lead to the discovery of new genes related to this phenotype. Although common clinical features define this group of syndromes, genetic and allelic heterogeneity makes classification difficult. Here we discuss, the role of the RAS/MAPK pathway in the development and maintaining homeostasis, the characteristics of different genes that cause RASopathies, and the genotype/phenotype relationship.

Plastoquinone analogs are privileged structures among the known antiproliferative natural product-based compound families. Exploiting one of these analogs as a lead structure, we report the investigation of the brominated PQ analogs (BrPQ) in collaboration with the National Cancer Institute of Bethesda within the Developmental Therapeutics Program (DTP). These analogs exhibited growth inhibition in the micromolar range across leukemia, non-small cell lung cancer (EKVX, HOP-92, and NCI-H522), colon cancer (HCT-116, HOP-92), melanoma (LOX IMVI), and ovarian cancer (OVCAR-4) cell lines. One brominated PQ analog (BrPQ5) was selected for a full panel five-dose in vitro assay by the NCI’s Development Therapeutic Program (DTP) division to determine GI50, TGI, and LC50 parameters. The brominated PQ analog (BrPQ5) displayed remarkable activity against most tested cell lines, with GI50 values ranging from 1.55 to 4.41 µM. The designed molecules (BrPQ analogs) obeyed drug-likeness rules, displayed a favorable predictive Absorption, Distribution, Metabolism, and Excretion (ADME) profile, and an in silico simulation predicted a possible BrPQ5 interaction with proteasome catalytic subunits. Furthermore, the in vitro cytotoxic activity of BrPQ5 was assessed, and IC50 values for U-251 glioma, MCF-7 and MDA-MB-231 breast cancers, DU145 prostate cancer, HCT-116 colon cancer, and VHF93 fibroblast cell lines were evaluated using an MTT assay. MCF-7 was the most affected cell line, and the effects of BrPQ5 on cell proliferation, cell cycle, oxidative stress, apoptosis/necrosis induction, and proteasome activity were further investigated in MCF-7 cells. The in vitro assay results showed that BrPQ5 caused cytotoxicity in MCF-7 breast cancer cells via cell cycle arrest and oxidative stress induction. However, BrPQ5 did not inhibit the catalytic activity of the proteasome. These results provide valuable insights for further discovery of novel antiproliferative agents.

The world is facing a once-in-a-lifetime situation: the COVID-19 pandemic. During the pandemic, the World Health Organization announced an infodemic as well. This infodemic caused infollution and sparked many controversies. Pandemics as extraordinary occurrences are always attractive to historians. However, infodemics and biased information threaten objective history-writing. Objectivity as it regards historians is already a much-discussed subject. In this commentary, the fundamental theories about objectivity are delineated. Second, the relationship between the infodemic and COVID-19 pandemic is explained. Lastly, the problems regarding objectivity in the historiography of the COVID-19 pandemic are explored.

Objective: It was aimed to identify the contaminant and determine the alternative disinfectant detection in the microbial growth observed in various parts of the cadaver stored in the formalin tank in the dissection laboratory of Marmara University Anatomy Department. We also performed a literature review of this unusual pathogen. Materials and Methods: Swab samples were inoculated on agar mediums. After incubation, matrix-assisted laser desorption ionizationtime of flight mass spectrometry (MALDI-TOF MS) analysis was used to identify the isolate from the detected uniform colonies. Sample solution from the cadaver tank, freshly prepared 5% formalin and 0.55% ortho-phthalaldehyde were used to determine the disinfectant sensitivity of the isolate. Results: According to 16s rDNA sequence analysis, it was concluded as Skermanella aerolata with 99% similarity. In the disinfectant susceptibility test, it was observed that S. aerolata and control bacteria could grow in 5% formalin taken from the cadaver tank. No growth was detected in other disinfectants. Conclusion: To prevent cadaver contamination in anatomy laboratories, the quality control of the embalming solutions and indoor air filtration of the dissection rooms should be checked at regular intervals. Members of Skermanella genus have been identified as environmental organisms in several studies, however, recent researches reported this bacterium as a human pathogen.

Objectives There are studies on associations between obesity and mortality in nursing home (NH) residents, but the presence of concomitant muscle weakness has not been examined. We considered that self-reported weakness might be a low muscle strength proxy marker. We aimed to examine associations of obesity alone, self-reported muscle weakness alone, and their combination with mortality in NH residents. Methods This is a retrospective longitudinal follow-up study. We noted age, sex, nutritional status, functionality, number of chronic diseases, and regular medication. Obesity was assessed by the body fat-percentage method estimated by bioimpedance analysis. Weakness was identified by self-reported muscle weakness. Survival was evaluated with a univariate log-rank test and multivariate Cox regression analyses. Results We included 214 participants. In a median follow-up time of 46 months, mortality occurred in 37.4%. In multivariate analysis adjusted by age, sex, undernutrition, number of chronic diseases, and regular medication, functional scores; \"non-weak non-obese\" participants or \"weak alone\" participants or \"weak+obese\" participants had higher mortality risk when compared with the \"obesity alone\" participants [hazard ratio (HR) = 2.6, 95% confidence interval (CI) = 1.2-5.5, p = 0.01; HR = 2.6, 95% CI = 1.2-5.9, p = 0.02; HR = 3.0, 95% CI = 1.2-7.7, p = 0.02]. Conclusion This is the first report showing that obesity was associated with lower mortality risk if the weakness was not present in NH residents. However, obesity with concomitant weakness was associated with mortality risk similar to non-weak non-obese or weak alone participants. Our study suggests a simple consideration of weakness that can easily be integrated into everyday practice.

Objective: The aim of this study is to determine the perceptions, attitudes, and behaviour of medical students and lecturers regarding the lectures and their effects on students’ learning behaviour.Materials and Methods: This was a qualitative study including multi-methods. Researchers observed lecture ambiance and activities in two courses. Lectures were observed and slide-presentations were evaluated. Additionally, in-depth and focus group interviews were conducted.Results: Two researchers attended and observed 75 lectures. The average number of attendees was 51.21. Eighty percent of lecturers did not introduce any activities to attract attention and prepare students for the lecture. Only 12% of lectures were taught interactively. Of the evaluated 43 (69.80%) slide-presentations, sufficient association or integration was not made between clinical and basic sciences.Conclusion: This study revealed that the lectures created negative feelings and thoughts in students and lecturers, and led to undesirable attitudes and behaviour. It is essential to focus on giving interactive lectures which aim at developing reasoning, decisionmaking, and evaluation competencies. The most significant factors determining students’ attendance and appraisal of the lectures were related to the preparation of the lecturers, the intensity of the content, integration between basic science and clinical science, and the presentation skills.

Background: Bile duct obstruction, which results in cholestatic liver injury, is also the major cause of acute pancreatitis. Phoenixin (PNX) was originally defined as a hypothalamic peptide associated with a wide range of physiological processes and exerts antioxidant and antiinflammatory effects. PNX is expressed in several peripheral organs including pancreas and liver. We aimed to evaluate possible therapeutic effects of PNX on hepatic and pancreatic damage induced by biliary or pancreaticobiliary duct obstruction. Methods: In male Sprague Dawley rats, bile duct ligation (BDL; n=16) or pancreaticobiliary duct ligation (PBDL; n= 16) was performed under ketamine anesthesia, while control rats (n=8) had sham-surgery. Either PNX-14 (50 µg/kg/day) or saline was subcutaneously injected immediately after surgery and in the following 2 days. On the post-operative 3rd day, hepatic and renal blood flow was measured using laser Doppler flowmeter under anesthesia and the rats were then euthanized. In the liver and pancreas samples, levels of malondialdehyde, antioxidant glutathione and myeloperoxidase activity were measured by spectrophotometry, while luminol- and lucigenin-enhanced chemiluminescence (CL) levels were measured to assess formation of reactive oxygen species (ROS). Tissue samples were stained by hematoxylin-eosin to calculate microscopic damage scores. Statistical analyses were made by one-way ANOVA. Results: Increased microscopic damage scores in the pancreas of saline-treated PBDL (p

Background and Aims: Eating disorders (ED) are an important public health problem for adolescents due to changing eating attitudes. Using the Eating Attitude Test (EAT-26) with a sample of Turkish adolescents aged 9-15 years, this study evaluated the behavioral risk of ED and its association with dental caries, age, body mass index (BMI), and gender. Subjects and Methods: The EAT-26 scoring system was used, and variables examined included demographic, familial, sociocultural, social, and clinical features. Data were analyzed using SPSS (R) Statistics for Windows, version 20.0. (IBM, New York, NY, USA). Results: A total of 112 adolescents, 46 (41.1%) boys, and 66 (58.9%) girls (mean age 11.46 +/- 1.91 years), were evaluated. EAT-26 mean scores were 16.0 (10.0-21.0) for girls and 14.0 (12.0-23.0) for boys (Mann Whitney U test; P = 0.509). There was no statistically significant difference between the mean BMI scores and the mean EAT-26 scores for girls and boys (Mann Whitney U test) (P = 0.509) (P = 0.636). The mean DMFT decay -missing -filled and total) was higher in EAT-26 > 20 than in EAT-26 < 20, and the difference was statistically significant (Mann Whitney U test; P = 0.008). BMI was not correlated with EAT-26 (Spearman rank correlation test, r =-0.013, P = 0.156), but there was a statistically significant positive correlation between the development of caries and age (Spearman rank correlation test, r = 0.405, P < 0.05). Conclusion: Early diagnosis of ED is crucial because it primarily starts during childhood and adolescence. It is responsible for the dft of the deciduous teeth. BMI is related to decay,missed,filled,total (DMFT), decay, filled, total (dft), and age in adolescents aged 9-15 years. Furthermore, we searched subgroups of EAT-26 for dental caries. Dieting score may be a significant factor for dental caries for ED. However, observing ability is an important factor for dentists because they can inform parents and provide information on preventing ED.

The aim of the study is to examine the effect of Ambroxol on TNF-α and IL-1β released after liver ischemia-reperfusion injury.Many drugs are being tried to reduce ischemia-reperfusion injury, which is life threating problem after many liver surgeries. In this study, it was investigated whether Ambroxol reduces the release of pro-inflammatory cytokines released after liver ischemia-reperfusion injury.Twenty-four Wistar albino rats were divided into 3 groups as Control (CTR; n=8), hepatic ischemia reperfusion (H-IR; n=8) and hepatic ischemia reperfusion+Ambroxol (H-IR+AMB; n=8). In H-IR+AMB group, Ambroxol (30 mg/kg) was administered orally 30 minutes before ischemia period. In H-IR and H-IR+AMB groups underwent 45 minutes of hepatic ischemia followed by a 60-minute reperfusion period. After reperfusion period, tissue and blood samples were collected from euthanised animals. ALT, AST, ALP, LDH, TNF-α, IL-1β concentrations and liver tissues were evaluated.Serum ALT, ALP, AST, LDH, TNF-α and IL-1β values were lower in the H-IR+AMB group compared to the H-IR group. In the histopathological examination, hepatocyte degeneration and congestion in the H-IR group were higher than in the H-IR+AMB group.It was determined that Ambroxol treatment suppressed the production of pro-inflammatory cytokines TNF-α and IL-1β in rats undergoing hepatic ischemia reperfusion (Tab. 1, Fig. 2, Ref. 28).

ObjectivesPaediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs.DesignA multicentre, international, collaborative cohort study.Setting91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020.ParticipantsPatients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin’s lymphoma, Hodgkin lymphoma, Wilms’ tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer.Main outcome measureAll-cause mortality at 30 days and 90 days.Results1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (pConclusionsThe COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally.

Giriş: Tip 2 Diayabetes Mellitus(DM) hastalarına yönelik, komplikasyonları önlemeye, geciktirmeye yardımcı olmak ve diyabetlerini yönetmeyi öğrenmelerini sağlamak için bir dizi kendi kendine yönetim araçları ve programlar geliştirilmiştir. Ancak bu yöntemler sağlık okur yazarlığı(SOY) düşük bireylerde çok etkili olmayabilir. Bu çalışmanın amacı; birinci basamakta diyabet yönetimi ve takibini kolaylaştırmak için hekimle hastanın birlikte geliştireceği ortak takip planını içeren müdahalenin diyabet özyönetim düzeyine etkisini ve bu etkinin hastaların mevcut SOY düzeyleriyle ilişkisini değerlendirmektir. Yöntem: Bu araştırma randomize olmayan kontrollü klinik çalışma olarak yapılmıştır. İstanbul ili Pendik ilçesinde bulunan 3 aile sağlığı merkezinden(ASM) müdahale(MG) ve kontrol(KG) gruplarında %95 güven aralığında %80 güçle yapılan örneklem hesabına göre en az 40’ar katılımcı ve grupları oluşturan katılımcılar farklı ASMlerden olacak şekilde 84 DM hastası ile çalışma yürütülmüştür. İlk görüşmede tüm katılımcılara diyabet özyönetim ölçeği ve SOY ölçeği uygulanmıştır. MG ile ayda bir kere görüşme yapılarak DM hastalığına ve komplikasyonlarına yönelik eğitim verilmiş, araştırmacılar tarafından geliştirilmiş kolay anlaşılabilir ve doldurulabilir takip araçları; diyabet kimlik kartı ve diyabet günlüğü hastalara verilerek hastalarla birlikte bir takip planı yapılmıştır. KG oluşturan katılımcılarla ayda bir kere telefon ile DM hastalığına yönelik bilgilendirmeleri içeren görüşmeler yapılmıştır. Üçüncü ayda tüm katılımcılara diyabet özyönetim ölçeği yeniden uygulanmıştır. Gruplar independent samples T test ile karşılaştırılmıştır. Bulgular: Katılımcıların yaş ortalaması MGde 54,97±8,20, KGde 59,00±8,82dir. Gruplar arasında SOY düzeyleri arasında fark bulunmamakta iken özyeterlilik MG daha yüksek bulunmuştur. Araştırma sonunda yapılan son test değerlerine göre MG özyönetim puanı 65,53’ten 73,64’e yükselmiştir(p0.05). Katılımcılara yapılan müdahale sonrası özyönetim puanlarının artışı ile mevcut SOY arasında istatistiksel olarak anlamlı bir ilişki bulunamamıştır. Sonuç: Bu çalışma ile geliştirdiğimiz ortaklaşa plan ve takip yönteminin, birinci basamakta SOY hangi düzeyde olursa olsun DM hastalarının özyönetimlerini artırılabileceği sonucuna varılmıştır

Objectives: The aim of this study is to present the clinical, oncological, and functional results of locally aggressive benign bone tumors treated with extended intralesional curettage without the use of adjuvant in a tertiary orthopedic oncology center. Method: A total of 172 patients treated with surgical curettage and high-speed burrs for the diagnosis of aneurysmal bone cyst, giant cell tumor, osteoblastoma, chondroblastoma, and chondromyxoid fibroma were included in the study. Demographic, radiological, and clinical data of the patients were analyzed. Results: One-hundred seventy two patients (101 (59%) female and 71 (41%) male) with a mean age of 23 years (6–84). The mean follow-up period was 48 months (18–108). In the study, a total of 8 (4.6%) patients had postoperative complications, 17 (9.9%) patients had recurrence in the postoperative period. Diameter greater than 5 cm was found to be a risk factor for recurrence (p Conclusion: Successful treatment results can be obtained with extended surgical curettage, high-speed burr, and cauterization without the use of chemical adjuvants in locally aggressive bone tumors.

Sigara Bıraktırma Polikliniğinden Tedavi Almış Hastalarda Nüks Sıklığı ve Nedenleri Saliha Serap Çifçili1 , Büşra Çimen2 , Handenur Tan Doğrusever1 1 Maramara Üniversitesi Pendik Eğitim ve Araştırma Hastanesi, Aile Hekimliği Ana Bilim Dalı 2 Van Gürpınar İlçe Devlet Hastanesi Amaç: Sigara kullanımı tüm dünyada önlenebilir hastalık ve ölümlerin en önde gelen nedenidir. Ülkemizde tütün kullanımı ile mücadele kapsamında Sağlık Bakanlığı önderliğinde çeşitli müdahale programları yürütülmektedir. Hastanemiz Aile Hekimliği Kliniği bünyesinde 2012 yılında açılmış olan sigara bırakma polikliniği o tarihten beri kesintisiz hizmet vermektedir. Benzer polikliniklerde başarı oranlarını bildiren çalışmalar bulunmaktadır. Ancak bırakmış fakat nüks olmuş hastaların sıklığı ve nüks nedenleri ile ilgili çalışmalar daha kısıtlıdır. Oysa nüks nedenleri tedavi başarısını yükseltmek adına önemlidir. Bu nedenle çalışmamızda polikliniğimizde hizmet sunulan hastalarda nüks sıklığı ve nedenlerinin araştırılması amaçlanmıştır. Yöntem: Tanımlayıcı nitelikte olan araştırmaya 01.2020-02.2022 tarihleri arasında sigara bıraktırma polikliniğinde değerlendirilen ve en az iki kez polikliniğe gelmiş olan tüm kayıtlı hastalar değerlendirmeye alınacaktır. Telefon ile ulaşılabilen ve çalışmaya katılmayı kabul eden tüm hastalara tarafımızca hazırlanan bir soru formu uygulanacaktır. Poliklinik başvurusundan sonra en az 6 ay süre ile sigara içmeyenler sigarayı bırakmış kabul edilecektir. Sigarayı bırakmış olarak değerlendirilen katılımcılara tekrar sigara içmeye başlayıp başlamadıkları, başladılarsa ne kadar süredir olduğu ve bunun nedenleri sorulacaktır. Dosya verileri incelenerek olguların demografik özellikleri (yaş, cinsiyet, medeni durum, eğitim düzeyi, meslek), sigara içme davranış ve tutumları (sigara kullanım öyküleri, daha önce sigarayı bırakma öyküleri, evde başka sigara içen kişinin olup olmadığı), Fagerstörm nikotin bağımlılık derecesi, eşlik eden medikal ya da psikiyatrik hastalıkları ve kullandıkları ilaçlar kaydedilecektir. Telefon görüşmelerinin ardından doldurulan anketler analiz edilecektir.

Background The human INHA gene encodes the inhibin subunit alpha protein, which is common to both inhibin A and B. The functional importance of inhibins in male sex development, sexual function, and reproduction remain largely unknown. Objective We report for the first time two male siblings with homozygous INHAmutations. Methods The medical files were examined for clinical, biochemical, and imaging data. Genetic analysis was performed using next-generation and Sanger sequencing methods. Results Two brothers complained of gynecomastia, testicular pain, and had a history of hypospadias. Biochemistry revealed low serum testosterone, high gonadotropin and anti-Mullerian hormone, and very low/undetectable inhibin concentrations, where available. Both patients had azoospermia in the spermiogram. We have identified a homozygous 2 bp deletion (c.208_209delAG, R70Gfs*3) variant, which leads to a truncated INHA protein in both patients, and confirmed heterozygosity in the parents. The external genital development, pubertal onset and progression, reproductive functions, serum gonadotropins, and sex hormones of mother and father, who were heterozygous carriers of the identified mutation, were normal. Conclusion Homozygosity for INHA mutations causes decreased prenatal and postnatal testosterone production and infertility in males, while the heterozygous female and male carriers of INHA mutations do not have any abnormality in sex development and reproduction.

Food Supplements(FS) were defined in ‘Turkish-Food-Codex-Supplementary-Food-Communique” in Turkey(2013). News about FS-usage during pandemic have been spread in community It was aimed to determine the prevalence of FS-usage of primary health care personnel in a district, in 2021 and their knowledge, attitude and practice about FS. In this cross-sectional study, data was collected by face to face in the 24 Family-Health-Centre in Gebze/Kocaeli(N:216). Ethical approval was obtained from Ethics-Committee (04.06.2021/09.2021.700), Kocaeli Provincial Health Directorate, and the informedconsent of the participants was taken. The data was analyzed in SPSS. The statistical significance level was accepted as p

Thrombosis due to hypercoagulable state is an important cause of morbidity and mortality in coronavirus disease 2019 (COVID-19). Increased D-dimer levels are an important marker of the presence and risk of thrombosis. In this report, we present that a 59-yearold male patient developed thrombosis in the distal radial arteries despite normal D-dimer level. The patient was treated with enoxaparin, iloprost infusion, and cilostazol. This case should lead us to be very careful that people diagnosed with COVID-19 with normal D-dimer levels may also have thrombosis.

Proteinüri ciddi böbrek hastalıkları ile ilişkilendirilen önemli bir bulgudur. Sağlıklı insanlarda az miktarda albümin glomerüllerden süzülür ve proksimal tübüllerden geri emilir. Cubulin, proksimal tübülde albüminin yeniden emiliminden sorumlu reseptör proteinlerden birisidir ve CUBN geni tarafından kodlanır. Bu çalışmada, CUBN genindeki mutasyonların neden olduğu proteinürisi olan beş hastanın klinik ve genetik özelliklerini değerlendirmeyi amaçladık

BK Virüs (BKV) genellikle immunsupresif tedavi alan böbrek nakilli ve kemik iliği transplantasyonu (KİT)hastalarında enfeksiyonlara yol açar ve asemptomatik hematüri,hemorajik sistit,üreter stenozu ve interstisyel nefrit yapabilir(2).BKV nefropatisi(BKVN) histolojisinde granülom görünümü nadirdir.Bu olgu sunumunda,KİT’ten 2 ay sonra gelişen akut böbrek hasarı(ABH)ile başvuran,patolojisinde nadir görülen granülomatöz nefrit ile prezente olan BKVN sunulacaktır

Çocukluk çağının en sık görülen vasküliti olan Henoch Schönlein Purpurası (HSP), küçük damarlarda vaskülite neden olup,damar duvarlarında IgA içerikli immünkompleks birikimi ile karakterizedir. Hastalarda sıklıkla pal pabl purpura, karın ağrısı,artrit/artralji ve böbrek tutulumu görülür.C3 Glomerulopatisi (C3G), kompleman yolaklarının uygunsuz sistemik aktivasyonu sonucu gelişen nadir bir glomerulopati grubudur.Glomerüllerde kompleman birikimi görülür. Bu olgu sunumunda, klinik bulguları ile HSP düşündüren ve takibinde C3G tanısı alan hasta sunulacaktır.

Posterior reversibl ensefalopati sendromu(PRES) baş ağrısı,nöbet,görme bozuklukları, mental değişiklikler ve fokal nörolojik bulgularla karakterize bir hastalıktır. COVID-19 enfeksiyonunun sitokin fırtınasına ikincil vazojenik ödemle PRES’i tetikleyebildiği bildirilmiştir. Bu yazıda, kronik böbrek hastalığı(KBH) ile izlenen ve COVID-19’un tetiklediği iki PRES olgusu sunuldu. Olgu 1: Dokuz yaşında kız hasta nefrotik sendrom tanısıyla 1.6 mg/kg/gün metilprednizolon tedavisi ile izlenirken ödemde artış ve pnömoni bulguları görülmesi üzerine alınan COVID-19 RT-PCR testi pozitif sonuçlandı. Enfeksiyon hastalıkları önerisiyle favipiravir ve seftriakson tedavileri başlandı. Kan basıncı 140/90mmHg saptanan hastanın KB enapril ve amlodipin tedavileriyle regüle oldu. Bir haftalık servis takibinde akciğer bulguları normal, ateşsiz izlendi. Taburculuktan 15gün sonra nöbet geçirme şikayetiyle acil servise başvurdu.Kan basıncı 150/100 mmHg ve beyin MRG’de PRES ile uyumlu bulgular görüldü. İntravenöz(IV) esmolol infüzyonuyla kan basıncı 72 saatte regüle edildi,antiepileptik başlandı. Kliniği üç hafta içinde düzelen hasta halen nörolojik olarak normal,düşük doz enalapril ile KB regüle izlenmektedir. Olgu 2: Dokuz yaşında kız hasta spina bifidaya ikincil son dönem böbrek yetersizliği ve periton diyaliziyle izlemi sırasında bacakta şişlik şikayetiyle acile başvurdu. Artrit ön tanısıyla servise yatışından bir hafta sonra antibiyotik tedavisi altında ateşinin tekrarlaması üzerine bakılan SARS-COV-2 RT-PCR testi pozitif sonuçlandı. Sistem tutulumuna ait bulgusu yoktu. RT-PCR pozitifliğinin 3.gününde taburcu edilen hasta iki gün sonra acil servise kusma, bilinç bulanıklığıyla başvurdu. Kan basıncı 160/100 mmHg ve beyin MRG’da PRES ile uyumlu bulgular görüldü. Kan basıncı IV esmolol infüzyonuyla 48 saatte regüle edildi. Belirgin volüm yükü bulguları yoktu, on gün içinde bilinç durumu giderek düzeldi,- nöbeti tekrarlamadı. Kan basınçları normal seyreden,nörolojik bulgusu olmayan hasta antihipertansif tedavisi düzenlenerek taburcu edildi. Halen normotansif ve nörolojik olarak normal izlenmektedir. Çıkarım:COVID-19 hastalarında PRES nörolojik bir komplikasyon olarak ortaya çıkabilir. Özellikle kan basıncı yüksek hastalarda riskin daha yüksek olabileceği akılda tutulmalı, bu hastalarda sıkı kan basıncı kontrolü sağlanmalı ve yakından izlenmelidir. Bilinç değişikliği görülen COVİD-19 hastalarında PRES gelişmiş olabileceği unutulmamalıdır.